Most people do well after a knee replacement, but some are left with pain that lingers for a year or more. Implant problems, infection, and pain from elsewhere must be ruled out first. After that, YOUNIFY Clinic, a Healthy Aging & Wellness Center based in Bangkok, Thailand, may discuss nerve treatment or genicular artery embolization for selected patients at its Silom clinic.
Contents
Key Takeaways
- Lingering pain after a knee replacement deserves a proper work-up, not acceptance.
- Infection, loosening, instability, and stiffness must be checked by an orthopedic surgeon before any pain procedure.
- Pain can also come from the hip, the spine, a nerve near the scar, or an inflamed joint lining.
- Early research suggests genicular artery embolization may help some people with pain after a knee replacement, but that evidence is small, short-term, and uncontrolled.
Why does my knee still hurt after a knee replacement?
A knee that has been replaced can still hurt for several reasons, sometimes more than one at once. Pain in the first weeks is expected; pain that stays well beyond the usual recovery, or returns after a good start, needs a look. Common causes include:
1. The implant: loosening, wear, instability, or position.
2. Infection: sometimes low-grade, with little more than pain and warmth.
3. Stiffness: scar tissue limiting movement.
4. The kneecap area: tracking or pressure problems at the front.
5. Nerves: an irritated skin nerve near the scar, or wider nerve pain.
6. Pain from elsewhere: the hip or lower spine.
7. An inflamed joint lining (synovitis): ongoing inflammation with increased blood supply.
The NHS lists ongoing pain and stiffness among the possible problems after a knee replacement, and notes that infection is usually treated with antibiotics but deep infection may need further surgery.
What should be checked before any pain procedure?
Implant and infection problems come first, because a pain procedure should never hide something that needs surgery or antibiotics. An orthopedic surgeon leads this work-up.
Typical steps include an examination, standing X-rays, blood tests for inflammation, and sometimes joint fluid, a CT scan, or a bone scan. The hip and spine are examined for referred pain. A pain-focused approach makes sense once no cause needing repair is found.
Can genicular artery embolization help pain after a knee replacement?
It may help some people once other causes are excluded, but the evidence is early. Genicular artery embolization (GAE) blocks small abnormal vessels feeding an inflamed joint lining, through a thin catheter in an artery rather than a knee incision.
In a prospective series of 37 patients with pain lasting at least one year after a knee replacement, 24 patients (64.9%) reported at least a 50% reduction in pain three months after GAE, and no serious complications were reported (Konduru et al., CardioVascular and Interventional Radiology, 2026). The study had no comparison group, lasted three months, and came from one center, so it shows the idea is worth studying, not that the result is predictable.
For knee osteoarthritis in general, pooled studies report meaningful pain reduction after GAE, but the certainty of that evidence is rated very low, and sham-controlled trials leave the size of the true effect uncertain.
| Option | What it targets | What to know |
|---|---|---|
| Physiotherapy and a graded exercise plan | Strength, range of motion, and confidence | First-line for stiffness and weakness |
| Revision surgery | A loose, unstable, infected, or poorly positioned implant | Decided by an orthopedic surgeon |
| Genicular nerve block, with radiofrequency treatment if the block helps | The small nerves that carry pain from the knee | Relief may last for months in some people and may need repeating; radiofrequency starting from THB 280,000, the diagnostic block quoted after a physician assessment |
| Genicular artery embolization | Inflamed joint lining with increased blood supply | Early, small studies; starting from THB 129,000 |
| Nerve pain medicines and a pain medicine plan | Nerve-related pain | Adjusted over time by a physician |
When to see a doctor urgently
Seek urgent care, or contact your surgeon the same day, if you notice:
- Fever, chills, or feeling generally unwell with a painful knee
- Increasing redness, heat, or swelling of the knee
- Discharge or an opening in the wound
- Calf pain or swelling in the leg
- Chest pain or sudden shortness of breath
- Sudden inability to bear weight, or the knee giving way after a fall
When we may advise against a procedure
We may advise against a procedure, or ask you to wait, when:
- Infection or implant loosening has not been excluded
- Blood thinners have not been reviewed
- There is an active infection elsewhere in the body
- Kidney function, contrast allergy, or narrowed leg arteries make an arterial procedure unsafe
- The pain clearly comes from the hip, the spine, or another source
- The hoped-for result is something a procedure cannot offer, such as fixing a loose implant
Physician perspective
In our clinic, we first ask whether the replacement itself is sound. We then examine the hip, the spine, and the skin nerves around the scar, because each can mimic knee pain. When the implant is secure and infection is excluded, we look for an inflamed joint lining or nerve-driven pain, and we explain how limited the evidence still is before planning any procedure.
