5 Reasons for Knee Pain After Arthroscopy

Arthroscopic surgery is a minimally invasive surgical procedure that is used to see inside your knee joint, and repair or remove any damage. While this all sounds gentle and noninvasive, it needs to be understood that your body will react to the trauma of surgery.

Persistent swelling is one of the most common symptoms after knee arthroscopy. Swelling is a difficult problem to resolve, as there are many possible causes, some of these listed below. In addition, some patients who have an arthroscopic surgery have persistent swelling as a result of lingering inflammation from the trauma of surgery. If more serious problems related to surgery, such as infection, has been eliminated treatments of swelling may include:

• Ice application
• Anti-inflammatory medications
• Compression wraps and braces
• Physical therapy

Infection is a very uncommon complication of arthroscopic surgery, but it is the complication most feared by patients. Typical symptoms of infection include:

• Persistent swelling
• The warmth of the joint
• Redness around the incisions or draining fluid
• Fevers, chills, or sweats

While an infection is an uncommon cause of pain after knee arthroscopy, it is one that needs to be a the top of everyone's list to consider as early treatment is essential to have the best chance at recovery. Treatment of infection requires prolonged antibiotic treatment and can require additional surgery to clean out the joint.

If the infection is untreated, there can be serious repercussions. Infection can damage the cartilage leading to the early onset of arthritis within a joint. As infection persists, it can be more difficult to cure.

When people have a knee injury, such as a torn meniscus or cartilage damage, they can develop poor mechanics of the knee joint. In order to protect their joint and reduce pain, people often limp or develop an abnormal gait. Once the problem is taken care of, patients may need to correct these mechanical abnormalities of knee function.

In addition, some knee joint injuries are the result of poor mechanics of the extremity. Current research is focused on dynamic stability of the lower extremity. In other words, how sturdy your knee is when subjected to normal forces and movements. Patients with dynamic instability may be more prone to injury and may require surgical treatment.

After surgery, your doctor may recommend specific rehabilitation to address weakness or gait abnormalities that may have caused an injury or be the result of having had an injury. Insufficient rehabilitation can be a cause of persistent knee pain after injury.

One complication that has been linked to knee arthroscopy is a condition called spontaneous osteonecrosis of the knee, or SONK. This condition is most often found in middle-aged women who have a knee arthroscopy. After their surgery, they develop persistent pain, typically along the inner (medial) side of the knee.

SONK is a condition that causes inflammation within the bone. While the condition is called osteonecrosis, a word that means there is spontaneous bone cell death, the problem has been thought to be the result of microscopic fracture of the bone around the knee joint. These subchondral fractures cause inflammation within the bone and significant pain. The pain is typically worsened by activity and relieved by rest.

Treatment of SONK can be very frustrating, and many patients find the pain worse than the pain they had prior to arthroscopy.  Eventually, that pain does settle down, but often the only way to find relief is to limit weight by using crutches for weeks or months after the knee arthroscopy. Braces and medications can also help with the symptoms.  In some patients, the symptoms can be so severe that patients end up having either a partial knee replacement or full knee replacement.

Probably the most common reason why patients have persistent pain after arthroscopic knee surgery is that their knee has damage to the cartilage of the joint that can't be adequately repaired by an arthroscopic procedure. It is well established that typical arthritis pain does not warrant an arthroscopic surgery; numerous studies have shown that the benefit of arthroscopy in these patients is no better than with nonsurgical treatments.

However, there are times when patients with osteoarthritis may have problems that can improve with arthroscopic surgery, or your surgeon may not be aware of the extent of arthritis until the time of surgery. In these cases, patients may have an arthroscopic surgery but may have to manage ongoing pain from arthritis that does not improve despite the surgical procedure. The good news is that there are many treatments for knee arthritis, and often these can help patients find relief from their symptoms.