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When Should I Get Knee Replacement Surgery

Risks Of Knee Replacement Surgery

Should You Try This Before Knee Replacement Surgery?

Knee replacement surgery is a common operation and most people do not have complications. However, as with any operation, there are risks as well as benefits.

Complications are rare but can include:

  • stiffness of the knee
  • infection of the joint replacement, needing further surgery
  • unexpected bleeding into the knee joint
  • ligament, artery or nerve damage in the area around the knee joint
  • persistent pain in the knee
  • a break in the bone around the knee replacement during or after the operation

In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.

Your Condition Could Get Worse As Your Joint Deteriorates

The leading cause of knee replacement is osteoarthritis. If you wait too long to have surgery, you put yourself at risk of experiencing an increasing deformity of the knee joint. As your condition worsens, your body may have to compensate by placing additional strain on other parts of the body . This could lead to stress or pain in the back, knee, or other parts of the body.

Is It Possible To Wait Too Long Before Getting Total Knee Replacement

There are definitely some disadvantages of waiting too long to have TKR. First, you dont need to be enduring the pain that you are suffering now.

My bone on bone pain is completely gone. As your bone wears you develop a limp that affects other parts of your body.

You may be making other parts of your body overcompensate for your bad knee. You may be putting undue stress on your hip and discover that it is causing you pain.

My hip was painful before surgery after long walks. Since my surgery, there has been no ache or pain in my hip.

The longer you wait and age, your body might not be able to heal and bounce back like it did when you were younger. The better shape that you are in prior to surgery the better the recovery.

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What Happens After Knee Arthroplasty

After surgery, you will get moved to a recovery room. The healthcare team will watch you for a short time to make sure you wake up from the anesthesia without complications. Theyll also monitor your vital signs and pain level.

Occasionally, people who have knee replacement surgery go home the same day. If you need to stay in the hospital, it will likely be for one day. Additional time spent in the hospital is based on medical necessity.

When Knee Surgery May Not Be For You

Knee replacement surgery (graphic)

Infections. Make sure you get them treated before surgery. For instance, take care of gum infections. It will lower the chance of getting an infection in your new knee.

Other medical problems. Do you have heart or lung problems, diabetes, or blood clots? It may raise the chances of complications from your surgery. You’ll need to get these under control before you can make a decision about knee replacement.

Other reasons for your joint trouble. “Is your knee really causing your pain?” Lajam says. “Sometimes you get pain from the low back that causes your knee pain. Sometimes people with bad hip arthritis have pain in the knee.” Work with your doctor to make sure you’ve found the real reason you hurt. If you don’t, your knee may still bother you just as much months after surgery.

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Recovering At Home And Working Remotely

Whats more, for some patients, being forced to stay home after recovering from surgery is a good thing. For many people this is actually a better time to have surgery because theyre working from home, so they can get back to work at home in a week or two, whereas getting back to work normally may have taken a month or more, says Dr. Haas.

Other Forms Of Treatment

Without replacement surgery, a severely osteoarthritic knee joint may continue to deteriorate until it is impossible to go about your normal daily activities, such as standing up, walking or getting up from a seated position. Other forms of treatment include:

  • The use of walking aids, such as frames or walking sticks
  • Non-steroidal anti-inflammatory drugs
  • Corticosteroid injections
  • Other surgery, such as osteotomy an operation in which diseased bone is cut away in an attempt to properly align the malformed joint.

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Is It Possible To Have Osteoarthritis In Your Knee And Not Feel It

In healthcare, a common way of diagnosing osteoarthritis is through an X-ray. On an X-ray, knee osteoarthritis will show up as decreased joint space. This is what people commonly refer to as bone on bone. With all of the damage that osteoarthritis does to the knee, and the effect this has on a persons ability to do daily activities, it may be confusing to be told you have knee osteoarthritis after getting an X-ray, but you have no pain.

X-rays are an important tool in healthcare. Generally, the more severe that arthritis appears on an X-ray, the more likely it is that symptoms, such as pain, are present. Although this is not always the case! While it is normal to have pain accompanied by an X-ray that shows knee osteoarthritis, it is actually just as common to have no pain. 44-53% of people with these positive X-ray findings have no pain in the knee. This doesnt mean that you should not have pain with arthritic X-ray findings, but rather it shows that X-ray findings ALONE are not a good tool to show if someone has knee pain or difficulty functioning, due to knee osteoarthritis.

