“What pain can I expect after surgery?” is a top question on people’s minds before signing up for a joint replacement. Regardless of the level of joint pain you’re experiencing before surgery, the thought of adding more pain to your future is scary. Unfortunately, the typical pain experienced after hip replacement surgery and knee replacement surgery is rather unpredictable and can vary. As Dr. Nima Mehran, orthopedic surgeon explains, “No two knees are the same. Even if someone had little pain on a left knee replacement, it doesn’t mean they will experience low pain on a right knee replacement.” In other words, dodging or experiencing a high level of pain can be like winning the lottery or drawing the shortest straw.
Here’s What We Know About Post-Op Joint Pain
- Typically, knee replacement surgery hurts more than hip replacement surgery (sorry, knee people).
- After surgery, pain is no longer achy and arthritic but stems from wound healing, swelling and inflammation.
- Hip replacement patients often report little to no pain around the 2-6 week mark.
- A large percentage of knee replacement patients report little pain around the 3 month mark.
- Pain, swelling, and bruising are part of the natural recovery process.
- PreHab in the weeks leading up to surgery can help reduce recovery pain. This is due to better preparing the body and muscles that support the affected joint and learning tips and tricks to manage joint pain.
- Fear and anxiety about pain and holding onto “old pain” after surgery can slow down your recovery.
Why Does A Knee Replacement Hurt More Than a Hip?
This year, twice as many Americans will undergo knee replacements over hip replacements. For this large group, chances are they will experience more pain than their hip replacement counterparts. The reason being is complex, but is likely because the knee joint is a much more confined space and postoperative swelling increases stiffness and pain. In addition, a total knee replacement involves more bone and cartilage being removed and more artificial components being introduced.
In recovery, knees require a period of intense therapy to ensure adequate flexibility for everyday movements. Simply walking does not suffice, but a structured physical therapy program prescribed by your surgeon should be followed with daily exercise. Dr. Mehran adds, “The hip is naturally a more mobile joint, and thus it is easier to regain range of motion post operatively. We naturally “stretch” the hip through sitting and standing.”
The rehabilitation of the knee joint is slower and varies for each person. However, most patients report feeling good around the 3 month mark.
What is Normal Joint Recovery Pain?
Every person and every joint is different. It’s important that you carefully monitor your pain throughout your road to recovery. As an overly simplistic rule of thumb, you should experience less pain as the days, weeks and months after your surgery climb. The more time between you and surgery day, the less pain you should feel. As you read on, you will see there is one exception to this rule for those recovering from a knee replacement.
95.5% of Total Hip Replacements (THR) patients reported having less pain 1 year after surgery than they did before surgery. 86.4% of Total Knee Replacements (TKR) reported having less pain a year later.
Hip and Knee Replacement Recovery Timeline
The following pain milestones and recovery timeline is a general trend for joint replacement patients. Your post-operative pain levels and experience may not be identical to those outlined below. Every patient and every joint is different.
It’s important to note your pain levels throughout the recovery process. These are the key pain milestones to track:
- Before surgery
- While you’re still in the hospital
- The first two weeks
- The weeks that follow as your mobility and therapy increase
- And more passively, from the 3 month mark on (this is especially true for those recovering from a total knee as the process is more drawn out and difficult).
How much pain are you in before surgery? In a survey done by McMaster University, groups were asked to rate their preoperative hip or knee pain on a scale of 0 (no pain) to 10 (extreme pain). The hip group rated their pain 7.9 out of 10 (mean) while the knee group rated their pain 8.2 out of 10.
We suggest that you take a proactive approach in your pain management, and rate you own pain before the operation. It will be a good benchmark to have as your enter recovery.
In the Hospital
The same patients from the McMaster University study were asked to rate their pain immediately following their total replacement while still in the hospital. The total hip replacement and total knee replacement groups rated their pain levels at a 5.0 and 5.5 out of 10 respectively. Amazing, right? This significant drop in pain is in part due to the IV medication that is being administered and the oral narcotics that majority of patients take post-surgery. The pain reduction is also a result of the arthritic, sharp pain being resolved.
A general rule by orthopedic surgeons is that a patient is not discharged from hospital until pain can be managed with an appropriate dose of oral medications.
What to Expect:
- Moderate pain due to the trauma of surgery.
- Prescribed oral and IV pain medications to keep pain controlled.
- Bruising, swelling and inflammation beginning to set in.
- Keep your affected leg elevated (ideally above your heart). This will help with bruising and swelling.
- Understand the pain medications you are on, when to take them, and how these meds may interfere with others prescribed or over-the-counter meds you will take at home.
- With the help of your care team, perform the recommended movements as best you can. You will be required to stand, go up and down a stair, get on and off the toilet etc. If you can master these movements, you may be able to recover at home and avoid a secondary care location.
