Why is a knee replacement so painful?

Knee replacement surgery can be quite painful for several reasons, both during the immediate postoperative period and in the recovery phase. One of the primary factors contributing to pain is the surgical trauma involved in the procedure. During a knee replacement, the surgeon makes a large incision and cuts through various tissues, including skin, muscles, ligaments, and bone. This manipulation causes the body to respond with inflammation, leading to pain, swelling, and tenderness. Additionally, the surgeon removes damaged parts of the femur, tibia, and sometimes the patella, reshaping these bones to fit the prosthetic components. The cutting and reshaping of bone contribute significantly to the pain experienced during the early stages of recovery.
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Post-surgery, inflammation is a natural healing response, causing swelling and pressure that can lead to discomfort, especially when it compresses nerves. Fluid buildup (edema) further intensifies pain. Muscle and ligament stiffness also contribute to discomfort, as the surrounding tissues become tight due to surgery and limited movement. Physical therapy is necessary to restore function but may cause pain as the knee is stretched and the muscles regain strength and flexibility.
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