Am I a suitable candidate for knee replacement surgery?

I am 65 years old. I lead a retired life and I am a master of my own time. I enjoy long morning walks in my neighbourhood park. I do yoga daily. My wife and I take our dog along for a walk a number of times daily. I can climb a flight of stairs with some difficulty as I have been suffering from knee stiffness and pain for some time which is gradually increasing over time. Lately, although it has started affecting my day-to-day life a bit I'm not sure whether I am at a stage where I should undergo a knee replacement, and if so, whether I should be operated on one or both knees at the same time or within a short span of time. From my friends and acquaintances as well as by searching on the Internet, I have learnt a lot of things, both good and bad, about elective knee replacement surgery. As a result, I have my own dilemmas and questions about the pros and cons of knee surgery.

In this background, let me share my basic concerns: Whether I am the right candidate, whether it is the right time for me go for knee replacement, and what if the surgery doesn’t go well? I have consulted many doctors. All of them have told me that I am fit for knee replacement surgery but when I look at my daily needs, I find that I am doing nearly all activities that I want to do and that too without much difficulty. Popping a pill for my knee pain every now and then is not much of a hassle. Hence my dilemma!

This is a common dilemma that almost every patient with knee pain and stiffness faces. Knee replacement surgeries are known to have substantial benefits such as alleviating pain, improving function, and thereby improving quality of life.

Four main things should go into your decision-making as to whether you should undergo knee replacement or not:

• Whether your damaged knee is the cause of your problem?
  Often, patients are unable to move around, not necessarily due to knee pain or stiffness (due to arthritis itself) but for other reasons, such as sciatica pain, neurological problem, etc. Doing knee replacement in such cases can be a total disaster.
  
• Even if knee itself is the cause of patient's disability, it is important to consider whether the deterioration of the knee is temporary and reversible. This can easily be made out by doing a few tests. Once it is decided that knee is surely the cause of pain and also the damage is irreversible, you are likely to benefit from knee replacement.
• The knee being damaged beyond repair, in itself, is not an indication for undergoing knee replacement. Whether to undergo knee replacement surgery is a quality of life dependent decision. Whether a particular person should be operated depends upon his expectation from the surgery, how that surgery is going to change his/her quality of life. For example, a person who is homebound, hardly walks a few steps and is comfortable, may not benefit a great deal from knee replacement. The risk may not be worth it.
• Even if the knee is badly damaged and the patient desires to undergo surgery, the most critical aspect of decision-making is whether knee replacement surgery is likely to be successful in that particular patient. The patient may hidden reason(s) which can mar the success of the operation, such as weakened bones, very weak muscles, background neurological problems, co-morbidities, psychological issues, etc. Much too often a technically well done knee replacement surgery does not give the expected outcome due to these hidden factors.

References:

• Dr. Jitendra Maheshwari https://landing.aims2health.com/dr-maheshwari-details.html