Knee Arthritis
What is knee arthritis?
Knee osteoarthritis is a gradual breakdown of the smooth cartilage that cushions the ends of the thighbone, shinbone, and kneecap. As the cartilage thins, the bones may rub together, and the joint lining, bone, and ligaments may also change, leading to pain, stiffness, swelling, and sometimes a sense of the knee giving way.¹,² Symptoms usually begin with activity-related pain and brief morning stiffness, and may progress to pain at rest or at night with reduced range of motion.²
Can knee arthritis be managed without surgery?
Often yes initially; conservative treatment usually combines exercise therapy, weight management where appropriate, and anti-inflammatory medications, and may include physical therapy, bracing, or a corticosteroid injection.⁴ Surgery is usually considered after these measures have been tried for at least six months without adequate relief.³
Knee Replacement Surgery
What is a knee replacement, and what does the surgery involve?
A total knee replacement removes the damaged cartilage and a thin layer of bone from the surfaces of the thighbone, shinbone, and sometimes the kneecap, typically replacing them with metal and high-grade plastic components that recreate a smooth, functioning joint. The decision to proceed is usually made jointly by you and your surgeon, weighing symptom severity, the degree of joint damage on X-rays, your overall health, and your personal goals.³
Is a knee replacement major surgery?
Total knee replacement can be considered a major operation, but it is also one of the most common and well-established orthopedic procedures, and serious complications are uncommon.³ Most patients go home within one to three days after surgery, and in selected cases on the same day.⁵
Who Is A Candidate
What are the signs that you may need a knee replacement?
Surgery may be considered when knee arthritis causes persistent pain and loss of function that limits daily activities, sleep, and quality of life, and that no longer responds adequately to non-surgical treatment. It is generally considered only after at least six months of appropriate conservative care has not provided sufficient relief.²,³
What is the typical age for a knee replacement?
The average age at surgery is approximately 65 years, though there is no strict age cutoff. The decision depends on the severity of symptoms, the degree of joint damage, and your overall health rather than age alone.³
The Road to Recovery
How long does recovery from a knee replacement take?
The greatest gains in pain relief and knee function usually occur within the first 3 months, with continued improvement in walking endurance and stair climbing through 6 to 12 months. Recovery is gradual, and some improvement may continue beyond the first year.⁶
What is the hardest part of recovery?
Pain is usually most intense in the first week and then decreases steadily over the following weeks.⁶ In the first year, the most common “nuisance” symptoms may include difficulty kneeling, numbness around the incision, and some residual swelling, though these usually have little effect on overall satisfaction.⁷
How painful is a knee replacement, during and after?
The procedure itself is done under anesthesia, so it is not felt at the time. Afterward, pain is usually most intense in the first week and decreases steadily over the following weeks; by 3 months, average pain levels are usually substantially lower than before surgery, with continued improvement expected through the first year.⁶ Pain is usually managed with acetaminophen and anti-inflammatory medications, with stronger medication potentially used briefly if needed.
How soon can you walk, climb stairs, and get around?
Most patients begin walking short distances with a walker or crutches on the first or second day after surgery, and physical therapy usually begins within 24 hours.⁸ A walking aid is usually needed for the first several weeks, with most patients moving to a cane and then walking independently as strength and confidence improve.³ Stair climbing is introduced early, though comfortable stair use usually improves over the first 1 to 3 months.⁶
When can you drive again?
Driving is usually possible around 2 to 4 weeks after a left knee replacement and 3 to 6 weeks after a right knee replacement, depending on your recovery, pain levels, and whether you can safely control the vehicle.⁹
As recovery is different for everyone, these timelines can only provide general guidance; your surgeon, and any physiotherapist you work with, will help discuss the specifics of your case and personalize your recovery plan.
The Risks
What is the biggest complaint after knee replacement?
Although the result is good for most, ≈10-13% of patients may be left with some ongoing pain, or find the result falls short of what they had hoped for in spite of a well-performed surgery.¹⁰ Less serious but common “nuisance” symptoms in the first year may include difficulty kneeling, numbness around the incision, and some residual swelling, though these usually have little effect on overall satisfaction.⁷
What are the most common complications of knee replacement?
Stiffness from scar tissue affects roughly 3-10% of patients,¹¹ but serious complications are uncommon. Knee instability, deep infection around the implant, or blood clots in the leg or lung each occur in about 1-2%.12-14. Nerve injury, affecting fewer than 1.5%, and a fracture in the bone around the implant, in under 1%, are less common still.¹⁵ Over the longer term, the implant may slowly loosen from the bone (≈ 3% by 15 years), which is a leading reason a replacement may eventually need to be redone.¹⁶
How long are you at risk for blood clots after surgery?
The risk is highest in the first few weeks after surgery, and blood-thinning medication is usually prescribed for up to 35 days to reduce it.¹⁷
Your surgeon will discuss these risks with you before surgery, including any others specific to your health, and how they apply to your individual case.
The Years Ahead
How long does a knee replacement last?
More than 8 out of 10 total knee replacements are still functioning at 25 years.¹⁵ Longevity depends on factors including age, activity level, and body weight.³
How likely are you to need another operation?
For a patient around 65, the lifetime risk of needing revision surgery is approximately 7%.³ Younger patients face a somewhat higher lifetime chance, mostly because they will live with the implant longer and place more demand on it.³
