Advantages and Disadvantages of Knee Replacement Surgery
Many people need knee replacement surgery at some point in their lives, whether due to arthritis or injury. Knee replacements can greatly improve quality of life, but they also have potential disadvantages and some risks. Your doctor can help you decide when knee replacement is a better option for treating your knee pain than conservative treatments.
Adam Olsen, MD, a Mass General Brigham orthopedic surgeon who cares for patients at Brigham and Women’s Faulkner Hospital, explains the pros and cons of knee replacement surgery and how to decide whether or not the surgery may be right for you.
What is a knee replacement?
A knee replacement surgery relieves the pain and other symptoms associated with damage to the bone and cartilage of the knee. Your surgeon removes the damaged parts of the knee and replaces them with implanted components made from metal and plastic, also known as prosthetics.
Pros and cons of knee replacement
Knee replacement can be life-changing for people living with chronic pain or other limitations, but it isn't right for everyone. Before you consider knee replacement, carefully evaluate the pros and cons of the surgery.
Knee replacement surgery: Advantages
Knee replacement surgery can give you a new lease on life. People who undergo knee replacement surgery typically experience:
Pain relief: Chronic pain, such as osteoarthritis pain, is the number one reason people have a knee replacement. Following surgery, most people experience a huge reduction in chronic knee pain, and some may no longer have knee pain at all.
Improved mobility: Arthritic or damaged knees often severely limit mobility. Getting a knee replacement can restore your range of motion and allow you to move better.
Greater independence: Knee problems such as chronic pain and stiffness can make it hard to perform daily tasks. Many people with severe arthritis have trouble climbing stairs or simply walking. A knee replacement can give you greater independence by enabling you to easily and painlessly perform daily tasks again.
Maintain activities you enjoy: It's common for knee problems to cause people to avoid activities they once enjoyed, such as cycling, walking, swimming, and other low-impact sports. A knee replacement would remove a barrier between you and the activities you enjoy.
Better quality of life: Most people who have knee replacement surgery report satisfaction with the results.
Knee replacement surgery: Disadvantages
Despite its many benefits, knee replacement surgery comes with disadvantages. These include:
Healing time: It can take up to a year to completely heal from your knee replacement surgery. During that time, you'll gradually return to activity, but you'll be limited in what you can do until you fully recover. “You may also need formal physical therapy to improve your recovery after you leave the hospital,” adds Dr. Olsen.
Cost: Knee replacement surgery is expensive. Depending on factors like the implant you need, the facility where the operation is performed, and your insurance, you may still have to pay a significant amount out of pocket.
Surgery complications: Knee replacement is an established, routine procedure with a very high success rate. However, no surgery is without risks (such as infection, blood clots, and collateral damage to nearby issues). Serious complications occur in less than 2% of knee replacement surgeries.
Not permanent: A knee replacement surgery doesn't last forever. Knee prosthetics last a long time — often 15 years or more — but you may eventually need to have your implant adjusted or replaced in a later “revision” surgery.
Not your original knee: A knee replacement can greatly improve your overall quality of life, but it won't feel exactly the same as your old knee, and you may still face limitations on your activities. For instance, you may be unable to practice high-impact activities like running or contact sports even after your knee replacement.
Types of knee replacement
Not all knee replacement surgeries are the same. The type of operation you get has pros and cons, too.
Pros and cons of partial knee replacement
The knee has three basic parts that can be replaced:
The medial compartment (the interior part toward the other leg)
The lateral compartment (the outside part)
The patellofemoral compartment (the central part below your kneecap)
In a partial knee replacement, the surgeon only replaces one or two of the compartments, usually because only a part of the knee is damaged. Partial knee replacements are more common in younger patients who have damaged their knees through an injury, rather than a progressive condition like arthritis.
Advantages of partial knee replacement: Partial knee replacements are less invasive and have shorter recovery times.
Disadvantages of partial knee replacement: The primary downside of a partial replacement is that you may need more surgery later if the unreplaced portions need to be replaced in the future.
Pros and cons of total knee replacement
In a total knee replacement, all three knee compartments are replaced.
Advantages of full knee replacement: Because the surgeon replaces all three compartments, you’re less likely to need a follow-up procedure in the near future, compared to a partial knee replacement.
Disadvantages of full knee replacement: A full replacement is more invasive and often involves a longer, more complicated recovery than a partial knee replacement.
Double knee replacement
A double or bilateral knee replacement is when the surgeon replaces both knees in a single surgery. While this is less common, your surgeon may recommend it if replacing both knees at once would help your recovery.
