When should you worry about joint pain after surgery. What are the common causes of post-surgical joint pain. How can nerve damage contribute to postoperative joint discomfort. What are the treatment options for persistent joint pain following surgery.

Understanding Post-Surgical Joint Pain

Joint pain after surgery is a common concern for many patients. While the primary goal of joint surgery is to alleviate pain and improve function, some individuals may experience persistent discomfort following their procedure. Understanding the causes, symptoms, and management options for post-surgical joint pain is crucial for patients and healthcare providers alike.

Types of Joint Surgery

• Hip replacement
• Knee replacement
• Shoulder replacement
• Elbow surgery
• Ankle surgery

Each type of joint surgery carries its own set of potential complications and recovery timelines. It’s essential to discuss these factors with your surgeon before undergoing any procedure.

Common Causes of Post-Surgical Joint Pain

Joint pain after surgery can stem from various sources. Understanding these potential causes can help patients and healthcare providers better address the issue.

Inflammation and Healing Process

Is inflammation normal after joint surgery? Yes, some degree of inflammation is a natural part of the healing process. The body’s response to surgical trauma involves increased blood flow and the release of inflammatory mediators, which can cause pain and swelling. This type of pain typically subsides as healing progresses.

Scar Tissue Formation

Can scar tissue cause joint pain after surgery? Absolutely. As the body heals, scar tissue forms around the surgical site. In some cases, excessive scar tissue formation can lead to restricted movement and persistent pain. Physical therapy and targeted exercises can help manage this issue.

Nerve Damage

Nerve damage during surgery is a potential complication that can lead to chronic pain. This may occur due to direct injury to nerves or compression from surrounding tissues. Symptoms of nerve damage can include burning, shooting, or electrical sensations in the affected area.

Identifying Nerve-Related Pain After Joint Surgery

Distinguishing between normal post-surgical discomfort and nerve-related pain is crucial for proper management and treatment.

Symptoms of Nerve Damage

• Sharp, shooting pain
• Burning sensations
• Tingling or pins and needles
• Numbness or loss of sensation
• Muscle weakness

Do these symptoms always indicate nerve damage? Not necessarily, but if they persist beyond the expected recovery period (typically 6 months or more), it’s important to consult with a healthcare professional.

Specific Joint Surgeries and Associated Nerve Risks

Different joint surgeries carry varying risks of nerve damage. Understanding these risks can help patients and surgeons take appropriate precautions.

Hip Replacement and Sciatic Nerve Involvement

Why is the sciatic nerve at risk during hip replacement surgery? The sciatic nerve’s proximity to the hip joint makes it vulnerable during the procedure. Dislocation of the hip or pressure from migrating cement can potentially damage the nerve, particularly its peroneal division.

Knee Replacement and Femoral Nerve Complications

How can knee replacement surgery affect the femoral nerve? The femoral nerve may be at risk due to its location near the surgical site. Compression or stretching of the nerve during the procedure can lead to postoperative pain and weakness in the thigh and leg.

Upper Extremity Surgeries and Radial Nerve Damage

What are the signs of radial nerve damage after elbow or shoulder surgery? Hand or wrist weakness and numbness in the affected limb can indicate radial nerve involvement following upper extremity joint surgeries.

When to Seek Medical Attention for Post-Surgical Joint Pain

Knowing when to consult a healthcare provider about post-surgical joint pain is crucial for proper management and recovery.

Timeline for Concern

How long should you wait before worrying about persistent joint pain after surgery? While some discomfort is normal during the initial recovery period, pain that persists or worsens beyond 6 months post-surgery warrants medical attention. This is especially true if the pain is accompanied by nerve-related symptoms.

Red Flags

• Severe, uncontrolled pain
• Signs of infection (fever, redness, swelling)
• Significant loss of range of motion
• Instability in the joint
• Unusual sounds or sensations from the joint

Should you immediately contact your surgeon if you experience these symptoms? Yes, these red flags require prompt medical evaluation to rule out serious complications.

Diagnostic Approaches for Post-Surgical Joint Pain

Accurate diagnosis is essential for effective treatment of persistent joint pain following surgery.

Physical Examination

What does a physical exam for post-surgical joint pain involve? A healthcare provider will assess the range of motion, strength, and stability of the affected joint. They will also look for signs of inflammation, infection, or nerve involvement.

