When Knee Replacement Doesn't Work: Understanding Your Options

Key Takeaways

About 15-20% of knee replacement patients experience ongoing pain or dissatisfaction after surgery
Common causes include infection, loosening, instability, nerve damage, or unrealistic expectations
A thorough diagnostic workup is essential to identify the specific problem
Treatment options range from conservative care to revision surgery, depending on the cause
Getting a second opinion is always appropriate when dealing with persistent post-surgical pain

You did everything right. You tried physical therapy, injections, and other treatments for your knee arthritis. When nothing else worked, you finally agreed to knee replacement surgery. You went through the operation and months of recovery.

But you’re still in pain.

If this describes your situation, you’re not alone—and it’s not your fault. While knee replacement surgery has a high success rate, studies show that 15-20% of patients don’t get the relief they hoped for. Some continue to have pain, stiffness, or difficulty with daily activities even after their knee has “healed.”

This experience can feel isolating and frustrating. You might wonder if you made the wrong decision, if your surgeon missed something, or if you’ll ever feel better. These feelings are completely understandable.

The good news is that there are reasons why this happens, and in many cases, there are solutions. Let’s explore what might be going on and what your options are.

Why Some Knee Replacements Don’t Work as Expected

A knee replacement that doesn’t provide adequate relief is sometimes called a “failed” knee replacement. This doesn’t necessarily mean the surgery was performed incorrectly—though that can happen. More often, it means the outcome didn’t meet your expectations or specific complications developed.

Here are the most common reasons:

Infection

Infection after knee replacement is rare (occurring in 1-2% of cases), but it’s serious. It can happen soon after surgery or even years later. Signs include:

Increasing pain rather than improving pain
Warmth, redness, or swelling around the knee
Fever or chills
Drainage from the incision site

Infections require prompt treatment, usually with antibiotics and sometimes additional surgery to clean the joint or replace the implant.

Implant Loosening

Over time, the artificial joint components can loosen from the bone. This is more common in younger, more active patients or those who’ve had their implant for 10-15 years or longer. Loosening causes:

Pain with activity
A feeling of instability
Sometimes an audible clicking or clunking

X-rays can usually detect loosening, though sometimes more advanced imaging is needed.

Instability or Improper Alignment

If the artificial joint components aren’t positioned correctly, or if the surrounding ligaments are too loose or too tight, the knee may not function properly. This can cause:

A feeling that your knee might give out
Pain with certain movements
Difficulty going up or down stairs

Stiffness and Scar Tissue

Some patients develop excessive scar tissue (called arthrofibrosis) that limits knee motion. This is more common in people who:

Had significant stiffness before surgery
Developed complications during healing
Couldn’t participate fully in physical therapy

Stiffness can cause pain and make it difficult to bend or straighten your knee fully.

Nerve Damage or Sensitivity

Sometimes nerves around the knee are stretched, compressed, or damaged during surgery. This can cause:

Burning or tingling sensations
Numbness
Sharp, shooting pains
Heightened sensitivity to touch

In some cases, nerve issues improve over time, but they can also persist or worsen.

Persistent Inflammation

Your body may continue to have an inflammatory response to the artificial materials, causing chronic pain and swelling. This is less common but can happen even without infection.

Unrealistic Expectations

This is important to acknowledge with compassion: Sometimes the surgery is technically successful, but the outcome doesn’t match what you hoped for. An artificial knee won’t feel exactly like a natural, healthy knee did when you were younger. It may not allow you to do all the activities you once enjoyed.

This doesn’t minimize your experience. The disappointment is real, and it’s worth exploring whether additional interventions might help—or whether adjusting expectations and focusing on what you can do might be part of the path forward.

What Your Doctor Should Do First

If you’re experiencing persistent pain or problems after knee replacement, your doctor should conduct a thorough evaluation. This typically includes:

A detailed conversation about your symptoms:

When did the pain start?
What makes it better or worse?
How does it compare to your pain before surgery?
Are there other symptoms like fever, swelling, or instability?

Physical examination:

Range of motion testing
Stability testing
Checking for warmth, swelling, or tenderness
Evaluating your gait (how you walk)

Imaging studies:

X-rays to check implant position and look for loosening
Sometimes CT or MRI scans for more detailed information
Nuclear medicine scans if infection is suspected

Laboratory tests:

Blood tests to look for signs of infection or inflammation
Sometimes aspiration (removing fluid from the joint with a needle) to test for bacteria

This workup helps identify the specific cause of your ongoing problems, which determines what treatment options are appropriate.

Your Treatment Options

The right treatment depends entirely on what’s causing your symptoms.

For Infection

Infections typically require aggressive treatment:

Antibiotics: Usually given through an IV for several weeks
Irrigation and debridement: Surgery to clean out the infected tissue while keeping the implant if caught early
Two-stage revision: For more established infections, the implant is removed, antibiotics are given, and then a new implant is placed several weeks or months later

For Loosening or Instability

Revision surgery replaces the worn or poorly positioned components with new ones. This is a bigger operation than the original knee replacement and typically has:

Longer recovery time
Slightly lower success rate (though still generally good)
Higher risk of complications

Despite these challenges, revision surgery can be very successful when loosening or instability is the problem.

