When is the right time for a knee replacement?

DEAR DOCTOR K:

I have osteoarthritis that’s gotten worse over the past few years. My doctor has explained the pros and cons of knee replacement, but it seems like the timing is up to me. How will I know when the time is right to replace my joint?

DEAR READER:

If your experience with a knee replacement is like that of most of my patients, you’ll know when the time is right only after the time has passed. I’ve rarely met a person who had a knee or a hip replacement who did not say, after the surgery, “I should have had the surgery long before I finally did.”

That surely was my experience with hip replacement due to osteoarthritis. Looking back, I should have had the surgery at least two years before I did.

It’s a simple question to ask yourself: Are other, non-surgical treatments giving you enough relief? Or despite the treatments, are you having to restrict your life in ways that make you unhappy? No one likes to face surgery, so you can kid yourself that your life is not restricted that badly and postpone considering surgery.

For me, it suddenly became clear after years of denial. I was on a vacation in a wonderful city, and I wanted to spend several hours walking. But after a few blocks, my hip hurt so much that I just couldn’t. That was the moment I said to myself: Enough is enough.

You may want to consider knee replacement sooner rather than later if one or more of the following statements applies to you:

  • You are unable to complete normal daily tasks without help.
  • You have significant pain daily.
  • Pain keeps you awake at night despite the use of medications.
  • Nonsurgical approaches — such as medications, the use of a cane and physical therapy — have not relieved your pain.
  • Less complicated surgical procedures (such as knee arthroscopy) are unlikely to help.
  • Pain keeps you from walking or engaging in other activities.
  • Pain doesn’t stop when you rest.
  • You can’t bend or straighten your knee.
  • You are suffering severe side effects from the medications for your joint symptoms.

The ideal candidate for joint replacement surgery is in good general health and not overweight.

During joint replacement surgery, the surgeon removes damaged bone and joint tissue. He or she then replaces it with an artificial joint made of metal or ceramic.

Together, you and your doctor must weigh the benefits and risks of joint replacement. Keep in mind that the average artificial joint lasts for about 15 to 20 years.

Knee replacements work well for many people. Still, you need to have realistic expectations about what joint replacement surgery will and won’t do for you. A new knee should help you return to normal activities for your age. But you won’t be able to do more than you could before osteoarthritis interfered with your activities.

The major consistent benefit of joint replacement is substantial relief from pain. My hip replacement was 14 years ago. I haven’t had a day of pain since.