The knee has been replaced, so why does it still hurt? A case study following knee joint replacement
Perhaps you have been through this yourself. Knee pain that lasts for months or even years, and according to the doctor the only solution is a total knee joint replacement (full knee replacement).
This operation is most often required due to advanced osteoarthritis - a degenerative condition in which the cartilage is gradually destroyed. The result is bone rubbing against bone, which causes pain, restricted movement, and in advanced stages also changes to the shape of the joint surfaces or the formation of bony outgrowths.
After the operation, it is natural to expect that the pain will disappear and everything will return to normal. The reality, however, tends to be somewhat more complex. The original pain does indeed subside, but it is often replaced by a feeling of stiffness, uncertainty when walking, or persistent swelling. Treatment does not end with the operation - on the contrary, the process of returning to full movement is only just beginning.
The course of events after the operation
Our client underwent a total knee joint replacement on 9 March 2026. It was already the second operation of this type, this time on the other lower limb. After the procedure she was hospitalised for a week and subsequently completed a further week of rehabilitation at a facility where she undertook individual exercise and used a continuous passive motion machine.
Despite this, however, two weeks after the operation she was not satisfied with her condition. Pain, swelling and restricted movement persisted. She therefore decided to undertake intensive rehabilitation and stayed for 10 days at the FYZIO KLINIK® apartment, where she received comprehensive care.
"I have the feeling that post-operative care is not always sufficient. During this period the patient often has to find their own bearings and look for a way to return to ordinary life as best they can."
Initial examination
On arrival the client underwent an orthopaedic examination and subsequently a comprehensive physiotherapy examination, which is used to assess movement capabilities and to set up an individual treatment plan.
At the initial examination:
knee pain persisted (analgesics 3 times per day),
swelling was present in the area of the knee,
a visible haematoma was present on the lateral side of the operated limb,
the scars had healed, in places still with scabs.
Range of movement:
flexion: 90°
extension: approximately 5° was lacking
Walking was possible with the aid of axillary crutches, with an asymmetric pattern and offloading of the operated limb.
The rehabilitation process
Based on the initial examination we set up intensive rehabilitation on a daily basis. The therapy focused on the gradual restoration of mobility, reduction of pain and a return to a correct walking pattern.
The rehabilitation included manual treatment of the scar and release of the soft tissues, mobilisation of the patella and the knee joint, as well as passive and active exercises to improve range of movement and muscle strength. Gradually we also focused on re-education of gait and the transition from axillary to forearm crutches.
As part of post-operative care we also made use of supporting therapies. Lymph therapy in the acute programme helped to reduce swelling, pain and inflammation in the operated area. The therapy also included oscillation therapy, which supported the absorption of the haematoma, reduction of swelling and improvement of blood circulation in the knee.
During her stay the client also received relaxation massages, which contributed to overall regeneration and release of tension.
The result of the rehabilitation
During the 10-day stay there was a marked improvement in the client's state of health. The pain and swelling gradually decreased and the range of movement improved.
By the end of the stay the client was taking pain medication only in the evening, so that the pain would not disturb her sleep. The range of movement had improved significantly - knee flexion reached 120 degrees and extension was full. The haematoma had been completely absorbed and swelling was only mild.
The client gradually began trying to walk without crutches over short distances. For longer distances she managed walking with forearm crutches without any problems.
Recommendations for the following period
To achieve an optimal result we recommended continuing outpatient rehabilitation approximately once a week. Regular check-ups and adjustment of the exercises will allow a gradual increase in load and will support a return to full function of the knee joint.
This article was prepared for you by physiotherapist Jana Pauer.
