Knee Replacements–When Are They Appropriate?

Knee replacement surgery has become more and more prevalent over the last fifteen years.  However, two recent studies from researchers at Virginia Commonwealth University in Richmond, after reviewing the records of 200 patients, suggest that in many cases, the surgery may not be appropriate or warranted.  The studies concluded that knee replacement should be performed only for those people who are suffering from advanced arthritis in the knee joint.  This is defined as encompassing severe pain, and impaired range of motion and function which hampers the person from getting out of a chair and walking without assistance.

According to data from the American Academy of Orthopedic Surgeons, knee replacements in people ages 45-64 skyrocketed 205% between 2000 and 2012.  For those aged 65 and older, the increase was a still substantial 95%.  The Virginia Commonwealth researchers indicate that surgical replacements are more indicated for patients over age 65 because the implanted materials last approximately 20 years.  Thus, if a 45 year old patient has the replacement, they will likely need another one during his or her lifetime. The researchers determined that about one third of the subjects were probably not good candidates for knee replacement surgery, because their arthritis was not substantial, and they had only slight pain and physical impairment.

Conversely, those whose arthritis was advanced benefited tremendously from knee replacement, with much improved function, and significantly less knee pain in the two years after the procedure.  Additionally, their knee function scores improved about 2o points.  In contrast, those whose knees didn’t justify the surgery had only a 2 point improvement in function scores.

The authors note that if there is no “bone on bone” arthritis, with most of the knee cartilage gone, then the patient should opt for physical therapy, with an emphasis on strengthening the joint and reducing pain.  In certain patients, losing weight is another helpful factor in recovering function and reducing pain.  Approximately 15 years ago, at the age of 68 and with a history of playing basketball and tennis for thirty years, my father was informed that he was a good candidate for double knee replacement.  He was experiencing significant bilateral knee pain, had difficulty going up and down stairs, and could not get out of a chair without assistance.  Additionally, he could no longer play tennis, which was something he did several times per week and was a huge loss to his quality of life.  He underwent bilateral replacements, followed this with an intensive and extensive physical therapy program, and returned to playing tennis within several months of the procedures.  He still plays now at the age of 83!  Thus, in some cases, knee replacement surgery can be a signficant boon to quality of life.

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