I have mild pain in my knee every now and then. My doctor took an x-ray, which showed advanced arthritis. She advised a knee replacement. Is this a good idea?
Doc: This is a good question. Knee replacement is now a very common procedure. It has helped so many people. But there are too many knee replacement surgeries being done, many of which are not needed. The doctor is often moved by the extent of degenerative changes seen on the x-ray of the knee and based on this will declare “You have really bad arthritis. You need a knee replacement.”
You may not need a knee replacement. The severity of arthritis affecting the knee as seen on an x-ray should not be the determining factor in your decision. Not uncommonly, an x-ray of a joint may show severe arthritis, yet the person may be painfree or just experience occasional episodes of discomfort. Bad arthritis (degenerative or osteoarthritis) on an x-ray therefore is not the reason to have your knee replaced.
What is important is the severity of your symptoms and the impact these symptoms have on your day-to-day activities. Are you able to cope at work? Are you able to do your usual walks? Are you able to manage your hobbies? Are you able to go out as usual? If you are no longer able to perform and enjoy your day-to-day activities due to the pain in your knee, or if you are not able to cope properly at work due to your knee pain, and the x-ray shows the cause is due to moderately severe arthritis then, yes, you should seriously consider a knee replacement.
But if you are managing your day-to-day activities and hardly affected by knee pain, then you are not really a candidate for a knee replacement, even though your x-ray shows really bad arthritis. You should continue with conservative treatment including exercises to keep your quadriceps muscles strong, anti-inflammatory medications when you need them, unloading type of knee braces etc).
Guy Slowik Orthopaedic Surgeon