Plus, what makes someone a good candidate for surgery?
We don’t think of how often we use our knees until the joints become painful. Chronic knee pain can affect your quality of life by keeping you from doing your favorite activities and making daily movement difficult. Depending on the cause of your chronic knee pain, the treatments you’ve already tried and your current health status, a total knee replacement might be a solution.
“A patient who is an excellent candidate for a joint replacement,” said Dr. Steve Engstrom, an orthopedic surgeon with Vanderbilt Orthopaedics, “has end-stage arthritis of their knee, and they have not seen success with conservative management, like physical therapy and injections. They also have significant difficulties in their daily life that can be improved with a joint replacement surgery.”
Causes of knee pain
A common cause of chronic knee pain is osteoarthritis. “That usually comes from years of wear and tear on the joint and thinning of the cartilage, which exposes the bone underneath,” Engstrom said. “That creates inflammation inside the joint and causes pain.” Sometimes, small problems with the alignment of bones and joints can make it more likely that someone will have early onset of osteoarthritis.
Also, an old injury to the knee can cause post-traumatic arthritis. “If somebody has to have a knee scope for a meniscus tear or an ACL (anterior cruciate ligament) construction, that can lead to arthritis down the line,” Engstrom explained. Rheumatoid arthritis, an autoimmune disease, can also cause the knee cartilage to break down, which could lead to a knee replacement, he added.
What makes someone a good candidate for surgery?
“Osteoarthritis is a slowly progressive, degenerative condition,” Engstrom says. “There’s not much that can be done to reverse course. And we never can predict how quickly the joint will deteriorate. So our strategy for treatment in those patients is symptomatic management.”
But if treatments like physical therapy or joint injections have stopped alleviating pain, then it may be time to consider surgery. “Some people really like to hike or really like to walk for leisure,” Engstrom said, “and they’re finding that the amount they can walk is slowly getting less and less.”
Evaluating the risks
Overall health plays an important role in what makes someone a good candidate for a knee replacement. “Underlying medical issues, especially those that are poorly controlled, can certainly increase the risk associated with joint replacement surgery,” Engstrom said.
But that doesn’t mean those risks can’t be improved. If someone has poorly controlled diabetes, for example, surgery can be delayed while a patient and their health care team work together to control the diabetes better. “The key is to just have all of their medical issues optimized to the best of their ability before proceeding,” he added.
Smoking and obesity are also risk factors that could lead to complications. “Smoking decreases blood flow to basically every organ in the body, and the bone is no exception,” Engstrom explained. “With decreased blood flow, they have a higher risk of infection, wound healing issues and early loosening of the artificial joint.” Obesity can lead to similar complications as well as deep vein thrombosis. Engstrom said patients with a BMI over 40 have a significantly increased risk for complications.
The recovery process after knee surgery is another thing to consider. “It’s a pretty involved rehabilitation after knee replacement,” Engstrom said, “and it requires a significant amount of patient participation.” In many cases, patients who receive a knee replacement through Vanderbilt Orthopaedics have the opportunity to rehab at home using an online digital platform, which makes the recovery process more convenient.
Struggling with joint pain?
Learn more about your options by downloading our free joint replacement treatment guide.
