No one likes to hear the word “failure” when you are scheduled for surgery. Those of us who made the decision to have total knee replacement (TKR) did so because we were looking forward to having a functional, pain-free knee.
The last thing we wanted were complications that needed additional medical care or further surgery.
Doctors are not perfect. When I was a youngster, I thought teachers, police and doctors could do no wrong. As I aged, I learned that everyone is human and can make a mistake. Even your surgeon.
There are other factors besides physician error that can cause complications after surgery. In the sections below, I will discuss some things that could go wrong during the knee replacement process.
Remember, there are several things that you can do prior to knee replacement surgery to improve the chances of a successful outcome. Building leg strength, stretching, exercising and weight management are a few pro-active steps you can do to increase the probability of success.
My experience, as well as my discussions with TKR veterans, leads me to believe that the vast majority of knee replacement surgeries have a positive outcome.
Mild Knee Replacement Complications
All of us will experience some mild knee replacement complications after surgery. Your recovery will be a time of adjustment and each person’s body adjusts to their new knee differently.
Complications can include bruising, swelling, tenderness and pain during the healing process. In most cases, these minor complications will last only a short time (several months).
Knee stiffness may develop after surgery, especially if you remain sedentary. Physical therapy will help with many of these mild complications.
Some mild complications may persist and need further attention from your physician. I’ll mention the more serious complications below.
Always follow your doctor’s instructions to reduce your risk of developing complications.
9 Signs Of Knee Replacement Failure
TKR infections can range from minor to severe. In my case, the hospital took special care to make sure my knee was sterilized before surgery.
I was assured that they made the same effort to sterilize the operating room, surgical tools, and implants. However, bacteria are everywhere and an open wound is susceptible to infection (read my article about going to the dentist after knee replacement).
If you have an infection after knee replacement surgery you may experience fever, tenderness, and redness, as well as swelling around the knee. My home physical therapist was very diligent about checking my wound for infection during each of her home visits.
My research leads me to understand that patients with poor nutrition, advanced age, and obesity can be at a greater risk of both superficial and deep infection.
If an artificial joint becomes infected, it may become stiff and painful. The implant may lose its attachment to the bone.
The pain, swelling, and drainage from the infection may make a revision surgery necessary. As I mention in prior articles, the better you prepare your body before surgery the better chance that you will have positive outcomes.
#2 Blood Clots
Blood clots are always a concern after surgery. Blood clots can block a patient’s blood vessels thus blocking or impeding the blood supply.
Immediately after surgery I awoke with compression stockings on both legs. I also had air cuffs on both legs that helped with blood flow during my time in the hospital.
I was encouraged to frequently move my feet and ankles immediately following my surgery to increase blood flow in my leg muscles. I was told it would help prevent leg swelling and blood clots (ankle pumps are a great exercise during recovery).
Some of my friends continue to wear compression stockings months after surgery, especially when flying. My doctor advised me that I did not need to wear compression stockings at all.
Check with your physician to see what is best for you.
#3 Nerve Damage
You may experience some level of nerve damage after TKR surgery. Most articles that I have read acknowledge that the chance of some nerve damage following TKR is possible.
During TKR the surgeon makes a long incision over the middle of the knee and cuts muscle, tendons, and ligaments to get to the knee joint. You will experience pain during your recovery. As the healing process takes place the pain and swelling should decrease.
If the nerve is traumatized or cut it can recover over time. Some patients report continued improvement over many months.
The severity of nerve damage can vary. Peroneal Nerve Palsy (PNP), which can be very serious, is a rare complication following TKR. If you are concerned about PNP, ask your doctor to explain the risks and treatment.
#4 Increase in Pain
Most of us opt for knee replacement surgery to reduce pain and to continue an active lifestyle.
In most of the articles I have read, about 10-15 percent of TKR patients experience a failed surgery. Possible explanations for such pain may include unrealistic expectations, surgical flaws, or pain from other sites on the body (read about the pain I experienced after knee surgery).
If pain persists you should report it to your physical therapist and doctor for analysis and possible treatment.
#5 Decrease in Function
Another sign of knee replacement failure is if overall knee function declines immediately after your TKR surgery. Remember that your knee will have a large incision and your knee joint has been traumatized (to say the least).
Recovery will take time! You will experience gradual improvement with physical therapy and exercise that can take up to a year or more.
I was able to enjoy all of my old activities without pain 4 months after surgery. I still experienced mild swelling. I did not quit my exercise routine recommended by my physical therapist and 18 months after surgery I am still working to strengthen my knee.
I plan to make my recovery exercises a lifetime routine.
