What is The Best Pain Killer After a Knee Replacement?

Pain Medications After Total Knee Replacement —

Congrats on getting your knee replaced, you made the right choice.  Now comes the ‘fun’ part, dealing with the aches and pains in your rehab and return home.

Understand that everyone and I mean everyone has pain after a total knee replacement.  In my 20+ years of physical therapy practice, not once has someone been pain free in their recovery from a TKR.  Never.

Your surgeon likely sent you home with some prescription pain medications along with other meds. However it can be confusing on how much to take, when to take and for how long.  Add to that your other medications plus all of your physical therapy exercises and you have a lot to handle.

My goal here is to give you some guidance on how to manage your knee pain using various methods, including pain medication.  Please first check with your surgeon’s office for specific instructions on using pain medications as they may have specific dos and don’ts.

I also want to discuss some specific areas of pain you may have after surgery and how to handle.  While most pains are within expectations, sometimes you may need to get evaluated if things worsen.

Discharge Medications for Total Knee Replacement Pain

As discussed previously you will be discharged from the hospital with some form of prescription pain killer to control your knee pain.  If you choose to avoid the stronger narcotic pain medications this is certainly your right to refuse.  Just be aware that your ability to fully participate in physical therapy may be affected due to pain.

Some of the more commons forms of narcotic pain medications include the following:  Oxycodone, Hydrocodone, Vicodin, Tramadol, Hydromorphone and Codeine.  You will likely be sent home with one or more of the above medications and need to properly manage.

Depending on the which of the above medications you take, you will get between 4-6 hours of pain relief.  The stronger the medication the lower amount of pain relief time.

Because of this short span of pain relief, these types of pain killers are very addictive as your body quickly wants pain relief.  Make sure that you are not taking 2 or more of the above at the same time as this can be too much of an interaction.

For many of my total knee and hip patients, the combination of Oxycodone and Tramadol is used safely.  Oxycodone is the stronger of the two medications and provides 4 hours of pain relief while Tramadol provides 6 hours.

When using a combination like Oxycodone and Tramadol, I instruct my patients to only allow a short amount of overlap time.  For example, if an Oxycodone is taken at 8 am, wait until at least 10:30-11 am to take a Tramadol so there is little overlap.  You do want a small amount of overlap time so there is not a break in pain control.

I would suggest you set up at least 2 weeks worth of blank medication tracking charts before your surgery.  They will come in very handy once you return home and have to handle all of your new meds.

Likely you will need to use pain medications to help with sleep at night as sleeping is the most troublesome time for my patients.

You will be taking these pain medications in addition to other medication types including blood thinners (ie. Aspirin, Eliquis), anti-inflammatories (NSAIDs) and gastric meds to maintain healthy GI motility.  

Pain Management Tips After Knee Replacement

One word of advice would be to be on the look out for any strong negative side effects from pain medications.  If you start to feel ill, itchy or anxious you may have an allergy or sensitivity to that medication.  Talk with your physical therapist and doctor to discuss symptoms and seek alternate pain meds.

Pain medications were designed for surgeries like total knee replacements.  They are meant to be used as needed on a temporary as directed basis.  The goal is to return to using little to no pain medications as soon as possible.

Strong narcotic pain medications taken without a plan or care can be addictive.  Everyone is connected to someone who has had pain killer addiction in their lives.  Be mindful of having a goal to stop taking the narcotic pain medications when you no longer need.

My answer as to what is the best painkiller after knee replacement: The least amount of medication that gives you pain relief to maximize your therapy.  

Over The Counter Pain Medications After Knee Replacement 

Most likely your surgeon will allow you to take some form of over-the-counter medications in combination with the prescribed medications. Often times you will be taking aspirin which is a blood thinner to decrease the chance of blood clots.

But what about other pain medication such as Tylenol/acetaminophen, Advil/ibuprofen or Aleve/naproxen? Are you allowed to take any of these after your surgery how much?

Please check with your surgeon regarding these over-the-counter medications.  I will go into some detail below on how I handle over-the-counter pain medications with my clients.

Tylenol After Knee Replacement

Yes by the time you get your knee replaced, good chances are that Tylenol or acetaminophen simply doesn’t cut it anymore with your knee pain. So is there any advantage to taking it after you have your surgery?

The answer is yes and this is why. You now have a clean new knee joint with no arthritis in the area. Because of this, the Tylenol should work properly to provide some pain relief to the area where it previously could not.

How much relief can you expect reasonably? For my patients they normally say a one or two point reduction in pain on the standard 0-10 pain scale.

A small reduction by itself would not be significant however in combination with stronger prescription level pain medication’s it can make a significant difference.

There are very few issues with taking Tylenol after surgery except for those with Liver issues who cannot take Tylenol anyway.  Your hospital discharge instructions should give you some instructions regarding this.

