How Do I Know If I Am Ready For A Knee Replacement?

Dr. Alexander Riordan, Blount Orthopaedic Associates

If you’re experiencing chronic knee pain and limited mobility, you’ve probably seen an orthopedic specialist or a physical therapist. When all options are exhausted and your pain and mobility are still not optimal, you may be thinking about surgery. OHOW’s Dr. Alexander Riordan says, “As a patient, this is the exact right question to be asking, and the answer is very personal.” If you haven’t had a conversation with your doctor, now is the time.

Who Do I Talk To About Knee Surgery Options?

Without question, the best source of information is your orthopedic surgeon. Make sure your surgeon takes the time to discuss nonoperative options with you. If you are signing up for a knee replacement, you should feel comfortable that you have tried treatments short of surgery that might have at least a reasonable chance of success. Again, your orthopedic surgeon is probably the most skilled person to have this discussion with you. Certainly, many patients talk to friends or family who have had knee replacements. They can be a great source for information, but keep in mind that those sources have the limitation of being single patient stories. Your surgeon has the knowledge and experience of many patients from all walks of life. 

Dr. Riordan states, “When discussing treatment options with my patients, I hope that they will gain enough knowledge to become comfortable discussing their own care, life situation, and goals. Their participation, knowledge, and understanding of the recovery process are some of the most important factors for a successful outcome.” 

Your doctor is also aware of research from large, randomized high-quality medical studies and research. In the medical world, that type of data is the most valuable and reliable. If you are not fully understanding what your surgeon is saying, or your personalities do not mesh, feel free to get a second opinion. A skilled and confident surgeon will have no problem with you seeking a second set of eyes on your case. It may be a red flag if your surgeon is unhappy about it.

Why Didn’t My Surgeon Suggest Surgery First?

There could be many reasons for this. First, your overall health should be as good as possible before your surgery. OHOW has an outstanding and dedicated team of medical providers that will assist you with this. Second, your insurance company might require you to try some nonoperative treatment prior to approving a knee replacement surgery. Most commonly, it is required for patients to try acetaminophen or anti-inflammatory (e.g. ibuprofen, naproxen, etc.) pain medicine, first. Muscle-strengthening exercises and physical therapy are also recommended. The therapists at OHOW see a high-volume of patients with knee arthritis and are very skilled at treating it. Depending on the degree of your arthritis, your surgeon may encourage—or discourage—certain exercises or therapies.

 Adjusting your lifestyle to avoid painful activities is one of the simplest treatments, but understandably difficult as that activity may be a big part of your life. Work with your surgeon to see if the type of activity you want to do is possible after a knee replacement. Most surgeons recommend activities that may prolong the life of your knee, like elliptical, bicycling, swimming, or brisk walking/hiking. If you are overweight with a BMI of 40 or more (calculate your own BMI here!), your surgeon will likely recommend weight loss before a knee replacement. It is well known that patients with high BMIs are a higher risk for surgical infections and complications. Don’t underestimate the power of a little weight loss by simply eating less, and healthier. After all, your knee can see up to seven times your body weight with certain activities, so just five pounds of weight loss could mean 35 pounds less stress for your knee.

Do Injections Work?

Cortisone type (corticosteroid) injections have a long track record of providing at least some temporary relief for knee arthritis. Many patients experience somewhere between two and six months of relief with a good result. Often, these injections help a recent worsening of symptoms calm down. It might allow patients to be comfortable enough to perform light exercise and some muscle strengthening, which can result in even longer-lasting pain relief. Hyaluronic acid, which is a gel-type lubricant, might also be useful in certain situations. However, hyaluronic acid injections are more expensive and more difficult for insurance plans to approve since research shows inconsistent results. However, when it does work, it seems to last for a longer period than a typical cortisone-type injection. 

Stem cell injections or biologics have been very closely looked at by the American Academy of Orthopaedic Surgeons (AAOS); they have recommended against their use except for within the setting of research and clinical trials. According to an official AAOS statement, “While gaining in popularity, and providing relief for some patients, biologic treatments may lack the demonstrated safety and efficacy of many traditional orthopedic therapeutics.”  There has been a significant amount of false advertising related to stem cells. They are not regulated by the FDA, and some clinics have been found to mishandle the cells, causing disastrous infections. 

I’ve Tried Everything. Now What?

If your x-rays show moderate or severe arthritis, and your surgeon has discussed the procedure, its risks, recovery, and rehab process with you, then you may be ready!  Keep in mind that at OHOW you will receive one-on-one education from a nurse practitioner, nurse educator, and a physical therapist prior to your surgery. So, if you walk out of your surgeon’s office and have forgotten to ask a few questions, write them down and see if they are answered at the OHOW comprehensive educational visit. If you still have questions, feel free to call your surgeon and discuss further. You should be very comfortable with your decision and have a full understanding of what you are about to undertake. Don’t be shy about it!

What If Surgery is My Only Option?

Even after mentioning all the options above, there are certain times when a surgeon will guide a patient towards knee replacement sooner rather than later. If that is the case, the surgeon likely believes that the patient may be doing more harm than necessary by delaying a knee replacement. For example, some patients with bone-on-bone arthritis may have little chance of symptom improvement. If their arthritis worsens, and their knee motion continues to decline or causes a significant knee deformity, it might make the recovery of motion after a total knee replacement more difficult. Another example might be a patient who is experiencing pain even while sitting and resting or one who frequently wakes up at night, or can’t sleep due to the knee pain. These things can cause considerable stress on patients’ day-to-day lives, and if other nonoperative treatments have failed, then knee replacement might be the best option. Also, keep in mind that knee replacements are sometimes recommended for diagnoses other than arthritis. For example, avascular necrosis, certain fractures, or significant cartilage injuries might harm your knee enough to need a knee replacement.

As you can see, the right timing for a knee replacement is a very individual choice. It requires an open and strong two-way relationship and discussion with your surgeon. Your surgeon should educate you on your options and give you an idea of how successful those may be. X-rays are important, but they never tell the whole story. Your lifestyle and goals play a huge role as well. So, whether you’re ready for a replacement right now, or you hope you are years away, contact an OHOW specialist at 414-961-6880 to discuss the entire spectrum of treatment.