Imaging Studies

• X-rays
• CT scans
• MRI
• Ultrasound

How do imaging studies help in diagnosing post-surgical joint pain? These tests can reveal structural issues, such as implant loosening or misalignment, as well as soft tissue problems like inflammation or nerve compression.

Nerve Conduction Studies and Electromyography

Can nerve conduction studies diagnose nerve damage after joint surgery? Yes, these tests can help identify and locate nerve damage by measuring the speed and strength of electrical signals in the affected nerves and muscles.

Treatment Options for Persistent Joint Pain After Surgery

Managing post-surgical joint pain often requires a multidisciplinary approach, tailored to the specific cause and severity of the pain.

Conservative Management

• Physical therapy
• Pain medications
• Ice and heat therapy
• Activity modification

How effective is conservative management for post-surgical joint pain? Many patients experience significant improvement with these non-invasive approaches, especially when started early in the recovery process.

Interventional Procedures

• Joint injections
• Nerve blocks
• Radiofrequency ablation

When are interventional procedures considered for post-surgical joint pain? These options may be explored when conservative measures fail to provide adequate relief or when specific pain generators are identified.

Surgical Intervention

Is revision surgery necessary for persistent joint pain? In some cases, particularly when there are mechanical issues with the implant or severe nerve entrapment, additional surgery may be required. However, this decision is made carefully, weighing the potential benefits against the risks of further complications.

Preventing Post-Surgical Joint Pain

While not all post-surgical pain can be prevented, certain strategies can help minimize the risk and severity of complications.

Preoperative Preparation

• Optimizing overall health
• Strengthening exercises
• Smoking cessation
• Managing chronic conditions

How does preoperative preparation impact post-surgical outcomes? A well-prepared patient typically experiences fewer complications and a smoother recovery process.

Proper Postoperative Care

• Following rehabilitation protocols
• Adhering to medication regimens
• Gradually increasing activity levels
• Maintaining a healthy lifestyle

Can proper postoperative care prevent chronic joint pain? While it doesn’t guarantee a pain-free recovery, diligent adherence to postoperative instructions significantly reduces the risk of complications and chronic pain.

Emerging Research in Post-Surgical Joint Pain Management

Ongoing research continues to shed light on the complexities of post-surgical joint pain and potential new treatment approaches.

Regenerative Medicine

How might regenerative medicine techniques impact post-surgical joint pain management? Stem cell therapy and platelet-rich plasma injections are being studied for their potential to promote healing and reduce inflammation in surgical sites.

Advanced Pain Modulation Techniques

• Neuromodulation
• Targeted drug delivery systems
• Virtual reality therapy

What role do advanced pain modulation techniques play in managing post-surgical joint pain? These innovative approaches aim to interrupt pain signals or alter pain perception, potentially offering relief for patients with persistent pain.

Personalized Medicine Approaches

How can personalized medicine improve outcomes for patients with post-surgical joint pain? By considering individual genetic, environmental, and lifestyle factors, healthcare providers may be able to tailor treatments more effectively, reducing the risk of chronic pain development.

Post-surgical joint pain remains a challenging aspect of orthopedic care. While advances in surgical techniques and pain management strategies have improved outcomes for many patients, a subset continues to experience persistent discomfort. By understanding the potential causes, recognizing warning signs, and exploring various treatment options, patients and healthcare providers can work together to address this issue effectively. As research progresses, new insights and innovative therapies offer hope for improved management of post-surgical joint pain, ultimately enhancing quality of life for those affected.

Joint Pain After Surgery | Dr. Eric H. Williams

When you have surgery to address joint pain, one of the normal expectations is that you will be better following the procedure. After all, that’s the very reason you are having an invasive procedure in the first place! There are times, though, when a patient doesn’t feel better afterwards.  

If the problem has been ongoing for longer than six months—and the symptoms include painful sensations that might be described as burning, shooting, stabbing, or tingling (amongst others)—it’s possible the issue comes down to nerve damage. In this case, come see us for a consultation and we can evaluate the problem and determine if we may be able to help.  

Orthopedic surgeons who perform joint surgery do their absolute best to correct whatever bone, muscle, or connective tissue problem is causing pain or restricting your movement. These doctors are highly-specialized in anatomical structure and how the body moves. Sometimes, though, when they are correcting the problem a patient has seen them for, issues develop afterward. 

