How Do You Know If You Need a Knee Replacement?
For people with serious injuries or arthritis, a knee replacement can be a life-changing procedure that restores mobility and independence — but it's not the first line of defense.
“In the beginning stages of knee arthritis, you can usually control your symptoms with conservative treatments like physical therapy, pain medication, and anti-inflammatory drugs. When those methods fail, joint replacement surgery is an option,” explains Adam Olsen, MD, a Mass General Brigham orthopedic surgeon. “Surgery removes and replaces all or part of a joint that is damaged from certain conditions or injuries. Hips and knees are the most commonly replaced joints.”
How bad does a knee have to be before it needs to be replaced? And why not get one immediately, if you have a condition that can be treated with one? Dr. Olsen, who cares for patients at Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital, describes certain signs that can suggest knee replacement may be necessary.
What is knee replacement?
A knee replacement is typically outpatient surgery, meaning you go home from the hospital the same day you have it. Most patients have the surgery to treat severe arthritis (especially knee osteoarthritis), and knee replacement is one of the most successful surgical procedures in modern medicine.
“Most patients go home the day of surgery, regardless of age,” says Dr. Olsen. “For those who qualify, outpatient surgery can offer decreased risk of infection, faster recovery, and less need for pain medicine.”
When do you need a knee replacement?
If you're experiencing the following symptoms, it may be the right time to consider surgically replacing your knee joint.
You're in pain most of the time.
In the beginning stages of arthritis, you may have mild pains that come and go. When your joint pain is severe and doesn't stop, a knee replacement can provide better relief than most other options.
You can't perform activities you love.
When arthritis prevents you from engaging in activities you used to enjoy, such as golfing or working out with friends, playing with your grandchildren, or hiking with your dog, it may be time to consider a knee replacement.
You make decisions based on your condition.
Knee arthritis that makes daily life difficult and affects your schedule needs to be treated by an orthopedic specialist. Do you plan outings based on how far you'll need to walk? Do you try to avoid going places that will require you to climb too many stairs? If you plan your days and activities around what you can do without discomfort and other ways to relieve knee arthritis pain haven’t worked, a knee replacement can help you regain your freedom.
You're not as independent as you'd like to be.
Progressive arthritis can make it difficult to perform everyday activities like sitting down and getting up without assistance, or even getting dressed in the morning. If you're beginning to struggle with routine activities that used to be easy, it may be time to talk to your doctor about a knee replacement.
Conservative treatments aren't working anymore.
Conservative methods like physical therapy and medication are preferable to a knee replacement for as long as they’re effective. Modern implants last a long time — often in excess of 15 or 20 years — but it's still a good idea to avoid getting a knee replacement too early in life, to minimize the chance of needing a second surgery (called a revision) to adjust or repair it.
However, as your arthritis progresses, conservative methods may prove to be less effective and you'll experience symptoms with greater frequency and intensity. When medications and other conservative treatments can no longer relieve your symptoms, it's an indication to explore knee replacement surgery.
What people wish they knew before knee replacement surgery
Everyone is different, with different experiences of arthritis pain and different recovery journeys, so there's no way to know for certain how you’ll feel about your knee replacement surgery in the weeks and months following the procedure. However, knee replacement surgical success is very high, with up to 87% of patients reporting satisfaction with the results. Some studies show that dissatisfaction is often the result of unsatisfied expectations from the patient, so talking with your doctor to get a realistic idea of what to expect after the surgery is crucial.
“You’ll start your recovery with prehab — a detailed education program before surgery that makes sure you know what to expect from the procedure and recovery,” adds Dr. Olsen.
Remember that a knee replacement isn't a cure-all. After the procedure, you may still experience occasional discomfort. You may also still need to limit certain activities, like high-impact and contact sports.
FAQs about when a knee replacement is needed
What happens if I wait too long to get a knee replacement?
Timing is important with knee replacement surgery. Getting the surgery too early raises your risk of outliving the new knee and eventually requiring revision surgery, but waiting too long has complications. As your arthritis progresses, it can cause permanent limitations, such as an inability to fully extend the leg, that may persist even after your surgery. Other possible complications include deformities of the lower limbs, such as bowlegs.
The longer you wait and the less active you are, the harder it will be to regain mobility and strength after the operation.
When you start to experience signs and symptoms of knee arthritis, it is important to consult with your doctor.
What is the average age for knee replacement?
The average age for knee replacement surgery patients is 67 years old, but younger patients can experience arthritis pain and may become candidates for joint replacement surgery before they reach their sixties.
What is the hardest knee surgery to recover from?
Total joint replacements, like knee replacement surgery, are among the most time-intensive orthopedic surgeries to recover from. Full recovery can take up to a year. Dr. Olsen notes that you also may need formal physical therapy to improve your recovery after you leave the hospital.
What is the hardest day after knee replacement?
The first week after surgery is usually the most difficult, marked by high levels of pain and swelling. As you do physical therapy and gradually return to activity, residual pain and swelling from the surgery will decrease, and you'll feel better. Full recovery can take 6 months to a year.
