Research will tell us that up to 1/3 of knee replacements performed in the United States were not needed. Most decisions by a surgeon to recommend a knee replacement are based on what the knee looks like on x-Ray. Joint space narrowing, bone spurs, or the dreaded "bone-on-bone" diagnosis will lead the recommendation of having a knee replaced. Although this can work for some individuals, the decision of whether or not to have a knee replacement should be based on more than just what the knee looks like on X-Ray.
With any type of knee pain, even if you have been diagnosed as having arthritis, the first step should be the most conservative. In most cases this involves having a good episode of treatment that not only helps manage your pain, but also attempts to get you exercising in a way that you can tolerate. There is good evidence to show that this type of treatment can help many people-even if they have arthritis. I wrote about this here:
These programs may include strengthening, flexibility, balance, aerobic, and water exercises. Most importantly though, they need to include education on what to expect, how much pain is ok, how long it will take to notice improvement, and how to progress or regress your program.
For someone with knee pain that comes and goes and does not limit their activity very much, I never recommend that they have a knee replacement-no matter what their X-Rays show. After a knee replacement it is not uncommon to still have some periodic pain and to be limited in some activities, so really there would not be much improvement for this person after the major surgery and extended recovery time. Conservative management would be best for this person and should be done before surgery is considered.
At ProMotion, we really try to help people avoid surgery but every now and then, surgery may be the best option. For individuals who experience very high pain levels, have minimal periods when they do not have pain, are very limited in their activities, and have not been able to progress with conservative care, surgery likely will help them. There are some very good surgeons here in Green Bay that do a great job with knee replacements, and I will refer people to one of these surgeons when needed and work with the patients after their surgery to help them get back to doing the things they want to do.
Having a knee replacement is a big surgery that has risks and requires an extended period of recovery and a lot of hard work. Hopefully, this article will help you or someone you know, make a better decision on when they should or should not consider having a knee replacement. If you have questions, feel free to reach out to me.
Thanks fo reading,