Need a New Knee? 5 Questions To Ask Now

Health Topics Jan 5, 2018

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Walking. Climbing. Bending. Squatting. Kicking. Kneeling. Jumping.

We depend on our knees to do many things, all the while supporting most of our body weight. Over the years, the wear and tear can take a toll, leaving some people in need of a knee replacement.

The number of people needing surgery to replace worn out knees is escalating, due in part to rising weight and obesity rates, as well as the aging baby boomer population. According to the American Academy of Orthopaedic Surgeons (AAOS), the number of total knee replacement surgeries more than tripled between 1993 and 2009. By 2030, AAOS reports, these surgeries are projected to grow by more than 670 percent to 3.5 million procedures per year.

Do you need a new knee? If your knees are starting to fail you, here are five questions you need to ask before considering a replacement.

Still, most patients – regardless of the procedure they undergo – are able to enjoy activities they haven’t been able to in quite some time.

1. Do I Really Need a Knee Replacement?

Generally, candidates for knee replacement experience one or more of the following:

Severe knee pain or stiffness that limits routine activities, including walking, climbing stairs, and getting in and out of chairs
Moderate or severe knee pain while resting, day or night
Chronic knee inflammation and swelling that does not improve with rest or medical treatment
Knee deformity — the knee bows in or out
Failure to improve with nonsurgical treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Dr. Matthew Lawless talks about correcting bowlegged deformity through knee replacement surgery.

Click play to watch the video or read video transcript.

The most common reason for these ailments is osteoarthritis. This is a degenerative disease that affects mostly middle-aged and older adults. It occurs when the cartilage that cushions the bone begins to soften and wear away. The bone itself can start to break down as well.

Rheumatoid arthritis, and arthritis caused by an injury, can also break down the knee joint. Fractures, torn cartilage, or torn ligaments can also cause irreversible damage to the knee joint over time.

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, according to the AAOS, but knee replacements have been performed successfully at all ages.

2. Are There Alternatives To Surgery?

You and your physician may consider nonsurgical treatments at first, including assistive walking devices (canes, walkers and the like), anti-inflammatory medicines, steroid injections, and braces.

But if those aren’t helpful, the next step may be knee replacement surgery.

“It’s common for people to live with the pain for a long time, more out of a reluctance to have anything done,” says Matthew Lawless, MD, an orthopedic surgeon. “But those people are usually the ones that come back and say, ‘I wish I would have done it sooner.’”

3. How Much Of My Knee Will Be Replaced?

There are two types of knee replacements: a “total” knee replacement, and a “partial” knee replacement. Understanding the difference between the two types of replacement surgery can help a patient decide which surgery is right for them, Dr. Lawless says.

In a “total,” all compartments of the knee – the medial and lateral compartments and the kneecap – are replaced. In a “partial,” just one compartment is replaced.

The type of arthritis or disease that led to the knee problems will dictate which surgery is the best option. Those who suffer from anything other than osteoarthritis – such as inflammatory arthritis, rheumatoid arthritis, or gout – will not be able to undergo a partial knee replacement. Usually, surgery to relieve those ailments requires removing all knee components.

Partial knee replacement also means reduced recovery time. The surgery is less invasive, resulting in less discomfort and a quicker recovery than with a total replacement. Patients undergoing partial replacement also can engage in a higher level of activity once recovery is complete.

Still, most patients – regardless of the procedure they undergo – are able to enjoy activities they haven’t been able to in quite some time, including simple things such as walking up the stairs without any pain, according to Dr. Lawless.

Dr. Matthew Lawless explains how long knee replacements last.

Click play to watch the video or read video transcript.

4. What’s the Surgery Like?

During knee replacement surgery, the damaged bone and cartilage of the knee are removed. Next, the orthopedic surgeon will put the new artificial knee (whole or partial) in place. It is usually cemented in place with a type of grout. In other cases, it may be attached to the bone with a fine mesh of holes on the surface, which allows the bone to grow into the mesh and attach naturally to the replacement.

Although each procedure varies, surgery to replace a knee usually lasts about two hours. During surgery, the patient may be under general anesthesia or awake with spinal or epidural anesthesia.

5. How Long Before I’m Ready to Resume My Life?

Knee replacement surgeries are typically very successful, Dr. Lawless says. While in the hospital, the patient begins physical therapy exercises to begin regaining range of motion in the knee. Once the patient goes home, physical therapy will continue, and pain medicine may be prescribed. The incision will have stitches or staples that will be evaluated after a few weeks.

Several factors determine how long your joint replacement will last, including age, activity level, and weight. On average, most joint replacements last 10 to 20 years. It’s not unlikely that some people will need to have their knee replaced more than once in their lifetime.

Think you might be a candidate for knee replacement? Talk to your health care provider. With the right treatment, you could soon be enjoying your daily activities again, pain-free.