Having said that, it’s important to make a distinction between post-surgical nerve pain and orthopedic issues. Orthopedics is the medical specialty concerned with skeletal issues. When the problem comes down to how your body moves, you may need the help of an orthopedic specialist. 

If you had joint surgery six months or longer ago and are having sharp, shooting, or burning pain, hypersensitivity, the feeling of pins and needles, or electrical sensations, then the problem is more likely nerve-related.  In this case, you would want to see a nerve surgeon instead of an orthopedic one. 

Generally speaking, potential causes of nerve damage during or after a surgery include severed nerves, nerves entrapped in scar tissue, and adjusted body tissue pressing against a nerve. 

Hip replacement is a specific procedure that can result in joint pain following the surgery. The reason for this is related to the position of the sciatic nerve in relationship to the hip joint. When the hip is dislocated or the sciatic nerve—specifically, the peroneal division—is stretched or impeded by migrating cement, there may be direct nerve damage. Another potential nerve that can be impacted by knee replacement surgery is the femoral nerve. 

With regard to an upper extremity nerve pain following a surgery, the radial nerve can become damaged when either the elbow or shoulder joint is replaced. Signs of this nerve damage include hand or wrist weakness and numbness in the limb. 

There are certainly other joint surgeries that may result in nerve issues. If you have had joint surgery—of any variety—and are experiencing problems related to peripheral nerve damage long after the procedure (6+ months), we might be able to help.  

Contact our office by calling (410) 709-3868 for more information or to request an appointment. We will be glad to evaluate your condition and determine if one of our procedures can possibly relieve the pain you’ve been living with for too long now. 

Case Report: Acute postoperative inflammatory polyarthritis associated with a lone IgM cardiolipin antibody

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BMJ Case Rep. 2015; 2015: bcr2014208218.

Published online 2015 Mar 2. doi: 10.1136/bcr-2014-208218

Case Report

Author information Article notes Copyright and License information Disclaimer

While the most recognised complication after joint surgery is septic arthritis, other forms of joint pathology may occur. We present a case of postoperative polyarthritis with high inflammatory markers, which responded to a course of prednisolone. The occurrence of high IgM cardiolipin antibodies that normalised with treatment suggests that this condition is a form of transient autoimmunity.

Postoperative inflammation polyarthritis is an uncommon complication of surgery. In many ways it mimics presentation of rheumatoid arthritis but is acute, seronegative and responds rapidly with a short course of steroids. The pathogenesis of this condition is unknown but may represent loss of immune tolerance to self-antigens in joint tissues. There is so far no autoantibody associated with this diagnosis suggested in the literature.

A 63-year-old man developed symmetrical acute polyarthritis affecting the small joints of the fingers of both hands, feet, ankles, knees, wrists and elbows, 10 days after right shoulder manipulation under arthroscopy (MUA), capsular release and decompression for interval adhesive capsulitis.

He reported severe early morning stiffness lasting 3 h and there was florid synovitis of small joints in the hands and feet, wrists, elbows, knees and ankles. He could barely stand up or walk and was very restricted in activities of daily living.

Three years prior, he had an uneventful left shoulder MUA decompression of left shoulder, release of anterior capsule and repair of an intra-articular supraspinatus tear. There was no recent history of infection or trauma and no history of psoriasis, iritis or inflammatory bowel disease. The patient did not have any significant history apart from a radical prostatectomy for carcinoma of the prostate. There is no family history of rheumatological conditions.

Laboratory investigations at presentation are shown on . Abnormal results are highlighted in bold.

