By the way, doctor: Should I have my knee replaced?
Q. Fifteen years ago, I had surgery for a torn meniscus and was told I had arthritis. I'm now 79, and my knee hurts most days, though I still exercise daily on a stationary bike. I hate to take pills. Should I consider a knee replacement?
A. Twenty years of follow-up data indicate that knee replacement surgery relieves pain and improves function in most patients. However, it's major surgery, so it's important to determine if you're a good candidate. You are if you have 1) x-ray evidence of joint damage, and 2) persistent pain that isn't relieved by nonsurgical measures and greatly limits your daily function and quality of life. You also need to determine if arthritis of the knee is the actual source of the trouble. The pain could be caused by tendinitis, bursitis, a ligament strain, or even another meniscal injury. Or it could be "referred" from a problem originating in the back or hip. A thorough evaluation by an orthopedic expert is important.
Even if you have x-ray evidence of advanced arthritic changes in the joint, there are noninvasive strategies you can try before considering knee replacement. If you're overweight, losing weight may help relieve the pain by reducing the load on your knee. Using a cane is another way to decrease the load. A knee brace and shoe inserts can help align the knee and improve weight distribution. You can also do exercises to strengthen the muscles involved in proper knee alignment.