When is it time for a knee replacement?
March 25, 2021
For even the most active adults, knee aches and pains are a common affliction. Often associated with wear-and-tear – from physical labor, playing high-impact sports, or living a long and happy life – knee pain is commonly caused by osteoarthritis, a degenerative condition that causes inflammation and breakdown of cartilage attached to the bones in your joints.
Osteoarthritis pain can make everyday tasks such as climbing stairs or walking to get the mail difficult. Over time, the negative effects of persistent knee pain on your quality of life causes many patients – some as young as their 40s – to consider knee replacement surgery.
The American Academy of Orthopaedic Surgeons calls total knee replacement "one of the most successful procedures in all of medicine." It is an elective surgery, and a 2018 study showed that most patients are satisfied with their results six and 12 months after surgery, noting significant improvements in pain, physical function, quality of life, and mental health.
However, not every patient with osteoarthritis needs knee replacement surgery – even if X-rays show significant cartilage wear in the knee. We sometimes see patients with arthritic knees who have relatively mild pain, while others may have debilitating symptoms. The key is matching the right treatment options to each individual patient.
Arthritis symptoms tend to worsen over time, so if persistent pain keeps you from enjoying your favorite activities, it might be time to talk with your doctor about treatment options. At UT Southwestern Frisco, patients can get comprehensive care for knee pain – from non-invasive treatments like physical therapy to surgery – all at one location.
Try these treatments to relieve knee pain
Many patients find that using noninvasive treatments and modifying their activities provide enough relief to keep them moving. While these options don't treat the cause of arthritis-related knee pain, they can help keep it at bay and potentially delay or avoid knee replacement.
Before recommending surgery, your doctor will likely recommend trying one or all of these nonsurgical treatment options first:
- Oral medications: Non-steroidal anti-inflammatory drugs (NSAIDs) – sold over the counter as Advil, Motrin, and generics – can effectively control mild to moderate osteoarthritis pain. However, NSAIDs may not be safe for patients who take blood thinners or have kidney disease, and they can increase the risk of heart attack, heart failure or stroke.
- Physical therapy: Participating in physical therapy can help strengthen the muscles around the knee. This helps provide better support to the arthritic joint, which can help reduce pain.
- Knee bracing: A knee brace can support and help stabilize the knee.
- Injections: Injections can be used every few months to help relieve pain from arthritis. Common types of injections include steroid injections, which reduce inflammation in the knee, and gel injections, which help lubricate the joint.
If you have tried everything and knee pain still interferes with your quality of life, it might be time to discuss knee replacement.
3 signs you’re ready for a knee replacement
What pushes us toward the option of surgery is asking you the question, is your knee pain keeping you from doing what you need or want to do? If your answer is yes, here are three scenarios when we might recommend surgery:
- Alternative treatments have stopped working: There are four general treatments to try before surgery, which we listed above, but if these are no longer helping reduce pain, surgery might be the next step.
- You lose range of motion: As arthritis progresses, it is accompanied by more osteophytes, commonly known as bone spurs. Osteophytes can stiffen the knee, resulting in decreased range of motion. When this happens, knee function can be significantly affected, and it may be time for surgery.
- You develop a knee deformity: With severe arthritis, deformity of the knee might occur, causing bowed legs or knock knees. People with this condition may notice that their legs are out of alignment, or their loved ones may tell them that their walking pattern has changed. In reality, it is a severe case of arthritis in the knee.
What to expect from knee replacement surgery
During a knee replacement, the arthritic bone is removed, taking away the source of the pain. We replace it with a prosthesis sized to your unique anatomy.
At UT Southwestern, we use the gold-standard in knee replacement devices that consist of two cobalt-chromium and titanium metal components , one on the end of the femur and another at the top of the tibia. A highly cross-linked polyethylene liner is inserted between the two metal pieces to provide a low-friction surface.
Many surgeons also resurface the patella (kneecap), replacing the arthritis on the patella with a plastic button. This allows the patella to glide smoothly on the rest of the prosthesis as you move.
Patients can safely put their full weight on the knee replacement immediately after surgery. Our goal is to have you up and walking with a walker on the day of surgery, with your physical therapist guiding you. Participating in physical therapy over the next 12 weeks or so will optimize your recovery by gradually improving your knee’s mobility and strength.
Most patients can return to many of their favorite low-impact activities – such as walking, swimming, and riding a stationary bike – within 12 weeks. Talk with your surgeon and physical therapist prior to trying high-impact activities, such as running or lifting heavy weight.
Full recovery from knee replacement can take six months to a year, and depending on your condition, you may not be able to safely return to certain activities that put excess strain on your knee.
Deciding whether to get knee replacement surgery comes down to a question of how much persistent knee pain keeps you from living a full, active life. Our orthopaedic team will work closely with you to explore noninvasive and surgical solutions. Whatever you choose, we’ll help you reclaim the quality of life you deserve.