An illustrative example
Illustrative example, not a real patient: a person two years after a knee replacement describes a constant ache at the front and side of the knee, worse at night. The surgeon's review finds a stable implant and normal blood tests. After a hip and spine examination, the team discusses a diagnostic nerve block first, and explains what embolization might and might not offer if the block does not settle the pain.
What happens next
1. Send your latest knee X-rays, surgeon's letters, and a short description of your pain.
2. Our physician reviews them and advises whether further tests or a surgeon's review come first.
3. If a procedure may suit you, you receive a written plan and a written quotation.
4. The procedure is scheduled once the plan is agreed.
5. Follow-up reviews check pain, movement, and daily function.
To start, send your imaging and a short history through WhatsApp at https://wa.me/66815569696 or LINE at https://lin.ee/5MIGher for a physician review.
Frequently Asked Questions
Is it normal for a knee replacement to still hurt after a year?
Some discomfort can last for months, but pain that remains after a year, or returns after a good recovery, should be investigated. Surgeons have a standard work-up for it, and the aim is to find a cause rather than accept the pain.
Could my new knee be infected even without a fever?
Yes. Some implant infections are low-grade and show only as pain, warmth, or mild swelling. This is why blood tests and, when needed, a joint fluid sample come before any pain procedure, led by your orthopedic surgeon.
Does genicular artery embolization damage the knee implant?
Embolization works on small blood vessels around the joint and does not touch the implant. The catheter enters through an artery in the groin or lower leg. It cannot fix a loose or poorly positioned implant, so those problems are excluded first.
How soon might I notice a difference after GAE?
In published studies, many people noticed a change within weeks to a few months. The study after knee replacement followed patients for three months, so how long any benefit lasts in this group is not yet known.
Can I still have revision surgery if a pain procedure does not help?
Yes. Nerve treatments and embolization do not rule out later surgery. If new findings suggest an implant problem, your orthopedic surgeon decides whether revision is needed. Keeping your records together helps both teams.
How much does it cost, and will insurance cover it?
Genicular artery embolization at YOUNIFY Clinic is starting from THB 129,000, and genicular nerve radiofrequency is starting from THB 280,000. The diagnostic nerve block and imaging are quoted after a physician assessment. Insurers treat these procedures differently, so we prepare medical documents for your own claim and suggest checking your policy first.
References
- Complications of a knee replacement. NHS (United Kingdom).
- Total Knee Replacement. American Academy of Orthopaedic Surgeons (AAOS), OrthoInfo.
- Konduru N, et al. Genicular Artery Embolization as a Treatment Option for Refractory Knee Pain Post Total Knee Arthroplasty: A Prospective Series. CardioVascular and Interventional Radiology, 2026;49:1384-1390.
- Alves LH, et al. Genicular artery embolization as a minimally invasive treatment for knee osteoarthritis: systematic review and meta-analysis. Skeletal Radiology, 2026.
Read next in this series
Medical Note
This article is for general information and does not replace medical examination, diagnosis, or treatment. If symptoms are severe, changing quickly, or urgent, seek medical care promptly.
Individual results may vary. Please consult a doctor before treatment.
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