Arthroplasty and when it is needed
1. You have bad arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis; rheumatoid arthritis, an autoimmune condition that causes joint pain and damage; or post-injury arthritis. “Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion,” says Nathanael Heckmann, MD, an orthopedic surgeon at Keck Medicine of USC and an assistant professor of clinical orthopedic surgery at the Keck School of Medicine of USC. “When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.”
2. Nonsurgical treatments are no longer effective
If you have arthritis of the knee, you’ll probably start with more conservative measures such as medications, steroid injections or physical therapy to alleviate your symptoms. But at some point, they may not be enough. “Anti-inflammatories, injections and physical therapy are temporary measures to provide pain relief, but they don’t reverse the underlying cause of pain and don’t allow cartilage to regenerate,” Heckmann says. “As time passes, these arthritic conditions tend to progress in severity, rendering these types of treatments less and less effective.” At that point, surgery may be an option.
3. Your pain prevents you from doing normal activities or caring for yourself If you can’t get relief from other treatments, your knee pain may start interfering with your daily life. “In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life,” says Jay Lieberman, MD, chief of orthopedic surgery at Keck Medicine and chair and professor of orthopedic surgery at the Keck School. “If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.”
4. You have severe pain even when resting, and you can’t sleep
According to Lieberman, pain while at rest that isn’t responding to other measures may make you a good candidate as well. “In addition, if you also have consistent pain at night, this can be quite debilitating,” Lieberman says.
5. Your knee is always swollen
Swelling is another sign your knee is not responding to other treatments. “A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray,” Lieberman explains. This can make you a candidate for a total knee replacement, he says.
6. Your knee has become deformed
If your arthritis is advanced, it can affect the way you walk, which can also lead to further problems elsewhere in your body. “As arthritis progresses, the knee may become bowed or ‘knock-kneed,’” Heckmann says. “If this type of deformity develops over time, a knee replacement may be indicated.” In addition, people with arthritis may also lose the ability to straighten their knee, according to Heckmann. “If this occurs, you should seek an evaluation with an orthopedic surgeon, as this loss of motion may be permanent, even after the knee has been replaced,” he adds.
7. You’re OK with avoiding certain activities afterward Patients should know what to expect after knee replacement surgery and understand that regular high-impact activities may not be advisable. “Total knee replacement is quite successful in enabling patients to return to an active lifestyle — patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf,” Lieberman says. “In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear of the prosthesis.”
8. You’re of a certain age
Knee replacement is generally done in older people over 60, in part because younger people’s more active lifestyles may put too much
stress on the artificial knee, causing it not to last as long; second replacement surgeries may not be as successful. But, knee replacements can be performed in people of all ages depending on your individual case, so discuss with your doctor whether you’re a good candidate.