Knee Replacement Necessary?

Modern medicine can literally rebuild a patient’s body.  Like a car needing new parts, doctors can replace hips, joints and even limbs in people with critical and serious injuries.  In fact, one of the most common surgeries in hospitals are artificial knee replacements.  As the Chicago Tribune reported earlier this month, “rates of the surgery doubled from 1999 to 2008, with 3.5 million procedures a year expected by 2030.”  But as the Tribune article also makes clear, these knee replacements are not a guaranteed cure.

Recent studies show that two thirds of knee replacement recipients still deal with chronic pain and one out of every five are dissatisfied with the outcome of their surgery.  A study by the BMJ medical journal found that patients with osteoarthritis who received a knee replacement felt that the surgery “had minimal effects on quality of life.”  Coupled with the fact that numerous artificial knee products are under medical recall should leave patients questioning the surgery and electing to proceed as an absolute last resort.Our firm receives more calls regarding negative outcomes following a knee replacement than almost any other surgery. We hear from patients whose artificial parts have failed, whose pain got worse or who now have more trouble walking with their new knee than their old.  Many of these patients require second surgeries or revision surgeries which, the Tribune notes are more likely to cause greater complications such as cracked bones, scar tissue or difficulty removing the cement holding the artificial knee in place.

One of the problems appears to be a rush to surgery.  Studies have shown that doctors are quick to order surgery for conditions such as minor arthritis when substantially less invasive options such as pain relief medication or physical therapy can be a more effective treatment.  A recent study in Arthritis & Rheumatology backs this up finding that one-third of patients receiving a knee replacement are not appropriate candidates for the procedure based on the limited severity of their condition.  Dr. James Rickert, president of the Society for Patient Centered Orthopedics told the Tribune that we simply “do too many knee replacements.”

Yet such surgery is big business for doctors, hospitals and the healthcare industry.  The surgery alone costs more than $30,000.  The procedure also requires months of rehab, physical therapy, pain medications and follow up doctors’ appointments which generate more revenue. Dr. Rickert argues that the surgery is vital to the financial health of the hospital and notes that doctors are incentivized to perform the procedure because they earn substantially more money in surgery than in conservative treatment.  He notes that medical advertising has created both competition amongst hospitals as well as an overt effort to sell patients throughout the community on the benefits of these surgeries.  By all accounts, this business model has been successful.  In 2014, for example, there were approximately 723,000 knee replacements performed in the United States generating more than $40 billion in costs.

So, what is the solution if you are presented with the option for a knee replacement?  First, it is always a good idea to seek a second opinion from another orthopedic surgeon to see if there are other, less invasive options available.  Second, you may want to ask your doctor if physical therapy or pain medications may provide relief.  Knee replacements are a very serious and invasive procedure.  The surgery should be considered a last resort which may mean trying conservative treatment for a reasonable length of time.

Finally, if after trying conservative treatment without success, think about the level of pain and how it impacts your every-day life. Is the pain constant?  Is it preventing you from doing the things that you love?  Is it something that impacts your everyday life?  If this is the case, talk to your doctor and ask specific questions about whether a knee replacement can actually solve these issues.

If you do elect to go forward with the replacement, we recommend getting a printout from your doctor stating all of the medical parts that will make up your new knee.  Go online and check these parts against the FDA database to make sure none of the products are under recall.  And remember that surgery may only be the first step to healing.  As with many medical procedures, a positive outcome requires a lot of work and effort to gradually get your body working with its new part.  That means months of rehabilitation and following your doctor’s orders.