Table 1

Laboratory investigations at presentation

Laboratory test	Presentation	Normal ranges
General haematology
Haemoglobulin	12.2	13–18 g/dL
White cell count	5.5×109	4–11×109/L
Platelet count	148×109	150–400×109/L
ESR	112	1–14 mm/h
Coagulation
Prothrombin time	10. 3	8.9–12 s
PTR/INR	1.0	0.9–1.1
APTT	22	21–31 s
APTT ratio	0.9	0.8–1.2
Thrombin time	0.9	12–17 s
Thrombin time ratio	1.1	0.8–1.2
DRVVT ratio	1.05	0.74–1.1
Lupus anticoagulant	Not detected
Biochemistry
Sodium serum	133	136–145 mmol/L
Potassium serum	4. 4	3.6–5.0 mmol/L
Urea	6.4	2.0–7.8 mmol/L
Creatinine	78	75–122 µmol/l
Estimated GFR	87	mL/min
Total bilirubin serum	8	2–22 µmol/L
Alanine aminotransferase	106	10–40 IU/L
Aspartate aminotransferase	50	10–40 IU/L
γ-Glutamyl transferase	89	8–78 μ/L
Alkaline transferase	51	30–130 IU/L
Total protein	67	64–83 g/L
Albumin	33	35–50 g/L
C reactive protein	142	2–7 mg/L
Uric acid	0. 306	0.21–0.42 mmol/L
Ferritin	649	10–160 µg/L
Calcium	2.26	mmol/L
Adjusted calcium	2.20	2.2–2.6 mmol/L
Inorganic phosphate	1.07	0.8–1.5 mmol/L
Endocrinology
Free T4 serum	18.6	10–24.5
TSH	1.44	1.44 mIU/L
Specialist proteins
Immunoglobulin G	10. 5	5.5–16.5 g/L
Immunoglobulin A	3.37	0.8–4 g/L
Immunoglobulin M	1.27	0.4–2 g/L
Rheumatoid factor	15	0–20 IU/mL
Autoimmune serology
ANA	Negative
IgG ANCA	Negative
Cardiolipin IgG	6.4	0–10 IU/mL
Cardiolipin IgM	132	0–10 IU/mL
Anti-B2 glycoprotein IgG	2. 5	0–10 IU/mL
Anti-B2 glycoprotein IgM	2.5	0–10 IU/mL
CCP antibody	1.6	0–10 IU/mL

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ANA, antinuclear antibody; ANCA, antineutrophil cytoplasmic autoantibody; APTT, activated partial thromboplastin time; CCP, cyclic citrullinated peptides; DRVVT, dilute Russell’s viper venom time; ESR, erythrocyte sedimentation rate; eGFR, estimated-glomerular filtration rate; INR, international normalised ratio; PTR, prothrombin time; TSH, thyroid-stimulating hormone.

Radiology of the hands and wrists did not show any abnormality.

Although this patient has a condition that resembles rheumatoid arthritis (RA), the duration of the polyarthritis lasted less than 2 weeks, which precludes the diagnosis of RA. The rheumatoid factor and anticyclic citrullinated antibody were both within normal range.

Another inflammatory condition that can present with raised erythrocyte sedimentation rate (ESR) in this patient’s age group is polymyalgia rheumatism (PMR). However, the pattern of involvement in this patient was peripheral rather than proximal. Therefore, his condition is not consistent with PMR.

The differential diagnoses for acute polyarthritis are wide and include infection-associated arthritis, reactive arthritis, Still’s disease, systemic lupus erythematosus and rheumatoid arthritis. In our case, there is no evidence of infection or systemic features of a connective tissue disease.

Raised ferritin is seen in hereditary haemachromatosis; however, this is unlikely in our patient, who is already in his sixth decade of age and does not have skin pigmentation, diabetes, impotence, cardiac or liver disease. There is also no evidence of iron overload; the patient had normal serum iron and transferrin levels. The elevated ferritin was an acute phase reaction and normalised when repeated.

Lastly, in relation to the raised IgM cardiolipin antibodies, the patient had no previous history of thrombosis or other features for the diagnosis of antiphospholipid syndrome.

After assessment, the patient was started on prednisolone 30 mg and hydroxychloroquine 200 mg twice a day.

The patient’s joint stiffness and pain largely disappeared within 1 day of receiving the prednisolone and treatment was tapered. The prednisolone was stopped after 6 months, and the hydroxychloroquine was reduced to 200 mg a day a year after onset. The improvement of his symptoms was mirrored by a steep drop in the IgM cardiolipin antibody, and inflammatory markers CRP and ESR (see ) returning to normal. Ferritin levels normalised at 236 with normal iron and transferrin levels making it unlikely that this patient has haemachromatosis.

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(A) Reduction of high erythrocyte sedimentation rate (ESR) at presentation with prednisolone and hydroxychloroquine given at day 0. (B) Reduction of high IgM cardiolipin antibodies at presentation correlate with reduction of ESR with prednisolone and hydroxychloroquine given at day 0.

The patient has been followed up now for 2 years with no relapse of arthritis. He is currently still on hydroxychloroquine 200 mg once a day and is on six-monthly follow-up.

