Total Knee Replacement: When is it time?

My patients who are potential candidates for knee replacement surgery (TKR) often ask me, “When is it time to have my knee replaced?” I usually reply, “You will tell me when it is time.” Then I sometimes get a look that says, “Well, thanks for that expert advice.”  So, what does that mean?

The answer depends on many things, such as your discomfort and activity level. It also depends on your desires and on your ability to perform your necessities of daily living.

If you are considering knee replacement, you may have to adjust your desired activity level to equal what is reasonable after surgery. Impact activities such as basketball and football aren’t a good idea for worn out knees or knees that have been through knee replacement. Before deciding on surgery you should judge your level of discomfort based on low impact activities such as walking, swimming, biking, low impact aerobics and low stress weights. Low impact exercise is the best and number one prescribed treatment for arthritis. With that said, let’s talk about what convinces you and me that it is time for knee replacement surgery.

Within the framework of low impact activity, if my patients are fully engaged with minimal or acceptable discomfort, and their discomfort is controlled with reasonable arthritis care, then it is not time to consider knee replacement. Knee replacement surgery is not without its potential problems. It is not a cure-all that restores your knees to your youth of high school when nothing hurt, when you could do whatever without a worry, and when there were no apparent risks of poor decisions. Knee replacements are mechanical devices which carry the potential issues of mechanical devices, including early failure and wearing out. Therefore, if your knees are working with minimal problems, stay active and keep your birth knees for a little longer.

But when my patients’ level of activity starts to decline and reasonable arthritis care no longer works, then maybe it’s time to start considering surgery. It is well established that if you can no longer maintain a regular activity level, especially a healthy exercise routine, then overall health starts to decline. Body weight may increase with corresponding health issues such as poorer blood pressure or diabetes control. That is not good. Also, a person may start to find they are limiting or no longer engaging in social or family activities which they enjoy. It is now probably time to consider knee replacement. Within the framework of reasonable activity expectations, the above mentioned risks become more acceptable and the benefits may start to outweigh those potential risks.

There are a lot of other things, such as a person’s health, to consider when my patients and I talk about any joint replacements including knee replacement surgery. But their ability to stay active is a very important part of it. In the end, you, as the patient have to be ready. You will be the one to tell your surgeon when it is time.

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