How do I know if I need Knee Replacement?

By Island Hospital   |   12.06.2020

Have you been dealing with chronic knee pain for several months now?

Have you tried over-the-counter medications, exercise, and physical therapy, yet nothing seems to alleviate the pain?

If you have tried everything you can to lessen your knee pain on your own, you may be frustrated and wondering about your next options.

If the simple act of getting out of bed in the morning, climbing a few flights of stairs or going on a brisk walk brings you instant knee pain, you might be concerned and you also may feel like it is just a sign that you are “getting older.”

But chronic knee pain is not normal, and it is not necessarily a sign of getting older. 

A total knee replacement could be the saving grace if you are experiencing severe pain, as well as trouble with range of motion, function and stability. But how do you know if the procedure is right for you, and what can you expect? 

Knee arthritis affects millions of people each year. It is usually a progressive disease leading to joint pain, stiffness, limitation of activity, and a decrease in the quality of life.

Your knee can be damaged from wear and tear over time, by rheumatoid arthritis, or by an injury. If you are experiencing consistent pain in your daily activities, you should be evaluated by an orthopaedic specialist. Rest, medication, and physical therapy are the first lines of treatment. Those whose cartilage is too worn or with malalignment (incorrect or imperfect alignment), a total knee replacement (knee arthroplasty) may be the best option. Total knee replacement surgery is generally reserved for those over the age of 50, but total knee replacement surgery can also be performed on younger people in special circumstances.

A total knee joint replacement (also known as total knee arthroplasty) is an operation to remove a severely impaired knee joint and replace it with an artificial joint. The aim of the surgery is to relieve pain and restore function to the joint.

When painful, stiff knees do not respond to conservative measures like physical therapy and medication, you need a more permanent solution.

If you experience severe knee pain both during activity and at rest and decreased range of motion and stiffness that doesn’t go away after non-surgical treatment, you may be a candidate for knee replacement surgery. 
You may also notice visible signs of a failing knee, including a bulge or inward bow.

The symptoms of knee arthritis are:

Knee pain and swelling begin to occur after physical activity. These symptoms gradually increase and eventually are present even at rest. In severe cases patients may have pain at night, as well as during the day. Motion in the joint decreases, and straightening and bending the knee becomes severely limited.

Arthritis can cause “crepitus”, which is a grinding noise in the knee during motion. Other symptoms include an inability to walk for long distances, difficulty rising from a chair, climbing stairs, and eventually, difficulty with routine activities.

If your arthritis is not responding to any of the alternative treatments, or if they are impractical for you; you may consider undergoing knee replacement surgery.  You may need a knee replacement if your knee gives you pain, stiffness, instability or loss of function that affects your daily life and activities.  Knee replacements are most commonly recommended for osteoarthritis, but sometimes for rheumatoid arthritis or other inflammatory joint diseases.

Some patients are willing to wait until their knee problem becomes severe before undergoing a knee replacement, while other patients are more willing to have the surgery completed so they can return to sports and daily activities. Some younger patients may benefit from a partial knee replacement at an early age to relieve pain knowing they may need a total knee replacement in the future. Your orthopaedic surgeon will help you determine the best timing to maximise your quality of life.

Not everyone with knee pain needs a knee replacement. But if your pain prevents you from doing everyday tasks or walking independently, knee replacement may be an option.

  • Ligament damage or infection that leads to severe osteoarthritis
  • Rheumatoid arthritis
  • Haemophilia
  • Crystal deposition diseases such as gout
  • Avascular necrosis – death of bone following loss of blood supply
  • Bone dysplasias – disorders of the growth of bone.
  • Severe osteoarthritis

Nine out of 10 patients who have knee replacement surgery experience less pain and greater mobility. You will need to have regular check-ups for the life-span of your artificial knee and ongoing rehabilitation such as physiotherapy and special exercises. In most cases, the prosthesis can be expected to last around 10 years or so, but excessive wear and tear can reduce its life span. It is particularly important to maintain a healthy weight for your height, as being obese can quickly wear out the prosthesis. You will need to understand that your artificial knee will never function as fully as a healthy one.

Total knee replacement is an option for the patient who has not improved after trying the conservative measures described above and whose quality of life is severely affected.

Knee replacement surgery is often recommended if you have:

  • arthritis or an injured knee joint that is severely painful and, impairing your mobility, ability to do everyday tasks and your quality of life and sleep and
  • tried non-surgical treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and steroid injections and, they have not relieved your pain and helped your movement.

The usual reason for a knee replacement is arthritis, with the most common type being osteoarthritis. This is the gradual wear and tear of your knee joint that results in damage to your cartilage covering the surface of your joint and the bone underneath and is very painful. 

An orthopaedic surgeon will assess the need for a knee replacement taking into account medical history, physical examination (especially knee motion, stability, strength and alignment), blood tests and x-rays of the damaged knee. A knee replacement is a major operation and there are many things to discuss with the surgeon, including the risks and benefits of the surgery.   


 

The orthopaedic surgeon at Island Hospital may recommend knee replacement surgery if:

  • you have pain in the knees that prevents you from sleeping.
  • the pain on your knees has not improved with non-surgical treatments such as medications, injections, or physical therapy for 6 months or more.
  • you suffer from severe knee pain that limits your everyday activities.
  • you have long-lasting knee inflammation and swelling that doesn’t get better with rest or medications.

In knee replacement surgery all diseased cartilage is removed, and a metal and plastic prosthesis or replacement, is inserted into your knee to replace the old worn ones. It is attached to the bone with bone cement or in-growth of bone into the prosthesis. The surgery takes one to two hours and requires a three to five day hospital stay. The results of knee replacement surgery are reliable and over 95% of patients report good to excellent results at ten years.

Most people who have knee replacement surgery start to walk with a walker or crutches the day of surgery or the next day. And most people can bear weight on the knee if it is comfortable.

A physiotherapist will help you gently bend and straighten your knee. Your therapist will also begin some simple exercises to help strengthen your leg muscles.

Physiotherapy continues after you go home from the hospital. You will continue physiotherapy until you are able to function on your own and you get back as much strength and range of motion in your knee as you can. You will keep working on increasing the amount you can bend your knee and on building strength and endurance. Total physiotherapy after surgery will take several months depending on your recovery.

You will have an exercise program to follow when you go home, even if you are still going for your physiotherapy. You should also take a short walk several times each day. If you notice any soreness, try a cold pack on your knee. You might also cut back on your activity a bit. But do not stop completely. Staying on your walking and exercise program will help you recover faster.

Your doctor may want to see you from time to time for several months or more to monitor your knee replacement conditions. Over time, you will be able to do most of the things you could do before surgery.

In general, knee replacement surgery is elective. At Island Hospital, we support and value your overall quality of life. Knee replacement surgery is typically done to provide you with pain relief.

If you are considering a knee replacement or any other knee surgery options, please contact us to schedule an appointment. 

Our orthopaedic surgeon are also able to do revision knee replacement such as revisions of unsuccessful surgeries done elsewhere. Our orthopaedic surgeon are committed to alleviating your pain and disability after a previous knee replacement surgery.

We offer you the best care possible, including less risk of complications and a decreased likelihood of needing additional surgery down the road.

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