Total Knee Arthroplasty – How do I know I’m ready?

Nathan Haile, MD

Osteoarthritis (OA), regular “wear and tear” arthritis, is one of the most common causes of knee pain. According to the CDC, over 54 million Americans carry a diagnosis of OA today.  Most patients can be treated successfully with non-surgical options for many years.  However, there are some patients who can benefit from surgery, specifically – Knee Replacement. One of the most common questions I get from my patients is, “When do I know I’m ready for a total knee replacement?” For many patients this is a very hard decision to make, and certainly one that should not be taken lightly.  Recently, researchers from Northwestern University attempted to answer that question. Their article entitled Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S. reviewed over 8,000 patients who either had knee OA or were at risk for developing knee OA.  Age, pain level, severity of damage on X-rays and knee stability were used to give each patient a grade for readiness, or “timeliness” for knee replacement. Each patient was then followed for up to 8 years. Patients were then divided into 3 categories:

  • Timely – Ready for surgery based on criteria and had surgery
  • Potentially Appropriate – Ready for surgery based on criteria but did not have surgery
  • Premature – Not ready based on criteria and had surgery

The group found that almost 91% of knees classified as “Potentially Appropriate” were not replaced within 2-4 years of meeting criteria.  The authors feel that this finding suggests that there are likely many people with knee OA that could gain great benefit and pain relief from a knee replacement.  The authors also found that over 25% of knee replacements were considered “Premature”.  They state that these patients likely gain little relief from surgery, while taking on all the risks associated with knee replacement.

When I have a patient in clinic with knee pain, the first thing I want to know is how often and to what extent does their pain bother them and limit their lifestyle.  Secondarily, I turn to the physical exam to determine if there is instability of the knee.  Finally, I review x-rays to evaluate the extent of joint damage.  As this paper shows, most patients with knee OA can treat their pain conservatively for years, and this is the approach that I take with all of my patients. In order to determine if a patient is ready for a knee replacement, I use 3 simple questions.

  • Do you have severe knee pain every day?
  • Does your knee pain limit your lifestyle on a daily basis?
  • Are you forced to make decisions that you do not what to make based on your knee pain?

If the answer to these questions is “Yes”, we turn to x-rays.  If x-rays show advanced damage to the knee joint, a knee replacement may be the right answer.  Knee OA affects millions of people in the United States alone, and knee replacement surgery has been proven to be an excellent treatment

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