Six Considerations to Ponder Before Total Knee Replacement

Receiving a total knee replacement can make huge, positive changes in your life. Many patients are able to become more active, stop taking pain medication, and leave behind the limitations of living with an arthritic knee. If your orthopedic surgeon has offered you a knee replacement and you are considering undergoing the procedure, you need to have realistic expectations. It is not the knee you had before arthritis. Understanding what you can reasonably expect from your new knee is integral to having a good result from your surgery. Here are six issues you need to consider before consenting to a total knee replacement.

1. Your Running Career Should End, but only to make your knee replacements last longer

Many people who run for pleasure or in competitions are disappointed to hear that frequent sustained running is not recommended once you undergo a knee replacement. Some patients take this too literally and panic if they forget themselves and run after a child or jog to catch a departing bus. This is not usually what your surgeon is forbidding, but rather he or she is talking about extended running or jogging for exercise, enjoyment, or competition. Running and jogging place enormous stress upon your knees. While many replacement knees can last between 10 and 20 years before failing, running for recreation can wear one out in only a few years due to the constant, percussive stress placed upon the knees. Most surgeons will suggest to preserve your knee you switch to a lower-impact recreational activity, such as swimming or biking. For those addicted to running, a support group can help you make the transition into another sport that will be kind to your joints and still provide you with the exercise you crave. There is no difference between the total knee replacements that permit or prohibit running. It is a judgement call to be made for both the doctor and the patient.

2. Kneeling and Squatting May Feel Strange

By the time you are a surgical candidate, the arthritis in your knee may have made kneeling or squatting impossible for quite some time. After surgery, some patients are shocked to discover that they are able to assume these postures without pain again. However, some post-operative patients resist kneeling or squatting due to the sensations, which patients sometimes describe as bizarre, strange, or unnatural. As long as these positions are not accompanied by any pain or discomfort, they should be perfectly safe. Ask your surgeon if you are anxious, but know that the strange sensations will eventually feel quite normal and commonplace if you practice them safely and use a kneeling pad on hard surfaces.

3. You Will Be Required to Keep Your Weight Under Control

For every pound of body weight you carry, four pounds of pressure grind down on your knees when you are walking, and ten pounds when you are running. For this reason, anyone who receives a total knee replacement will need to keep their weight under control for the rest of their life. If you do become overweight or obese post-surgery, the added stress on your new knee can cause it to fail early. Early failure will require a revision surgery or even another full replacement procedure.

4. The Joint May Click or Snap

The components of a joint replacement are usually metal alloys and medical-grade plastic. These items, when placed in the joint, can make some disconcerting noises when you move. Some patients are annoyed by this and may worry that their knee replacement was not successful. On the contrary, clicking or snapping noises can be normal but, of course, bring it up to your surgeon if you are concerned. Sometimes, the noises will stop on their own as the surrounding tissues heal.

5. You Are Committing to Follow-Ups Every Few Years

With as much as you may want to move on from your painful knee and never give it a second thought, a replacement joint will always need to be checked by your surgeon. Some may request to see you every two years, while others may suggest every five years if you are of a normal weight and not experiencing any issues. It is common practice for your surgeon to order periodic x-rays to make sure the joint is seated properly and wearing normally. You must make time in your schedule to have your new knee checked at regular intervals and comply with your surgeon’s instructions. If you move away from your surgeon or he retires, you will need to have your records transferred to a nearby orthopedic surgeon for routine checks.

A total knee replacement can be an awesome change in your life. However, having realistic expectations will help you to have a better outcome and know what to expect from your new joint. If you have any additional doubts or concerns, you should feel free to talk to your orthopedic surgeon or his physician’s assistant. Agreeing to life-changing surgery should always be an informed and educated decision.

6. You have fully considered the risks, potential benefits, and alternatives of a total knee replacement at this time of your life and all your questions have been answered.

Total knee replacements are indicated for severe symptomatic knee arthritis that has failed to improve satisfactorily after a reasonable attempt at nonsurgical care. Patients with only mild to moderate arthritis usually improve with treatment without surgery and may do well for years. Your doctor should help you understand your condition, how it can be treated medically, surgically, and with lifestyle changes. Your doctor has an obligation to help you understand the risk, benefits and alternatives of the recommended care.

Theodore A Evans M.D. and the team of South Florida International Orthopaedics