When Is It Time for a Knee Replacement?

If you suffer from knee pain, you may wonder if surgery is the right choice for you. If your pain is persistent, worsening, limiting your daily activity, not improving with rest and medication, it may be time to explore the surgical route.

Knee replacement surgery, or knee arthroplasty, is one of the most common elective surgical procedures in the United States. It resurfaces the bearing surfaces of the knee, typically due to the presence of painful or debilitating arthritis.

Most people are between the ages of 50 and 80 when they have a knee replacement procedure done. However, people experience pain differently. There is no specific age threshold or cutoff. Many people will pursue the surgical route when they are no longer able to tolerate or perform daily tasks important for their quality of life.

More patients are having total joint replacements done at younger ages. The longevity of the implant is always a factor to consider, but improvements in technology have increased the lifetime of joint replacements.

Symptoms that may signal the need for a knee replacement include:

• Persistent or worsening knee pain associated with increased activity
• Pain along the front or medial side of the knee, sometimes in the back of the knee
• Catching, locking and giving way can be signs of problems in the knee joint
• Changes in alignment of the knee, including a bowlegged or knock-kneed

Are there different kinds of knee replacement surgeries?

There are three different types of knee replacement surgeries:

• The most common is total knee arthroplasty where all bearing surfaces of the tibia (shin bone), femur (thigh bone) and patella (kneecap) are replaced with an artificial prosthetic bearing.
• Another type of knee replacement surgery is unicompartmental knee arthroplasty. This is for people who have problems confined to one area of the knee.
• Less commonly performed is a different kind of partial knee replacement called patellofemoral arthroplasty. That's a procedure for people who have severe arthritis limited to the surfaces between the kneecap and the front of the femur.

Before you consider total joint replacement surgery, there are some nonsurgical options to consider. You may try rest, alternating ice and heat treatments, changing your activity, trying oral and topical anti-inflammatory medications, physical therapy, home exercise programs and joint injections. A surgeon will help you set realistic goals for pain and function improvement.

What happens during knee replacement surgery?

During a knee replacement, the surgeon will open a person's knee and remove the degraded native cartilage surfaces of the knee, replacing them with a prosthetic knee bearing. It's usually done to the tibia, femur and often the patella. This process takes one to two hours on average, but exact length of surgery depends on many factors, including technical complexity.

Recovering from knee replacement surgery

Everyone is different, but the average person will recover and return to normal activities without restrictions within 12 weeks (about 3 months). During the first two weeks, your incision will heal and you will have basic mobility for your daily living. Between two and six weeks you can increase your activity, work on strengthening your knee and start getting back to normal activities.

Possible complications from knee surgery include:

• Pain that will recover with time
• Damage to major blood vessels or nerves surrounding the knee
• Infection
• Needing a revision later in life

The goal is to take away pain that's associated with arthritis and joint deformity. You may still have some long-term pain related to the degeneration and deconditioning of muscles and ligaments. Knee replacement technology has progressed over time, making the prosthesis feel better and more natural.

Good surgical candidates are motivated and have clear improvement goals for pain and function. These people are in overall good health or have stable chronic medical issues. Some factors may put a person at risk for poor outcomes including obesity, poor diabetic control and smoking or using nicotine. You and your surgeon need to consider these factors to decide whether surgery is the best choice for you.