Pain after total knee replacement might be hip

DEAR DR. ROACH >> I read your recent column about a person who had knee pain after a knee replacement.

I am a retired orthopedic surgeon who performed on over 10,000 total joints of the hip, knee and shoulder in my 47 years of active surgical practice. A well-done total knee replacement does not give the patient much pain postoperatively. I saw many patients who had this story in my career, and the first thing that comes to mind is that the patient was having referred pain to the knee from an arthritic hip joint.

Oftentimes, the surgeon who performed a painful knee replacement never X-rayed the hip or did a complete exam to look for a limited range of motion in the hip. The patient who has knee pain after a total knee replacement needs to have an examination and X-ray of the hip.

I saw more than a few patients who had surgery on their knee when it was their arthritic hip causing referred knee pain that was the real diagnosis. In this case, performing a total hip replacement may eliminate the pain completely. Qualified orthopedic surgeons will agree with me in this case. My advice to inexperienced surgeons is: “Always check the hip before jumping into a total knee replacement!”

— Gary Wolfgang, M.D., Retired Orthopedic Surgeon

DEAR READER >> I thank Dr. Wolfgang for writing and for the important reminder of the close connection between the knee and hip. It isn’t that the knee doesn’t have any problems; it’s that there may be more than one cause for knee pain, and I have certainly seen, as Dr. Wolfgang has, many patients with knee pain whose pain was actually due to a hip problem.

DEAR DR. ROACH >> I have just had my prostate gland surgically removed three weeks ago, and I am experiencing incontinence because of the surgery.

— M.G.

DEAR READER >> Some degree of incontinence is extremely common after surgery for prostate cancer. But you will be glad to hear that over time, most men regain much better control over their bladder function. The rates of complete continence are much higher one month after surgery compared to one week, and the rates continue to improve months or even years after surgery.