Ask the Doctors March 2019 Issue

Ask The Doctors: March 2019

Q: I had knee replacement surgery four months ago. Why do I still have pain?


Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A: Joint replacement surgery, including for the knee, has a high success rate for relieving pain from osteoarthritis. But it requires some patience, as well as a commitment to the work of rehabilitation. Recovery from surgery can take several months.

At four months after surgery, it's not unusual to continue to have soreness in the knee that was operated on. This is a result of the increasing intensity of rehabilitation exercises, which put a tremendous amount of stress on muscles that have not been used for some time. Joint replacement surgery is the last step in treatment for arthritis. By the time a person has surgery, other treatments have failed to help and the condition usually has been going on for a long time. Pain and stiffness probably limited your mobility and your muscles became deconditioned. These muscles will be sore until you restore their tone. And that can take some time.

Your physical therapist gave you exercises to do at home. These involve bending and straightening the knee. You may find them painful, especially at first. But keeping up with a physical therapy rehabilitation program is a major component of a successful outcome.

Postoperative swelling also is a major source of pain after surgery. This will subside over time. Most people continue to have pain from six months to one year following surgery. Knee replacement surgery won't give you back the knee you had when you were 20, but it should provide good pain relief and improved function. But be aware that people who've had knee replacement frequently have intermittent pain throughout the life of the knee replacement implant. However, this pain should be intermittent and not constant.

Q: I have gum disease, and I was recently diagnosed with rheumatoid arthritis. I've heard these may be linked. Did gum disease cause my arthritis?

A: Some studies have shown a possible connection between periodontal disease, commonly called gum disease, and rheumatoid arthritis. But the exact nature of this association is not yet understood.

Rheumatoid arthritis and periodontal disease share some features. Both involve a wayward immune response and inflammation. Rheumatoid arthritis is an autoimmune disease, in which the body's immune system mistakenly attacks healthy tissue with an inflammatory response. It's thought that some type of insult triggers the onset of the disease in genetically susceptible people. That insult may involve a bacterial infection.

Periodontal disease is a condition in which gums become inflamed in response to an overgrowth of bacteria that causes a hard plaque to form on teeth. This damages bone and tissues that support the teeth. One type of bacteria involved (called Porphyromonas gingivalis) can cause citrullination, which is a process that changes proteins in ways that make them more likely to trigger an immune response. That response targets the lining of joints (synovium).

It's been found that people with rheumatoid arthritis are more likely to have gum disease than people without rheumatoid arthritis. And rheumatoid arthritis is more common among people with gum disease. Which comes first-gum disease or rheumatoid arthritis-and how they might affect one another continues to be studied.

While the connection between the two conditions remains controversial, it is wise to get optimal treatment for them both.

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