Is knee replacement right for you?

Does knee pain hold you back from activities you enjoy? Things like parties, shopping, hiking or travel? Do you cringe at the thought of taking stairs?

Maybe you know friends or family who got new knees. Are you wondering if that might be right for you?

Many people who have knee replacement surgery are glad they did it. But it’s a big decision. And a personal one.

How do you know if it’s right for you and when?

If you have knee pain that affects your daily living and quality of life, it could be time, says Bruce Watanabe, MD, an orthopedic surgeon at PeaceHealth in Florence, Oregon.

Reasons for knee replacement

Doctors often recommend total knee replacement for advanced osteoarthritis, also called “wear and tear” arthritis. This means you have little to no cartilage left to cushion the joint where two bones meet. 

Once cartilage is lost, there’s no building it back up. And if the bones are rubbing, you may be in a lot of pain. Those bones will wear down over time. It can sometimes cause malalignment — bow leggedness or knees that knock together. That’s why joint replacement can be a life changer. 

Dr. Watanabe notes this is the most common reason for joint replacement. Replacement can also help people with rheumatoid arthritis (a condition where the immune system attacks the joints). And those with certain knee conditions or post-traumatic arthritis can also benefit from this surgery.

Symptoms and questions 

How do you know if you have advanced osteoarthritis? Every move will be almost more than you can stand. Stiffness might keep you from moving your knee or leg. And bending or flexing your knee feels next to impossible. 

Dr. Watanabe often asks his patients the following questions to see if surgery could benefit them:

• Does your pain wake you up at night?
• Do you have pain or throbbing when you’re sitting? 
• At the store, do you lean on the cart or need to use a scooter to grocery shop? 

Other factors to think about

Your joint symptoms and diagnosis aren’t the only things to consider. Your age, weight and medical conditions might factor into whether you’re a candidate. 

Surgeons will look at other aspects of your health. Is your heart strong enough for surgery? How well will your body recover? Do you have trouble healing from cuts? Will your overall health be better after the surgery?

Will surgery improve your life?

While joint replacement has helped many people, it’s not a quick fix. It’s still major surgery. And you’ll want to do some research — not only about the surgery, but also about yourself.

What do you like to do? Do your hobbies or work involve a lot of kneeling? Kneeling after a replacement surgery can be difficult and uncomfortable.

“A patient in his 70s asked me about knee replacement. He’s very active and often kneels to work on his boat but says he doesn’t have much pain in his knees,” says Dr. Watanabe, “In his case, the surgery wouldn’t improve his quality of life at this point.”

Less pain vs. pain free

Dr. Watanabe also points out the need for realistic expectations. 

Knees are a “hinge” style joint. Unlike the hip joint, which is a “ball and socket” type joint, knees take more pressure. Knees also bear more of your body’s weight than your hips.

Patients getting a replacement have to work hard to get the most out of a new knee. It means consistent physical therapy to build strength and range of motion.

After recovery, about 20% of knee replacement patients will be pain free, says Dr. Watanabe. Most patients may have some minor discomfort. But they still feel the surgery is worth doing. 

“Patients are sometimes happy about even just reducing their pain to low levels.”

No need for early surgery

Timing is another thing to keep in mind.

People in their 40s or 50s may ask about surgery. If their knees function well and their pain is relatively mild, Dr. Watanabe often recommends waiting.

“Knees aren’t like an airplane engine. They don’t have to be replaced before they break down,” he says. “If the pain doesn’t keep you from playing pickleball, it might not be time.”

Preparing to talk with your doctor

PeaceHealth offers a joint quiz to help you begin your personal exploration. 

The short questionnaire asks about topics such as your:

• Usual level of joint pain.
• Pain at night.
• Level of difficulty doing activities such as shopping, transportation and self-care.
• Experience when climbing stairs, kneeling or limping.
• Weekly exercise level, height and weight.

It costs you nothing to take the quiz. But what you get back will be a valuable resource. 

Your personalized report

After submitting your answers, you’ll get a clear, brief assessment of your symptoms. Your report will include recommendations based on your answers.

If your pain is mild, you will get tips for protecting your joints. If you have severe pain that limits your activities, the next step is to talk with your primary care provider or an orthopedic doctor.

Either way, your personalized joint report is something you can keep and use. 

It’s a helpful tool for discussing your joint pain with your PCP or surgeon. And you can refer to it to compare how you feel as time passes. If you feel things are getting worse, you’ll know it’s time to meet with your doctor.

If you’re tired of holding back, take the joint health quiz to help you move forward.