When is it time for knee replacement surgery?
Written by:When your knee is severely arthritic, causes you pain most of the time and affects your sleep and daily function, you need to see a specialist. Before considering knee replacement surgery your doctor should always exhaust non-operative conservative treatments. We’ve asked leading orthopaedic surgeon Mr Paul Trikha for his expert opinion on whether knee surgery is always necessary in cases of knee pain.
How can I manage my knee pain?
More often than not the first line of treatment is non-operative with simple painkillers or anti-inflammatory tablets. It's important to change your activity from high-impact exercises such as tennis or running to more of a low-impact sport such as cycling and swimming. In some cases, it is important to get your weight down in order to unload the knee joint.
What tools or medications can help?
It's important to consider other forms of treatment such as a brace or support to allow you to function and there are some very good unloader braces available now. When pain particularly becomes severe, we can consider injections. These range from injections used for acute flare-ups to hyaluronic acid gel injections, when the knee is dry. This replaces some of the lubricants within the knee.
There are now newer injections known as platelet-rich plasma injections. We take your blood and the good healthy platelets from the blood and inject them in the knee. They are used to try and allow the cartilage to settle down and heal. There are also stem cell injections, which are taken either from the bone marrow or from the fat but there's very limited evidence to support these at the moment.
It's important to try non-operative treatments before you embark on a knee replacement which is a major joint-sacrificing procedure. Preserving your native knee joint is important. Although patients don't feel that doing any exercise can help their knee, having a prescribed exercise programme that suits and is tailor-made to you can definitely help.
Is knee surgery necessary? How can I rate my pain level?
If you maintain your range of motion and can keep your pain under control, you might be able to put off a knee replacement for some time. This is important because not all patients do well with the knee replacement.
If you have a pain score of 8 out of 10 (where 10 is severe pain and zero is no pain) then 80 per cent of patients after a knee replacement will have a much-improved pain score. They generally have very little pain. That is a score of one or two, or three out of ten, then that's very much more manageable.
Ten per cent of patients have an absolutely brilliant knee, which feels normal. They can play sports and may wish that they had the surgery earlier. But the most important reason to delay a knee replacement is there is a real risk in some (10 to 15 per cent) that a new placement does less well in. It doesn't feel like a normal knee after surgery.
It doesn't have the same pain relief that the patient expects and the pain score can still remain high and those patients regret having the knee replacement.
That's why it's important to delay a knee replacement as long as you can to remain at the back of a queue for a knee replacement as with any degenerative condition because replacing your knee joint isn't without risk.
Do not hesitate to book an appointment with Mr Trikha if you're concerned about your knee.
