Knee surgery, whether it involves a minimally invasive meniscus repair or a full knee replacement, can significantly transform mobility and quality of life. But like any operation, it carries risks. Some patients undergoing knee surgery experience lingering or unexpected issues in the months and years following the procedure. Understanding the potential complications of knee surgery helps you identify early warning signs, protect your investment in recovery, and determine whether surgery is the right first step for you.
Common Complications Following Knee Surgery
Even when knee surgery goes exactly as planned, the healing process still puts stress on the bones, tissues, and blood vessels around the joint. Most people recover well, but a small percentage experience complicatons.
Here are some common issues that can occur after a full knee replacement or smaller knee procedures:
Infection (surface or deep inside the joint)
Both partial and full knee replacement complications may involve infection. Mild infections at the incision site are more common and typically appear within a few days. These often improve with antibiotics.
Less commonly, a deeper infection can develop around the artificial joint itself. This is known as a periprosthetic joint infection (PJI). These infections are more difficult to treat and may sometimes require additional surgery. Watch for signs like increasing redness, drainage from the incision, fever, or a knee that feels hot and swollen.
Blood clots (DVT or pulmonary embolism)
When you’re recovering from surgery, blood can slow down and pool in the veins of your leg, especially if you’re not moving around much. This can lead to a deep vein thrombosis (DVT), a blood clot typically found in the legs, such as the calf or thigh. If the clot breaks loose and travels to the lungs, it becomes a pulmonary embolism (PE), which is very serious and can be life-threatening. Symptoms to look for include sudden swelling in one leg, calf pain, shortness of breath, or chest pain.
Stiffness and excess scar tissue (arthrofibrosis)
Some people develop too much scar tissue inside the knee as they heal. This can make it hard to fully bend or straighten the leg, even with physical therapy. This condition is called arthrofibrosis and may require another procedure to help improve the range of motion. The best way to avoid this is to follow your physical therapy plan closely and stay as active as your care team recommends during recovery.
Nerve irritation or nerve pain (neuropathy)
During surgery, small nerves in the skin and surrounding tissue of the knee can become stretched or irritated. This can lead to symptoms like tingling, burning, or sharp, shooting pain, sometimes long after the incision has healed. Treatment options include nerve pain medications, numbing patches, or targeted procedures, such as image-guided nerve blocks.
Loosening of the implant or wear and tear
Most knee implants are designed to last 15 to 20 years. However, in some cases, especially among younger, heavier, or more active patients, wear can occur earlier. As the artificial joint components rub together over time, they may loosen or shift slightly, causing a painful clunk or feeling of instability. When this happens, revision surgery may be needed to replace or reposition the parts.
Bone fractures near the implant (periprosthetic fracture)
The bone above or below the artificial joint can break after a fall or sudden twist. These injuries are rare and often need plates, screws, or rods to stabilize the bone, and sometimes even a second knee replacement.
Delayed healing or bleeding inside the joint (hemarthrosis)
Certain health conditions, like poor circulation, diabetes, or blood-thinning medications, can slow down wound healing or increase the risk of bleeding inside the knee. This can lead to fluid buildup, swelling, or wounds that take longer to close.
When Knee Pain After Surgery Isn’t Normal
Some soreness, warmth, and intermittent swelling are expected to persist for weeks. Seek medical attention if you notice any of these red flags:
- Pain that suddenly spikes after an initial improvement
- Night pain severe enough to disrupt sleep more than once weekly
- Increasing calf tightness, redness, or one‑leg swelling (possible DVT)
Persistent fever or wound drainage beyond 72 hours - Instability, giving way, or new locking sensations
Ignoring these signs can convert a manageable issue into a revision surgery.
What Can Delay or Disrupt Your Recovery
Even the smoothest operation can derail if key risk factors aren’t addressed:
- Poor circulation or vein disease: Varicose veins can slow wound healing and increase the risk of blood clots.
- Uncontrolled blood sugar: Diabetics face higher infection rates. Tight glucose control is non‑negotiable.
- Smoking and nicotine use: Smoking nearly doubles wound‑breakdown risk and reduces bone‑implant bonding. Quit at least six weeks before surgery for best results.
- High body mass index: Elevated BMI predicts stiffness after manipulation and higher PJI rates. A supervised weight‑loss program lowers these odds.
- Inadequate physical therapy: Early motion limits arthrofibrosis; skipping sessions is a top factor for prolonged pain and swelling.
- Mental health factors: Depression and anxiety can magnify post‑operative pain perception and lengthen rehab.
An Alternative to Knee Surgery You Might Not Know About: What Is GAE?
Genicular artery embolization (GAE) is a minimally invasive procedure designed to relieve knee pain caused by OA. It works by selectively blocking blood flow to inflamed areas of your knee joint. The procedure targets the small blood vessels that supply the synovial membrane, the tissue lining the knee joint that becomes inflamed in arthritis.
During GAE, a board-certified vascular surgeon uses advanced imaging to guide a tiny catheter through the leg arteries to the genicular arteries in the knee. Tiny particles are then delivered through the catheter to block abnormal blood vessels, reducing inflammation and pain at the source. The entire procedure is performed on an outpatient basis.
How to Decide If Knee Surgery Is Really Right for You
Knee surgery can be life-changing, but it’s not always the only or best solution. Before moving forward, ask yourself:
- Have you tried at least three months of non-surgical care? This includes exercise, weight management, and anti-inflammatory treatments. Many people improve with these alone.
- Does imaging show severe joint damage? Bone-on-bone arthritis or joint deformity must be present to justify surgery.
- Are you prepared for the recovery process? Physical therapy is essential, and some side effects, such as stiffness or nerve pain, can persist for months.
- Have circulation issues been ruled out? Vein or vascular conditions can mimic knee arthritis.
If you answered “no” to any of the above, a second opinion may be in your best interest. Empire Vein & Vascular Specialists can help you review your options and choose the right path forward, surgical or not.
Next Steps
Knee pain shouldn’t dictate how far you walk, work, or play. At Empire Vein & Vascular Specialists, we believe surgery should only be considered when truly necessary. That’s why we offer advanced, minimally invasive solutions like GAE as part of our patient-first approach:
- Every GAE procedure is performed by one of our board-certified specialists.
- We accept Medicare, IEHP, and most PPOs and HMOs. We will verify your coverage in advance.
- You will receive a comprehensive care plan tailored to your unique needs.
If you’re still struggling with knee surgery complications or want to avoid it altogether, call 1‑800‑KNEE‑CARE or visit our website to schedule your no‑obligation evaluation.