• Bryan Morrow

Should You Have Knee Replacement Surgery?


Some experts question whether knee replacement surgery is being done too often or too soon on patients who have not adequately explored less invasive approaches.

The knee is the most commonly replaced joint in the body. The decision to have knee replacement surgery is one that you should make in consultation with your orthopedic surgeon and your physical therapist. Usually, total knee replacement surgery is performed when people have:

  • Knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases, or fracture that has not responded to more conservative treatment options

  • Knee pain or alignment problems in the leg that cause difficulty with walking or performing daily activities, which have not responded to more conservative treatment options

To be sure surgery is right for you, some surgeons advise younger patients to put off replacement surgery as long as possible because those with a life expectancy of 15 years have a much better chance of avoiding a future operation than those expected to live another 30 years. Among nearly 55,000 people who had a knee replacement, 10.3 percent needed revision surgery within 20 years, although the longevity of current knee replacements is likely to be greater thanks to better prosthetic materials and surgical techniques.

Experts are now asking if all these operations are really necessary, One recent study conducted by Daniel L. Riddle, a physical therapist at Virginia Commonwealth University, and two medical colleagues, for example, examined information from 205 patients who underwent total knee replacements. Fewer than half — 44 percent — fulfilled the criteria for “appropriate,” and 34.3 percent were considered “inappropriate,” with the rest classified as “inconclusive.” Although patients with less severe pain and loss of function may still benefit from replacement surgery, the researchers suggested that their gains are likely to be smaller. “What this study does show is that the cost associated with these small changes is very high,” Dr. Riddle said. “People who are on the very severe end of the spectrum of pain and functional loss have a lot more gain to make.”

It’s important for patients to have a clear understanding of the benefits and harms of knee replacement surgery because recovery from it is no picnic.

How Can a Physical Therapist Help?

The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function, and return to daily activities.

Your physical therapist can help you prepare for and recover from surgery, and develop an individualized treatment program to get you moving again in the safest and most effective way possible.

Before

The better physical shape you are in before TKR surgery, the better your results will be (especially in the short term). A recent study has shown that even 1 visit with a physical therapist prior to surgery can help reduce the need for short-term care after surgery, such as a short stay at a skilled nursing facility, or a home health physical therapy program.

Before surgery, your physical therapist may:

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