Dr. Matthew Levy, orthopedic surgeon, writes a monthly column for the Cleveland Jewish News focusing on orthopedic issues, concerns and topics. This column was originally published in Cleveland Jewish News on October 9, 2020. 

When’s right time for knee replacement?

One question patients ask almost every day: “When is the right time to have a knee replacement?”

The answer is not clear-cut and takes thoughtful consultation between physician and patient.

Research from Northwestern University in Evanston, Ill., suggests the timing of a total knee replacement plays a key role in determining outcomes. If a patient waits too long, they risk not being able to restore full function. If they proceed too soon, they may not see the expected results.

Ninety percent of patients in this study considered ready for knee replacement waited too long, often delaying more than two years. This can result in additional deterioration and deformity, such as bowing, resulting in more complex surgery and affecting a patient’s ability to fully straighten the leg and restore mobility.

In addition, chronic pain and stiffness may curtail regular activity, reducing muscle strength and contributing to risk factors, such as excessive weight, diabetes, high blood pressure and depression. All of which complicate the replacement surgery and the recovery process.

Conversely, this study also found that 25% of patients determined not ready for surgery, went ahead with the procedure. Some patients, in particular those that are younger, opt for surgery thinking this will be a quick fix, rather than taking the necessary steps of strengthening exercises or less invasive treatments proven effective in reducing knee pain.

After undergoing major surgery, these patients can find themselves less than satisfied by the results, largely the result of unrealistic expectations. I like the comparison of going away on a tropical vacation after a cold winter in Cleveland. When it is snowing and freezing here, and you end up on a 90-degree beach three hours later, you appreciate the difference. But, if you go to the same place in June, the difference won’t seem the same.

Patients with minimal or moderate knee pain might not appreciate the difference of a new knee the same way as those experiencing high levels of pain. In addition, given the life span of a well-performed knee replacement may be 15 to 20 years, if the surgical option is chosen too early, patients may face a secondary replacement surgery down the road, with less predictable results.

That is why it is critical patients work with their physician to find the sweet spot – the balancing point between the use of less invasive treatments and the risk of additional deterioration that may impede restoration of function.

In my practice, I take into account level of pain, functional impairment, sleep problems and ability to live the life my patient wants to live. I want to know if the pain responds to over the counter medications, if the patient has ever had cortisone or gel injections, and if the patient has had previous surgery. A thorough physical examination and X-rays provide additional information. All of these factors weigh into my recommendations as a surgeon to the appropriate timing for knee replacement.

Knee replacement, when done for the proper reasons, typically results in high levels of patient satisfaction. While the decision is ultimately up to the patient, working in partnership with your physician to determine the optimum timing helps ensure the best long-term results.

Born and raised on Cleveland’s east side, Dr. Matthew Levy worked for 14 years as team physician for local sports teams. After graduating from Case Western Reserve University Medical School in Cleveland, he completed his internship and residency at Mount Sinai Medical Center in Cleveland. Levy is also fellowship trained in sports medicine. He sees patients in Solon, Independence and downtown Cleveland.