The reason one person with an arthritic X-ray might have pain and another person might not is related to the person’s leg strength, presence of other medical conditions, and mental health status. Increased leg strength, proper management of other medical conditions, and good mental health are likely factors that contribute to having less pain in your arthritic knee.

What Else Do I Need To Consider

10 Questions to Ask Before Knee Replacement Surgery

Other factors worth considering before the operation:Insurance: Some companies don’t insure drivers for a certain period of time following their procedure. It’s best to check what cover your provider offers.Medication: When returning to drive, nobody should be experiencing the sedative effects of painkillers or other medicines which can inhibit reaction speed. The DVLA: The Driver and Vehicle Licensing Agency states that they must be informed of operations and if the person is still unable to drive 3 months later. See here for more details.

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Preoperative Exercises For Knee Replacements

Note: Always talk to a medical professional before beginning a new exercise program. Your surgeon or physical therapist can recommend exercises prior to your knee replacement and help you decide which exercises are best for your abilities.

If an exercise causes an increase in your pain or discomfort, stop performing that exercise.

How Is A Total Knee Replacement Performed

First, the orthopedic surgeon makes an incision in the knee and moves the patella to the side. If are any bone spurs are present, as sometimes occurs in osteoarthritis, they will be removed.

Next, the two menisci between the femur and tibia are removed, as are the anterior cruciate ligament and, in some cases, the posterior cruciate ligament . In some types of knee replacement, the PCL is retained.

During the main phase of the operation, the surgeon cuts and remove cartilage and some bone from the upper part of the tibia and lower sections of the femur. The femoral sections removed are two knobby protuberances called the femoral condyles. The tibia and femur are then be capped with metal implants to create new surfaces for the joint. The surface of the femoral component mimics the shape of the original femoral condyles. If the kneecap has also degraded, the surface on its underside may also be cut away and replaced with a polyethylene implant.

Finally, the various layers of tissue are repaired with dissolvable sutures and the skin incision is closed with sutures or surgical staples. A bandage will be wrapped around the knee and the patient is be taken to recovery.

Fixed-bearing knee implant with a polyethylene articulating surface sandwiched between the metal tibial implant and metal femoral implant.

Side-view illustration of a knee with a fixed-bearing knee implant in place.

X-ray of a knee after total knee replacement, showing the implanted prosthesis)

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Pain Level 6 Months After Knee Replacement

Before knee replacement surgery, I felt pain with every step I took. The bone on bone pain was always there.

Now, there is no bone on bone pain. I do feel some soreness around the knee after exercise especially after the longer hikes. Ive read that the knee will take a full year to improve.

A few times Ive overdone it and the soreness and swelling remain for a couple of days. There really is no pain inside the knee, just soreness and some achiness around the knee.

While Im engaged in everyday activities, I experience little pain and I dont need to favor the knee . I can feel the clicking in my knee when going up steps or hiking up hills.

The clicking is a strange feeling but occurs without pain.

Can Rehabilitation Be Done At Home

Draining My Knee After Surgery

All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

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Could A Nonsurgical Option Be Right For You

If youre having problems with knee pain and swelling due to osteoarthritis, there are a number of nonsurgical treatments you can try. Anti-inflammatory drugs such as ibuprofen, certain exercises to strengthen the muscles around the knee and injections offer relief for many people.

If these measures work for you, you dont need to have surgery. But if it gets to the point where youre staying home because it hurts too much to walk, or youre unable to do simple activities like climbing stairs, it may be time to seriously consider having knee replacement surgery.

Youre Of A Certain Age

Knee replacement is generally done in older people over 60, in part because younger peoples more active lifestyles may put too much stress on the artificial knee, causing it not to last as long second replacement surgeries may not be as successful. But, knee replacements can be performed in people of all ages depending on your individual case, so discuss with your doctor whether youre a good candidate.

Topics

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Have A Conversation With Your Doctor

Before you make up your mind about having your knee replaced, talk with your doctor about the possible risks of surgery. These can include infection, loosening of the knee replacement parts, and movement limitations. Also, talk about any health conditions you might have that could make the operation and your recovery more difficult.

Its also important to have realistic expectations for how quickly you will recover from the surgery. It can take several weeks to several months to feel back to normal after a knee replacement. Youll also need to commit to physical therapy and exercise. Your doctor can talk through the factors that can speed up or slow down recovery, and help you decide if the timing is right.

