Having knee pain doesn't automatically mean you need a knee replacement.
Even having arthritis doesn't automatically mean you need one.
The decision usually becomes relevant when the damage to the knee is causing significant pain or loss of function, everyday activities are becoming difficult, and appropriate non-surgical treatments are no longer providing enough relief.
So if you've been told you have knee arthritis, or your knee pain has become increasingly difficult to live with, the useful question isn't:
“Do I need a knee replacement?”
It's:
“What is causing my symptoms, how much is it affecting my life, and what treatment options are appropriate for me now?”
An orthopaedic assessment helps answer those questions.
What Is Knee Replacement Surgery?
Knee replacement, also called knee arthroplasty, is an operation in which damaged parts of the knee joint are replaced with artificial components.
During the procedure, damaged bone and cartilage are removed from the affected joint surfaces and replaced with metal and plastic components designed to restore the joint surface.
Depending on which parts of the knee are damaged, a surgeon may consider a partial knee replacement or a total knee replacement.
The aim is generally to reduce pain and improve how the knee functions.
Why Might Someone Need a Knee Replacement?
One of the most common reasons for knee replacement surgery is osteoarthritis.
Osteoarthritis causes changes within the joint that can lead to pain, stiffness, swelling and difficulty moving normally. As joint damage becomes more severe, everyday activities such as walking, climbing stairs or getting out of a chair can become increasingly difficult.
But the decision to consider surgery isn't based simply on whether an X-ray shows arthritis.
Your symptoms and how they affect your life matter too.
5 Signs It May Be Time to Discuss Knee Replacement With an Orthopaedic Surgeon
These signs don't mean you definitely need surgery.
They mean a conversation with an orthopaedic specialist may be worthwhile.
1. Knee Pain Is Seriously Affecting Everyday Life
Think beyond how painful the knee feels while you're sitting in the doctor's office.
What has the pain stopped you from doing?
Can you walk comfortably?
Use stairs?
Stand for the amount of time your work requires?
Get out of a chair without significant difficulty?
Sleep comfortably?
Carry out your normal daily activities?
NICE recommends considering referral for joint replacement when symptoms such as pain, stiffness, reduced function or progressive deformity are substantially affecting quality of life and non-surgical management has been ineffective or unsuitable.
That makes impact on your life an important part of the decision.
2. Your Knee Has Become Increasingly Stiff or Difficult to Move
Pain isn't the only symptom that matters.
Significant stiffness and reduced movement can make normal activities increasingly difficult.
An orthopaedic surgeon can assess your range of motion, stability and strength as part of determining the condition of the joint and what treatment options may be appropriate.
3. Non-Surgical Treatment Isn't Giving Enough Relief
Knee replacement usually isn't the first treatment considered for knee osteoarthritis.
Depending on the individual, non-surgical management may include therapeutic exercise, weight management where appropriate, pain relief and other treatments recommended by a healthcare professional.
NICE recommends considering joint replacement when appropriate non-surgical management has been ineffective or is unsuitable.
So the question isn't simply:
“Have I tried painkillers?”
It's whether appropriate non-surgical treatment has given you enough improvement to live and function reasonably well.
4. Your Mobility Is Becoming More Limited
Perhaps you've started avoiding stairs.
You walk shorter distances.
You plan outings around how far you'll need to walk.
You need more support to move around.
Or activities you used to do routinely have become difficult because of your knee.
Those changes matter.
Knee replacement is intended to reduce significant joint pain and improve function in appropriately selected patients.
5. Your Orthopaedic Assessment Shows Significant Joint Damage
Your symptoms tell one part of the story.
Clinical assessment tells another.
An orthopaedic surgeon may assess the knee's movement, stability, strength and alignment. Imaging such as X-rays may also be used when appropriate to understand the extent and pattern of joint damage when planning treatment.
No single symptom or scan should make the decision for you.
The decision should come from the overall clinical picture and a discussion about the potential benefits, limitations and risks of surgery.
Does Severe Knee Arthritis Always Require Surgery?
No.
People can have knee osteoarthritis without immediately needing a knee replacement.
Treatment depends on symptoms, function, general health, previous treatment and other individual factors.
For some people, non-surgical treatment provides enough relief to continue their usual activities.
For others, symptoms progress to the point where those approaches are no longer enough.
This is why two people with “knee arthritis” may receive very different treatment recommendations.
What Happens Before a Knee Replacement Is Recommended?
Before deciding whether knee replacement is appropriate, your orthopaedic surgeon needs to understand both your knee and your overall health.