The strong temporal association implicates the joint surgery as a cause for the polyarthritis. One surgical procedure reported to cause polyarthritis is intestinal bypass surgery for morbid obesity.¹ The pathogenesis was postulated to occur from the exposure of gut bacteria antigens systemically resulting in immune complexes, which activate the classical as well as alternate complement system, resulting in the polyarthritis.² However, routine joint repair surgery is usually aseptic, which contrasts starkly with intestinal bypass surgery. In this case, neo-self-antigens are more likely to be the trigger in activating the immune system. The patient had previous joint surgery that may have sensitised his immune system resulting in polyarthritis during the next joint surgery.

Antibodies to cardiolipin can occur acutely in a wide variety of conditions including infection,³ cancer,⁴ acute myocardial infarction⁵ and organ transplant,⁶ but these conditions were not reported to occur with polyarthritis. In one study, 95% of patients receiving knee or hip replacement developed a new lupus anticoagulant, however, it is unusual to develop antibodies to cardiolipin (2%).⁷ We report an unusual case of polyarthritis after shoulder surgery associated with high levels of IgM cardiolipin antibody, which, when treated with immunosuppression, resulted in rapid improvement and reduction of the IgM cardiolipin antibody. It is unknown if the IgM cardiolipin antibody is an epiphenomenon or if it directly causes the polyarthritis.

Learning points

• Although it is important to exclude rheumatoid arthritis in a patient with symmetrical polyarthritis, other causes of acute inflammatory arthritis should be considered.

• Acute inflammatory arthritis can be successfully treated with prednisolone and hydroxychloroquine.

• It is important to recognise postoperative inflammatory arthritis, and IgM cardiolipin antibodies may be associated with this condition.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

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Articles from BMJ Case Reports are provided here courtesy of BMJ Publishing Group

Advice for patients undergoing total knee replacement

If your knee joint is severely affected by arthritis or injury, it may limit your physical activity, such as walking or climbing stairs. You may even experience pain at rest.

If medications, decreased physical activity, and use of additional walking support no longer help, a total knee replacement may be considered. As a result of this operation, pain can go away, the deformity of the limb can be corrected, and normal physical activity can return.

One of the most significant achievements in orthopedics of the 20th century, total knee arthroplasty was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased the efficiency of this operation. In the US, approximately 300,000 of these surgeries are performed annually.

What will change after total knee arthroplasty?

When deciding whether to have an operation, it is important to understand what awaits you without surgery and what surgical treatment can give you.

More than 90 percent of people who underwent this operation expect the complete disappearance of pain and a significant increase in mobility for the possibility of a normal, active life. However, total knee replacement cannot do more than you could before arthritis developed.

After surgery, you must avoid certain movements and sports, including running and contact sports.

Even with normal use of the endoprosthesis, its components, especially the polymer pad, will wear out. If you experience increased stress on the joint or are overweight, the wear process can accelerate and cause instability of the prosthesis and renewed pain. With adequate use, a knee replacement can last for many years.

Hazardous activities after surgery: running, jumping, contact sports, aerobics.

Activities that exceed the usual recommendations after surgery: too long or tiring walks, tennis, lifting weights over 25 kg.

Permitted activities after surgery: non-fatiguing walks, swimming, golf, driving a car, “non-extreme” tourism, ballroom dancing, climbing low stairs.

Recommendations for the home

The following are some suggestions to make your return home easier during the rehabilitation process.

• Fixed handrails in the bathroom or shower.
• Strong handrails along all stairs.
• Sturdy chair with a sturdy, high seat, strong backrest, two armrests, and a footrest.
• High toilet seat.
• A stable bench in the shower or a chair in the bathroom.
• Remove loose carpets and electrical wires from the area where you walk.

Operation

You will be admitted to the clinic some time before the operation. Next, you will be examined by an anesthesiologist. The most common types of anesthesia for total arthroplasty are endotracheal anesthesia (you will sleep during the operation and the ventilator will breathe for you), spinal anesthesia or epidural anesthesia (which will allow you to breathe on your own, but your legs will not feel anything. Anesthesiologist will discuss with you the advantages and disadvantages of these methods and help you choose the most appropriate type of anesthesia.

The operation takes on average about two hours. The surgeon will remove the damaged cartilage and part of the bone and then install new metal and polymer articular surfaces in order to restore the axis of the limb and the function of the knee joint.

Many different types of prostheses are currently used in total knee arthroplasty. Almost all of them have three components: the femoral component (made of highly polished, durable metal), the tibial component (consisting of a tough polymer, often placed on a metal platform), and the patella (also made of polymer).

