The Rehabilitation Medicine Group

27/07/2025

With rising numbers of knee replacements being performed in Australia each year, the number of people needing help with pain that persists after knee replacement is also expected to rise.

The graph shows the increasing numbers of knee replacements (including primary total, primary partial and revision) over the past decade in Australia data source: https://aoanjrr.sahmri.com/home

The years 2020-2022 demonstrate the impact of Covid-19.

Most people (98%) having knee replacements are having them performed due to knee osteoarthritis. There is a slight majority of females (56%) and the average age is 69 years.

Data (also from the Australian Orthopaedic Association National Joint Replacement Registry) indicates that unfortunately 50% of people continue to experience pain at 6-months post-surgery.

This includes 25% of people reporting moderate to severe pain.
Based on the latest (2023 data), up to 20,000 people might still be experiencing moderate to severe pain at 6-months after having surgery.

Our previous published research showed that there was only one trial of a rehabilitation program to treat persistent pain after knee replacement https://thermg.com.au/research

Kneed, the first online pain rehabilitation program for people with pain that persists after knee replacement is now available here: https://thermg.com.au/shop/

04/07/2025

Why do people continue to have pain after surgery?

There are two clinically different groups:
(A) people having surgery to treat their pain e.g. a knee replacement for knee osteoarthritis or spinal surgery
(B) people having surgery for another reason e.g. for breast cancer or for heart surgery.

Those in group (A) have often had pain for years before their surgery and this pain can lead to changes in the central nervous system (sensitivity), shaping how they experience pain and how they move before surgery.
Surgery then creates a large inflammatory response that can further sensitise this system leading to further changes in movement patterns and function.
So even if the "surgery is a success" these alterations can persist and with them, pain.

For those in group (B), pain usually starts with surgery (but can develop later) related to the inflammatory response that can sensitise the central nervous system.
As an unintended complication, surgery can also injure other tissues such as nerves leading to neuropathic pain - research indicates that this is quite common in breast and cardiac surgery.

For both groups, how you feel about your pain and the surgery, as well as mood, sleep dysfunction, stress and lack of exercise also play a role in the persistence of pain.

With all these factors, a comprehensive approach is recommended to manage pain that persists after surgery.

Kneed, the first online pain rehabilitation program for pain that continues after knee replacement, has been developed from research on why pain persists and how to treat it.
Learn more about Kneed here: https://thermg.com.au/about-kneed-2/
Kneed is now available with the first module free: https://thermg.com.au/shop/

Kneed is the first and only evidence-based online pain rehabilitation program developed specifically for people who continue to have pain after a knee replacement. Kneed will be launching here soon.Kneed is an original self-management program designed and developed by Dr Nathan Johns as part of his....

01/07/2025

How many people continue to report that they still have severe pain in their knee 3 months after a knee replacement?
In a research study, we estimated that 70% of people had severe pain due to knee osteoarthritis prior to surgery.
Fortunately, this reduced to 10% of people with severe pain at 3 months. Research article here: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05800-0
In Australia, this represents 8,000 people a year with severe pain at 3 months!
This is one of the reasons why Dr Johns designed, created and researched Kneed, an online pain program for people with pain that persists after knee replacement.
A free sample of Kneed can be found here: https://thermg.com.au/shop/

30/06/2025

Do you still have pain more than 3 months after your knee replacement?
Kneed, the first online pain rehabilitation program to treat it, is now available.
Find out more here: https://thermg.com.au/about-kneed-2/
Sign up for a free sample or purchase the online program to complete over 8 weeks in your own time from home.
The Rehabilitation Medicine Group delivers rehabilitation directly to you!

02/02/2025

What is Rehabilitation Medicine?
(Also known as Physical Medicine and Rehabilitation or Physiatry)

Rehabilitation Medicine is a very fulfilling medical specialty that focuses on improving function and quality of life in everyone, no matter what their medical condition is! It’s the clinical medical specialty that is primarily focused on assessing and treating people who have reduced functional ability due to illness, disease or injury.

Rehabilitation medicine physicians (aka physiatrists) are specialist doctors who utilise the holistic biopsychosocial model of Engel which encompasses all of the biomedical, psychological and social aspects of health and life.

Extensive research has demonstrated that rehabilitation programs can improve function and quality of life for people with varied medical conditions which are often life-changing. These include persistent pain, deconditioning, heart disease, lung disease, stroke, Parkinson's disease, traumatic brain injury, spinal cord injury, amputations, arthritis, long covid, cancer, chronic fatigue syndrome, following joint replacement and fractures.

Rehabilitation medicine is also focussed on preventing the consequences of bed rest in hospitalisation and preventing the complications that can arise when someone is affected by a sometimes life changing condition listed above.

As you can see, it is a pretty important specialty.

02/02/2025

What do Rehabilitation medicine physicians do?

People often ask me what I do as a specialist doctor in rehabilitation medicine as they haven't met a rehabilitation physician before. There are only about 450 rehabilitation physicians in Australia and if everything is going well with you and your family’s health, you won’t get to meet us professionally! We usually see patients once their acute (immediate) medical or surgical problem has been stabilised.

I describe our in-hospital role to Registrars (who are junior doctors training in Rehabilitation Medicine) as having two major components:

1. Provide medical care to keep our patients well or help to make them well enough so that they can participate in rehab programs

2. Educate, motivate, guide and counsel people so that they want to participate in rehab programs

Rehabilitation medicine doctors working in hospitals provide team-based care involving the patient and their supports as well as their clinicians who can include nurses, physiotherapists, occupational therapists, social workers, psychologists, pharmacists, exercise physiologists and dietitians.

Outside of inpatient care, in private or hospital-based clinics, rehabilitation physicians provide medical treatment for pain and other medical conditions interfering with recovery. In this setting, we continue to assist people to restore their independence so that they may continue to live their life in their place of choosing. We help people return to their enjoyable activities, driving, study and work.

Our focus is always on helping people to live their best life.

27/01/2025

My PhD journey started over 6 years ago and will conclude May, 2025

07/10/2024

We have new page RMG Research: https://www.facebook.com/profile.php?id=61566015673260

This page is the launching pad for the Kneed feasibility trial - an Epworth Monash Rehabilitation Medicine Research Unit study - investigating an online pain rehabilitation program (Kneed) for people with moderate to severe persistent pain after total knee replacement.

The Kneed trial is due to commence in 1 week!

RMG Research is the research arm of The Rehabilitation Medicine Group led by Dr Nathan Johns.