Knee Replacement Option

Knee Replacement Surgery: When Is This My Best Option?

Knee replacement surgery has become increasingly common over the past 20 years and the rate of knee replacement surgery is expected to increase 673% by 2030 from the rate over the past decade. This increase in surgery has also lead to greater numbers of patients with complications and poor outcomes requiring repeat (revision) surgery, which will also likely increase in the future. How does a patient know when this is the best option for treatment of their knee pain?

Knee replacement (total knee arthroplasty) is a surgery performed for severe arthritis of the knee which has failed conservative treatment. Arthritis can have multiple causes, entails the destruction of the articular cartilage (white smooth covering of the bone ends) and meniscus (shock-absorber type cartilage between the femur and tibia) of the knee, and results in severe pain, stiffness, and dysfunction in its most severe forms. In general, non-surgical treatment options should be exhausted before resorting to knee replacement surgery. These may include anti-inflammatory medications, bracing, physical therapy, cortisone or hyaluronic acid (i.e. Synvisc, etc) injections, walking assistive devices (cane), activity modification, and sometimes lower-level surgeries such as arthroscopic debridement. Many patients experience relief of symptoms with these interventions, and if function improves, extensive surgery is not necessary. Most people with knee arthritis never require knee replacement surgery, and radiographic arthritis (bad looking xrays) are not, in and of themselves, a reason to have this surgery.

However, in appropriately-selected patients, knee replacement is one of the most successful operations available today. For people who are over the age of 50, have severe radiographic arthritis (bone-on-bone), and have tried conservative interventions without relief, knee replacement can be a wonderful option. 95% of patients who meet these criteria have significant improvement in pain and mobility after healing, leading to vastly improved quality of life. Total knee arthroplasty is performed through an incision on the front of the knee, requires division and release of contracted soft tissues, removal of the degenerated bone and cartilage joint surfaces using surgical instruments (precise saws and bone cutting instruments), and resurfacing of the ends of the femur, tibia, and patella (thigh, shin, knee cap bones) with metal implants separated by polyethylene (plastic) spacers. This removes the source of arthritic pain and allows restoration of flexibility and improved function. Recovery usually takes 6-12 months, but most people are better in terms of pain than they were pre-operatively by about 4 weeks after surgery. Rehabilitation after surgery involves aggressive flexibility exercises to improve mobility and avoid recurrent stiffness. While advancements in pain medications used peri-operatively are helpful and can help decrease post-op pain, the surgery cannot be done in a completely pain-free manner. Any advertising to the contrary is simply misleading. Rehab is challenging, but so is living with an arthritic knee, and the results are generally worth the work. Most knee replacements last 15-20 years before needing to be revised (re-replaced), and some of the implants available today have laboratory data indicating 30 year implant survival expectancy. Innovations in implant design occur on a constant basis, but unfortunately this is largely market-driven, and truly impactful changes in design over the past 40 years have been rare. Like other industries, orthopaedic implant manufacturers are financially-motivated to constantly develop new designs and enhance profits. A concerned surgeon should be able to help you sort through data which is scientifically-legitimate from that which is not. The list of failed implant designs over the past 40 years is extensive, but it may take 5-10 years of clinical use before design flaws are detected. In general the use of implants with a long, proven record of success (90% 20-yr survival in clinical series) is wise. While complications are rare, they can be devastating, so your surgeon should be very precise and detail-oriented when evaluating whether this surgery is right for you.

If you have concerns or questions about what options are best for you, we’d be happy to help you get some answers. Please contact my office at the Alabama Orthopaedic Center at 205-271-6503 for your consultation.