WHILE a total knee replacement can ease pain and improve function in individuals who suffer the pain of arthritis with every new day and with every step, sometimes even keeping them up at night — before you consider a knee replacement, understand the pros and cons of the procedure and whether you’re a good candidate for it, says the March 2016 issue of the Cleveland Clinic Men’s Health Advisor.
Perhaps most importantly, you have to prepare yourself physically and mentally for the surgery and have realistic expectations about it, a Cleveland Clinic expert advises.
“The purpose of knee replacement is to improve pain and function, not necessarily to get you back to being an outstanding athlete,” says Carlos Higuera, MD, with Cleveland Clinic’s Department of Orthopedic Surgery.
“Can you get back to that? Sure, but we would be lying to patients if we said that every single one is going to get back to that level.”
Whereas knee replacement used to be considered only after long-term treatment with medications, injections, physical therapy, and other conservative treatments, today, as advances in implants and surgical techniques have led to better operations and shorter recovery times, doctors and their patients are more likely to consider knee replacement earlier.
In fact, a report published in September 2015 by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics shows that the rate of total knee replacements performed in the U.S. doubled from 2000 to 2010, making the operation the most frequently performed inpatient procedure on individuals age 45 and older.
Also, the average age of knee replacements done in men decreased by about three years, to about age 66 — one reason that knee replacements are being done at younger ages is that today’s knee implants are expected to last at least 15 years or more, thus benefiting most patients for the rest of their lives, Dr. Higuera says.
“If you have knee pain that has been getting progressively worse for more than three to six months, if you have pain at night, if you’ve experienced a decrease in activities over that period of time and you’ve already tried some conservative management, then definitely look for advice about surgery,” adds Dr. Higuera.
Age is no barrier to knee replacement — in fact, Dr. Higuera says that some of his 80- to 85-year-old knee-replacement recipients are among his healthiest patients.
Rather, other factors that can determine your candidacy for a total knee replacement include:
• Your overall health — If you’re relatively healthy and active, you might be better off having knee replaced sooner rather than waiting for months or years, Dr. Higuera says.
Conversely, he adds, continuing with conservative management may be the best course of action if you have other medical conditions, such as cardiovascular disease, that makes surgery too risky.
• The extent of your osteoarthritis — If Xrays or other imaging studies show only mild knee arthritis, you’re less likely to gain significant improvement from a knee replacement, Dr. Higuera explains — “Those are the patients I tell to optimize conservative management and probably try to avoid a knee replacement,” he adds.
The health letter offers tips on what to do:
1. Before your knee replacement...
• Ask your doctor if knee replacement is right for you, based on your overall medical condition, symptoms, functional impairment and the extent of your knee arthritis.
• Establish realistic expectations.
Ask your surgeon what activities you can continue to do after knee replacement, as well as any limitations or issues you should expect.
• Talk to your doctor and/or your physical therapist about exercises you can do before surgery to improve your knee’s strength and range of motion, without causing pain.
• Work with your physician to lose weight and reduce strain placed on your knees.
• If you smoke, discuss cessation strategies with your physician — studies have linked smoking to worse outcomes from knee replacement surgery.
• Prepare your living environment.
If you live in a multi-story home, set up a sleeping area on the ground floor — clear paths to the bathroom, kitchen and living area.
Recruit friends and family members to help out around the house.
2. After your knee replacement...
• Commit to the rehab exercises your surgeon and physical therapist recommend in addition to your formal physical therapy.
• To reduce your risk of blood clots after surgery, take any anti-clotting medications exactly as your doctor prescribes them.
• Follow your physician’s advice regarding precautions you may need to take in the weeks after surgery.
• Choose low-impact exercises (walking, hiking, swimming and biking) instead of high-impact activities, such as running, singles tennis or contact sports.
If you ski, avoid moguls and rough terrain that can jar your knee.
Most knee replacement patients are about 90 percent fully recovered in about three months, with the remaining 10 percent improvement occurring over the next year or so, Dr. Higuera explains.
You will be up and walking the day of your surgery and remain in the hospital for one or two days, participating in physical therapy each day.
After you leave the hospital, you will continue with at-home physical therapy, followed by outpatient physical therapy.
Thereafter, your job is to do other exercises that your surgeon and therapist recommend — “What we’ve found is patients who are highly motivated do way better,” says Dr. Higuera.
Typically, golfers can return to the links in about three months — although many can resume chipping and putting sooner.
Dr. Higuera recommends setting realistic expectations for your life afterwards.
He cautions that while a knee replacement can produce dramatic improvements, that doesn’t mean you’ll be free of problems — such as: a) Your new knee might click or make other noises; b) It may swell when the weather changes; and c) you might experience numbness around the area of surgery.
Finally, Dr. Higuera says, “Patients who have a knee replacement are never going to feel like they were in their 20s with a normal knee. It’s not perfect. It’s polyethylene and metal.”
Thus, when sometimes patients may ask, “Why am I having these issues with my knee?”
“Well, you’re having them because you had knee replacement. It’s part of the deal,” concludes Dr. Higuera.