When is it Time to Have a Knee Replacement?
Knee replacement is one of the most successful operations in medicine and has improved the lives of millions of patients.
Patients often ask about when they should get a knee replacement. This page explores conservative treatments for knee arthritis, the risks associated with knee replacement and signs that it may be time to consider knee replacement.
Conservative Treatment for Knee ArthritisI am a firm believer that conservative treatments for knee arthritis work well and are an appropriate solution for many patients.
Physical TherapyOne of the most effective means of treatment is physical therapy. The most effective therapy is called closed-chain quadriceps strengthening, which involves maneuvers when the foot is planted on the floor to strengthen the large thigh muscles. This therapy often improves the way the kneecap moves through the knee joint, alleviating pain and improving ability to function.
Weight loss is also a very effective means of dealing with knee arthritis. When we speak about a patient's weight, we usually speak about the body mass index (BMI), which is a ratio of weight and height that can be calculated using an online calculator. Patients with BMI above 30 should consider weight loss to see whether that improves their symptoms before they embark on any kind of joint replacement.
The way the mechanics work in the body, if you lose 1 pound of overall body weight, it takes 3 pounds of stress off your knee. We have had several patients who were too heavy to undergo joint replacement, and we asked them to lose weight before the joint replacement surgery.
When they lost the weight, they decided that they no longer needed the joint replacement because their pain had dramatically lessened.
Certainly, this does not apply to everyone, but it has convinced me that attempting weight loss before knee replacement is a sound strategy for patients with BMI over 30.
Steroid injections into the knee are commonly administered as treatment for knee arthritis. Although a very small risk of infection is associated with the injections, they are remarkably effective at relieving pain. Unlike steroid pills, they rarely have any major effects on the whole body other than a temporary rise in blood sugar in diabetic patients.
Steroid injections can be administered into the knee every 3 months at the doctor’s office (we have to wait 3 months between shots), and some patients have been able to delay joint replacement for years with the help of routine steroid injections.
Pain-relief medications, such as acetaminophen (Tylenol) and ibuprofen, are also very effective. For acetaminophen to be effective, patients should take it three times a day. For example, patients without liver problems can take two Extra Strength Tylenol (1000 mg acetaminophen) three times a day to maximize the results. Ibuprofen and naproxen, which are anti-inflammatory medications, can be taken for pain relief as long as patients do not experience stomach problems, such as ulcers or bleeding.
Excessive use of ibuprofen or naproxen can cause kidney damage, so follow the instructions on the bottle.
Other treatments, such as knee unloader braces, heel wedges placed in the shoe and injections of hyaluronic acid (a gel that is injected into the knee), have also been used for conservative treatment of knee arthritis. The American Academy of Orthopaedic Surgeons has not found them to be of substantial benefit.
However, if patients want to try heel wedges, unloader braces or injections of hyaluronic acid gel, we are more than happy to accommodate them.