After the operation, after full awakening, you will be transferred to your room.

You will be in the clinic for several days. After the operation, you will feel pain in the operated joint. You will receive pain medication to relieve pain.

Walking and light exercise for the operated joint is essential for recovery and should begin shortly after surgery.

To prevent lung complications, you must breathe deeper and cough more frequently.

The surgeon will take certain measures to prevent thrombosis and prevent swelling, such as elastic bandages, stockings, and the use of anticoagulants.

Foot and ankle exercises should also be done immediately after surgery and help increase blood flow to the extremities, reducing swelling and the risk of blood clots. Many patients begin knee exercises the day after surgery. Your physiotherapist will teach you specific exercises to strengthen your knee and restore the movement needed for walking and normal daily activities shortly after surgery.

Possible complications after surgery

The risk of complications after this operation is low.

Serious complications such as infection of the operated joint occur in less than two percent of cases. Serious complications such as myocardial infarction or stroke are even rarer. However, chronic diseases can increase the risk of complications. Although they are rare, these complications can prolong your recovery period.

Thrombosis of the veins of the thigh or pelvis is the most common complication of total hip arthroplasty. Your podiatrist will take steps to prevent blood clots from forming in the veins of your legs and pelvis. These measures include special elastic bandages or stockings, exercises, and anticoagulants.

Despite the fact that the biocompatibility of implants and the technique of the operation is constantly progressing, over time, the endoprosthesis may wear out or its fixation in the bone may weaken. In rare cases, important vessels or nerves in the area of ​​the knee joint may be damaged during the operation.

Homecoming

The success of the operation largely depends on how you follow the recommendations of the orthopedist at home during the first few weeks after the operation.

Careful attitude to the postoperative wound. Stitches or special staples will be placed along your wound along the anterior surface of the knee joint area, or it will be sutured with a subcutaneous suture. The braces or stitches will be removed approximately two weeks after surgery. The subcutaneous suture does not require removal.

It is necessary to be careful not to get water on the wound until it is completely sealed. You can put a bandage on the wound to prevent clothing or elastic stockings from irritating the wound.

Diet. A slight decrease in appetite is often present for several weeks after surgery. A balanced iron-rich diet is essential to assist in tissue healing and muscle strength restoration. Of course, you need to drink enough fluids.

Activity. Exercise is a crucial component of your home rehabilitation, especially during the first weeks after surgery. You should return to normal activities and daily life within 3 to 6 weeks after surgery. During this time, you will experience slight discomfort during active movements and at night.

Your activation program should include:

• Gradually increasing walking time, first at home and then outside.
• Practice essential movements such as sitting down, getting up from a chair, walking up stairs.
• Return to the necessary household chores.
• Special exercises a few minutes a day to develop movements in the knee joint.
• Special exercises a few minutes a day to strengthen the knee joint.
• Physiotherapy can be done at home.

Driving a car is possible when you develop movements in the operated joint in order to get into the car without difficulty and when the muscles can provide an adequate response when pressing the pedals. Most often this happens 4 to 6 weeks after surgery.

Prevention of complications after surgery.

Prevention of thrombosis. Carefully follow your doctor’s instructions to reduce the potential risk of blood clots. These problems may arise especially in the first few weeks after surgery.

The following signs indicate the formation of blood clots:

• Pain in the leg, in the calf muscles, not associated with the incision.
• Soreness, swelling, redness on the back of the leg.
• Swelling of the thigh, lower leg, ankle or foot.

Indications for thromboembolism:

• Sudden difficulty in breathing.
• Sudden pain in the chest, aggravated by deep breathing and coughing.

Contact your doctor immediately if these symptoms occur!

Prevention of infection.

The most common routes of infection after arthroplasty are through the introduction of bacteria into the bloodstream during dental procedures, urinary tract infections, and skin infections. These bacteria can infect the space around the prosthesis.

For up to two years after surgery, you may need to take prophylactic antibiotics before dental procedures, including cleaning of the enamel or other surgical procedures where bacteria can enter the bloodstream.

Watch out for the following signs of an incipient infection:

• Continued fever (temperature above 37°).
• Fever or chills
• Increasing redness, swelling, soreness in the area of ​​the postoperative wound.
• Wound discharge.
• Increased pain on exertion and at rest.

