“It’s not my knee” – understanding ongoing pain and discomfort after total knee replacement through (re)embodiment

Objective: Up to 20% of people who undergo total knee replacement surgery have ongoing pain and discomfort. The aim of this study was to understand what role the concepts of embodiment (of both having a body and experiencing the world through one’s body) and incorporation (integrating something into one’s body) might have in understanding experiences of pain and discomfort after total knee replacement.

Methods: We conducted semi-structured interviews with 34 people who had received total knee replacement at either of two National Health Service hospitals in the United Kingdom, and who had chronic post-surgical pain (n=34, age 55-93 years). Data were audio-recorded, transcribed and analysed thematically.

Results: Two main themes were identified: 1) When describing chronic post-surgical pain, some participants also described sensations of discomfort including heaviness, numbness, pressure and tightness associated with the prosthesis; 2) Participants reported a lack of felt connection with and agency over their replaced knee, often describing it as alien or other, and lacked confidence in the knee.

Conclusion: Participants’ experiences indicate that some people do not achieve full incorporation of the prosthesis. Our study emphasises the importance of physicians treating patients as whole people and moving beyond clinical and procedural ideas of “success”. Our findings suggest that to optimise post-operative outcomes rehabilitation must focus not only on strengthening the joint and promoting full recovery to tasks but on modifying a person’s relationship to the new joint, and managing sensations of otherness to achieve full incorporation of the joint or re-embodiment.