Do You Actually Need Knee Replacement Surgery?
Whether you inherited arthritis or suffer from an old running injury, knee pain can make climbing stairs, staying active, and even getting a good night’s sleep more challenging. On average, people spend 13 years with knee pain before getting surgery, according to the Arthritis Foundation. But do you really need knee replacement surgery?
First things first — are you a good candidate?
Knee surgery is an elective procedure. “I don’t like to say someone needs surgery,” says David Silva Iacobelli, M.D., an orthopedic surgeon at the University of Miami Health System. Instead, Dr. Iacobelli assesses whether patients are good candidates for surgery. This means they’re likely to experience improved pain, better function and a higher quality of life with surgery.
If arthritis isn’t advanced and symptoms are mild, knee replacement surgery is probably not the right choice for you right now.
Partial vs. total knee replacement (and how doctors decide)
When doctors refer to partial versus total knee replacement, this refers to the specific area of the knee that requires surgery. There are three parts, or compartments, of the knee:
- Medial: Inner side
- Lateral: Outer side
- Patellofemoral: Front, where the kneecap is located
When assessing your knee using imaging, your doctor examines the location of your pain and the site of the arthritis. If both pain and arthritis are in one compartment, such as the medial side, this can mean you’re a candidate for a partial knee replacement. A total knee replacement for more severe arthritis replaces all three of these compartments.
Dr. Iacobelli says that with total or partial knee replacements, your surgeon will decide if resurfacing the patella is necessary. This involves shaving damaged cartilage under the kneecap and replacing it with plastic to help the kneecap move more easily and with less pain.
Robotics and navigation tools are not autopilots
In the past, surgeons had to rely on their expertise and eyesight to ensure that knee implants were aligned correctly, allowing both legs to remain straight. “Traditional knee surgery insisted that everything be straight, so every patient got the same alignment, even though everyone’s anatomy differs,” says Dr. Iacobelli.
Today, technology like surgical robotics and navigation allows surgeons to be much more precise and patient-specific when removing bone and placing implants, down to the millimeter.
Robotics and navigation in knee surgery are tools that allow surgeons to refine the surgery process, but they don’t perform the surgery on their own. Some technologies create a 3D map of your knee to help guide surgeons in removing bone with greater precision in specific amounts and areas. Technology also allows surgeons to match the implant position to the patient’s natural ligament balance, reducing soft-tissue trauma.
“More precision gives you a better implant fit unique to your anatomy, as well as less damage to nearby soft tissues,” says Dr. Iacobelli.
Up and walking the same day
New recovery methods like pre-op pain control, targeted nerve blocks around the knee during and after surgery and care coordination consisting of physical therapists and nurses mean surgery no longer requires an extended hospital stay. “In the past, patients stayed in the hospital five to seven days, often in bed. Now, we aim to have most patients up and walking the same day,” says Dr. Iacobelli.
Now, many patients are waking up from surgery with lower pain levels and can get up and move that same day. By three months, most patients experience noticeable improvements and achieve full benefits after 12 months.
What to expect from a new knee
The goal of knee surgery is to relieve pain and improve function and motion. But a replaced joint isn’t a normal knee, he adds. You can expect a scar, possible numbness over a small area and stiffness, which can improve with physical therapy. Returning to activities like walking, biking, swimming, and hiking occurs at different paces for each person, depending on the procedure and physical therapy regimen.
That’s not to say you can’t have high expectations for agility after knee surgery. Dr. Iacobelli regularly sees patients return to running, pickleball and even serious mountain climbing after knee surgery.
Dr. Iacobelli cautions that high-impact activities, such as training for a marathon, can wear down joint components more quickly after knee surgery. “Be active and enjoy the joint, but understand that more pounding usually means less longevity,” says Dr. Iacobelli.
Why younger people aren’t waiting for knee surgery
For many people in their mid-50s in South Florida, improved knee surgery techniques and surgical precision are reasons to choose surgery sooner to maximize their quality of life.
Implants can last 20 to 30 years. “In the past, we’d tell a 55-year-old with severe arthritis to wait until 65 to maximize implant longevity. Now, many don’t want to suffer for a decade. If they meet criteria, they opt in earlier,” says Dr. Iacobelli.
The near future: what’s promising (and what’s hype)
While biologics like stem cell therapy show some theoretical promise, Dr. Iacobelli cautions that the technology isn’t yet there. “Stem cells could one day regenerate cartilage, but much of what’s marketed as stem cells aren’t true stem cells and claims of arthritis disappearing on an X-ray after injections aren’t supported by evidence,” he says.
Still, Dr. Iacobelli is hopeful that true cartilage regeneration and biologic knee replacement will be the future of knee surgery.
For now, doctors rely on improved implants and techniques to tailor surgeries to individual anatomy. “Surgeons often develop expertise with a given system or switch when evidence and experience suggest an improvement,” says Dr. Iacobelli.
Is knee replacement right for you?
Living with knee pain, but wondering if surgery is the right step? Request a knee assessment with the UHealth joint replacement team.
Written by Wendy Margolin.
Tags: Chronic knee pain solutions, Dr. David Silva Iacobelli, Knee rehabilitation exercises, Patient-specific knee treatments