Contact your doctor immediately if these symptoms occur!

Fall prevention.

A fall during the first weeks after surgery can damage the endoprosthesis and lead to the need for another operation. Be especially careful when walking up stairs. You should use a cane, crutches, walker, handrails, or other assistive devices until the joint is strong, mobile, or strong.

Your surgeon or physiotherapist will advise you on which assistive devices you need after surgery and when it is safe for you to stop using those devices.

What is special about your new knee joint.

After the operation, you may feel numbness in the skin around the scar. You may also feel some difficulty in bending your knee. Restoration of movement in the joint is one of the goals of total arthroplasty, but complete recovery is not always possible.

The metal components of the joint can be detected by metal detectors at airports and other facilities. In such cases, inform the security staff that you had an operation with metal implantation. You can ask the surgeon for a certificate that you have implanted an endoprosthesis.

Be sure to do the following after surgery:

• Participate in training programs to maintain the stability and mobility of the new joint
• Follow special guidelines to prevent falls and injury. Patients who have suffered a fracture after total joint replacement may require new surgery.
• Let your dentist know that you have had a total arthroplasty. Antibiotics are required before dental procedures for up to two years after surgery, possibly more, depending on the course of the postoperative period. Recommendations for the use of antibiotics for the surgeon and dentist are available on the AAOS and ADA websites.
• Periodically see the surgeon for examination and x-ray control, even if you do not experience any problems with the joint.

Exercises.

For a full recovery and a gradual return to normal life, regular exercises are necessary to help restore normal movement in the joint and muscle strength. Your orthopedist and exercise therapist may advise you to exercise for 20-30 minutes two to three times a day, as well as walk for half an hour 2-3 times a day. They may suggest some of the exercises below. The brochure will help you understand how to do these exercises.

Exercises in the early postoperative period.

Start the following exercises as soon after surgery as possible. You can start them already in the recovery room. At first, you may experience discomfort, but they will speed up your rehabilitation.

1. Contraction of the quadriceps muscle. Contract your quadriceps. At the same time, try to straighten your knee and raise your leg, holding it for 5 to 10 seconds. Repeat this exercise 10 times for 2 – x. minute period, rest for a minute, then repeat. Continue until you feel fatigue in your thigh.
2. You can also lift your leg when you are sitting. Try to straighten your knee more. Continue this exercise until you can straighten your knee completely.
3. Flexion – extension of the foot. Slowly bend and unbend the foot at the ankle joint. Do this exercise several times every 5 to 10 minutes. You can start this exercise immediately after the operation and continue until you fully recover.
4. Knee straightening exercise. Place a small roller under your ankle so that your foot does not touch the bed. Contract your quadriceps. Exercise until you straighten your knee, then place your foot on the bed. Hold the knee fully extended for 5 to 10 seconds. Repeat until you get tired.
5. Bed-supported knee flexion. Slide your heel towards your buttocks, bending your knee as much as possible. Hold the knee in the maximum bent state for 5 to 10 seconds, then straighten it. Repeat until you get tired or can’t fully bend your knee.

Walking in the early postoperative period.

Shortly after the operation, you will start walking short distances within the room and start taking care of yourself. Early activation will strengthen muscles, restore range of motion in the joint, and speed up recovery.

Walking with a walker / walking with full weight bearing on the operated leg. Stand up straight and distribute your body weight on crutches or a walker. Move the crutches or walker forward a short distance. After that, move forward yourself, raising the operated leg so that you feel the floor, touching it. As you move, your knee and ankle joint will be bent. To rest, lower your leg to the floor. When you take a step, it is permissible to lift your foot off the floor. Move the walker forward again and move your foot forward again for the next step. Remember, first you need to touch the floor with your heel, then straighten your leg, then tear your leg off the floor. You are allowed to walk as much as you can. Do not hurry. As your muscle strength and exercise tolerance increase, you will be able to walk more and more. Gradually, you will increase the weight load on the operated leg.

Walking with a stick or crutches. Walkers are often used for the first few weeks to help balance and prevent falls. Then a cane or crutches are used until full recovery of strength and range of motion. Hold the cane in the hand opposite the operated joint. You will be ready to switch to a cane or crutches when you can balance and stand without a walker, when you can fully distribute the weight on both legs, and when the walker becomes uncomfortable to hold in your hands.

