Risks of Knee Replacement Surgery and Osteoarthritis
Positive and Negative Outcomes of Knee Surgery
In this article, I provide my own experience with knee problems and first-person experience with individuals who suffered knee injuries, along with some useful criteria for making decisions for effective treatment.
In personal and professional settings, I have seen many individuals who suffer severe arthritis of the knees and hips. Several underwent knee replacement surgery with good outcomes, while others suffered increased pain and difficulty walking.
The field of joint replacement surgery is advancing in effectiveness, reduced surgery times, reduced recovery times, and overall patient benefit; and each patient can decide the pros and cons of joint replacement with the help of qualified medical professionals.
Examples from Team Treatment Work and Life
In a positive outcome of knee replacement in the 1990s, a female colleague of mine in her late seventies kept the same set of replacement knees for over 25 years, without pain or walking problems. At the age of 75, she was still taking a walk every day and never needed pain medications.
While working alongside physical therapists in the Ohio Industrial Commission Rehabilitation Division, I experienced a case of a woman in her fifties who rejected the idea of knee replacements, even though first and second medical opinions recommended to undergo the procedure. She suffered arthritis, which worsened, and she became wheelchair bound.
A neighbor of mine a few years ago was diagnosed with rheumatoid arthritis that particularly affected the hips, knee, and ankles. Knee and hip replacements had not been recommended; but, this patient was able to gain enough relief through exercise, orally-taken herbal preparations, and dietary changes that her condition improved. Each case is an individual challenge and surgery is not always the answer.
Some Advances in Knee Replacement
Dramatic improvements are underway since the late 1980s at The Ohio State University. Medical scientists and bio-engineers developed a ceramic knee replacement reported to last a lifetime. This relieved patients of the dread of looking forward to new knee replacements every 15 to 20 years.
Another improvement is the development of different replacements for men and women, based in the differences hip angles and lower body structures.
My Avoidance of Surgery
I first injured my left knee at age five, when I struck my left instep against the sharp edge of a concrete step during a fall. The next injury occurred in fall on a gravelly playground at age seven.
At age 19, I sprained the same knee on a trampoline. That was the most interesting injury because it resulted in several occasions of the knee stiffening without pain—I would rise from my desk at school and, later, at work, with my knee remaining bent for a short time.
I sprained the same knee seven additional times over the years. These were all short-lived injuries that healed quickly, but in 2007, I discovered a book about knee health that I use even today. It explains the workings of the knee, how to exercise properly, how to use a proper diet to maintain healthy joints, how to use alternative medical knowledge for the joints, and even some information about how to decide to have surgery or not.
The useful book is called the by Jack Jensen, MD, who has worked successfully with several Olympic athletes. It contains several suggestions I still use today, along with much pertinent information given by a qualified medical doctor. I recommend it to anyone with knee problems, as long as they consult their own physician as well. Athletes can also benefit from its contents. One-Stop Knee Shop
Jack E. Jensen, M.D., F.A.C.S.M. is and has been a well known orthopedic surgeon, a director of a medical Knee Center, a consultant to US Swimming and US Gymnastic groups, and a team physician to Bela Karolyi Gymnastics.
What Are the Complications of Joint Surgery?
Knee Infections and Hospital Infections
Although a rare postoperative condition, a knee can become infected, showing signs of severe pain, joint swelling with heat or warmth, fevers, and inability to walk, bend the knee, or hold one's weight. This can occur with or without arthritis but can worsen the overall knee condition if arthritis is already present. Infections can be mistaken for arthritis.
Hospital infections are an ongoing challenge in hospitals, but many of these facilities have a complete department dedicated to the prevention and removal of such infections.
Obesity and Weight Gain
Morbid obesity works against the successful rebuilding of leg joints. A patient I saw during her rehabilitation with the Industrial Commission after a work-related accident needed to lose 80 pounds before surgery but was unable to do so. Osteoarthritis occurring before and after her accident damaged her knees to the extent that no further time for weight loss could be chanced.
Unfortunately, the first replacements failed and the second replacements provided her with limited range of motion. However, medications for the osteoarthritis help reduce her pain, but her weight continued to increase, given her limited ability to move. This contributed to Type II Diabetes and hypertension.
According to the 2010 discharge data from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the in-hospital mortality rate for 721,443 hospital discharges for knee arthroplasty [replacement] was 0.08% [eight hundredths of one percent, small].— H. Mulcahy. et.al.; American Journal of Roentgenology; 2014
Temporary numbness may occur around the knee areas after surgery for an average of six weeks or less, but feeling should definitely return. For example, I recall that after a minor foot surgery, my instep was numb for about four weeks. The knee area may take a little longer.
