How to Know When It’s Time for a Total Knee Replacement

Studies show that over 10% of Americans will undergo a knee replacement surgery by the time they reach 80 years of age—but when is it the right time for you? While the decision to have a knee replacement procedure is always a personal one, it may be time to consider it if you’re experiencing frequent knee pain when climbing stairs, walking, or moving from a seated to standing position. A total knee replacement is always a last resort, when non-operative methods such as physical therapy have not worked for you. 

Here are some signs it may be time to speak with a professional about having a knee replacement. 

You’re experiencing pain even when at rest.

Knee pain is relatively common when the joint itself is in use, such as when climbing stairs, walking or jogging, or even bathing. However, if you’re feeling pain when sitting or standing still, this is an indicator that your joint inflammation is more serious. “Every person has varying levels of tolerance to pain,” explains Eric L. Grossman, M.D., an orthopaedic surgeon with Rothman Orthopaedics. “You may not be capable of realizing the extent to which knee pain and weakness have come to affect your life because of the compensatory mechanisms you’ve developed to handle it.” Alternative remedies may not be able to take the place of a total knee replacement, so surgery may be your best option. It’s estimated that between 90-95% of younger patients who undergo a knee replacement surgery are left with no pain after their recovery, making this course of action a good one for those who are seeking a pain-free lifestyle. 

Your knee is often stiff or swollen.

Swelling at the joints can be an indication of significant knee inflammation. While not all patients who experience knee pain see swelling, those who do are often best off considering surgery in their treatment plan. A total knee replacement procedure removes not only the affected bone and cartilage in the joint, but also much of the damaged and inflamed tissue at the site as well. For this reason, the experts at Rothman Orthopaedics often list “chronic swelling that does not improve with rest” as one of the signs it may be time to consider a knee replacement procedure.

You’ve experienced a traumatic injury to the joint.

General wear-and-tear on the cartilage in the joint is the most common source of worsening knee pain. However, if you’ve experienced a sports injury or other trauma to the joint, this can be all the more reason to consider a total knee replacement. The arthritis can occur because of injury or trauma or simply due to degeneration of the joint over time. Regardless of the cause, the result is the same. If you have had severe damage to your knee as a result of a previous injury, or if that injury still causes pain or stiffness, and conservative treatment has failed it may be time to consider talking to your doctor about knee replacement surgery. He or she will help you determine what is the best option for you to give you the best results, whether it be a total or partial knee replacement or to continue with non-surgical treatment, such as injections and physical therapy.

Your range of motion has declined.

Decreased range of motion in your knees and other joints can occur gradually or may become more pronounced over a short period of time. In many...cases, the pain gradually sets in, along with a decrease in the joint’s range of motion, due to a medical condition such as arthritis, resulting in a rapid or gradual loss of cartilage in the knee joint. When this cartilage wears away, there is nothing left to prevent the femur (thigh bone), the tibia (shin), or the patella (knee cap) from rubbing against each other, and the pain that results from this bone-on-bone grinding can be excruciating. Naturally, this pain makes it less likely for individuals to attempt to use the offending joint, which can further limit the range of motion. If you’ve noticed a pronounced loss of range of motion when going about your daily activities, it may be time to consider a knee replacement that will restore your joints to their former state.

Other joint pain relief strategies haven’t worked for you.

[Some patients] too quickly assume that total knee replacement surgery is the right option for them when there are quite possibly other more conservative treatment options that could reduce pain and restore the flexibility of the knees without surgery. All possible treatments should be considered and discussed with a knee specialist before a patient comes to a conclusion about something as serious as whether to have a surgical procedure. But if you’ve tried non-invasive attempts at knee pain management before—such as physical therapy, weight management, injections and other medications—without success, it is likely time to speak to a specialist about turning to surgery. Alternatively, if the wear and tear on your joint is limited to a specific area, your orthopaedic doctor may recommend a partial knee replacement instead, wherein the surrounding normal cartilage and ligaments are not removed and the recovery time is lessened.

You’re under 80.

While it’s always advisable to try all non-surgical interventions before committing to a knee replacement, there are some benefits to undergoing the surgery when you’re on the younger side. For instance, patients under 80 are more likely to be eligible for a simultaneous bilateral knee replacement, meaning the procedure is done on both joints at the same time, which lessens the length of recovery after knee replacement surgery overall. And whereas in the past, joint replacements were more likely to wear out over time and require followup surgeries, Rothman Orthopaedics now reports a success rate of ninety-eight percent after ten years and ninety-four percent after 20 years with their implants. Meanwhile, delaying the procedure can actually allow the condition to worsen with continued use of the joint, which may explain why patients under 65 are now the fastest-growing group of candidates for knee replacements. By leaving your joint pain untreated, you not only keep yourself from getting work done and enjoying fun activities, but you are putting yourself at risk of developing other conditions in your hip, back, and neck.”

Still not sure if you're a candidate? Learn more about knee injuries here.