Climbing and descending stairs. The ability to move up stairs requires a certain range of motion and muscle strength. First, you will need handrails for balance and extra support, and at first you will only be able to step over one step at a time. Always go up the stairs with your good leg and go down with your operated leg. Remember “rising from the healthy” and “descent from the sick.” At first, you may need help. Climbing stairs is a very good muscle and joint exercise. Do not climb steps that are more than 7 inches (18 cm) high and always use the handrails.

The following exercises.

Full recovery will take many months. Soreness before surgery and pain after will weaken your muscles. The following exercises will help restore muscle strength.

1. Standing knee flexion. Standing straight with the support of a walker or crutches, raise your hip and bend your knee as far as possible, holding in this position for 5 to 10 seconds. Then lower your leg, trying to feel the floor. Repeat several times until you get tired.
2. Supported knee flexion. Lying on your back, wrap the belt around your lower leg and, helping yourself with your hands, try to bend your knee as much as possible.
3. Exercises with load. You can place a small weight on your ankles and do the above exercises. The load can be given 4 to 6 weeks after the operation. At first, use a load of 500 – 1000 g, then gradually increase.

Exercise bike. The stationary bike is an excellent exercise for restoring muscle strength and full range of motion. Adjust the seat height so that when your knee is almost extended, your foot is just touching the pedal. First, the pedal turns back. Forward movement is possible if the pedal is comfortably rotated backwards. As muscle strength increases (over about 4 to 6 weeks), increase the resistance of the machine. Do 10-15 minutes twice a day, gradually increasing to 20-30 minutes three to four times a week.

Pain and swelling after exercise. You may experience pain and swelling in the area of ​​your operated knee after exercising. You can bring them down by keeping your leg elevated and applying cold.

Your orthopedic surgeon is a doctor with extensive knowledge in the diagnosis, therapeutic and surgical treatment of injuries and diseases of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

Rehabilitation after arthroplasty in the department of physiotherapy

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Pain and conditions after arthroplasty

Joint arthroplasty is one of the most frequently performed operations for pathologies of the musculoskeletal system.

The need for arthroplasty is determined by the complete destruction of the cartilaginous tissue of the joint, as a result of which movements in it are extremely difficult. As a result, disability sets in, the only way out of which is a surgical operation – the replacement of a natural joint with an artificial one.

Like other surgical procedures, arthroplasty requires a rehabilitation period. Physiotherapy methods used in our clinic help to significantly relieve pain, condition and speed up recovery after arthroplasty.

How is pain and condition relieved after arthroplasty?

Pain after arthroplasty is explained by tissue trauma and the response of the inflammatory process. In order to alleviate the symptoms during the rehabilitation period and at the same time accelerate it, a complex therapeutic effect is necessary.

This is how the rehabilitation methods used in our clinic work.

Their effectiveness is based on the action of physiotherapy. First of all, the use of shock wave therapy (SWT) shows good results. This procedure is the impact of acoustic waves of infrasonic frequency. Freely penetrating into the focus of inflammation and pain, they have a local effect with an impulse, intense massage. Unlike massage of the surface of the body, acoustic massage works inside, quickly and significantly improving blood and lymph flow. As a result, tissue nutrition improves, metabolic processes are activated, healing and tissue renewal are stimulated.

In combination with other procedures (acupressure, electropuncture, laser therapy, etc.), shock wave therapy has analgesic, anti-inflammatory, anti-edematous, immunomodulatory effects.

Non-steroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain after arthroplasty, but they do not in any way speed up tissue repair or shorten the rehabilitation period.

In contrast, physiotherapy methods accelerate recovery processes by mobilizing the body’s internal reserves. Thanks to this, a complex result is achieved:

• improves mobility, motor functions, physical performance,
• relieves inflammation and pain,
• improves the quality of life,
• significantly accelerates adaptation to normal physical activity.

The methods used in our clinic affect the causes of degenerative-dystrophic and inflammatory processes in the joints that require arthroplasty (gonarthrosis, coxarthrosis, etc.). Their use not only facilitates the consequences of the operation, but also normalizes natural metabolic processes. Due to this, prolonged results are achieved, a further process of destruction of the joints and the musculoskeletal system as a whole is prevented.

Stages of rehabilitation after arthroplasty

In general, the rehabilitation period after the operation takes about a year. The main task of rehabilitation medicine during these months is not only the elimination of pain and discomfort after arthroplasty, but also the maximum restoration of motor activity.