Knee replacements are one of the most commonly performed orthopedic procedures in the United States. When performed on the appropriate patient the outcomes can be life-changing. I am often asked the question of whether or not it is time for my patient to go forward with the surgery. There are a host of factors to consider when coming to a final decision.
The first thing to consider is whether or not a knee replacement is an appropriate surgery. Knee replacements are appropriate where there is a significant degenerative change in the knee. Not all knee pain is from arthritis. When other modifiable factors in the knee can be addressed (such as meniscus tears) then that would be a more appropriate first step.
If arthritis is the established cause for knee pain then patients need to consider conservative versus surgical options. There are a host of non-surgical options that can help temporarily relieve arthritic knee pain. These include:
- Injections (corticosteroid, PRP, stem cells)
- Weight loss
Knee replacements are mechanical devices and will wear out with time. This is why in younger patients it is important to put off a knee replacement as long as possible. Generally speaking, you can expect a knee replacement to last about 20-30 years. Younger patients are more active and will likely wear out the prosthesis sooner. The revision surgery required at that point is never as good as the first and that is why it is preferable to put it off when possible.
When conservative options are no longer effective and pain becomes more unbearable then patients usually start asking for a knee replacement. There are no specific criteria for when a knee replacement should be performed. I always tell patients that no one should tell them they need a knee replacement. The only reason for performing the surgery is to relieve pain and improve mobility. The pain experienced by people with arthritic knees does not correlate with their X-ray findings. Some people have horrendous arthritis with no pain and others have milder X-ray changes with terrible pain. The decision to have a knee replacement comes down to expectations about activity and how much the pain is impacting your life.
A knee replacement will not make you new again but it will allow you to move without pain, and for most of my patients who are suffering that is music to their ears.