Musculoskeletal Condition · Glastonbury, CT

Knee Pain After Total Knee Replacement

Persistent pain after knee replacement may involve nerves, scar tissue or implant issues. Learn about evaluation with Dr. Tortland in Glastonbury, CT.

Written and clinically reviewed by

Paul D. Tortland, DO, FAOASM, CAQSM, RMSK

Dr. Paul Tortland, DO is a non-surgical orthopedic & sports medicine physician specializing in regenerative orthopedics and surgical alternative treatment. He is dual board-certified in Sports Medicine & Osteopathic Manipulative Medicine (OMM) and Regenerative Medicine, Fellowship-trained in Sports Medicine. He became the first physician in the world to earn board certification in Regenerative Medicine in 2015. Diplomate, American Board of Regenerative Medicine (ABRM), 2015. Registered in Musculoskeletal Ultrasound (RMSK).

Condition

Why can knee pain persist after replacement?

Persistent pain after total knee replacement can have several causes, including stiffness or scar tissue, irritated nerves, infection, implant loosening, instability or alignment problems. These causes need different evaluations; possible infection and implant-related problems should be assessed with the orthopedic surgeon before considering soft-tissue or nerve-directed care.

Dr. Tortland uses live ultrasound to assess selected soft tissues and peripheral nerves when appropriate. This does not replace the surgeon’s assessment of the replacement itself.

Explore related conditions: Browse the Knee condition hub for related diagnoses and treatment options.

CARE OPTIONS

How is persistent pain after knee replacement evaluated and treated?

Dr. Tortland’s potential treatment options: Dr. Tortland may assess selected soft-tissue or peripheral-nerve causes of persistent pain and, only when appropriate, consider ultrasound-guided nerve hydrodissection. This care is complementary: it does not replace the joint-replacement surgeon’s evaluation for infection, loosening, instability, fracture, or alignment problems.

Physical therapy and traditional care: Treatment depends on the cause and may include supervised physical therapy for motion, strength and gait; swelling management; and a clinician-directed plan for scar sensitivity or nerve symptoms. The orthopedic surgeon should guide rehabilitation and any restrictions.

When other care may be needed: Contact the surgical team promptly for fever, wound drainage, increasing redness or warmth, sudden swelling, or rapidly worsening pain. Do not assume pain is caused by scar tissue or a trapped nerve until implant-related and infectious causes are assessed.

Common questions

Questions about knee pain after total knee replacement

Why does my knee still hurt after a total knee replacement?

A painful knee after replacement can have several causes, including stiffness, scar tissue, nerve irritation, infection, implant loosening, instability or alignment issues. A clinician should help identify the cause before treatment is chosen.

Could scar tissue or a trapped nerve be causing my pain?

Scar tissue may limit motion, and small nerves around the knee can become irritated or entrapped. These are only two possibilities; the orthopedic surgeon should evaluate infection, implant loosening, instability and alignment before care focuses on soft tissues or nerves.

What is hydrodissection, and can it help after a knee replacement?

Ultrasound-guided hydrodissection places fluid around a selected nerve to separate it from nearby tissue. Evidence specifically for nerve pain after knee replacement is limited, so it may be considered only after the orthopedic team has assessed the replacement and other causes. Benefit is not guaranteed.

When should I be seen, and does it replace my surgeon's follow-up?

Contact the surgeon promptly for fever, increasing redness or warmth, wound drainage, sudden swelling or rapidly worsening pain. Persistent symptoms should be evaluated rather than assumed to be scar tissue. Dr. Tortland’s care is complementary and does not replace follow-up with the surgeon who performed the replacement.