Understanding Chronic Knee Pain

Chronic knee pain following a knee replacement is a frustrating condition that can significantly impact a patient's quality of life. Despite undergoing surgery to alleviate joint issues, some individuals continue to experience persistent pain that interferes with daily activities and mobility. Various factors, including nerve irritation, scar tissue formation, or complex regional pain syndrome, may cause this ongoing discomfort. When traditional treatments and pain management strategies prove ineffective, patients may feel they have exhausted their options for relief.

Joint denervation surgery offers a promising solution for those suffering from chronic knee pain after replacement. This innovative procedure, performed by specialized surgeons, involves identifying and surgically cutting the specific nerves responsible for transmitting pain signals from the joint. Through small incisions, the problematic nerve is severed and repositioned into nearby muscle tissue to prevent continued pain signaling. Importantly, this technique targets only the sensory nerves, preserving normal joint function while potentially providing significant pain relief. For patients who have tried other treatments without success or wish to avoid long-term pain medication use, joint denervation can offer a lasting solution to improve mobility and overall quality of life.

It is particularly important to seek medical attention promptly if your chronic knee pain follows a knee replacement surgery, as this may indicate complications or issues with the implant that require specialized evaluation and treatment. Symptoms of chronic knee pain include:

• Persistent aching or throbbing
• Stiffness, especially in the morning or after periods of inactivity
• Swelling or inflammation
• Weakness or instability in the knee
• Reduced range of motion
• Difficulty walking, climbing stairs, or standing for extended periods
• Clicking, popping, or grinding sounds when moving the knee
• Warmth or redness around the joint
• Pain that worsens with activity
• Difficulty fully straightening or bending the knee

The most common cause of joint pain is osteoarthritis (arthritis). Osteoarthritis is when the cartilage that provides a protective cushion between two bones wears away over time. Chronic joint pain can also result from numerous other conditions, such as:

• Rheumatoid arthritis (RA): A chronic disease that can cause joint swelling, pain, and deformity.
• Gout: A condition where crystals from the body collect in a joint such as the big toe, causing severe swelling and pain.
• Viral infection: Such as hepatitis B or C.
• Trauma: Such as overuse, injury, or surgery.
• Nerve damage: Caused by trauma or surgery.

Nerve-Related Joint Pain

When nerves are directly injured by trauma or surgery, the affected nerve can send pain signals to the brain, even if there is no apparent reason for the pain – for example, structural damage to the joint. Nerve-related joint pain can be either acute (appearing suddenly) or chronic and long-lasting.

In most cases, joint pain occurs when a joint is injured by trauma or overuse. In the case of nerve-related joint pain, orthopedic surgery or trauma can increase the risk of an occurrence. Joint pain, including chronic knee pain, is more common in individuals who:

• Have previous or recurring joint injuries
• Repeatedly use or overuse a muscle or motion
• Have been diagnosed with arthritis, rheumatoid arthritis, or osteoarthritis
• Are overweight or obese
• Are aging
• Have undergone knee replacement surgery
• Suffer from conditions like gout or lupus
• Have a job or hobby that puts repetitive stress on the knees
• Have poor posture or alignment issues
• Lack muscle strength or flexibility, particularly in the legs
• Have a family history of joint problems
• Have had previous knee surgeries or procedures
• Participate in high-impact sports or activities
• Have experienced a direct blow or trauma to the knee
• Suffer from certain metabolic disorders
• Have leg length discrepancies
• Experience chronic inflammation in the body

These factors can contribute to the development or persistence of chronic knee pain, whether following a knee replacement or in general. It is important to note that having one or more of these risk factors does not guarantee chronic knee pain, but it may increase the likelihood.

To ensure a proper diagnosis, your doctor will perform a physical examination, ask about your medical history, and may request additional tests. They will also look for signs of injury to the muscles, tendons, and ligaments surrounding the affected area.

Additional testing may include imaging, which will allow your doctor to see joint deterioration, bone spurs, fluid, and other possible causes of your pain, or minimally-invasive procedures. Some of the most commonly used methods for diagnosing joint pain or nerve-related joint pain include:

• EMGs: Electromyography (EMG) measures the health of muscles and the nerve cells, known as motor neurons, that control them.
• X-rays and/ or MRI: Magnetic resonance imaging uses magnetic fields and radio waves to create an image.
• Tinel’s sign test: A test where the nerve is gently tapped to assess nerve damage.
• Nerve block: An injection around a nerve to block pain. If a nerve block is successful, it indicates that the pain is nerve-related.
• Blood test: To rule out viral infections or other diseases that may be causing pain.

Your joint pain doctor may first recommend conservative treatment for alleviating pain before moving on to more aggressive treatment options. Common conservative treatments for joint pain may include:

• Heat or ice
• Changes to exercise routine
• Anti-inflammatory and/ or pain medications
• Weight loss
• Dietary supplements, such as glucosamine
• Topical medicines such as creams or gels (over-the-counter or prescription)
• Braces, canes, or other supportive aides
• Physical therapy
• Steroid injections

If the pain does not respond to conservative forms of treatment, your doctor may recommend surgery. At the Institute for Advanced Reconstruction, we offer multiple surgical procedures to address chronic joint pain, including:

Joint Denervation

Joint denervation is an innovative surgical procedure that identifies and severs specific sensory nerves transmitting pain signals from the knee joint. Through small incisions, the surgeon cuts problematic nerves and repositions their endings into nearby muscle tissue, interrupting the pain pathway. This technique is particularly effective for patients experiencing persistent pain after knee replacement surgery.

Arthroscopy

Arthroscopy is a minimally invasive procedure using a tiny camera and specialized instruments inserted through small incisions to diagnose and treat joint problems. Common treatments include repairing cartilage, removing bone fragments, and addressing inflammation. This technique offers less pain and faster recovery compared to traditional open surgery.

Joint Replacement

Joint replacement surgery removes damaged parts of a joint and replaces them with artificial components called prostheses. The surgeon removes damaged bone and cartilage, replacing them with metal, plastic, or ceramic components designed to replicate healthy joint movement. This procedure is most commonly performed on hips, knees, and shoulders.

Nerve Decompression

Nerve decompression surgery alleviates pressure on compressed nerves by removing or altering surrounding tissue causing the compression. The surgeon identifies the affected nerve and creates more space for it, often by removing portions of bone, ligament, or other tissue. This procedure can be performed on various body parts to relieve pain, numbness, tingling, or weakness.

The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.

If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment. 

• Horizon Blue Cross Blue Shield of New Jersey
• Medicare
• Railroad Medicare
• Aetna
• Cigna
• United Healthcare
• Oxford (Freedom, Liberty)
• MagnaCare 

If your joint pain is persistent, lasting longer than 3 months, and has not responded to conservative forms of treatment, you may be a candidate for advanced chronic joint pain treatments, such as nerve reconstruction or decompression surgery.