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When Should I Get a Knee Replacement?

Some people might put off having knee replacement surgery. But when the pain becomes too much, it's time to take action.


Knee replacement surgery involves resurfacing or replacing a damaged or worn knee with an artificial joint to relieve severe pain and improve mobility. During the procedure your orthopaedic surgeon will cut away damaged bone and cartilage from your kneecap, thigh and shin bones and replace what they remove with an artificial joint typically made of metal and plastic materials.

Some people might put off having knee replacement surgery while they try out other non-surgical treatments. However, knee replacement is still the most reliable way to eliminate severe pain.

What conditions lead to knee replacement?

The most common condition that leads to knee replacement is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis can all affect the knee. Old sports injuries, prior knee trauma and fractures can increase your chances of developing arthritis and needing surgery.

“When you get knee surgery is more trending to how active you are than something like hip replacement surgery,” says Craig Moe, MD, an orthopaedic surgeon at The Iowa Clinic’s West Des Moines campus. “I see a decent number of older adults with joint degeneration who put wear and tear on their joints and maybe suffered from some type of sports injury in the past.”

There are many risk factors for arthritis. Some you can control and some you can’t. Modifiable risk factors for arthritis include obesity, infection, joint injuries and smoking. Non-modifiable risk factors include age, genetics and gender. Women are more likely to get arthritis than men.

The main goal of knee replacement surgery is to relieve pain and improve mobility. Walking, climbing stairs and getting in and out of chairs may be difficult for someone with knee problems. The right time for knee replacement is whenever the pain is interfering with your quality of life.

Is there a recommended age for knee replacement?

While some people need a knee replacement at a younger age due to sports injuries, knee replacement surgery is still most commonly performed on older adults between the ages of 60 and 80. Physical therapy is an important part of the recovery process and the more you move after surgery the better your results will be. This is why doctors often recommend getting knee replacement surgery while you are still mobile and able to participate in regular exercise.

An orthopaedic surgeon may recommend a partial knee replacement if performing the operation on someone younger than age 65 or in an instance where damage to the knee is less severe. Dr. Moe says it is common for people to want to try alternative means of pain relief prior to surgery.

What to expect at your orthopaedic appointment.

The first thing an orthopaedic surgeon will do when someone has symptoms of degenerative joint disease of the knee, such as pain, tenderness, or stiffness, is perform a knee assessment. Your physician will order an X-ray to determine the location and severity of degeneration.

From there, your orthopaedic surgeon will discuss potential treatment options.

“There are a variety of conservative pain management options available to treat knee pain,” says Dr. Moe. “A lot of times people will try injections, therapy and other non-surgical options. I make sure patients who come to see me about knee pain know what options are available to them.”

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Whereas other methods offer temporary relief, knee replacement surgery is a proven method to relieve knee pain and restore mobility. That’s why it’s important to manage expectations. Dr. Moe recommends knee surgery whenever the pain is stopping you from doing the things you enjoy.

“People come to you and they are just hopeful about non-surgical treatment,” says Dr. Moe. “The truth is, most nonoperative treatments are not proven to provide lasting relief for patients.”

For those patients who decide to move forward with knee replacement surgery, The Iowa Clinic has an on-site scheduling team that will help you set up a date and a time for surgery.

How complex is knee replacement surgery?

Knee replacement surgery is a complex procedure. Your doctor may recommend either a total or partial knee replacement based on several different factors. Every situation is a little different.

“There is a lot more therapy involved with a knee replacement than some people might expect,” says Dr. Moe. “Physical therapy helps you get the motion back and provides better results.”

Usually the knee surgery recovery process goes something like this:

  1. Patient is walking with a walker (until about a week or two after surgery).
  2. Patient is walking with a cane (until about a month to six weeks after surgery).
  3. Patient is walking without a walking aid (about a month to six weeks after surgery).

Note that some people rely on walking aids for a longer period of time. Dr. Moe says that some patients need a walker to get around for six weeks or more, but that is not as common.

I’ve heard knee replacement surgery is painful. Is that true?

Any joint replacement surgery is going to involve some amount of pain during recovery. And yes, the recovery process for knee replacement surgery can be painful and tiring at times. However, once recovered, knee replacement patients report having less pain and increased mobility.

“I think the biggest change with knee replacement surgery is our ability to control pain,” says Dr. Moe. “In the past we said, yes, we’ll do what we can to ease pain, but it’s going to hurt. Now we do multimodal pain management. We work to account for the patient’s pain ahead of surgery.”

“We get ahead of pain by using anesthesia that diminishes the use of post-op narcotics,” adds Dr. Moe. “This helps control pain faster so that you can get your knee bending and moving. Our goal is no more than an overnight stay at the hospital and then we’ll get you into outpatient status.”

The sooner a person is up and moving and checked into rehabilitation the better their mobility will be in the long run. That’s why it’s important to find an orthopaedic surgeon you can trust.

How has knee replacement changed over the years?

Dr. Moe says how he performs knee surgery has not changed drastically, but the parts he uses have gotten better in recent years. Metal and plastic are still the most common materials, but the construction and design of artificial knees has gotten more refined over time to support mobility.

Two of the biggest factors that go into a successful knee replacement surgery are choosing a surgeon that you get along with and trust, and active participation in physical therapy.

“We emphasize learning more about the patient and figuring out what they need ahead of time, so that their post-op recovery is as successful as possible,” says Dr. Moe.

Dr. Moe shared two potential scenarios that would affect a person’s situation:

  • One patient is 85 and lives alone in a second floor apartment. They may need to stay in a nursing home for a while where they have access to first-floor accommodations.
  • Another patient is 65 and in good shape. They live with a spouse or have kids nearby who can visit and check in on them. That person can go home with no problem.

“We do our best to learn those things ahead of time and make sure everything is accounted for,” says Dr. Moe. “At The Iowa Clinic, someone who opts for knee replacement surgery will meet with a scheduler and attend a session that we call joint camp. There we will figure out what sort of medications the patient is taking, what they are allergic to, what type of shower you have.”

“All of those things are things we can work with you on ahead of time in order to get you back home safely,” adds Dr. Moe. “We don’t want to have someone go home the next day and return two days later because they fell or had some other issue while home. We want to avoid that.”

Dr. Moe says The Iowa Clinic builds its physical therapy around the patient’s situation. For example, if someone has to go up three steps to get into their home, then the physical therapist will work with the patient to make sure that they can navigate three steps before going home.

I think I need a knee replacement. What now?

Choosing a skilled surgeon you trust and like and putting your best effort into physical therapy after surgery are the two best ways to ensure your knee replacement is successful.

“I wouldn’t say there is anything else better available than what we do here at The Iowa Clinic,” says Dr. Moe. “We offer patients a well-trained surgeon with great outcomes that I’d put up against anybody else. We do complicated procedures. Our orthopaedic team can handle situations where other surgeons have tried and failed. We can take care of any issue.”

The first step to addressing your knee problems is to set up an appointment. The Iowa Clinic offers specialized orthopaedic care within its West Des Moines and Ankeny campuses.

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