For Clinicians
Supporting people with persistent pain after knee replacement with evidence-based online pain rehabilitation.
Some people continue to experience moderate to severe knee pain months or years after surgery, even when the knee joint has healed as expected.
Kneed is a structured, online pain rehabilitation self-management program designed to complement usual care once complications have been excluded.
Patients can begin with Free Kneed (education-only) to understand why pain can persist and whether a rehabilitation approach feels right, before deciding whether to progress.
Persistent pain after knee replacement is common
Many people recover well after knee replacement. However, a meaningful minority experience ongoing pain that persists beyond expected tissue healing timeframes, despite reassuring clinical review and investigations.
For these patients, persistent pain is often best understood in a biopsychosocial rehabilitation framework, where pain is shaped by nervous system sensitivity, movement patterns, sleep, stress, mood, and learned protection.
What persistent pain can look like
Pain can continue to affect walking, sleep, exercise tolerance, confidence and participation in valued activities even when the joint has healed structurally.
Why repeated investigations don’t always resolve the problem
Once complications are excluded, the driver of persistent pain is often not a single structural finding, but the way the nervous system and protective behaviours have adapted over time. A rehabilitation approach can help patients build understanding and skills to move forward.
Where pain rehabilitation fits
Pain rehabilitation is commonly used when recovery is not following a straightforward path. It supports understanding, gradual restoration of movement and confidence, flare-up management and re-engagement with activity and life roles.
What is Kneed?
Kneed is an online pain rehabilitation self-management program for people with persistent pain after knee replacement.
It provides:
Pain education and skill-building
Guidance for safe, graded exercise and activity
Brain-based strategies (motor imagery and sensory retraining)
Practical self-management tools including goal setting, sleep strategies, relaxation and flare-up management
What Kneed is not
Kneed is designed to complement usual clinical care.
It is not:
A diagnostic service
A substitute for review for new or worsening symptoms
Individual medical advice or prescribing
A supervised physiotherapy program
Kneed explicitly advises participants to seek medical review if they have concerns about infection, prosthesis complications, neurological conditions or other serious causes of symptoms.
Suitable for patients who…
Kneed is designed for people with persistent pain after knee replacement who can safely engage with an online program.
”>
Pain persisting beyond expected tissue healing timeframes.
Persistent pain affecting function
Impacts walking, sleep, exercise tolerance, activities or confidence
Reassured about complications
Appropriate clinical review has excluded surgical complications.
Ready for active self-management
Able to use online resources and exercise safely at home.
Needs clinical review first if…
Kneed is not a diagnostic pathway. Patients should have appropriate medical review first if red flags are present.
Concern for infection or implant complication
Seek urgent assessment and investigation as clinically indicated.
Planned revision or further surgery
Program is not designed around imminent surgical pathways.
Alternative primary diagnosis likely
Neurological conditions, malignancy or other causes should be assessed and managed first.
Severe mental health crisis
Acute psychological distress requires immediate, appropriate mental health support before self-directed programs.
What the Kneed program includes
Kneed is a modular online program combining education, movement retraining, brain-based strategies and practical self-management skills. Patients choose which modules to engage with and when.
Pain education
Clear explanations of why pain can persist after knee replacement and what pain does (and does not) mean.
Sensitisation
Understanding peripheral and central sensitisation and strategies to reduce over-protective pain responses.
Medication education
Evidence-informed explanations to support shared decision-making with treating clinicians.
Safe, graded exercise
Guidance on pacing, progression and rebuilding confidence with movement (includes videos)
Movement retraining
Strategies to normalise movement patterns and reduce fear-based avoidance.
Desensitisation techniques
Skin, sensory and tactile strategies to reduce sensitivity around the knee.
Motor imagery & left/right judgement training
Brain-based techniques targeting altered pain and movement representation.
Relaxation training
Guided progressive muscular relaxation and stress regulation.
Sleep strategies
Practical sleep hygiene guidance relevant to persistent pain.
Flare-up management & goal setting
Structured planning to respond early to pain flares and support meaningful activity goals.
Evidence base
Kneed was developed as part of doctoral research at Monash University and evaluated in a pilot randomised controlled trial delivered entirely online.
The trial demonstrated the feasibility and acceptability of an unsupervised digital pain rehabilitation program for people with persistent pain after knee replacement, with high participant satisfaction and engagement.
A larger trial is required to further evaluate clinical efficacy.
- 60 participants
- 8 week program
- Kneed v Usual Care
- 75% of Kneed participants reported that the program effectively helped them manage their pain and function
How to refer a patient
No formal referral is required. Clinicians can simply suggest that suitable patients explore the program independently.
1. Exclude red flags or complications as clinically indicated
2. Suggest Free Kneed as an education-only starting point
3. If appropriate, the patient may choose to enrol in Kneed
Dr Nathan Johns is a specialist Rehabilitation Medicine Physician with over 20 years’ experience in pain and rehabilitation medicine.
He founded The Rehabilitation Medicine Group which develops evidence-based online rehabilitation programs that improve access to care while maintaining clinical integrity.
The Rehabilitation Medicine Group develops digital rehabilitation programs designed to complement, not replace, usual clinical care.
