Do I Need a Knee Replacement?

Living with knee pain may significantly impact your quality of life, making simple daily tasks like getting out of bed or walking a major challenge.

Over 53.2 million people in the U.S. experience intense knee pain due to arthritis, which is the leading reason for knee replacement surgery.

As an orthopedic surgeon, my patients often ask me, “Is replacement my only option?” or “How do I know if I even need a replacement?”

So, in this article, I’ll explain who should consider surgery, how to know which choice is right for you and alternative options.

About Knee Replacements

Knee replacement surgery, also known as arthroplasty, removes the damaged part of your knee joint. After that, your joint is replaced with an artificial one made of plastic or metal. 

The surgery can significantly reduce pain and improve movement, making it ideal for those with severe knee injuries or arthritis.

Who Should Get a Knee Replacement?

Here are some conditions that may require knee replacement:

• Osteoarthritis (OA): Caused by cartilage wear and tear, leading to pain, stiffness, and swelling. It’s the most common reason for knee replacement.
• Rheumatoid arthritis: An autoimmune condition that causes joint swelling, stiffness, and knee pain.
• Traumatic arthritis: Results from injury that damages the knee’s cartilage.
• “Bone-on-bone” arthritis: A severe form of OA where cartilage is almost gone, causing bones to rub together which leads to intense pain.

Other conditions that may lead to knee replacement include:

• Knee deformity
• Gout
• Hemophilia

How Do I Know if I Need a Knee Replacement?

Many of my patients believe that their knee pain will improve on its own. But, delaying treatment, especially surgery, may worsen the condition. 

So, when do you need a knee replacement? The answer depends on these three factors:

Severity of Your Symptoms

If you’re experiencing any of these symptoms, then surgery might be the next step:

• Persistent and severe knee pain, which doesn’t get better even after taking pain-killers. Or you’re taking a hefty dose of medications that are having a negative impact on your life!
• Swelling and stiffness in your knee joint which make it difficult to bend or straighten your knee.
• Trouble with everyday tasks like getting out of bed, bathing, shopping, or walking.
• Pain that interrupts your sleep and prevents you from enjoying activities like cycling or hiking.
• Knee instability that makes walking difficult and increases the risk of falling.

If you have any of these signs, your orthopedist will use two primary tests to assess the damage to your knee and see if surgery is appropriate for you.

• X-rays to check for cartilage loss in your knee. If the space between your knee bones has narrowed, it could be a sign of osteoarthritis.
• Use the Oxford Knee Score (OKS), a questionnaire used to measure how knee arthritis affects your daily life. The OKS has 12 questions that check your ability to perform everyday tasks and pain severity. Some surgeons use it to determine if knee surgery might be necessary.

Effectiveness of Non-Surgical Options

Before considering surgery, I often suggest to my patients to try non-surgical treatments like:

• Anti-inflammatory or pain-killer medications
• Joint injections
• An MRI to check for cartilage or ligament damage and assess how severe the problem is.
• A knee arthroscopy (camera inserted into your knee joint) to get a clear view of the damage.
• Physical therapy
• Exercises

These offer temporary relief to arthritis patients from pain, swelling, and discomfort. However, they don’t treat the underlying cause of your knee pain, i.e., loss of cartilage. 

As your arthritis becomes more severe, these options may not work well. In such cases, knee replacement surgery might be a better option.

Weighing the Benefits and Risks

This is basically how we weigh the whole decision up. Is a replacement more likely to help you, or make you worse?

Knee replacement is a safe and effective surgery with a relatively minor chance of complications. Any surgery comes with risk, with one large study reporting a major complication rate of 14.4%. However, this could vary based on factors like age (especially for those over 80).

I reassure my patients that while there are risks, they are rare and manageable. Some of the risks the surgery may have include:

• Infection
• Blood clots
• Knee stiffness

The long-term outlook also shows a high success rate. 

The American Academy of Orthopedic Surgeons (AAOS) reports that the vast majority of knee replacements are still successful even after 15 years. In addition to that, a significant number continue to last for at least 25 years.

If you’ve already undergone knee replacement surgery, read about the top mistakes to avoid after the surgery.

Alternative Options for Knee Replacement Surgery

Some of my patients believe that knee replacement surgery is the only option for relieving knee pain. However, non-surgical treatments could be just as effective for the right person.

Medications

• Aspirin, naproxen, or ibuprofen reduce knee inflammation. But, if you’re older or have stomach or kidney problems, you should speak to your physician before taking them!
• Creams like Voltaren gel or lidocaine patches may also ease pain and stiffness.

Braces

Knee braces are used to improve stability, reduce pain, and make it easier for people with osteoarthritis to move. Your orthopedic surgeon may recommend these two types of braces:

• Unloader braces take pressure off the damaged part of the knee.
• Support braces provide overall support and compression.

I often recommend knee braces to my patients, as they improve mobility, reduce pain, and make daily activities easier. And if you’re having trouble with balance, using a walking cane could make a difference.

Physical Therapy

Physical therapy, including muscle-strengthening exercises, can reduce your pain and improve movement. 

In addition to physical therapy, resistance, and land-based exercises are also effective and safe. These exercises help improve the quality of life for osteoarthritis patients.

Moreover, water therapy is another helpful option for knee rehabilitation and strengthening. Studies have shown that water-based therapies can reduce discomfort and improve knee movement.

Low-impact Exercises

Low-impact exercises like swimming, cycling, yoga, and walking may help to:

• Strengthen knee muscles
• Improve flexibility
• Increase fluid flow around the knee to prevent stiffness

Injections Therapy

Injections could help manage early arthritis symptoms, though the relief is temporary. These include: 

• Cortisone injections are involved in reducing swelling and pain for a few months but don’t repair damaged cartilage.
• Gel shots add a lubricating fluid to reduce stiffness and pain and are best for mild to moderate arthritis.
• PRP and stem cells may support the healing of the cartilage.

Genicular Artery Embolization (GAE)

GAE is an FDA-approved procedure that targets the blood vessels causing inflammation in the knee. Studies have reported that after the treatment patients experienced less pain. They also had better knee movement, and an improved ability to perform daily activities. 

Cartilage Regeneration

If you have mild arthritis, your orthopedist might suggest replacing the cartilage. Instead of replacing the entire joint, this could be done using the FDA-approved autologous chondrocyte implantation (ACI) therapy.  

During ACI, your cartilage cells are grown in a lab and then returned to your knee to repair the damage.

Final Verdict

Knee replacement surgery could improve your quality of life, but it’s a decision that should not be taken lightly. I’ve worked with patients who wished they had treatment sooner, as addressing knee problems early on could significantly lead to better outcomes.

Understanding your condition is important. Think about non-surgical treatments, and weigh the benefits and risks to make the best choice for your health.

Don’t let knee pain hold you back. Schedule a consultation with Dr. Pamela Mehta today to discuss your options and take the first step towards a more active, pain-free life.