When is it Time to Consider Knee Replacement Surgery?

The decision on when to get knee replacement surgery is a topic many Americans struggle with. In 2020, Northwestern Medicine published a study that found 90 percent of people waited too long to fix their knee with joint replacement surgery, and 25 percent of people who had it done did so prematurely.

Recognizing the right time to pursue knee replacement surgery involves understanding the impact of chronic knee pain on your quality of life and mobility. Gerardo Myrin, M.D., a board-certified, fellowship-trained orthopedic surgeon with INTEGRIS Health Baptist Medical Center in Oklahoma City, says “Every patient is different. Your orthopedic team will confirm how much arthritis you have, what are the best treatment options are for your stage of symptoms and discuss the risk and benefits of each.”

Why do people put off knee replacement?

The idea of having an artificial joint placed in your knee can be a tall mental hurdle for many people. Whether it’s the removal of damaged bone and cartilage, the joint replacement itself or the long recovery time, many people kick the tires down the road and put off surgery until it’s absolutely necessary.

Fear of surgery

While knee replacement surgery is one of the more common orthopedic surgeries (about 790,000 each year, according to the American College of Rheumatology), the procedure itself is still labor intensive.

For starters, the incision needed to access the knee can range from 4 to 6 inches (for a minimally invasive approach) to 8 to 11 inches (for a traditional open approach). Once the orthopedic surgeon makes the incision, they remove damaged cartilage and bone within the knee joint. Then they insert an artificial joint made of metal alloys, plastics and polymers. From start to finish, the surgery takes one to two hours.

Knowing how involved the surgery is, many people will put off knee replacement to avoid going under the knife. Some people also have surgery anxiety due to the potential risks and complications. All surgical procedures come with an increased chance of side effects, including blood clots, infections or nerve damage. Others also deal with anxiety about receiving general anesthesia.

Recovery process

A full recovery from knee replacement surgery can take up to a year, which can make patients second guess their decision. The rehab process itself involves many steps and hurdles to resume normal, everyday activities.

Although most knee replacements are outpatient procedures, knee discomfort (stiffness and soreness) typically lasts about six weeks and possibly up to three months for some people. Following surgery, rehab typically begins a week after surgery and can occur several times a week for about 12 weeks. Patients can resume most activities in six months, but they may not feel 100 percent for a year.

The recovery process can also be a hindrance for those with external factors such as caring for family members or concerns about how the knee replacement will impact their health.

Uncertain outcomes

Most, but not all, people have successful outcomes following knee replacement surgery and they’re able to live a pain-free life. However, there are some people who experience poor outcomes. Sometimes, implants fail in about 5 to 10 percent of patients and others may still suffer from pain even with a successful implantation.

People who question the effectiveness of knee replacement are more likely to hold off on the procedure.

How do you know if you need a knee replacement?

Your doctor will typically recommend knee replacement surgery if you have advanced end stage joint disease, have tried non-surgical treatment without any success and generally have good overall health. Contact a specialist if you begin to experience significant pain that impacts your daily life.

Signs you need a knee replacement

• Persistent arthritis: Osteoarthritis is a degenerative joint disease that occurs when cartilage wears down and can no longer protect the knees. As this condition worsens, pain, tenderness, stiffness and loss of flexibility occur in the knee. Knee replacement is a common option to relieve arthritis.
• Failed non-surgical treatments: When knee pain begins, your doctor will recommend conservative treatments such as anti-inflammatory medications, physical therapy or steroid injections. If these options no longer provide relief, it usually signals the need for joint replacement surgery.
• Progressive knee pain: Constant knee pain is one thing, but chronic knee pain that progresses over time is a good indicator your knee needs replacement. 
• Lack of mobility: Once stiffness sets in, it becomes increasingly more difficult to bend and flex the knee. A decrease in range of motion makes it harder to perform routine movements such as walking, climbing stairs or bending over.
• Bone-on-bone pain: Without the protective cartilage between bones, you may begin to experience severe pain when the bones rub together. For example, you may start to feel grinding or cracking in the joint.
• Advanced age: The older you get, the more wear and tear your body takes. Most people over the age of 60 with chronic knee pain are good candidates for knee replacement surgery. It’s the most effective form of relief.
• Leg bows in or out: Arthritis in the knees can cause gradual wear and tear and instability that makes the legs bow in or out. Gait instability is a tell-tale sign you need to be consulted about a knee replacement.

“Some of the major reasons to consider surgery is when just basic standing or walking is painful and limited, pain wakes you up at night and/or when the symptoms are affecting physical, mental, emotional, or social health aspects of your life,” Myrin says.

Questions to ask your doctor

It can be overwhelming for many reasons to consider knee replacement surgery. When making a decision about the procedure, be sure to ask your doctor questions about the surgery itself, the recovery timeline and any other fears you may have. They can help alleviate any anxiety you’re having.

• What does the procedure involve? What type of knee replacement approach do you recommend?
• What does the recovery process look like and what is the specific timeline for recovery?
• How will this knee replacement address my current level of pain and limitations in mobility caused by knee arthritis?
• What are the risks and complications of knee replacement surgery, and how do you address them if they occur?
• What alternative treatments are available to consider before knee replacement surgery?
• How long is the knee implant expected to last?
• Are there any long-term restrictions on physical activities following the surgery?
• As it relates to a rehab plan and post-operative care, what are the keys to a successful recovery?
• What if I have anxiety about the surgery itself? Are there resources available to help alleviate my concerns?
• What role does my overall health and any existing medical conditions play in the decision to undergo knee replacement surgery?
• What is the best way to prepare for surgery to maximize outcomes?
• What is your experience with knee replacement surgery and how successful are these surgeries?

Dangers of delaying knee replacement surgery

Postponing or pushing back knee replacement surgery for several months, a year or even longer can have negative consequences. The longer joint damage goes untreated, the harder it becomes to correct symptoms with a knee replacement.

Progression of joint damage: Severe joint damage can lead to bone loss and cartilage deterioration, making it more challenging to successfully perform a surgery due to structural issues.

Poor quality of life: Without any cartilage cushion, bones will continue to rub against each other and produce symptoms that worsen. Chronic pain, swelling and inflammation can significantly decrease your quality of life.

Increased health issues: A lack of mobility due to a debilitating knee condition can create new health problems or make existing conditions even worse. For example, being sedentary can cause weight gain and cardiovascular issues. It can also worsen diabetes or high blood pressure you may already have.

Lack of mobility: Severe knee pain causes a lack of mobility by limiting the range of motion and weight-bearing capacity of the affected leg. This makes it difficult to perform daily activities such as walking, standing and climbing stairs.

Potential complications: Your chances of complications, such as blood clots, stiffness, nerve damage, wound healing and implant failure, increase the longer you wait to undergo replacement surgery.

Dealing with chronic knee pain can significantly impact your mental and physical well-being. If you or a loved one has knee pain that has either become increasingly more problematic or failed non-surgical treatments, contact an orthopedic surgeon for a consultation on joint replacement surgery.