By: Kathleen A. Hogan, MD
Each year, over 700,000 total knee replacements are performed per year in the United States. Many people who have arthritis can have pain relief with non-operative treatments such as weight loss, braces, activity modification, medications, and injections. But when these treatments are no longer effective, joint replacement is often recommended. However, some people delay or avoid surgery, despite being in pain.
Common Reasons People Are Afraid to Have a Knee Replacement
There are some common reasons that people are afraid to have a knee replacement. Fear of pain is usually the top reason. Concerns about missing work or important events is the second most cited reason to delay surgery. Some people feel they are too old for surgery. Others worry about complications of the procedure.
Knee replacement is a painful procedure. Bones are covered with a thin layer of tissue called periosteum which contains nerve fibers. During a knee replacement, the bones are cut and this causes a painful inflammatory response. To prevent pain, the best treatment is to be proactive. For example, my patients usually take an anti-inflammatory medication 3 days prior to surgery. A nerve block is given before the surgery and local anesthestic agents are placed within the joint during the surgery. Some medications, such as tylenol and toradol are given around the clock after surgery, and narcotic pain relievers provide additional relief as needed. This multi-modal pain regimen provides excellent relief of pain, but the knee will still be stiff and sore. The pain is at its worst during the first few days after the surgery and then improves.
Returning to Work
Returning to work after surgery is dependent on the requirements of the job. However the first 2-4 weeks you should concentrate on feeling better and working with physical therapy. If your job does not require much standing, lifting, or climbing, you may be able to go back to work in 6 wks; more strenuous jobs will require more time off. Everyone is different in regards to how long it takes to return to work.
How Old is Too Old?
How old is too old for a new joint replacement? So far, insurance companies have not denied patients joint replacements based solely on their age. A healthy 90 year old may have a longer life expectancy than a 60 year old diabetic with heart disease who smokes. Recommendations for or against surgery should be based on your health and the amount of arthritis in your joint, not on just your age.
What about complications? No surgery is without some risk. The majority of people who have knee replacement surgery are very pleased with the outcome and many wish they had chosen to have the surgery sooner. Occasionally, complications such as medical problems (pneumonia, heart attack, blood clots), stiffness of the joint, continued knee pain, implant loosening, implant failure, and infection can occur. However, these complications are rare and over 90% of people are very satisfied with their new knees. Certain activities, such as running are not recommended because of the risk of premature wear and loosening of the implant. Less than 1% of knee surgeries are complicated by infection, but infections can also spread from elsewhere in the body to the metal joint, so prophlaytic antibiotics are sometimes recommended before dental and other medical procedures.
Ask Your Surgeon Questions
If you have been told that you need to have a knee replacement do not be afraid to ask questions. Have you tried all the non operative treatments for arthritis? Are their any options other than surgery? Make sure you are comfortable with the surgeon who will be performing your knee replacement. You should be able to talk to your surgeons about your concerns and fears about joint replacement.
Don’t let fear keep you from doing the things you enjoy in life.