Knee Replacement Problems

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Knee replacement problems are usually fairly minor and short lived, with approximately 90% of knee replacements being extremely successful.

Unfortunately, problems do occasionally develop. All surgery carries risks and in the early days following a knee replacement, things can feel uncomfortable. 

The best way to ensure you make a great recovery after a knee replacement is to do knee replacement exercises both before and after surgery until you have regained full movement, strength and function in your new knee.

Some pain after a knee replacement is to be expected but this doesn't usually last long. In fact, people often find that they have less pain than they did before their knee replacement surgery as they no longer have any arthritis knee pain and the knee is able to move more freely.

When you wake up after knee replacement surgery, there shouldn't be much pain as the anesthesia will still be working to some extent. Once the anesthesia starts to wear off, the knee may feel sore both inside the knee and around the scar initially. 

It is really important to be having effective pain relief to keep this under control. Don't try and manage without medication too quickly. It is much better to take prescribed medication to keep the pain under control so you can start you rehab exercises and get up and about otherwise you may develop other knee replacement problem such as stiffness and weakness.

Keeping the leg elevated when you are lying down or sitting helps the excess fluid drain away from the knee and reduce swelling. 

Another thing that can help is using ice therapy. When used properly, this helps to slow the blood flow and any bleeding in the joint, reducing knee swelling. There are a number of different ways to apply ice after a knee replacement. Cryo cuffs are often used in hospitals and once you get home you can use an ice pack - find out more in the ice wraps section.

Movement and exercise is another great way to reduce swelling after knee replacement surgery as it pumps any excess fluid out of the joint. However, you have to get the right balance - if you try and do too much too soon, you can actually make the swelling worse. Follow the guidance of your physical therapist.

Some surgeons like their patients to use a CPM machine (continuous passive motion) initially to help reduce knee replacement problems. A CPM automatically bends your knee up and down and the amount of movement can be adjusted to gradually increase how much the knee bends. CPM's are a great tool for helping reduce knee stiffness but they are not a replacement for exercises - your knee needs to be actively using its muscles to move too.

If stiffness continues to be a problem longer term after your knee replacement, then your doctor may want to do a manipulation under anaesthetic (MUA) where they put you to sleep and bend your knee to break down any scar tissue or adhesions that have formed.

You can find out more about knee range of motion and how to improve it.

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Longer term knee replacement problems are rare but include:

1. Wearing of the Prosthesis: 85% of knee replacements last at least 20 years
   
   
2. Loosening of the Prosthesis: 1.4% of patients require a repeat total knee replacement, known as a revision knee replacement
   
   
3. Infection in the Knee Joint: this can occur years after surgery

Specific risks associated with knee replacements include:

1. Blood Clots: also known as deep vein thrombosis or DVT, these can travel around the body and cause problems such as heart attack or stroke
2. Infection: usually at the site but the infection can spread around your body.
3. Blood Vessel/Nerve Damage: may affect the sensation around the knee joint
4. Pain Kneeling: you may need to kneel on a cushion
5. Complex Regional Pain Syndrome: rare problem with circulation and sensation leading to pain and swelling