SURGEONS treating patients with unexplained pain after knee arthroplasty face profound clinical and emotional challenges, according to a new qualitative study that highlights the complexity of decision-making in this setting. The findings underscore the need for holistic patient care strategies that extend beyond technical intervention.
Researchers conducted semi-structured interviews with seven consultant knee surgeons to explore how they approach cases of persistent, unexplained pain following arthroplasty. Analysis identified six major themes shaping their experience. Surgeons emphasized the importance of understanding a patient’s journey and expectations but described consultations in these cases as particularly difficult. Many felt pressure to act as the “fixer,” even when clinical clarity was lacking, creating tension between professional identity and medical uncertainty.
The study revealed discomfort among surgeons when considering revision procedures for pain without a clear cause, with several expressing reluctance to operate in such circumstances. Asking for help was described as complicated, reflecting the professional and systemic barriers that influence multidisciplinary collaboration. Beyond the clinic, surgeons reported that these cases carried lasting emotional weight, with unresolved patient outcomes leaving a persistent sense of responsibility.
The authors concluded that management of unexplained pain after knee arthroplasty requires an approach that integrates modern pain theory, patient-centered communication, and collaborative care. The results suggest that supporting surgeons through improved frameworks for consultation, shared decision-making, and multidisciplinary engagement may improve both clinical outcomes and professional wellbeing.
By placing surgeon experience at the forefront, this analysis provides rare insight into the psychological and relational dimensions of orthopedic practice. For clinicians, the study reinforces the importance of balancing surgical expertise with empathy and systemic collaboration when caring for patients experiencing unexplained pain after knee replacement.
Reference: Sabah SA et al. The experience of surgeons treating unexplained pain after knee arthroplasty: a reflexive thematic analysis. Bone Jt Open. 2025 Sep 17;6(9):1115-1121. doi: 10.1302/2633-1462.69.BJO-2025-0019.R1.
