The answer is not found in an X-ray, but in how much that bum knee affects your quality of life
As an orthopedic surgeon who specializes in knees, the number one question that I get is, “When do I know when I need to have my knee replaced?” The answer is pretty straightforward, it really doesn’t matter how bad the knee looks on an X-ray but is all about the patient’s quality of life and how it is being affected by the knee.
Some people have horrible looking knees in an X-ray but are functioning quite well and don’t need surgery. But I see others whose knees are moderately arthritic, and they are not doing well getting around. These patients often are great candidates for a knee replacement.
Most people come to the conclusion that they are ready to have a knee replacement due to knee pain. They find themselves avoiding things and not doing activities they really enjoy like hiking, playing golf and traveling. I constantly see people who want to continue doing the activities they enjoy but they find that if they do, they pay such a price in terms of pain and swelling in the knee that it is not worth it.
When someone gets to that point they hit a brick wall and say, “My knee is drastically affecting my quality of life.” That is when they need to do something, and I tell them they are ready for knee replacement surgery.
The most common cause of chronic knee pain is osteoarthritis, rheumatoid arthritis or post-traumatic arthritis. Symptoms that can accompany knee pain include:
- Warm to the touch.
- Weakness or instability.
- Crunching or popping noises.
- Inability to fully straighten the knee.
Options to try before surgery
Prior to a total knee replacement surgery, it is important for a patient to have tried alternative treatment options. This could include physical therapy, braces, medication or injections. Injections offered at MOS for knee pain include corticosteroids, platelet rich plasma, stem cells, hyaluronic acid and lipogems.
Another recommendation from a doctor prior to surgery could include the patient losing weight. This can often improve knee pain and eliminate the need for surgery.
Factors to consider before a knee replacement surgery
Many people think that age plays a large role in whether or not a patient should get a surgery. But that is not the case. Instead, the doctor will look at the patient’s physical health and preexisting medical conditions. As a doctor I want to make sure that my patients can do the postoperative physical therapy that is necessary to have a full recovery.
Having the right mindset is the other thing that is important prior to surgery. A patient must know that it is not an easy surgery to recover from and will need discipline and willpower to do the work necessary to make the surgery a success.
It is also important that you see a good orthopedic surgeon who can perform a good replacement surgery. Having the good basic framework of a properly implanted knee will allow a patient to feed off of a successful surgery and use that as a platform to continue the physical therapy work necessary to get to the point where he or she can say, “It seems like a natural part of me again.”
The importance of post-surgery care for a knee replacement
What I emphasize to people is that the operation to replace the knee is just the first step in recovery. Postoperative rehabilitation is just as critical as the surgical procedure.
People often think that once they are done with four to six weeks of physical therapy that they will be great and get back to participating in activities they love. I make it clear to my patients that is not the case. It can take up to a year of diligent work to rebuild muscle mass, get stamina back, and improve coordination and balance.
I tell people that even if they have never been a gym rat, they should consider joining a gym for at least six months after finishing formal physical therapy. During this time a patient should continue a workout program to maximize the potential of reaching that point where he or she can say, “My knee now allows me to do all the things that I couldn’t do before.”
Prevalence and types of total knee replacements
The number of people living with a total knee replacement is growing. A 2015 study that looked into the prevalence of total knee replacements in the United States found more than 1 in 10 Americans will have a total knee replacement by the time they reach 80 years old.
Knee replacement surgeries are helping the older population stay mobile despite severe arthritis or trauma. This is something that would have not been possible prior to the new technologies that have advanced the process for a knee replacement surgery.
At MOS our preferred knee replacement method is a minimally invasive total knee replacement. This type of surgery is completed through a 4- to 6-inch incision instead of the larger incision used for a traditional open total knee replacement surgery. Another benefit of this option is that it spares or minimally cuts the quadriceps muscles and tendon. This leads to a less painful and faster recovery.
As an orthopedic surgeon who specializes in knees, I complete 350 to 400 knee replacement surgeries a year. This helps me be confident that I am giving my patients the care they need to return to the quality of life that allows them to enjoy the activities they loved prior to experiencing knee pain.