When to talk seriously about knee replacement

What to notice before deciding

Look across several weeks, not one bad afternoon. Notice whether soreness comes most days, wakes you often, shortens a store trip, or makes stairs unsafe. Write down those steady changes.

Home care may still help enough to put off surgery. Brief walks, strength exercises, or a brace may keep daily life manageable. If each month takes away more movement, repeating care that hasn't helped may waste time and money. Be honest about that cost.

What to ask the surgeon

Ask why replacement fits now, what it may improve, what may stay sore, and what can go wrong during recovery. Don't accept an answer you can't follow.

Ask about help at home, medicine, driving, and time away from usual duties. A total replacement covers all the worn knee surfaces. A partial replacement covers only the damaged part. Ask which operation fits the damage in your knee and why.

What to do while you wait

Keep moving only as far as possible without making swelling or soreness clearly worse later that day. Use a fitted cane or brace, and split larger chores into smaller ones. Don't test the knee with a long outing. Save your strength for daily life.

Call sooner if the knee grows hot and red while you have a fever. Get quick care if the injured leg gives way under you, the knee locks, or the calf becomes warm and swollen. These signs need prompt medical help.

When to ask about an option before surgery

If you wait, choose a date to review walking, sleep, and safety, then decide which worsening change means you'll call sooner. That keeps a few hard months from quietly becoming a hard year.

Surgery may still be right after another exam. QC Kinetix's Scottsdale medical providers can examine the knee before surgery and explain regenerative care, including platelet-rich plasma (PRP), made by spinning the patient's blood before it's used as a knee shot.

Sources

1. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

2. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

3. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.

4. Pooling the OAI and MOST cohorts (8,002 participants followed up to 8 years, 3,417 classifiable knees), validated appropriateness criteria classified only 290 knees (8%) as receiving a TIMELY total knee replacement, 2,833 knees (83%) as potentially appropriate but not replaced more than 2 years after replacement became appropriate, and 294 knees (9% of all knees, 26% of the 1,114 replacements actually performed) as PREMATURE. Of the potentially-appropriate-but-not-replaced knees, 1,204 (42.5%) had severe symptoms.

   Ghomrawi HMK, Mushlin AI, Kang R, et al. — Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.. Journal of Bone and Joint Surgery (American), 2020. DOI: 10.2106/JBJS.19.00432.