Knee replacement: Life changing or a disappointment?

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

While there are more than 100 types of arthritis, osteoarthritis is by far the most common. It’s the age-related, “wear-and-tear” type of arthritis that affects almost everyone fortunate enough to live a long life, affecting up to 80% of older adults. Fortunately, symptoms may be mild. But for those in whom symptoms are severe, treatment can make a big difference.

So what can be done for osteoarthritis?

The available treatments for osteoarthritis include:

  • Non-medication approaches, such as physical therapy, loss of excess weight, or use of braces or a cane
  • Complementary and alternative treatments, such as acupuncture, massage, or tai chi
  • Medications, such as pain relievers, anti-inflammatory medications, or cortisone injections
  • Surgery, such as knee or hip replacement.

Surgery is usually a last resort. But for severe osteoarthritis, it’s often the only option likely to make much difference. In the United States alone, more than 600,000 knee replacements and 300,000 hip replacements are performed each year; and predictions are that these numbers will rise dramatically in the coming decades.

And just how good is joint-replacement surgery?

Most articles about joint replacement surgery (and the surgeons who perform them) make statements such as: “The vast majority of patients who have their knees replaced are markedly improved” or “More than 80% of people who have their hip replaced are glad they had it done.” While these statements are generally quite true, there is still a significant number of people who get less than they expected from the surgery. Part of the disappointment may be because their expectations were too high.

Two recent studies analyzed the question of how good knee replacement surgery is — but not from the surgeon’s perspective. These studies surveyed patients directly. After all, joint replacement surgery is intended to reduce pain and improve function, so it’s the patient’s perspective that counts! Here’s what they found:

  • A 2014 study enlisted an independent survey center to interview individuals after knee replacement surgery. While 90% were satisfied with the function of their new knee, about one-third reported that their knee did not feel “normal.” Up to one half reported at least some continued symptoms or trouble with function. The authors noted that some of the “cutting edge” advances in knee replacement surgery — such as the use of computers to more accurately align the new joint — did not seem to improve these numbers much.
  • A 2015 study compared people who had knee replacement surgery with those who were also good candidates for surgery but had not yet had it. Those having surgery reported better pain control and better function after one year than those treated non-operatively; however, those having surgery had far more complications, such as blood clots in the leg veins.

Is joint replacement right for you?

These studies show that we still have a way to go when it comes to the treatment of osteoarthritis. Even the most “definitive” treatment — surgical joint replacement — has significant limitations. But I think another message in these studies is that if you are considering joint replacement surgery it’s important to know what to expect:

  • It’s a big operation with a significant recovery time.
  • There are some important risks.
  • There’s a reasonable chance your knee will not feel completely “normal” afterwards.

Still, for many, having a severely arthritic joint replaced allows them to walk with far less (or no) pain and to have a dramatically improved quality of life. No, it’s not perfect. But for most people who need it, joint replacement is far better than the alternatives.

Comments:

  1. Deb

    Life changing x 2. In comparing notes with others , I would stress the importance of PT. It appears that some of those who were disappointed had not devote their full energy to this.

    • Claire Renee

      I think you are correct Deb. When I took my mom to her pre-op session the presenter emphasized that the outcome of knee surgery is largely in the hands of the patient. She encouraged the patients to do their pre-op exercises diligently and the same with the post op ones. My mom did so and her physiotherapist at the hospital was astounded at how well she did. She was in a lot of pain prior to her surgeries and was very motivated to have a good outcome.