Knee Pain: When Joint Replacement is the Best Option
Knee replacement surgery has become increasingly more common over the last 15 years, mainly because the obesity epidemic has increased the prevalence of osteoarthritis (OA) in the knee. More than 600,000 total knee replacements (TKRs) are performed each year in the U.S., according to figures from the Agency for Healthcare Research and Quality.
Thomas P. Sculco, MD, professor of orthopedic surgery at Weill Cornell Medical College, says that replacing an arthritic joint with a prosthetic one relieves the pain and stiffness that accompanies arthritis. “In fact, research indicates that a well-functioning TKR may help an older adult maintain good functional capacity for 20 years or more,” he observes. “The procedure is in high demand because it’s so effective.” However, a recent study (Arthritis & Rheumatology, June 30, 2014) suggests that many knee replacements are “inappropriate.” How can you be sure that this surgery is right for you?
WHAT YOU CAN DO
These strategies may help you
delay TKR:
➤ Maintain a healthy weight. Being obese raises the risk that OA will progress to become severe. Losing as little as five percent of your body weight can help to slow OA progression and ease discomfort.
➤ Get enough exercise. A recent study suggests that walking the equivalent of an hour each day may help improve knee OA and prevent disability. Strengthening exercises for the thigh muscle (quadriceps) can help knee function before surgery and facilitate a more rapid recovery afterward.
➤ Consider non-drug pain relief. Research suggests that acupuncture may help relieve chronic pain from OA; there also is evidence that massage can help ease stiffness and help preserve range of motion.
“Inappropriate” surgeries
The study included 205 older adults whose knee replacement surgeries were classified using a Spanish classification system that ranks TKR as appropriate, inconclusive, or inappropriate on the basis of a patient’s age, symptoms, functional status, and mobility, among other factors.
The data indicated that 44 percent of TKRs were appropriate, 21.7 percent were inconclusive, and 34.3 percent were inappropriate. However, according to the researchers, the goal was not to suggest that TKR is frequently an inappropriate option in the U.S., but rather to highlight the extent of variation in the key characteristics of patients who undergo the procedure.
“TKR may not be objectively appropriate for patients with milder symptoms,” Dr. Sculco explains. “However, each joint replacement patient has to be individualized. Even slight or moderate functional loss may indicate that surgery could be helpful to that specific patient; moreover, intervening earlier in the course of arthritis helps to avert deterioration and preserve function.”
Nonsurgical approaches
Dr. Sculco points out that TKR is normally performed only after nonsurgical treatments fail. “Conservative therapies can provide relief initially,” he says. “Physical therapy can strengthen the muscles around the joints and preserve mobility, while anti-inflammatory medications can relieve pain and inflammation. Some patients get relief from OA by losing weight. But, as yet, there isn’t a disease-modifying treatment that slows OA progression, and it becomes increasingly difficult to prevent the pain it causes.”
If your OA has reached the stage where chronic stiffness and swelling prevent you from bending and straightening your knee, and pain is disturbing your sleep and limiting your mobility, you may be a candidate for TKR.
WHAT HAPPENS DURING KNEE REPLACEMENT SURGERY?
Total knee replacement (TKR) is a one-to-two hour surgery, during which damaged cartilage and bone are removed and new metal and plastic surfaces are positioned over the surface of the femur (thigh bone) and tibia (shin bone), and underneath the kneecap. “You’ll be encouraged to stand and start walking within 24 hours of the operation,” Dr. Sculco says. “Most patients are able to walk without a cane within six weeks of the procedure, and can start driving again within about three to four weeks.”
TKR has low rates for complications, mortalities, and length of hospital stays; however, obese individuals are at higher risk of complications, such as post-surgical infections and revisions (a second replacement surgery). You will be advised to maintain a healthy weight after your surgery to make revision less likely.
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