Total Knee Replacement Surgery Considerations

Just as medical treatments changes, so do patients. There’s been a substantial increase in recent years in the number of people younger than 60 receiving total joint replacements, especially total knee replacements (TKR), and the numbers are expected to continue rising. 

That doesn’t mean you have to jump on board. Some people are eager to have their knees replaced because they’re in pain and want their active lives back. But others prefer to delay surgery for as long as possible. Consider these pros and cons, with your doctor’s help. 

Goodbye to (most) pain. “The No. 1 reason to have TKR is for pain management,” says Brian S. Parsley, MD, clinical associate professor in the department of orthopedic surgery at Baylor College of Medicine in Houston. The success of TKR in younger patients: about 90% to 95%.

A long-lasting fix. An implant can last from 15 to 25 years. “If you’re under 60, you’re probably facing a revision [or do-over], but the most common revision is usually just an exchange of the plastic insert,” says Dr. Parsley. That means most of the original implant stays, and the surgeon won’t necessarily need to remove more bone.  

Resuming what you love.Age 60 is too young to give up activities you love because of disabling pain, says Andrew Glassman, MD, chief of adult reconstructive surgery at The Ohio State University Wexner Medical Center in Columbus. “If a procedure can [extend] your ability to do those things for 25 years, that’s reasonable to do.” 

Committing to recovery. Having any kind of surgery, especially joint surgery, requires time, money and a commitment to making it work. You’ll need to make preparations before surgery and carefully follow your treatment and recovery program afterward. If you are willing to maintain a healthy weight and stick to your physical therapy routine, your chances of having a long-term improvement in your joint are much greater. 

A second, or revision, surgery. “Younger patients do have a higher rate of failure and early revision because of obesity, more activity and because they are living longer than older patients,” says Dr. Parsley. How much you have to have redone depends on what part of the implant has failed. For instance, debris from the implant’s wear can damage bone. “So, if you don’t follow up with your doctor for 10 to 15 years and then have bone damage, you may need to remove old components and replace them with all new ones,” explains Dr. Glassman. 

Hazards of surgery. As with any surgery, there is a risk of infection and blood clots. Or the implant itself could fail if, for example, a bone fractures or if the implant loosens. 

Unrealistic expectations. “Many patients think they will go back to a normal lifestyle, that they will be pain-free or that they can return to a higher level of activity than we recommend,” says Dr. Parsley. “Your knee will be better, but never normal.” 

Try everything else first. “Have a thorough evaluation and explore conservative options,” says Dr. Parsley. “For instance, if you restore strength and flexibility in the muscles around the knee, you will reduce pain and improve function.”

Other nonsurgical treatments include pain medications, losing weight and steroid or lubricant injections.

Understand that surgery isn’t a cure. Although TKR will relieve some symptoms of arthritis, it isn’t a cure for the progressive condition. Even if you have joint surgery, you will still need to manage your arthritis by maintaining a healthy weight, staying strong and flexible through exercise, taking your prescribed medications and keeping up with your overall health. 

Recognize the gamble. You may face the prospect of revision surgery, whereas someone who is older might not, in part because you’re likely to be more active. Revisions in younger patients happen twice as often as in older patients.

Consider partial knee replacement. This is a good option for someone with arthritis in only one part, or one of the three compartments, of the knee, says Dr. Glassman. It’s a smaller surgery, potentially with a faster recovery and less pain. But partials usually wear out in 10 to 12 years. Or you may develop arthritis in the other two knee compartments and then need a full replacement.

Get the most experienced surgeon. Ask your internist to refer you to an orthopedic surgeon who primarily does knee replacements, Dr. Glassman recommends, and make sure that surgeon will also treat complications.