Knee Replacement Problems After 2 Years

Knee replacement surgery, also known as total knee arthroplasty, is a common orthopedic procedure aimed at alleviating pain and restoring function in individuals with severe knee joint conditions. While the surgery has a high success rate, some patients may encounter problems in the postoperative period, particularly after two years. This article examines the various knee replacement problems that can arise after two years, including infection, implant failure, instability, persistent pain, limited range of motion, component wear, periprosthetic fractures, patellar complications, neuromuscular issues, psychological impact, allergic reactions, functional limitations, medical complications, and the potential need for revision surgery. Additionally, it discusses the causes of these problems, their impact on patients, and the management strategies available to address them.

Knee replacement surgery has significantly improved the lives of individuals suffering from debilitating knee conditions such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. While the majority of patients experience successful outcomes, a subset may face complications or problems after the two-year mark. These problems can impact the patient's quality of life and require appropriate management. This article aims to provide an in-depth analysis of the knee replacement problems that may occur after two years, exploring their causes, complications, and potential management strategies. Understanding these issues is crucial for healthcare professionals and patients to facilitate informed decision-making, early detection, and effective management of postoperative complications.

Infection

Infection is one of the most serious complications following knee replacement surgery. While relatively rare, it can lead to severe consequences if not promptly diagnosed and treated. Infection can be classified as either early-onset (within the first few months) or late-onset (after two years).

Early onset is your typical infection symptoms including redness at the incision site, oozing at incision site, and/or fever. 

Late onset infections have very different symptoms. A late onset infection can present as the patient all of a sudden having difficulty bearing weight on that leg/knee, general feeling of malaise, severe pain, sudden swelling, sudden onset of redness and warmth. Of course, there are many more symptoms and if you think you have an infection at anytime, you should contact your physician or surgeon. 

Common pathogens responsible for infection include Staphylococcus aureus and coagulase-negative Staphylococcus. Factors such as obesity, diabetes, immunosuppression, and previous joint infections increase the risk of infection. Diagnostic procedures, including blood tests, joint fluid analysis, and imaging techniques, aid in identifying the infection. Treatment options range from antibiotic therapy to irrigation and debridement, with severe cases requiring prosthesis removal and revision surgery.

Implant Failure

Implant failure is a significant concern after knee replacement surgery. It can occur due to various reasons, including implant loosening, wear and tear, or malalignment. Early implant failure often presents within the first year, while late implant failure may occur after two years or more. Typically, an implant is supposed to “fail” by 25 years, which is how long a knee replacement lasts. Symptoms may include pain, instability, difficulty walking, and joint stiffness. Diagnostic methods such as X-rays, CT scans, and bone scans help assess the integrity of the implant. Treatment options depend on the underlying cause and may involve revision surgery, where the existing implant is removed and replaced with a new one. Strategies to minimize implant failure include proper surgical technique, implant selection, and adherence to rehabilitation protocols.

Instability

Knee instability is a common problem that can arise after knee replacement surgery. It refers to a lack of balance and control in the knee joint, leading to discomfort, reduced mobility, and an increased risk of falls. Instability can result from factors such as ligamentous laxity, malalignment, or inadequate soft tissue balancing. Symptoms may include a feeling of giving way, a sensation of looseness or instability, and difficulty performing activities requiring knee stability. All of these symptoms are very common the first year after surgery due to weakness; however, these symptoms would not be normal or common after 2 years post surgery. If you suddenly have these symptoms and have not had them before, a call to the surgeon is warranted. Physical examination, imaging studies, and functional assessments aid in diagnosing instability. Treatment options include physical therapy to strengthen the muscles around the knee, bracing, and, in some cases, revision surgery to address the underlying cause. Surgeons may also employ techniques such as ligament reconstruction or joint stabilization procedures to restore stability and improve patient outcomes.

Persistent Pain

While knee replacement surgery aims to relieve pain, some patients may continue to experience discomfort even after two years. Persistent pain can have multiple causes, including nerve damage, infection, or prosthetic malalignment. Accurate identification of the underlying cause is essential for effective management. Diagnostic methods, such as physical examination, imaging studies, and nerve conduction tests, may be utilized to determine the source of pain. Treatment options vary depending on the cause and may involve medications for pain management, physical therapy to improve strength and flexibility, or revision surgery if there is an implant-related issue.

Limited Range of Motion

Limited range of motion is a problem that some patients may encounter after knee replacement surgery, even after two years. Factors contributing to restricted joint movement include scar tissue formation, component wear, or soft tissue contracture. Limited range of motion can significantly impact daily activities and quality of life. Physical examination, imaging studies, and range of motion assessments are used to evaluate the extent of limited motion. Treatment options may involve physical therapy focused on stretching and strengthening exercises, manipulation under anesthesia to break up scar tissue, or arthroscopic intervention to address specific joint issues.

The key to preventing range of motion problems is to continue to stretch even after you reach your range of motion goals. Even at 2 years post surgery, stretch your knee to full range of motion every day.

