When Is It Time For A Knee Replacement?

Over the past few weeks, I have been working with some people after they have had a total knee replacement as well as some people who were told they needed one, but are doing very well without having the surgery. The question I get asked from the group that so far have not had surgery is "When do I need to have it replaced?"

In this Blog, I would like to discuss some things that might help you know when you should, and maybe more importantly, when you shouldn't be considering a knee replacement....

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. 

When considering whether or not to have a knee replacement, the amount of pain, frequency of pain, and the amount a person is limited by their pain, should all be considered with the X-ray findings. I have had many patients who were told they are "bone-on-bone" who have minimal and very intermittent pain episodes, and they are able to still do many of the things they want. I have also had people who have X-Rays that do not look that bad, but have a lot of knee pain and limitation. Because of this, basing the decision to have a replacement only on X-Rays is not the best. 

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:
www.promotiongb.com/blog/knee-pain-from-arthritis-exercise-may-be-your-best-option
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,
​Bob
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