My Knee Still Hurts After Surgery. What Should I Look At?

Key points in 30 seconds

1. Surgery looks at the inside of the knee; we look at the conditions outside it.
2. We check the foot arches, the height of the pelvis on each side, and the way you walk.
3. Once the major pain settles, a cause that was hidden may come to light.
4. Have pain after surgery checked first by the clinic that did the surgery.
5. If it's swollen or warm, or suddenly gets worse, that comes first.

What we often hear

• "They say the surgery went well, but it still hurts."
• "I'm starting to wonder if I just have to live with this."
• "Could the problem be somewhere else?"

My knee still hurts after surgery. What should I look at?

Surgery dealt with the problem inside the knee. The outside conditions that made force land on the knee the wrong way aren't changed by surgery. We look at whether those conditions are still there.

This doesn't mean the surgery went wrong. If the inside of the knee has been fixed but the way you use that knee stays the same, the same force lands on it again.

What do you mean by outside conditions?

Whether the foot arch has collapsed, whether leg length or pelvis height differs between left and right, and whether your weight piles onto one side when you walk.

In the clinic, we look at the feet first for people like this. If there's no arch or the two sides differ in height, the knees and pelvis twist when standing and walking, and the pelvis ends up at different heights. Walking like that, force doesn't land evenly on the knee that was operated on either.

Why didn't anyone notice before surgery?

Because before surgery, the problem inside the knee was bigger. Once the major pain settles, other causes that had been hidden sometimes come to light.

That's why we don't see pain remaining after surgery only as "the surgery failed." The order may simply have been reversed. Now that the inside of the knee has been sorted out is also a good time to look at the outside conditions.

What are the limits of this judgment?

Pain after surgery has many causes. The feet and pelvis are one of them, and we have no data to say they're the most common cause.

Something important to add. Pain after surgery must be checked first by the clinic that did the surgery. Things like infection, a loosened artificial joint, or problems at the surgical site aren't something we can treat. If the knee is swollen or warm, or the pain suddenly gets worse, the clinic that did the surgery comes first.

Only after that check is done and you've been told "there's nothing in particular" is it time to look at the outside conditions this column talks about.

We look separately at what the surgery fixed and what's still left. If the joint has been sorted out but what's above and below it stays the same, the pain remains.

If they say your surgery went well but your knee is still the same, come see us. We don't look only at the knee; we follow it through to the feet and pelvis.

The pattern of remaining pain differs from person to person, depending on the type of surgery and how long it has been.