Knee replacement is a safe and common procedure. But getting one is not an easy decision. An injury or a medical condition is usually involved. Any surgery has risks and recovery time to consider. Quality of life is a big factor.
In this video, William Bugbee, MD, an orthopedic surgeon at Scripps Clinic, joins San Diego Health host Susan Taylor to discuss chronic knee pain, treatments, including surgical treatments (such as partial and total knee replacement surgery), rehabilitation, and long-term results.
“If nonsurgical treatments, such as over-the-counter pain relievers, anti-inflammatory medications, doctor-administered knee injections and physical therapy have been unsuccessful, you may be ready to consider a knee replacement,” Dr. Bugbee says. “When it’s the right time, it can be life-changing.”
The most common reason for a knee joint replacement is severe osteoarthritis in the knee. “It's deterioration of the structures of the joint,” Dr. Bugbee explains. X-rays confirm when cartilage in the knee has worn away allowing the bones to rub together, causing pain and damage.
Knee replacement is considered effective in reducing pain and restoring function. In recent decades, it has become an increasingly common procedure in the United States. In 2014, there were nearly 700,000 knee replacements in the US, according to the American Academy of Orthopaedic Surgeons.
But orthopedic surgeons don’t recommend surgery for every patient who comes to their office. Surgery is usually a treatment of last resort for people whose knee no longer functions without pain due to cartilage loss caused by age, a previous injury or medical condition. According to Dr. Bugbee, “If they’ve been through years of medical treatment with pills and shots, I’m going to say, ‘Are you ready for surgery?’”
Dr. Bugbee likens knee replacement to retreading a worn tire rather than replacing it. “The major structures of the knee remain intact. We’re just resurfacing it.”
In knee replacement, a surgeon removes damaged portions of the lower end of the thigh bone and upper end of the shin bone and replaces them with metal and plastic implants. The back of the kneecap may also be resurfaced and fitted with a plastic insert.
Most knee replacement surgeries are total knee replacements, which today tend to last 20 years or longer. As a result of improvements, younger patients need not be as concerned as before about the knee implant wearing out and needing a second knee replacement later in life, according to Dr. Bugbee.
“In the old days, people would say ‘Oh it only lasts 10 years. I’m going to live a long time. I don’t want to have another one. So, I’ll just suffer from 50 to 70 years old and then have one,’” he says. “But the technology and the skill of surgeons today make it so that a knee replacement usually will last a lifetime.”
The other knee procedure is a partial knee replacement, which involves replacing only part of the joint. “If part of your knee is damaged, but the rest is healthy, we’ll just replace the one part of the knee that's damaged. That allows the rest of the structure to be intact. It results in generally a more normal feeling knee and a more normal performing knee,” Dr. Bugbee says.
Advances in anesthesia and postoperative pain management, as well as quicker rehabilitation, have resulted in shorter hospital stays, better outcomes and fewer complications.
“You can have a knee replacement and never go to the hospital,” Dr. Bugbee says, describing one possibility. “Just come and have it done and go home.”
Hospital stay usually depends on the health of the patient and the system the doctor has in place, he adds. “I feel more comfortable having my patients stay overnight so I can see them and make sure my therapists see them first to get them going and make sure their transition home is easy.”
Knee replacement is usually an hour and a half procedure. Most surgeons will want you get you out of bed and walking as quickly as possible afterward for health reasons.
Depending on the type of knee replacement surgery, full recovery can be anywhere from a few months to six months or longer. “Rehab is everything,” Dr. Bugbee says. “If you want a good outcome, you have to do the work.”
Restrictions are generally few. “Most surgeons who do a lot of knee replacement don’t generally tell their patients what they can or can’t do,” he says.
Most people are usually able to return to normal activities and work. Most sporting activities are fine though there is caution about high-impact sports.
The goal is always less pain and improving function as well as getting used to an artificial joint.
“It doesn’t work exactly like your joint. It doesn’t feel exactly like your joint. But compared to what you had before it's a tremendous improvement.”