Knee Replacement Surgery | How Painful Is It?

[00:00:00]I know you. You're not afraid of the surgery. You're afraid of the pain after. You're not afraid of the incision or the scar. You're afraid of the pain.

[00:00:08]The kind that keeps you up at night. The kind that makes you regret the decision.

[00:00:13]I'm Dr. Tyler Goldberg, an orthopedic surgeon in Austin, Texas. For the last 25 years, I've performed more than 12,000 hip and knee replacements. And today, I'm going to give you the honest answer to a question most surgeons just simply gloss over. Does knee replacement hurt? Let's talk about what ex actly it feels like day by day and how to think about pain the right way. First, let's get straight to the point. Yes, it hurts. Let's start with that. It's the plain truth. Yes, [music] it hurts.

[00:00:43]Total knee replacement hurts.

[00:00:46]It's a major joint reconstruction.

[00:00:48]>> [music] >> We remove the damaged bone and cartilage. We reshape the joint. We fill it with metal and plastic. We rebalance your ligaments. Your body responds with inflammation. But, here's the key. The pain is predictable. And predictable pain is manageable pain. Well, what kind of pain is it? Knee replacement pain is not sharp stabbing. It's [music] usually this deep pressure throbbing. It's this tightness. It's all due to that swelling, right? And swelling creates stiffness. [music] Your muscles are going to feel sore. The joint is surrounded by a large soft tissue envelope. And when that tissue swells, motion is going to feel tight and restricted. Most discomfort in that first 72 hours actually comes from the swelling, not the implant. And that distinction matters. The first 72 hours are really sort of the most uncomfortable. Typically, your nerve block that you got in surgery starts to wear off. Your swelling starts to increase and your inflammation starts to peak. And pain often peaks around day two, three, four, right? That surprises most patients. They expect improvement every day, but instead there's sort of this short plateau or slight worsening before improvement begins. That is physiologic. That's normal. It does not mean something went wrong. Well, how bad is it on a scale, right? Well, most patients will often describe early pain as five to seven out of 10, right? At rest, it's often only three, four, five maybe. It's uncomfortable, but it's rarely unbearable when it's managed properly. And that management is often structured. In my practice, I have a dedicated list of medications that I take patients through in their recovery process because I can predict where their pain is and how to intervene before it becomes unmanageable. Well, three things really amplify pain after knee replacement. Number one is the most obvious one. It's [music] swelling, right? We swell physiologically. It's normal. Number two is the anxiety that we bring with it. You're like, is this the new me? Is this the new normal all this swelling? And number three, it's actually another thing we do to ourselves. It's overdoing our physical therapy. Well, let's talk about each one of those. Number one is the swelling.

[00:03:11]Swelling creates mechanical pressure inside the joint. That pressure creates tightness and it creates pain.

[00:03:18]Controlling swelling is a more important than chasing range of motion in the first week. You do ice, you do elevation, you do compression, you do gentle motion, right?

[00:03:28]>> [music] >> We want to do things to remove the swelling. Pain control and range of motion the first six weeks after surgery is all about the swelling. Number two, let's talk about that anxiety. Fear amplifies your pain perception. When patients think, "This shouldn't hurt."

[00:03:44]they interpret normal healing as danger.

[00:03:48]When patients understand, "This is expected." the experience sort of changes, right? [music] Pain is physical. Suffering is often the interpretation. Patients often believe, if I just push harder, I'll recover faster. [music] No pain, no gain. Not true in the joint replacement world.

[00:04:04]Forcing motion actually increases your inflammation. And when your inflammation increases, your pain increases. When your pain increases, your guarding increases. Early recovery after a knee replacement is about consistency, not [music] intensity. Right? How long does the pain last? Well, here's the timeline that most patients experience. Your first 72 hours are usually the most intense, right? Week one starts where you're still sort of uncomfortable, but you start to see some slow improvement.

[00:04:33]Weeks two to three, you actually get a very significant reduction in the amount of pain. Most patients even taper off of all their pain medication in weeks two to three. Weeks four to six, it's just manageable soreness, right? You're still icing maybe. You might take some Tylenol, but it should be manageable. By month three, dramatically better. Your sleeping has improved. You feel like your life is coming back to you again.

[00:04:57]Months six to 12, you're going to get into that maturation phase where you're going to have continued refinement of your healing. A knee is slower to calm down than a hip. That's just anatomy, right? It's physiology. [music] It's not necessarily failure. Well, what about night pain? Night pain can be very disarming early. It's common, though.

[00:05:17]Inflammation builds during the day. You lie still, the fluid shifts, your knee starts to throb. That improves as the swelling decreases. But think about it.

[00:05:28]During the day, you're upright, all that energy in your body's going toward moving your mouth and your hands and your eyes. At night, all that energy goes to whoop, your affected joint, your knee joint. So, it's normal for it to throb at night. Sleep disruption in week one is totally expected. It does not last forever. Well, when is pain not normal? There are a few things where you should call your surgeon. Call your surgeon if your fever is over 101.5.

[00:05:55]Call your surgeon if you have severe calf pain or you have suddenly sharp worsening pain with shortness of breath and chest pain. Call your surgeon if you have increasing redness spreading over your leg or you have unnecessary drainage from the knee. Otherwise, most of that early pain is a normal inflammatory response. Here's the part most people don't hear enough. At 3 to 6 months, most patients have gone through that looking glass and they say those magical words, "I should have done this sooner." Not because the first week was easy, but because the long-term relief outweighs the short-term discomfort. And that short-term discomfort should be manageable. A total knee replacement is one of the highest satisfaction rates in all of orthopedic medicine, but no one really enjoys week one. That's just reality. If your fear of pain is what's holding you back from knee replacement, I built a 2-minute joint pain quiz to help you understand whether or not you're even a candidate. It's in the description below. Clarity always reduces fear. So, how about the bigger picture? Let's get to the big question.

[00:06:57]Does knee replacement hurt? I think we just talked about it. Yes, it's manageable, but yes. Is it permanent pain? It should not be. That discomfort should be temporary. The improvement in function can last decades. If you're researching hip or knee replacement in Austin or around the country or you're trying to understand what recovery actually feels like, I hope this gave you a grounded answer, not marketing, because pain is part of healing, [music] but fear doesn't have to be. I'll see you in the next video.