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decision pointShould I have knee replacement surgery?

How you and your doctor decide upon treatment for your osteoarthritis of the knee depends on things such as your age, your activity level, and the degree of pain and disability you are experiencing. Consider the following when making your decision:

  • Knee replacement surgery may be a consideration if other treatments, including exercise, medicines, physical therapy, and modification of daily activities, have failed to significantly relieve your symptoms.
  • Rehabilitation after knee replacement surgery requires daily exercises for several weeks.
  • Osteoarthritis may continue to erode the bones of the knee, and some people may need to have their knee replaced again. Over 90% of knee replacement surgeries last for at least 15 years.1

What is osteoarthritis?

Osteoarthritis is a progressive condition of the cartilage in joints. The cartilage breaks down until the bones, which were once separated by cartilage, rub against each other, resulting in damage to the tissue and underlying bone. The symptoms of osteoarthritis include joint pain, stiffness after inactivity, and limited motion.

What surgeries may be considered to treat osteoarthritis?

Surgery is reserved for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other methods and who have significant loss of cartilage. Surgery relieves severe, disabling pain and may restore joint function and mobility. Surgical choices include:

  • Arthroscopy, which can provide temporary (and sometimes long-term) relief of symptoms of osteoarthritis. Arthroscopy can also fix a joint if it becomes "locked" or stuck due to loose cartilage or bone fragments.
  • Osteotomy, used in cases of abnormality or deformity of the legs in active people younger than 60 with mild osteoarthritis.
  • Knee replacement surgery, considered in cases of knee pain associated with disability and damage that is visible on X-rays.
  • Arthrodesis, surgery that joins (fuses) two bones in a diseased joint so that the joint can no longer move. It is rarely used in the knees. But it may be a treatment choice in cases of severe osteoarthritis in a young person who cannot have total knee replacement.

What happens in knee replacement surgery?

Total knee replacement involves surgery to cap the ends of the damaged thighbone and lower leg bone, and usually the kneecap, with artificial surfaces lined with metal and plastic. Doctors usually use cement to secure knee joint components to the bones.

What should I expect after knee replacement surgery?

Rehabilitation is usually intense after knee replacement surgery. Most people who have knee replacement surgery start to walk with a walker or crutches the day after surgery and begin physical therapy immediately. Your doctor may recommend that you ride a stationary bicycle to strengthen your leg muscles and improve your ability to bend your knee. Rehabilitation will take several weeks. But you should be able to resume walking, climbing stairs, sitting in and getting up from chairs, and other daily activities within a few days.

If you need more information, see the topic Osteoarthritis.

Your choices are:

  • Have knee replacement surgery.
  • Continue to manage your joint pain and other symptoms with nonsurgical treatments, such as exercise, pain relievers, or joint injections, or, if appropriate, another type of surgery, such as arthroscopy.

The decision about knee replacement surgery takes into account your personal feelings and the medical facts.

Deciding about knee replacement surgery
Reasons to have knee replacement surgery Reasons not to have knee replacement surgery
  • Your symptoms of pain and stiffness have become so severe that you are unable to complete reasonable daily activities.
  • Other methods of treatment, such as education, exercise, and pain medicine, do not relieve your symptoms.
  • You want to be able to do low-impact activities, such as swimming and golf as well as chores and housework.

Are there other reasons you might want to have knee replacement surgery?

  • Surgery may not improve your range of motion, and the artificial knee will not be as functional as a normal, healthy knee.
  • Risks of knee replacement surgery, though not common, include:
    • Infection in the surgical wound or joint.
    • Blood clots-more common in people who are overweight.
    • Nerve injury around the surgical site.
    • Difficult wound healing-more common for people with immune system diseases, such as diabetes.
  • Knee replacements generally last 10 to 20 years, so you may need to have another surgery later in life if the joint wears out or loosens.

Are there other reasons you might not want to have knee replacement surgery?

 

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about knee replacement surgery for osteoarthritis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

1. Medicines are controlling my symptoms. Yes No Unsure
2. I have more bad days than good. Yes No Unsure
3. My quality of life is poor with my current treatment. Yes No Unsure
4. My general health is good. Yes No Unsure
5. I have to severely limit my activities because of my knee(s). Yes No Unsure
6. I am worried about needing another replacement surgery in 10 or 20 years. Yes No Unsure
7. I am anxious to be able to resume hiking or other activities. Yes No Unsure
8. I know complications sometimes occur with surgery, but getting relief from pain and regaining some use of my knee is worth the risk. Yes No Unsure
9. I think my bad knee is going to continue to get worse. Yes No Unsure
10. I am concerned that an artificial knee will not be stable. Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not to have knee replacement surgery for osteoarthritis.

Check the box below that represents your overall impression about your decision.

Leaning toward having knee replacement surgery

 

Leaning toward NOT having knee replacement surgery

         

Citations

  1. Moore KD, Cuckler JM (2005). Surgical treatment of knee arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1067–1076. Phildelphia: Lippincott Williams and Wilkins.

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Richa Dhawan, MD - Rheumatology
Last Updated April 17, 2009

WebMD Medical Reference from Healthwise

Last Updated: April 17, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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