Under the right circumstances, a knee replacement can significantly boost your quality of life. More than 90% of people who get new knees are able to resume their normal activities shortly afterward and are happy with the results, according to the American Academy of Orthopaedic Surgeons. And pinpointing a good time to have a knee replacement is a key part of having success with the procedure.

What About Exercise Following A Knee Replacement

Should You Have Knee Surgery? Arthroscopic? Replacement? Meniscectomy?

Exercise and sport are recommended after knee replacement, apart from contact sports, which may weaken the cement and lead to loosening of the joint components. Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.

Exercising the main muscle groups around your knee is very important both before and after having a knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin.

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The National Joint Registry

The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.

The registry also gives you the chance to participate in a patient feedback survey.

It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.

How Does Knee Pain Affect Lifestyle

How pain is perceived and tolerated is unique to each individual. If knee pain affects working, socializing, sleeping, maintaining good hygiene, or other daily activities, then it may be time to consider knee replacement surgery.

Knee pain and active lifestylesPeople who live active lives may be more affected by knee pain and decide to have knee replacement surgery sooner. For example, a person whose regular activities include standing for work, babysitting grandchildren, and walking a pet dog may be more affected by arthritic knee pain than a person who lives a more sedentary life.

See Knee Pain and Arthritis

Pain and joint damage do not always match upThe decision to have knee replacement surgery should not be based solely on medical imaging that shows severe knee degeneration. Rather, it should be based on moderate to severe knee arthritis symptoms that correlate with medical imaging.

See Knee Osteoarthritis Diagnosis

For example, a person whose x-ray shows a severely degenerated knee but who experiences only mild pain is probably not a good candidate for knee replacement. In contrast, a person who has a moderately degenerated knee and experiences severe pain may be a good candidate for knee replacement.

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What The Alternatives To Knee Replacement

A healthcare provider may recommend knee replacement surgery after other treatments for knee pain dont help anymore. These earlier options may include:

  • Exercise or physical therapy to strengthen the muscles around the joint which will provide stability.
  • Medications such as NSAIDs and cortisone shots.
  • Walking aids or supports and bracing.

Exercises To Do Before Your Knee Replacement Surgery

4 Types of Quad Exercises to Do After Knee Replacement ...

You may think you have everything you need to buy before a knee replacement, like a grab bar or a sock aid, or maybe you even purchased a knee kit. But youre not done preparing yet! While those products will help you care for yourself after your knee replacement, these pre-surgery exercises will help your knee recover after surgery.

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Have Other Treatments Been Exhausted

Experts typically recommend that anyone with knee osteoarthritis pain try nonsurgical treatments before considering knee replacements. Nonsurgical treatments include, but are not limited to, engaging in physical therapy and exercise, bracing, losing weight, taking pain medications, and getting therapeutic knee injections.

Knee osteoarthritis can affect joint biomechanics and increase the risk for falling, bone damage at the knee, and other wear-and-tear injuries.

The risk of fallingFalling can result in life-altering injuries, particularly as people age. If knee arthritis symptoms include a sensation that the affected knee may buckle, or if there are other risk factors for falling, knee replacement surgery may be advised.

The risk of bone damageModerate to severe knee osteoarthritis can result in damaged bone. Bone damage can reduce the likelihood of a successful knee replacement surgery.

Knee arthritis is a progressive, degenerative condition, meaning the joint damage gets worse over time. As knee cartilage wears away, friction can occur between the bottom of the femur and top of the tibia . Over time, the friction can lead to bone damage.

There is no surefire way to predict if and how fast bone tissue will become damaged. However, medical imaging can evaluate the current bone health of the knee joint.

A physician or physical therapist can evaluate the kneeĆ¢s biomechanics and help identify other existing or potential joint problems.

This Common Procedure Can Help Reduce Pain And Restore Your Ability To Move Better But How Do You Know When Its Time For Surgery

Knee replacement surgery is one of the most successful procedures in all of medicine, according to the American Academy of Orthopaedic Surgery . Its also very common: Over 790,000 knee replacements are performed each year in the United States. A complete knee replacement more correctly, a resurfacing places metal pieces to recreate the surface of the joint, with a plastic separator in between and possibly a plastic resurfacing of the inside of the kneecap .

Although youll need a little help afterward, you should be able to begin walking again either the same day or the day after surgery. And the procedure is overwhelmingly successful: The AAOS estimates that 90% of modern total knee replacements are still working more than 15 years after surgery.

How do you know if you need a knee replacement in the first place? Deciding when its time is a personal decision between you and your doctor, but there are some factors that make you a more likely candidate for surgery.

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