I recommend to my patients to take 1000 mg every 8 hours for the first 2-3 weeks however please check with your surgeon.

Can I Take Ibuprofen After Knee Replacement Surgery?

Heading into surgery many people are relying heavily on ibuprofen or another form such as Advil.  Whether your surgeon allows you to take Ibuprofen after your total knee surgery depends on a few things.

First, there are some orthopedic surgeons who believe based on studies that NSAIDs inhibit bone growth.  In this case your surgeon would not allow you to take Advil or Ibuprofen after your knee replacement.  However most orthopedic surgeons do not follow this belief as the studies have been questioned.

Second, some surgeons feel that Ibuprofen can affect blood clotting. If you are already taking a blood thinner such as Aspirin or Eliquis likely your surgeon will not allow Ibuprofen.  

Some surgeons do allow Ibuprofen or Advil after surgery so the bottom line is:  Check with your surgeon.  Ibuprofen after knee replacement is not a one size fits all answer.

Can You Take Naproxen After Knee Replacement?

Naproxen (Naproxen) or the over the counter version Aleve are both common pain and anti-inflammatory drugs taken by those with knee arthritis.  So can these be taken after knee replacement?  

Naproxen and Aleve are both in the NSAID category just like Advil or Ibuprofen.  And just like those drugs, there are a lot of question marks from surgeon to surgeon on what they will allow. 

If you want to take Naproxen after your knee replacement surgery you will need to get the ok from your surgeon first.

Can You Use Biofreeze After Knee Replacement?

Biofreeze gel is one of the most popular forms of topical pain relief used by those with knee arthritis.  It works using the ingredient Menthol by provide a cool numbing sensation the region 

Biofreeze is not an NSAID nor does it provide the longer pain relief timeframe like Tylenol or Ibuprofen give.  Topicals only provide relief to the area it is applied to, different than the oral pain killers which affect the entire body.

Most surgeons will allow you to use Biofreeze after a knee replacement as long as you get nowhere near the incision area.  The worry would be infection or irritation to the newly healing incision skin region which can be very sensitive.  

I advise my patients to avoid these type of topicals in the early few weeks after surgery to simply remove any chance of skin or incision issue.  Yes the chances are low there will be an issue but I would err on the side of caution. 

Can You Use Voltaren Get After Knee Replacement?

Voltaren gel contains the active ingredient diclofenac sodium which is also in the NSAID classification.  Because of this classification, most orthopedic surgeons will not want you to use Voltaren on your knee replacement in the early phases.

You can certainly ask permission from your doctor however most likely the answer will be no.  The chance of aggravating your incision or directly affecting blood clotting with a topical should be enough to steer you away from using it.

Can You Get Cortisone Injections After Knee Replacement?

You will not be able to receive a cortisone injection after your total knee replacement.  Anything involved with placing a needle or exposing the new joint to possible infection is not allowed after a knee replacement.

There is a debate amongst surgeons and orthopedic professionals of whether or not you can receive a cortisone injection in the knee years down the road.  Most physicians will never give a cortisone shot into an artificial knee hip or other joint at any time because of the infection risk.

Any artificial joint or implant is a much greater risk of getting infected simply because it is not an organic part of your body.  When your body is invaded by a bacteria or virus it is much more likely to go to the artificial joint because of this. 

Can You Use a TENS Unit After Knee Replacement Surgery?

TENS units are very effective in providing temporary pain relief by masking the pain using electrical stimulation techniques.  TENS units are extremely safe to assist with local pain relief in normal circumstances.

Because TENS units do utilize electrical current to mask the pain, naturally you would wonder if  it is safe to use with a metal implant like titanium.  

I advise my patients that they can use a TENS unit only in muscular regions not directly on the knee joint itself.  If your lower back area or upper quad area are sore, using a TENS unit in these muscle regions is safe and will not affect the new joint.

Please check with your surgeon regarding using TENS units however most will allow you to use them as I described above.

Ice Packs for Knee Replacement Surgery

Using ice is by far the best source of pain relief for you after your knee is replaced.  Whether ice is considered a pain killer or not is a debate for another time but understand ice does work.

Icing your knee between 20-30 minutes but no longer than 60 minutes provides the most beneficial effects. Ice your knee anywhere from 3-7 times per day in the first few weeks after hip replacement.   Continue icing between 30-90 days after knee replacement depending on your symptoms. This protocol allows opportunity to improve your symptoms and ease return to activities of daily living (ADLs).  

Final Thoughts on What is The Best Pain Killer After a Knee Replacement

• Ask Your Surgeon About Specific Pain Medications and Their Safety
• Narcotic Pain Medications Do Provide Relief and Should Be Used With Care
• Over the Counter Pain Medications Are Helpful In Recovery 
• Using Ice for Additional Pain and Swelling Relief is Crucial In Your Recovery