Component Wear and Loosening

Over time, the components of a knee replacement prosthesis may experience wear and loosening, leading to problems after the two-year mark. The wear of the plastic spacer between the metal components can cause debris accumulation, leading to inflammation, pain, and potential implant failure. Loosening occurs when the bond between the implant and bone weakens, resulting in instability and discomfort. Factors such as excessive weight, high-impact activities, and improper alignment may contribute to accelerated wear and loosening. Diagnosis involves imaging studies like X-rays and CT scans to assess component position and signs of wear. Treatment options range from conservative measures, such as activity modification and pain management, to revision surgery if significant wear or loosening is detected. Regular follow-up appointments and proper implant selection are important for minimizing wear and loosening.

Periprosthetic Fractures

Periprosthetic fractures are fractures that occur around the knee implant, often as a result of trauma or stress on weakened bone. These fractures can lead to instability, pain, and difficulty walking. The risk of periprosthetic fractures can increase over time, particularly in individuals with osteoporosis or those engaged in high-impact activities. Diagnosis involves imaging studies, such as X-rays or MRI, to assess the extent of the fracture and its impact on the implant. Treatment options depend on the severity of the fracture and may involve non-surgical approaches, such as bracing or casting, or surgical intervention with internal fixation or revision surgery. Rehabilitation protocols, including weight-bearing restrictions and protective measures, are crucial for promoting fracture healing.

Neuromuscular Complications

Neuromuscular complications after knee replacement surgery can include nerve injuries, muscle weakness, or neuropathic pain. Nerve injuries may occur during surgery, leading to numbness, weakness, or altered sensation in the affected area. Muscle weakness can result from disuse or damage to the muscles around the knee. Neuropathic pain refers to chronic pain caused by nerve damage or irritation. Proper surgical technique and careful handling of nerves can help minimize the risk of nerve injuries. Physical therapy and rehabilitation play a crucial role in restoring muscle strength and function. Medications, such as nerve pain medications or neuromodulators, may be prescribed to manage neuropathic pain.
 

Allergic Reactions and Hypersensitivity

In some rare cases, patients may develop allergic reactions or hypersensitivity to components of the knee implant. These reactions can manifest as localized swelling, redness, or rash around the surgical site. Allergies to materials such as nickel, cobalt, or bone cement used in the prosthesis can trigger immune responses. Diagnosis involves a thorough evaluation of the patient's symptoms and medical history, including allergy testing if necessary. Treatment options may involve medication management to alleviate symptoms and, in severe cases, revision surgery with implant components that are compatible with the patient's allergies. Proper preoperative assessment and implant selection, including consideration of potential allergens, can help minimize the risk of allergic reactions.

Functional Limitations and Disability

Despite successful knee replacement surgery, some patients may experience functional limitations and disability after the two-year mark. Factors such as pre-existing comorbidities, obesity, poor rehabilitation, or incomplete recovery can contribute to ongoing difficulties with activities of daily living and reduced overall function. Comprehensive functional assessments, including gait analysis and functional outcome measures, can help identify specific limitations. Treatment options may include personalized physical therapy programs, assistive devices, and lifestyle modifications to improve overall function and quality of life. Patient education and adherence to rehabilitation protocols are crucial in maximizing functional outcomes.

If you feel your rehabilitation is currently not what you need or what you expected, please look into Dr. Samantha Smith’s Post Surgery Course.
 

In cases where the complications after two years of knee replacement surgery are significant and conservative management measures are ineffective, revision surgery may be necessary. Revision surgery involves the removal and replacement of the original knee prosthesis to address the underlying issues and improve patient outcomes. The decision to undergo revision surgery is based on careful evaluation, considering factors such as the severity of the problem, patient symptoms, functional limitations, and the overall health status of the patient. Revision surgery can be complex and may involve additional challenges compared to the initial surgery. However, it provides an opportunity to address the underlying problem, restore function, and alleviate pain. Proper preoperative planning, extensive evaluation of the implant components, and selection of appropriate surgical techniques are essential for achieving successful outcomes.

The chart below from the American Joint Replacement Registry explains why revisions are most commonly completed. 

Knee replacement surgery is an effective treatment for individuals suffering from severe knee joint conditions. While most patients experience successful outcomes, some may encounter problems after the two-year mark. These problems can range from infection, implant failure, instability, persistent pain, limited range of motion, component wear, periprosthetic fractures, patellar complications, neuromuscular issues, allergic reactions, functional limitations, medical complications, to the potential need for revision surgery. Understanding the causes, complications, and management strategies associated with these knee replacement problems is crucial for healthcare professionals and patients alike. Early detection, accurate diagnosis, and appropriate management can help mitigate the impact of these problems and improve patient outcomes.

Future research and advancements in knee replacement techniques, implant materials, and rehabilitation protocols may further enhance the success rates and reduce the incidence of postoperative complications. Moreover, patient education and counseling should be emphasized to help individuals understand the potential challenges they may face after knee replacement surgery, empowering them to actively participate in their recovery process.

In conclusion, knee replacement problems after two years can significantly impact the lives of patients. Prompt recognition, appropriate diagnosis, and tailored management strategies are essential for addressing these problems effectively. By focusing on comprehensive care, including preoperative evaluation, proper surgical technique, rehabilitation, and long-term follow-up, patients can enhance the success rates of knee replacement surgery.