Your assessment may include:
- Your symptoms and how long you've had them
- How the pain affects everyday activities
- Treatments you've already tried
- Your medical history
- Examination of the knee
- Range of movement
- Stability and strength
- Appropriate imaging
- Your expectations from treatment
The decision should be made together with your surgeon after discussing the reasonable options.
NICE recommends using clinical assessment rather than numerical scoring systems alone when deciding whether someone should be referred for joint replacement.
Total vs Partial Knee Replacement: What's the Difference?
Not every knee replacement involves replacing the entire joint surface.
Total Knee Replacement
In a total knee replacement, damaged surfaces at the ends of the thigh bone and shin bone are replaced with artificial components.
This is the more common form of knee replacement.
Partial Knee Replacement
If damage is limited to a particular part of the knee, a partial knee replacement may be considered in appropriately selected patients.
Only the affected portion is replaced.
Which approach is appropriate depends on factors such as the location and extent of joint damage and the individual patient's clinical circumstances.
What Are the Risks of Knee Replacement Surgery?
Knee replacement is major surgery, so the potential benefits need to be considered alongside the risks.
Possible complications can include:
- Infection
- Blood clots
- Nerve or tissue injury
- Persistent pain or stiffness
- Problems with the replacement joint over time
The individual risk of complications varies according to factors including a person's overall health and circumstances.
Your surgeon should explain the risks that are particularly relevant to you before you decide whether to proceed.
What Is Recovery Like After Knee Replacement?
Recovery doesn't end when you leave the operating theatre.
Movement and rehabilitation are important parts of recovery.
Patients are typically encouraged to begin moving relatively early after surgery with appropriate support. Physiotherapy and prescribed exercises can help restore movement, strength and function. Full recovery can take several months or longer and varies between individuals.
Your recovery plan depends on factors such as:
- The type of knee replacement
- Your health before surgery
- Your mobility
- The condition of the knee
- Your progress after surgery
- Your rehabilitation needs
Your surgical and rehabilitation teams should tell you what to expect based on your individual circumstances.
How Successful Is Knee Replacement?
For appropriately selected patients, knee replacement can substantially improve pain and function.
However, no surgery can guarantee a particular outcome.
Some patients may continue to experience pain, stiffness, instability or other problems after surgery, and replacement joints can eventually wear or loosen.
That's why the decision isn't simply about whether knee replacement can work.
It's about whether the likely benefits make sense for your particular knee, symptoms and circumstances.
Considering Knee Replacement Surgery in Ibadan?
Banby Specialist Hospital provides orthopaedic and joint replacement surgery in Ibadan, including total knee replacement and total hip replacement where clinically appropriate.
Banby was founded by Professor Bade B. Omololu, MBBS, FRCS, FWACS, Professor of Orthopaedic Surgery, and orthopaedics remains one of the hospital's specialist surgical services.
If knee pain is significantly affecting your mobility or everyday life, an orthopaedic consultation can help determine what's causing it and whether non-surgical treatment, surgery or another approach is appropriate.
You don't need to decide whether you need a knee replacement before seeing the surgeon.
That's what the assessment is for.
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Frequently Asked Questions About Knee Replacement
At what point do you need a knee replacement?
There isn't one symptom or test that determines this for everyone. Joint replacement may be considered when pain, stiffness or reduced function is substantially affecting quality of life and appropriate non-surgical treatments have not provided enough relief or aren't suitable.
Is knee replacement only for older people?
Age alone shouldn't determine whether someone is referred for consideration of joint replacement. NICE specifically advises against excluding people from referral based solely on age, among several other individual characteristics.
Whether surgery is appropriate depends on clinical assessment and the person's circumstances.
Do I need knee replacement if I have arthritis?
Not necessarily.
Many people with knee osteoarthritis are managed without joint replacement. Surgery becomes a consideration when symptoms and loss of function are significant and appropriate non-surgical treatment is no longer sufficient or suitable.
Is knee replacement the same as knee surgery?
No.
“Knee surgery” covers many different procedures. Knee replacement specifically involves replacing damaged joint surfaces with artificial components.
How long does recovery from knee replacement take?
Recovery varies. Full recovery can take several months or longer, although patients usually begin moving much earlier with support and rehabilitation.
Your surgeon and rehabilitation team can give you guidance based on your procedure and individual progress.
The Decision Starts With the Right Diagnosis
Knee replacement can be an important treatment for some people with severe joint damage.
But the decision shouldn't begin with surgery.
It should begin with understanding why your knee hurts, how much the condition is affecting your life, and what treatment options are still available to you.
If surgery eventually becomes the appropriate option, you and your orthopaedic surgeon can make that decision with a clearer understanding of the potential benefits, risks and recovery involved.
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This article provides general health information and does not replace individual medical advice, diagnosis or treatment.