First 2 Weeks
Depending on your surgeon and pain medication plan, two weeks is often the time you’re dose of narcotic pain medications will be lowered, if not stopped completely. Prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) are continued longer to help with swelling and inflammation.
For hips, the two week mark and beyond is when patients report feeling a significant drop in pain, experiencing only mild discomfort. Right out of the gate, hip replacement patients are forced to movements that help increase range of motion. This helps fast-track recovery and shorten the window of pain. For all replacements, the incision site will likely still be tender and painful. For knees, the arthritic pain is gone, but pain levels will be higher. Patients report feeling moderate but tolerable pain.
What to Expect:
- Bruising should be down (or gone).
- Scar and wound tenderness.
- Staples or sutures, if used, will be removed (don’t worry, with the exception of a few pinches, this shouldn’t hurt).
- You’ll still be using your walker or crutches to get around.
- Keep on the recommended schedule for pain meds. Skipping medication because you are feeling better is not always a good idea. Consult your doctor before changing doses.
- Stay active. Performing the recommended movements will reduce swelling and inflammation–both of which are responsible for pain.
- Ice 4-5 times a day for 15-20 minutes. This helps with swelling.
- Try not to overthink getting your staples removed. Most patients are surprised at how painless this quick doctor visit is.
- Most surgeons recommend not showering for 48 hours after staples have been removed.
For knee replacements, this post-op window can prove trying. This is the time period when therapy is well under way and movement, motion and bending have picked back up. This added exercise can lead to increase in pain but is a necessary part of gaining back knee strength and flexibility. As motion is regained, pain should gradually decrease.
For post-op hips, pain should be quite tolerable. Toward the 6 week mark, majority of patients report significant improvements from their preoperative pain scores
What to Expect:
- Swelling has gone down.
- Engaging in more physical therapy and daily exercises to increase motion.
- Scar and wound tenderness.
- Hip replacements patients will have minimal difficulties with walking and sitting.
- Knee replacement patients will feel more mobile, but may be in more pain than the first two weeks due to increase work with therapy
- When caring for your incision site, gently massage the scar tissue. This helps stretch out tissue and can decrease your chance for mechanical issues
- Daily exercises and consistent therapy will help with swelling.
- Ice after being on your feet for longer periods and after therapy through to the 6 week mark. This will also help with swelling.
- For the first 6 weeks, wearing compression stockings to bed at night can help with achiness and swelling.
- Take any prescribed pain medications or over the counter NSAIDs like Tylenol before physical therapy. Ice (or add heat) to the affected joint after.
3 Months +
If you haven’t got the gist, hip replacements have a quicker recovery time and can expect less pain for a shorter period. Knees on the other hand are more complicated, with a longer recovery period and an extended opportunity for pain. In say that, around the 3 month mark, knee pain should be more than tolerable, decreasing with time. Swelling and inflammation are the leaders of post-op pain and shouldn’t be much of a factor by this stage in the game.
At the 3 month mark pain should be drastically decreased. We recommend you speak to your doctor or surgeon if:
- You’ve gone through rehab therapy and pain is getting worse.
- Your pain has never gone away, steadily causing you noticeable discomfort.
- Your pain has gone away (or is quite low) and then suddenly comes back.
What to Expect:
- You should be walking comfortably without assistance.
- For the average joint replacement candidate, physical therapy classes have ended or are significantly less regular.
- Some swelling (residual swelling can last for 3-6 months and as long as a year after surgery).
- Hip replacement post-ops should be close to pain-free.
- Knee replacement candidates should have increased joint movement with less pain.
- Whether you’re still going to physical therapy, staying active and exercising your joint is vital for flexibility, strength, mobility. Avoid stiffness like the plague!
- Understand that joint replacement surgery is a traumatic procedure. Cut yourself some slack and give yourself the time you need to heal–even if the process is longer than you hoped.
Are you thinking about a hip or knee replacement? Get matched with a top orthopaedic surgeon near you who offers PeerWell PreHab and ReHab for free. PreHab gets you mentally, physically and environmentally prepared for surgery, putting YOU to greater control your outcome and recovery.
Dr. Trevor North, M.D., OS is a board-certified orthopedic surgeon at Henry Ford Hospital systems in Detroit Michigan and surrounding area. Dr. North completed medical school at the University of Sydney, receiving the highest distinction for academic and clinical performance. He finished his residency at Henry Ford Hospital where he was chief resident. Dr. North did his Adult Reconstructive Orthopedic Surgery fellowship at the renowned Cleveland Clinic. He currently specializes in complex hip and knee replacement surgery. Dr. North is well-published in Pub Med journals, won research resident of the year at Henry Ford and also won the Henry Ford research symposium.