Why is walking still difficult after knee replacement?

For many people, being able to walk further, more comfortably and with greater confidence is one of the main reasons for having a knee replacement.

However, some people find that their walking does not improve as much as they had hoped.

There are several reasons for this including ongoing muscle weakness and reduced fitness but for many people, persistent knee pain is an important reason why walking remains difficult.

Why does knee pain continue after surgery?

During the first few weeks after knee replacement, pain is largely related to the surgery itself, inflammation and healing of the surrounding tissues.

By three months, most of the initial surgical healing has usually occurred.

However, some people continue to experience knee pain for months or even years after surgery, even when the knee replacement is functioning as expected.

Why does this happen?

Pain is not simply a measure of injury or damage to the knee.

Pain is produced by the nervous system and influenced by many factors, including how the nervous system processes information, muscle activation, movement patterns, sleep, stress, activity levels and worry about pain.

After osteoarthritis and knee replacement surgery, the nervous system can become more sensitive and protective. This can contribute to ongoing pain during activities such as walking, even after the initial surgical healing has occurred.

This does not mean that persistent pain is imaginary or that there cannot be a problem with the knee replacement. Ongoing pain should be medically assessed to exclude complications or other treatable causes.

How does persistent pain affect walking?

When walking causes pain, people naturally change how they move.

They may walk shorter distances, slow down, limp or avoid it altogether.

Over time, these changes can contribute to reduced strength, fitness and confidence in walking.

This can create a cycle where pain reduces walking activity and reduced activity makes walking more difficult.

This is why ongoing difficulty walking after knee replacement is not always just a problem with the knee itself.

What does this mean for rehabilitation?

When pain persists more than three months after knee replacement, rehabilitation needs to consider more than the knee joint, muscle strength and range of movement.

Understanding why pain continues and how it influences movement and activity, is the first step of this approach.

The Rehabilitation Medicine Group has developed a free educational email series explaining why pain can persist after knee replacement and the principles of pain rehabilitation.

Explore our free educational email series → click here

For people looking to start a structured rehabilitation program today, Kneed is our online program developed through doctoral research at Monash University and evaluated in a pilot randomised controlled trial.

Learn more about Kneed → click here