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• How much pain can be expected with a total knee replacement?
  
  

  I am a candidate for a total knee replacement (TKR) somewhere in the future. One question I have is how much pain can a patient expect after TKR? - James, Winchester, MA

  It is very common to have questions regarding pain after knee replacement surgery. Most patients who undergo a total knee replacement have severe pain prior to surgery. Many find the pain after surgery to be more tolerable. Generally within a few days, the pain is less than the pain they were experiencing before the surgery. During and immediately following the operation, the anesthesiologist controls the pain medication. This can include epidural injections, intravenous pain medications or a combination of the two. Within a few days, most patients begin taking pain tablets or receive other types of injections. Most patients will experience some aches and pains for about six to nine months after surgery, but again it should be less than the pre-surgery pain. In addition to the pain tablets, we frequently recommend anti-inflammatory medications, ice packs and special exercises to decrease the patient's discomfort and pain. Your doctor will help choose the right pain management plan for you depending on the severity of your pain. Thank you for your question! Carl Talmo, MD, Orthopedic Surgeon

  
  
  
• I have pain in the upper part of my tibia and the side of my knee. Could I have runner's knee?
  
  

  I have pain in the upper part of my tibia and the side of my knee after I run (rarely do I notice it while running). I feel the pain when walking during the day after a morning run or while sitting for longer periods of time. I think this is "runner's knee" and I've tried resting and stretching to no avail. I'm wondering who I should see for help? - Craig/Connecticut

  Your primary care physician should be able to examine you and decide whether this is likely a problem with your muscles, ligaments, cartilage, or bones. The usual approach to knee pain that is related to overuse is to encourage some rest along with an anti-inflammatory medication for a period of a few weeks to see if it results in improvement. If you return to running, icing your knee after a run might also help, as might an elastic knee brace to remind you to go easy on the knee. Avoiding hard running surfaces and wearing shoes with good arch supports can also help. And, it might turn out that your days of regular running are best put behind you -- to be replaced with other sports such as swimming or biking. Dscussion of your symptoms and evaluation of your running technique with a trainer may help. In addition, physical therapy can sometimes help both with rehabilitation and with running technique, especially if you have a therapist that is knowledgeable about sports injuries. However, if you are not getting better with some of these interventions, or if your doctor suspects a mechanical injury that might need surgery, then an MRI scan of the knee will be needed to further evaluate it. Thank you for your question! Brian McKeon, MD, Orthopedic Surgeon

  
  
  
• My daughter, who is a gymnast, recently hyper-extended her knee. What is the treatment for this type of injury? How long does it take to heal?
  
  

  My daughter, who is a gymnast, recently hyper-extended her knee. What is the treatment for this type of injury? How long does it take to heal? - Susan, Salem, New Hampshire

  Hyperextended knee refers to an injury in which the knee is forced beyond its normal fully straightened position. This position forces the lower leg excessively forward in relation to the upper leg. A hyperextended knee often occurs as a result of an awkward landing after a jump or from a contact injury to the lower leg. It is a common injury in jumping or leaping sports, such as gymnastics, basketball, volleyball and some types of dance. Treatment of a hyperextended knee depends on the severity of the injury. Sometimes the damage is relatively minor, with pain and swelling when you try to extend your knee. But a hyperextended knee may also lead to a partial or complete ligament tear, especially in your anterior cruciate ligament (ACL). An injury severe enough to cause knee joint swelling, instability, impaired motion or pain should be evaluated by a doctor. Thank you for your question! Robert Patz, MD, Orthopedic Surgeon