Pros and Cons of Knee Surgery for Osteoarthritis
If you’re living with osteoarthritis (OA) of the knee, chances are you rely on some non-surgical treatment strategies like NSAIDs, physical therapy, and maybe even injectable treatments to keep pain, swelling, and stiffness under control. These can all be effective ways to manage OA symptoms for a long time. But what happens when they’re no longer enough? At a certain point, you may consider knee replacement surgery, also known as knee arthroplasty. When that happens, this article is a great place to start.
When to Consider Knee Replacement Surgery
The first question: Have you already tried and failed non-surgical treatment options? If the answer is yes, the next thing to consider is how much knee OA impacts your life. “Once you get to a point where you feel like your knee is dictating the decisions you make and preventing you from doing what you want to do, then that’s the time to strongly consider having a knee replacement,” says E. Grant Sutter, M.D., orthopedic surgeon at Northwestern Medicine Central DuPage Hospital in Naperville, IL.
What Happens During Knee Replacement Surgery
During a knee replacement surgery, metal and plastic parts are used to essentially replace the existing damaged knee joint. The knee is composed of three compartments: medial (inside), lateral (outside), and patellofemoral (underneath the kneecap), explains Savyasachi C. Thakkar, M.D., assistant professor of orthopedic surgery at Johns Hopkins Medicine in Columbia, Maryland. If you have significant damage in just one compartment, you can get a partial knee replacement—a less invasive procedure that’s quicker to heal. But the majority of knee replacements in the U.S. are full knee replacements, Dr. Thakkar says.
Weighing the Pros and Cons of Surgery
At least for now, surgery is the only way to stop or “cure” OA, says Kirk A. Campbell, M.D., orthopedic surgeon at NYU Langone Health. But that doesn’t mean it’s right for everyone. There are many non-surgical ways to manage OA first, he says, but knee replacement is available if those aren’t sufficient. “The most important thing to know is that you don’t have to live in pain,” Dr. Campbell says. If you think surgery might be right for you, consider the following pros and cons, and then work with your doctor to decide the best path forward.
Pro: Surgery Reduces Pain and Improves Function
That’s two pros in one! “Whether it’s a total or partial knee replacement, the surgery reliably improves pain and function in patients with arthritis,” Dr. Sutter says. “Our number-one priority is to improve pain, and number two is maintaining range-of-motion and getting normal function back.” A good and experienced surgeon can do this quite reliably. “We can get patients back to living a normal life after surgery,” he says. It may not make your joint 100 percent pain-free, Dr. Thakkar notes, “but for the most part, people have a tremendous reduction in pain.”
Pro: You Can Use Your Knee Freely Again
A joint replacement is a fresh start, like getting a brand new joint that you can use however you please. “It’s a very successful surgery that gets people back to functioning normally,” Dr. Campbell says. Once you’re completely healed (typically three to six months after a total knee replacement, but it can take up to one year), you shouldn’t have to limit your activities at all. “In terms of function, there’s no restriction after joint replacement,” Dr. Thakkar says. “Patients can do whatever they want to do; they can do any activity they want to pursue.”
Con: There’s a Chance You’ll Be Unhappy With the Results
This could be considered a pro or a con, depending on your perspective. While most people are happy with their knee replacements (85%, according to Dr. Thakkar), a small portion are unhappy. Why? A knee replacement is not a perfect fix, Dr. Thakkar says. The knee is a complex joint, and every implant has its limitations. While a knee replacement is a replica, it’s never going to be exactly the same as the original knee. It can be pretty close, though, which is typically valuable enough for anyone who’s been dealing with pain and limitations for a long time.
Con: All Surgeries Come With Risks
“There’s no such thing as a zero-risk surgery,” Dr. Sutter says. Knee replacement surgery, in particular, comes with risks of infection, blood clots, and damage to surrounding tissues, he explains. “The risk of complications is really low, but there are real risks, and I counsel all my patients on them.” Some pre-existing health conditions may also be associated with a higher risk of complication, including diabetes, renal disease, and obesity. Your doctor will work with you to minimize any and all risk factors as much as possible before surgery.
Con: Recovery Requires an Active Commitment
We’ve said it before, but it’s worth repeating: The knee is a complex joint. This means physical therapy is required to make sure the joint regains its full range of motion after surgery, Dr. Sutter says. “The surgeon will make sure you have full motion in the operating room, but pain and swelling are natural parts of the post-surgery process so you need a physical therapist to work with you multiple times per week to help you get the motion you want and need,” he explains. The first six weeks post-op are generally most important for recovery and physical therapy.
Con: Knee Replacement Surgery Is Expensive
The exact cost of your surgery will depend on your specific procedure, doctor, hospital, and health insurance plan, but chances are it’ll make a dent in your wallet. In addition to the procedure price, you also need to consider how much it will cost you to take time off work and to pay for physical therapy as you recover, Dr. Campbell says. “There are definitely a lot of factors that come into play. It’s not a decision people should take lightly,” he says.
- Types of Knee Replacement: American Association of Hip and Knee Surgeons. (2017). “Full vs. Partial Knee Replacement: What's the difference?” hipknee.aahks.org/full-vs-partial-knee-replacement-whats-the-difference/
- Satisfaction After Knee Surgery: Official Journal of Korean Knee Society. (2016). “Patient Satisfaction After Total Knee Arthroplasty.” jksrr.org/journal/view.html?uid=124&vmd=Full&
- Knee Replacement Outcomes: The Lancet. (2018). “Knee Replacement.” thelancet.com/journals/lancet/article/PIIS0140-6736(18)32344-4/fulltext