Surgical patients often feel tired for a matter of weeks after surgery, but this should pass. Alert your physicians if you feel that fatigue is not declining.
Some individuals produce larger amounts of scar tissue than do others, and I have seen a few cases in which additional surgery has been necessary to remove accumulated scar tissue around knee replacements. Ask your physician and surgeon about this possibility before you attempt knee replacement surgery.
Failure Because of Delaying Surgery
One of my back-pain patients with the Industrial Commission was to have knee replacement surgery on both legs to relieve osteoarthritis and injuries connected to military service and factory work. He agreed to only one knee surgery the first time, having staved off pain with alcohol consumption for a period of years.
When he awoke after the procedure, he was informed that the knee replacement could not be accomplished, because the knee was in too deteriorated a condition. The bones had to be fused, eliminating the knee joint entirely. Unfortunately, he became wheelchair bound.
Results of Neglecting Physical Therapy and Exercise
I have worked with dozens of joint and back injury patients and found that they must attend all of their physical therapy sessions as scheduled and perform prescribed exercise on other days in order to see and maintain improvement.
After physical therapy is terminated, these individuals must continue to exercise in prescribed drills at least three times per week, in my experience. Some cases require exercise six times a week—once or twice a week sometimes produces no results at all.
This is an individual matter, but I think almost daily exercises are vital.
Failure to Have and Use Properly Fitted Shoes
Wearing the wrong type of shoes can lead to joint problems before and after knee replacement surgery.
Those folks that I have seen in practice improved best when they wore well-constructed shoes with a good arch support. In fact, one patient was able to wear four-inch high heels for work, just six weeks after surgery.
Additional Arthritis Post Surgery
A patient in a clinical psychology practice where I worked suffered additional arthritis after knee replacement surgery, according to her physician's reports. Pain increased with the spread of arthritis, and relaxation exercises helped somewhat.
Arthritis spread into the remaining bones of the legs and progressed into the back and even into some muscles (certain arthritis can attack muscles). It is important to maintain follow-up treatment with one's surgeon and general practitioner after surgery, because preventative treatments for arthritis may be appropriate.
Failure to Obtain a Second Opinion
Second and third opinions about the advisability of knee replacement therapy should be obtained and then the decision should still be carefully considered.
One item to consider is the type of hospital to which you will go for your surgery:
- Teaching hospitals at universities can produce superior results since they are likely able to access the latest research and surgical techniques.
- Orthopedic hospitals that specialize in join surgeries produce the most positive outcomes.
The best course of action is likely to read everything you can about knee replacement surgery, learn about the hospitals and doctors that will treat you, get a second and third opinion, and weigh all of the information carefully in making your decision.
Other Risks in Knee Replacement Surgery
- Blood clots, and not always in the knee/leg region. A clot can damage the lungs or brain.
- Fractures in the bones of the leg during surgery, especially near the knees—Surgical cement is being used instead of metal screws, in many cases, and this damage is thereby avoided.
- Neurological Involvement: 1) a type of palsy in the legs and/or 2) Restless Legs Syndrome
- Pain and stiffness in some cases
- Psychological involvement, particularly depression
- Tissue death from over-long tourniquet use
- Vascular disease associated with the tourniquet required on the leg during surgery
If you are considering joint surgery, make sure to understand the possible negative results of the procedures required. Read all the paperwork your doctors provide and ask them questions.
Making a Decision About Knee Surgery
If left untreated, arthritis in the knees can become crippling. Sometimes non-surgical treatment does not even work. However, sometimes knee replacement surgery is not as successful as it might be in certain cases. On the other hand, dramatic improvements in knee replacement parts and therapy techniques make for a better picture for the future of knee patients.
The keys are
- Patient education and
- A partnership between doctor and patient to work together for the best possible outcome in each unique case.
- Balato, G., Di Donato, S. L., Ascione, T., D’Addona, A., Smeraglia, F., Di Vico, G., & Rosa, D. (2017). Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate. Joints, 5(2), 107–113. http://doi.org/10.1055/s-0037-1603901
- Jack E. Jensen, M.D., F.A.C.S.M. One Stop Knee Shop. Booksurge; 2007.
- Meier, E., et al. (2016). First clinical study of a novel complete metal-free ceramic total knee replacement system. Journal of Orthopaedic Surgery and Research 2016 11:21
- Mulcahy, H., & Chew, F. S. (2014). Current concepts in knee replacement: complications. AJR. American Journal Of Roentgenology, 202(1), W76-W86. doi:10.2214/AJR.13.11308
- Zanasi, S. (2011). Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. European Orthopaedics and Traumatology, 2(1-2), 21–31. http://doi.org/10.1007/s12570-011-0066-6
Questions & Answers
© 2008 Patty Inglish