For someone whose knee is sore and creaky, the prospect of replacing it with a new, metal-and-plastic version of the joint can be beguiling. The surgery seems so easy and to promise so much: better mobility, less pain, an approximation, almost, of youth. But there is growing evidence that knee-replacement surgery may be too seductive — and that many people considering the procedure would be better served to first try other ways to improve their knees.

--Think Twice Before Choosing Knee Replacement, The New York Times, 11/13/14

Total knee replacements are becoming more common surgical procedures, with 600,000 knee replacements performed in 2012, compared to only 250,000 over a decade earlier. Recent research is showing that many of the patients who are having these surgeries are getting them prematurely. The ‘life’ of a knee replacement is approximately 15-20 years, depending on a patient’s activity level after surgery.

Many surgeons are hesitant in performing a knee replacement on patients under 60-65 years of age because of this, hoping to avoid the need of another knee replacement later in life. However, the number of knee replacements in patients between 45-64 years increased by over 200% from 2000 to 2012.

Just because a painful knee shows signs degeneration on imaging (such as x-ray), it alone does not mean is the patient is appropriate for a knee replacement. Many individuals have moderate levels of knee arthritis shown on imaging, but experience minimal pain or dysfunction. On the other hand, some people have knees that look relatively normal on imaging, yet they have high levels of pain and functional loss.

Before you jump to the conclusion that you need a total knee replacement, consider these questions:  

  • What is your present level of activity level and what are your activity goals?
  • What is the level of pain in your knee?
  • What conservative measures (i.e. physical therapy, injections, acupuncture, bracing, etc.) have you taken to address the problem?
  • What is your education on the knee surgery and the rehabilitation involved, which includes  the pre-operative preparation and the post-operative rehabilitation in order to maximize your outcomes?
  • How psychologically prepared are you for the surgery and the post-operative demands for recovery? This includes finding the right time in your life to have the surgery, and making sure your social support is in place to help you in the early stages of recovery.
  • What does your knee look like now? The amount of swelling, pain, range of motion, strength, and function of the leg going into surgery will help determine how well your outcomes are post-op. Take home the message: “The better you are going in to surgery, the better you are coming out of surgery.”

With the right course of treatment, you may be able to avoid surgery altogether, or at least prolong it until you are a better candidate for it in worst cases. Knee osteoarthritis can be treated by a conservative approach that utilizes manual therapy, special exercises that improves strength and joint alignment, a focus on regaining normal functional usage of the affected leg, and education on long-term self-management of the arthritic knee. This approach has been shown to decrease pain and increase function in individuals with knee osteoarthritis.

If surgery is unavoidable, you will be more ready after conservative treatment. Research shows the better prepared you are—physically, emotionally and psychologically—the better your long-term outcome will be.