Surgery: Why wait? Why not?
Is there a “right” age for a knee replacement?
Just as medicine changes, so do patients. People younger than 65 are now the fastest-growing age group opting for total knee replacement (TKR), according to a 2014 study funded by the Agency for Healthcare Research and Quality. Overall demand for the procedure is rising as well, with numbers expected to increase from more than 645,000 TKRs done in the United States in 2011 to 945,000 in 2015.
That doesn’t mean you have to jump on board. Some people are eager to have their knees replaced because they’re in pain and want their active lives back. But others prefer to delay surgery for as long as possible. How to decide? Here are the pros and cons.
The Upside for Knee Replacement
- Goodbye to (most) pain. “The number one reason to have TKR is for pain management,” says Brian S. Parsley, MD, clinical associate professor and director of Adult Reconstruction Fellowship at Baylor College of Medicine in Houston. The success of TKR in younger patients: about 90 to 95 percent.
- A long-lasting fix. An implant can last from 15 to 25 years. “If you’re under 60, you’re probably facing a revision [or redo], but the most common revision is usually just an exchange of the plastic insert,” says Dr. Parsley. That means most of the original implant stays, and the surgeon won’t need to remove more bone.
- Resuming what you love. These days, 60 is too young to give up activities you love because of disabling pain, says Andrew Glassman, MD, chief of Adult Reconstructive Surgery at The Ohio State University Wexner Medical Center in Columbus. “If a procedure can [extend] your ability to do those things for 25 years, that’s reasonable to do.”
The Downside for Knee Replacement
- Committing to recovery. Having any kind of surgery, especially joint surgery, is an involved endeavor. It requires time, money and a commitment to making it work. You’ll need to make preparations before surgery and carefully follow your treatment and recovery program afterward. If you are willing to maintain a healthy weight and stick to your physical therapy routine, your chances of having a long-term improvement in your joint are much greater.
- A second replacement – or revision – surgery. “Younger patients do have a higher rate of failure and early revision because of obesity, more activity, and because they are living longer than older patients,” says Dr. Parsley. How much you have to have redone depends on what part of the implant has failed. For instance, debris from the implant’s wear can damage bone. “So, if you don’t follow up with your doctor for 10 to 15 years, and then have bone damage, you may need to remove old components and replace them with all new ones,” explains Dr. Glassman.
- Hazards of surgery. As with any surgery, there is a risk of infection and blood clots. Or the implant itself could fail if a bone fractures or if the implant loosens, for example.
- Unrealistic expectations. “Many patients think they will go back to a normal lifestyle, that they will be pain-free or that they can return to a higher level of activity than we recommend,” says Dr. Parsley. “Your knee will be better, but never normal.”
The Bottom Line
- Try everything else first. “Have a thorough evaluation and explore conservative options,” says Dr. Parsley. “For instance, if you restore strength and flexibility in the muscles around the knee, you will reduce pain and improve function.” Other nonsurgical treatments include pain medications, losing weight, or steroid or lubricant injections.
- Understand surgery isn’t a cure. Although TKR will relieve some symptoms of arthritis, it isn’t a cure for the progressive condition. Even if you have joint surgery, you will still need to manage your arthritis by maintaining a healthy weight, staying strong and flexible through exercise, taking your prescribed medications and keeping up with your overall health.
- Recognize the gamble. You may face the prospect of revision surgery, whereas someone who is older might not, in part because you’re likely to be more active. Revisions in younger patients happen twice as often as in older patients.
- Consider partial knee replacement. This is a good option for someone with arthritis in only one part, or one of the three compartments, of the knee, says Dr. Glassman. It’s a smaller surgery, potentially with a faster recovery and less pain. But partials usually wear out in 10 to 12 years. Or you may develop arthritis in the other two knee compartments and then need a full replacement.
- Get the most experienced surgeon. Ask your internist to refer you to an orthopaedic surgeon who primarily does knee replacements, recommends Dr. Glassman. And make sure that doctor will also treat complications.