Double knee replacements have similar pros and cons to individual knee surgeries, depending on whether you're getting partial or total replacements. In addition, there are some pros and cons unique to bilateral knee replacement:
Advantages of double knee replacement: If you need to have both knees replaced, getting the operations together can reduce your overall recovery time, since both knees are recovering at once. That means less time missing work, sports, and other activities. For example, if you replace one knee, you may need to take 4 to 6 weeks off work. If you then replace the other knee, you'll need to take another 4 to 6 weeks off. Performing the operations together means you may only miss work once.
Disadvantages of double knee replacement: The recovery process is more complicated for a bilateral knee replacement. For instance, it will take longer before you can walk independently since both legs are recovering. A double knee replacement is also more expensive than a single replacement.
Robotic knee replacement
A robotic knee replacement uses special robotic equipment to assist the surgeon — it doesn't mean you'll get a robotic knee.
Advantages of robotic knee replacement surgery: Robotic surgery has benefits for certain patients. Your surgeon may recommend it based on your specific anatomy and surgical history.
Disadvantages of robotic knee replacement surgery: Robotic surgery requires special training and practice. Not all surgeons and hospitals offer it, so it may not be available where you are. It's also more expensive than traditional surgery.
Is knee replacement worth it?
Patients generally report high satisfaction rates after a knee replacement surgery. The procedure can restore mobility, reduce pain, and improve quality of life. However, you should try conservative therapies like pain medication, anti-inflammatory drugs, and physical therapy before you consider surgery.
When is knee replacement necessary?
Knee replacement is necessary when a person suffers from chronic pain and other arthritis symptoms that significantly affect their life and that can't be managed effectively with conservative treatments.
Learn more about the signs you need a knee replacement.
Do knee replacements work?
Knee replacement is a well-established surgical treatment that can provide tremendous benefits to patients with damaged knees. They last a long time and allow most patients to return to many activities they couldn't pursue without the replacement.
“The important thing is to get you back to doing the things you love — pain free,” says Dr. Olsen. “And both outpatient and inpatient knee replacement can do just that.”
Is knee replacement a same-day surgery?
Most knee replacements are outpatient surgeries, where the patient goes home the same day of their procedure. “Rapid recovery outpatient surgery can offer decreased risk of infection, a quicker recovery, and less need for pain medicine,” says Dr. Olsen.
The truth about knee replacement surgery
For many people, knee replacement is hugely beneficial and puts them back in control of their lives. However, studies show that when people are dissatisfied with the results of their knee replacement surgery, one of the biggest reasons is because of unmet expectations.
Dr. Olsen notes that setting realistic expectations before your operation is vital. “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.”
Talk to your doctor about what you can expect and what limitations you're likely to face after the operation. Be realistic about what will be possible. Keep in mind:
A knee replacement isn't a cure for a progressive disease.
Some patients who get a knee replacement still have some knee pain afterward.
You need to be committed to the recovery and physical therapy process to get the best results.
Knee replacements don't last forever. You may eventually need to have more surgery (called "revision”) to make adjustments or repairs to the prosthetic knee, especially if you have the procedure when you're younger.
FAQs about knee replacement pros and cons
Should I avoid knee replacement?
Knee replacement isn't a first-line treatment. It's a good solution for people who can no longer control their symptoms with other methods. Before you consider knee replacement surgery, you should try conservative treatments like physical therapy and anti-inflammatory drugs.
What is the best age to have a knee replacement?
Most people who get a knee replacement are between the ages of 60 and 80 years old. Younger patients face an increased risk of wearing out the prosthetic and needing additional surgery. On the other hand, older patients tend to recover more slowly, so waiting too long can be a problem. Some studies recommend the early 70s as an optimal time to get the benefits of the operation with minimal risk of needing a second, revisional surgery later.
However, the cost-benefit ratio of the operation is more important than age. Doctors and patients should consider factors like how much pain the patient experiences, how their condition limits their activities, and how risky a surgery would be based on the patient's health and medical history.
What happens if you wait too long for knee replacement?
Waiting too long for a knee replacement can cause your knees to further deteriorate, leading to more pain and further limiting your activity and mobility.
Also, as you get older, surgery becomes riskier, and recovery takes longer. Delaying your operation too long can increase the risk of complications and make it harder to return to normal activities after the operation.
Are you ever the same after a knee replacement?
A knee replacement can give you a lot of independence and improve your quality of life, but it won't be the same as having a healthy knee in good condition. You'll need to be careful about high-impact sports and may still have knee pain even after your knee replacement.
How many years does a knee replacement last?
Modern knee replacements last a long time. Studies show that in as much as 98% of patients, the implant is still working 20 years after the operation.
