When to Get a Knee Replacement

The question of whether or not someone should undergo any surgery is always a very serious decision.  I frequently consult patients with degenerative / arthritic knees about whether they should try to manage their symptoms with Physical Therapy and medication or take the plunge and get a knee replacement.

Here are some of the criteria that I would consider significant enough to warrant a knee replacement:

1) your pain is present at all times while on your feet and your walking tolerance is less than 1/4 to 1/2 mile.
2) your knee range of motion is limited so your function is significantly affected.  This could mean that your knee is locked in flexion (does not fully straighten) and you cannot walk normally.   Or your knee cannot bend sufficiently to allow you to sit down normally.  The problem here is that either of these restrictions will lead to compensations and degeneration of other related joints (hips and low back).
3) you develop the compensations mentioned before (opposite knee, hip, or low back pain)
4) you are unable to tolerate participating in your preferred activities (golf, skiing, tennis, etc.) due to your knee pain.
5) your health starts to decline in other ways due to inactivity related to your knee pain (increase in body weight, increase in blood pressure / cholesterol, poor control of blood sugar). If you wait too long, doctor’s will be hesitant to operate.

Here are some of the reasons I would consider avoiding or delaying a knee replacement:

1) fragile medical condition where at least one of the doctors you interview is hesitant about performing the procedure
2) younger age (<60 years old).  We don’t know how long the hardware is going to last these days, expect at least 20 years with normal activity.

What you can expect if you decide to undergo a knee replacement.

>Rehab begins in the hospital either the same or next day when a PT will get you up and walking on your new knee and begin working on bending your knee
>You may have a continuous passive motion machine that will work on bending and straightening your knee
>You will be in pain that will be managed with medication
>You will either go home or spend 1-2 weeks in a rehab facility (possibly more if you live by yourself)
>A short period of home physical therapy or you will transition straight into outpatient physical therapy (where you should come see me)
>Continued pain as you will be working on bending your knee and making sure it gets completely straight
>A battle for 3-4 months to make sure you maintain your gains in motion (this gets better as each day goes on).  Most people have nearly their full motion in 6-8 weeks, but the body is still trying to reverse that progress by laying down scar tissue every night – you have to maintain your gains for awhile.
>Somewhere around 2-4 months after surgery, you are feeling much better than before surgery and your PT is probably wrapping up.  About 6 months later, you can’t believe you waited so long.  You are doing more than you did prior to surgery (if your rehab is done well).

Doctors are doing a great job with these surgeries.  Most people shouldn’t fear the surgery as the procedure and the hardware has made continual improvements.

Feel free to contact me if you would like to discuss your personal situation.  I always think it’s good to try PT first, but if your knee is too degenerative, there is only so much that PT can do to help.