If there’s one question patients ask us more than any other, it’s probably this:
“Is it time for me to get a knee replacement?”
It’s a really important question. When you’re struggling with a bad knee, the pain and disruption feels all-enveloping. It’s also true that once you hit a certain age – the mid-60s and up – you’ll hear of more contemporaries having knee replacements. The thought begins to form: should I be thinking about a replacement myself? How would I know the time is right?
The short answer
Without wishing to be flippant, the most likely answer is: no. For most people. That’s because knee replacement is usually only recommended for a) the most severe knee cases and b) when the alternatives aren’t working. Let’s explore those in a little more detail.
What is a severe case?
Generally speaking, it’s when you have osteoarthritis that has seriously damaged – ie depleted – the protective cartilage in your knee joint. (It can be recommended after gout damage or sporting injuries, but this is rare.) That damage will be seriously hampering your daily activities, to the extent that it stops you from living a normal life. For example:
It’s interfering with basic everyday activities – the pain or stiffness is making it hard or impossible to climb stairs, descend steps, go for walks, and so on, or gets worse soon after attempting them
You’re finding it hard to sleep – osteoarthritis pain typically feels worse at night. It can present as a dull, persistent, gnawing pain. Or it may be acute. Either way, it can make sleeping miserable
You’re getting persistent inflammation – your knee joint keeps swelling up and you struggle to reduce the swelling with medicines or rest
You have a deformity in your knee/s – arthritis or genetic conditions can cause the legs to become bowed, putting even more pressure on the joint surfaces
The pain is getting more and more intense – although it may have come on gradually, the pain now feels worse, or is happening more frequently, or even all the time. To quote Ed, a 56-year-old patient who had a partial knee replacement with us some years ago:
“By this stage I was feeling pretty cheesed off. I had tried to stay positive. I’d tried ignoring the pain, but it was just becoming more frequent. I was even struggling to get to sleep at night because of it.”
In other words, the discomfort and disruption are becoming really overwhelming.
What are the alternatives to knee replacement?
But if most painful knee problems don’t need replacement surgery, what are the other options? Well, fortunately, there are quite a few different ways to manage arthritis-related pain these days. Here are some of the main ones:
Lifestyle changes – it isn’t always what people want to hear, but lifestyle changes – such as weight loss – can make a huge difference to a damaged knee. Carrying too much weight puts the knee joint under more strain than many people realise, particularly when climbing and descending stairs
Low-impact exercise – sometimes it’s a case of changing the type of exercise you’re doing – switching running and tennis for activities that put less pressure on the knees. Typically, that means things like swimming, cycling and walking – things that strengthen your muscles without overtaxing your joints
Walking aids – walking sticks come in all shapes and sizes these days and can be very helpful for arthritis. You may also want to investigate footwear options; there are a number of different shoes and insoles on the market that are designed to provide support for arthritis sufferers
Medication – there are various routes for pain relief when it comes to arthritis, so it’s worth discussing these in depth with us or your doctor. The options range from creams and gels to NSAIDs and others – though mind and body therapies as an alternative to medication are becoming more popular
Steroid injections – a course of hydrocortisone, one of the main steroid treatments, which is injected into the knee joint, can help to relieve pain and swelling from arthritis
Hyaluronic injections – hyaluronic acid is a lubricating fluid that occurs naturally in our bodies. Some patients find that injections of hyaluronic acid into the inner part of the joint can provide pain relief over a significant period of time
Debridement – debridement is a keyhole procedure aimed at removing little pieces of frayed or damaged cartilage that may have become trapped in the knee joint
Microfracture – often performed along with debridement, microfracture involves making tiny holes on the surface of bones to encourage the growth of new cartilage
Osteotomy – osteotomy is an operation to alter the angle of the leg in order to relieve pressure on a joint compartment that has become damaged by osteoarthritis. For more detail on the procedure, see What is an osteotomy of the knee?
We’ll be looking at alternatives to knee replacement again in an upcoming article. In the meantime, though, if you’re suffering from knee pain and worried about what you should do next, please get in touch with the team. We’ll be very happy to look at your knee in depth and explore the best options for you.