For Stiffness

Treatment may include:

Intensive physical therapy: Focused on improving range of motion
Manipulation under anesthesia: The surgeon moves your knee through its range of motion while you’re asleep
Surgical scar tissue removal (lysis of adhesions): Removing excess scar tissue arthroscopically

For Nerve Pain

Options include:

Medications: Nerve pain medications like gabapentin or duloxetine
Nerve blocks: Injections to calm overactive nerves
Physical therapy: Gentle desensitization techniques
Pain psychology: Strategies to manage chronic pain

For Persistent Inflammation Without Clear Cause

Conservative treatments include:

Anti-inflammatory medications
Physical therapy
Activity modification
Injection therapy (though this is less common after knee replacement)

The Importance of a Second Opinion

If you’re not getting answers or improvement, seeking a second opinion is always appropriate—and often very helpful. Consider seeing:

Another orthopedic surgeon, preferably one who specializes in revision surgery
A pain management specialist
A physical medicine and rehabilitation (PM&R) doctor

A fresh perspective can sometimes identify issues that were overlooked or suggest different treatment approaches.

Don’t worry about offending your current doctor. Good physicians understand that complex cases benefit from multiple expert opinions.

What About Non-Surgical Options?

Before considering revision surgery or other invasive treatments, it’s worth exploring conservative options if your situation isn’t urgent (like an active infection).

These might include:

Working with a physical therapist who specializes in post-surgical rehabilitation
Trying different pain management strategies
Using assistive devices like braces or canes
Modifying your activities to reduce stress on your knee
Addressing other factors like nutrition, sleep, and stress that affect pain perception

Some patients find meaningful improvement with these approaches, especially when combined with time for continued healing.

The Emotional Side of Failed Surgery

Living with ongoing pain after major surgery is emotionally difficult. You might feel:

Frustrated that you went through so much and still hurt
Worried that you’ll never get better
Regretful about having the surgery in the first place
Isolated because people expect you to be “fixed”
Angry at your surgeon, your body, or the situation

All of these feelings are normal and valid.

Consider:

Talking with a therapist who understands chronic pain
Connecting with support groups (online or in-person) for people dealing with similar situations
Being honest with friends and family about what you’re going through
Practicing self-compassion rather than blame

Your mental health matters as much as your physical health in navigating this challenge.

Questions to Ask Your Doctor

When discussing your ongoing knee pain with your healthcare provider, consider asking:

What do you think is causing my persistent pain?
What tests do we need to identify the problem?
What are all my treatment options, from least to most invasive?
What are the success rates and risks of each option?
How long should I try conservative treatment before considering surgery?
Would you recommend I see a specialist or get a second opinion?
What should I expect if we take a watch-and-wait approach?

Finding a Path Forward

If your knee replacement hasn’t given you the relief you hoped for, start by getting a thorough evaluation to understand why. Sometimes the problem has a clear solution. Other times, the path forward involves trying different approaches to find what helps most.

Remember:

You deserve to have your concerns taken seriously
Ongoing pain after knee replacement is a recognized medical issue, not something you’re imagining
Many people in your situation do find relief with the right diagnosis and treatment
Even if your outcome isn’t perfect, improvements are often possible

Take it one step at a time. Get the information you need, explore your options, and make decisions that feel right for you.

Frequently Asked Questions

Is it normal to still have pain a year after knee replacement?

Most people see steady improvement for up to a year after surgery, with the majority of healing happening in the first 3-6 months. If you’re still having significant pain a year later, it’s worth investigating further. Some minor aches or weather-related discomfort can be normal, but persistent daily pain that limits your activities deserves evaluation.

How do I know if my knee replacement is failing?

Warning signs include increasing pain rather than decreasing pain, instability or feeling like your knee might give out, warmth and swelling around the knee, fever, or drainage from the surgical site. If you’re experiencing any of these, contact your surgeon promptly.

Can a failed knee replacement be fixed?

In many cases, yes. The treatment depends on the cause. Infections can often be treated successfully, loosened implants can be revised, and stiffness can sometimes be improved. However, revision surgery is more complex than the original procedure and has slightly lower success rates.

Should I just learn to live with the pain?

Not necessarily. While some adjustment of expectations may be part of the process, persistent significant pain should be evaluated. Many causes of post-surgical pain can be treated. Get a thorough assessment before resigning yourself to ongoing discomfort.

How successful is revision knee replacement surgery?

When performed for appropriate reasons (like loosening or instability), revision surgery has good outcomes, though success rates are somewhat lower than primary knee replacement—typically 75-85% versus 90-95%. Success depends heavily on the specific reason for revision and your overall health.

Last medically reviewed: March 2025

This article is for informational purposes only and doesn’t replace professional medical advice. If you’re experiencing persistent pain after knee replacement surgery, consult with your orthopedic surgeon or seek a second opinion from a specialist.