#6 Joint Instability
Some patients complain that their new knee isn’t stable after TKR. They feel like their knee is giving out and the supporting structures around their knee are not strong enough to support standing and walking.
They may need to continue to work with a physical therapist to strengthen the muscles and tendons around the knee, especially if the knee was weak and unstable before surgery.
Improperly placed implants may also cause instability. Age, weight, fitness and health also may affect your recovery. If your joint feels unstable or loose after surgery, be sure to call your surgeon and accurately describe the feeling.
If you are experiencing knee stiffness after knee surgery there can be several reasons for the stiffness.
- Did you have stiffness and limited range of motion before your surgery?
- Is your knee’s stiffness merely due to temporary swelling?
You may have to work harder with your physical therapist to eliminate stiffness and improve range of motion. The longer your knee remains immobile after TKR surgery, the greater the chance of developing stiffness.
In my case the hospital physical therapist had me doing exercises to strengthen the knee and to improve range of motion the afternoon after my surgery. Some post TKR stiffness is normal but the sooner your physical therapy starts the better.
My neighbor experienced what she called” stiff knee syndrome” which is caused when excessive scar tissue forms around the knee joint limiting range of motion and causing pain. Her surgeon manipulated her knee under anesthesia to break up the scar tissue.
She has since made a good recovery and is back to her pre surgery activities including golf and walking.
If your stiffness is due to swelling then it’s common, and should be temporary. As the knee heals, swelling should gradually subside. It can take up to a year for swelling to decrease.
Don’t forget to ice and elevate the leg after surgery to manage swelling.
Knee replacement failure can be caused by many factors. Alignment plays an important role in the success of TKR surgery.
As I mentioned at the beginning of this article, nobody is perfect including your surgeon. The computer assisting your surgeon is used to ensure your knee is properly aligned.
Although unlikely, you can have a malalignment during your TKR surgery that can cause problems after surgery. A revision (a 2nd surgery) might be necessary.
Malalignment can cause loosening of the new metal or plastic components in your knee. The importance of correct component (your artificial knee parts) alignment position in TKR is key to a successful surgery.
In my case, my leg was beginning to bow noticeably. During my surgery, my surgeon realigned my knee and leg so that I no longer had a bow in my leg. After many years, I now have a straight leg again.
I have also come across articles that mention that obese patients run the risk of early component loosening. This is likely due to added pressure (greater weight) placed on the knee joint.
#9 Periprosthetic Fractures
A periprosthetic fracture is a broken bone that occurs around the components of a total knee replacement.
During TKR surgery your bone(s) will be cut and holes will be drilled into the bone to attach and cement implants. Good bone quality going in to surgery can make a significant difference in the outcome.
Periprosthetic fractures after TKR may occur in any part of the femur, tibia, or patella. Fractures of the patella are less common.
Fractures can be caused by malalignment or malposition of the implants. Most patients who experience periprosthetic fractures around the knee are elderly with poor bone quality.
Periprosthetic fractures can also be the result of a fall.
Periprosthetic fractures can be treated non-surgically however depending on the severity of the fracture a revision surgery might be required.
Revision Total Knee Replacement
According to what I have read, total knee replacement is one of the most successful procedures in all of medicine. In most cases it allow patients to live an active pain free life.
A knee replacement can fail for several reasons. Symptoms may include pain, swelling, stiffness, and lack of stability.
If your knee replacement fails or wears out your doctor may recommend that you have a second surgery called revision total knee replacement. In this procedure, your doctor will remove some or all of the parts from the original implants and replace them with new parts.
Just like your first surgery, the goal of revision surgery is to relieve pain and improve the function of your knee.
Revision surgery is longer and a more complex procedure. Most patients who have revision surgery experience good long-term outcomes.
After surgery I was tired and experiencing pain and swelling. After 1 week I was moving around fairly well, but my body needed months to heal.
Thankfully, I didn’t experience infection or other serious complications after my surgery. I was careful to monitor my wound and follow my surgeon’s orders to ensure I had a smooth recovery.
Even if you take all the precautions, it is possible to experience setbacks in your recovery. Knee replacement failure isn’t common, but it does happen.
In this article we looked at 9 signs of knee replacement failure. A few of the serious signs are:
- Joint instability
- Pain (though there will be pain early on in recovery)
- Periprosthetic fracture
If something goes wrong after surgery, a knee revision surgery can help correct the problem (though no one wants to experience a second surgery).
To give yourself the best opportunity at a successful recovery, be sure to prepare yourself accordingly. Exercise, strengthen your leg muscles, stretch, manage your weight, and ask your surgeon questions. Learn as much as you can about your upcoming surgery so you are ready!