What symptoms show that I might benefit from a knee replacement?
The main reason for needing a knee replacement operation are pain in the knee - a knee replacement operation is essentially a painkilling operation. The pain can affect how far you can walk and may affect your ability to work. It is usually at its worst when you stand on the affected leg and is often really bad at night. You won't necessarily need a knee replacement if you have been told you have arthritis in your knee, as there are lots of other treatments that will help if the symptoms aren't severe. However, if the pain is severe despite taking painkillers, losing weight and physiotherapy, and you are finding that you are increasingly disabled by it, a knee replacement operation may be a sensible option.
Symptoms will often vary from day to day for no apparent reason. This is really common. Some people think their symptoms vary according to the weather or according to how much they have been doing - but it can be completely random.
Sometimes you will be aware of a grating or grinding feeling coming from your knee. This is called crepitus. On its own this does not necessarily indicate a serious problem with your knee.
What can I do to put off needing a knee replacement?
The most effective treatment for the symptoms of osteoarthritis of the knee is weight loss.
Losing weight also helps if you do end up needing a knee replacement, as people who are obese or overweight just don't do as well as people of normal weight after having a knee replacement.
Other treatments that are recommended for all patients with osteoarthritis of the knee include:
- General exercise - walking, tai chi, etc.
- Strength training - to increase the strength of the muscles in the legs.
- Water-based exercise - swimming and water aerobics
- Using a walking stick or cane - and in the UK an umbrella! Use the walking aid on the side opposite to your affected (or worst) leg. For example, if you have a bad right knee, hold the walking aid in your left hand. Then move the bad leg and the aid at the same time, so that the load is shared.
Further reading and references
Mini-incision surgery for total knee replacement; NICE Interventional Procedures Guidance, May 2010
Carr AJ, Robertsson O, Graves S, et al; Knee replacement. Lancet. 2012 Apr 7379(9823):1331-40. doi: 10.1016/S0140-6736(11)60752-6. Epub 2012 Mar 6.
Hofstede SN, Nouta KA, Jacobs W, et al; Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2015 Feb 4(2):CD003130. doi: 10.1002/14651858.CD003130.pub3.
Ferket BS, Feldman Z, Zhou J, et al; Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ. 2017 Mar 28356:j1131. doi: 10.1136/bmj.j1131.
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