When Should I Get My Knee Replaced?
For those suffering with arthritic knee pain, there is a common question, “When is it the right time to get my knee replaced?” Arthritis can be extremely painful and limit the things you want and need to do. Joint replacement surgery can be a phenomenal option for improving function and reducing pain, but it is a big step to take especially because of the long recovery period.
It is difficult to make the decision to get your knee replaced, since there are so many variables to consider and likely limited background knowledge on the procedure. A quick google search after a doctor who said you have “bone on bone” is little help when it comes time to actually make the decision.
The goal of this article is to provide some background so you can make an educated decision about when you should seek out a knee replacement or at least a surgical consultation.
Why Wait? Why Not Get Your Knee Replaced ASAP?
Despite what seems like an immediate fix of getting a new knee after surgery, there is a 4-8 month recovery period post-operatively. The length of recovery is due to multiple factors including:
Surrounding tissue healing from the surgery
Your bones healing from the replacement being implanted
Regaining the strength you lost from before surgery or due to surgery
Improving your overall condition to return to things you want and need to do as this healing occurs.
On top of this long-term recovery timeline, you can plan for at least a month of your life being drastically altered. The first 4-6 weeks after a knee replacement tend to be very difficult and limiting, with potentially less than 15 minutes of walking tolerance soon after surgery. While this is not a hard and fast rule and all cases will progress at a different rate (there are many cases where patients will progress very quickly), avoiding increasing swelling after surgery is the most important factor in a speedy recovery. If you have a busy month planned and consistently irritate your new knee, your progression past the initial healing phase will be delayed.
These factors should not dissuade you from getting your knee replaced, but should be heavily considered so that you can plan for your surgery. Surgeons frequently explain the post-operative timeline loosely and provide you with benchmarks such as, “It will take about six months to heal” or “you will be up and walking without a cane in three to four weeks.” While these benchmarks are true, they leave out what is required day to day in meeting these milestones and the rehab that is required to make these goals happen. It is important to understand that these milestones do not happen timely without physical therapy and hard work.
Because of this lengthy rehabilitation timeline, it may be in your best interest to exhaust any and all conservative options prior to undergoing surgery. You may be surprised at how much your pain levels decrease and how much more activity you can tolerate after a 6-8 week bout of good physical therapy. Even if PT or other conservative methods do not fully improve your symptoms, they may put you in a stronger and much better position to have a speedy recovery after your knee replacement. It is important to know that your strength going into surgery is directly linked to your pain levels and how quickly you progress after surgery.
What are the Best Non-operative Options for My Knee?
Even if you have the worst case of bone-on-bone arthritis, conservative options can still make a huge difference in knee arthritis pain and improve your ability to do daily activities. This is tough to imagine considering physical therapy or injections cannot truly change the arthritis in the joint, but they are surprisingly effective in about 70% of cases according to research (Skou et al. 2019). The three best conservative options that you can consider are:
Strengthening (this is more effective if worked on with a physical therapist)
Weight loss (even as little goes a long way)
Injections
1. Strengthening
The most cutting edge research in knee arthritis has found that you can make significant reductions in knee pain with even a slight increase in quadriceps strength. The quadriceps are the muscles that you would use to kick a soccer ball and stop your knee from buckling when you walk down a hill. You don’t have to turn into a powerlifter, but even a little strength improvement can go a long way in reducing your pain. A physical therapist is skilled in making sure this is performed in a safe manner and tailored to you. It is important to know what exercises to add at what point in your rehabilitation to not cause setbacks.
2. Weight Loss
Even as little as eight pounds of weight loss can make a difference in arthritic pain levels. There are many reasons as to why weight loss can help pain but the two main mechanisms are reducing how much work your muscles have to do to offload your joints, and decreasing inflammation associated with increased body fat. Consider talking with a nutrition professional to make changes in your diet that will be most effective for you.
3. Injections
Injections (either cortisone or gel) can be a helpful part of the pain management process. These injections may aid you in moving more normally or allow you to better tolerate strengthening that will be a better long term solution. Injections will be much more effective when paired with other non-operative treatments such as physical therapy and weight loss.
When is it Time to Consider Speaking to a Surgeon?
Non-operative Treatments Have Been Fully Exhausted
While most patients with arthritis will improve with non-operative solutions, some will not regain their function, reduce their pain, or regain their range of motion. When this is the outcome, an evaluation with a surgeon may be your best option. This does not mean they will recommend a knee replacement immediately, but they may have meaningful input on what you should do next.
It is important to realize that it may take 6-8 weeks of physical therapy and/or strength training to make a change in your symptoms, and even longer to improve your ability to do more athletic or challenging tasks. Since post-op rehabilitation will be much longer than eight weeks, it may be worth your while to try more conservative care. If you have met this criteria, seeking a surgical consultation is in your best interest to figure out the next step.
Your Range of Motion is Very Limited and Not Improving
In most knee arthritis cases, physical therapy can fully restore knee range of motion. But if it is not improving and this is what is limiting your progress, it may be time to get surgery. The ability to fully straighten your knee is required to walk properly. It’s likely that other body parts will begin to compensate if normal walking is not restored. While this is not a medical emergency, it may be time to talk to a surgeon sooner rather than later if this knee range of motion is not improving.
Your Day-to-Day Function is Significantly Limited
If you are beginning to change the way you do things in your home, in the workplace, or when you are out and about because of your knee pain, it may be beginning to weigh on you both physically and emotionally. If your knee is impacting the way you navigate your home safely, or your job performance despite your best efforts of conservative rehabilitation, you may want to consider taking the next step. Conservative care is effective at improving day-to-day function in most cases, but if your knee pain and range of motion is not changing and your function is declining, it is a good idea to talk to a surgeon.
Hopefully these tips are helpful in your decision making process. If you would like to speak with a physical therapist, simply call us at 908-598-9009 or use our Request and Appointment form. No referral is required for your initial consultation and you will be evaluated by one of our physical therapists.
Reference:
1- FOR WEIGHT LOSS: http://www.robindimatteo.com/uploads/3/8/3/4/38344023/adapt_trial_messier_et_al-2004-arthritis___rheumatism.pdf