Do your homework before jumping into knee replacement surgery

Melissa Martin, Ph.D.

According to the American Academy of Orthopaedic Surgeons, “More than 600,000 knee replacements are performed each year in the United States. With an aging population staying in the workforce longer and obesity on the rise, demand for total knee replacement surgery is expected to exceed 3 million by the year 2030.”

Do you need knee replacement surgery? What surgeon and hospital do you select? What are the risks? What are the side-effects? What are the other options? Where do you find information?

“The explosion of knee replacements is forcing physicians to grapple with the questions — and whether all knee replacements are warranted,” reported journalist Courtney Humphries in a 2012 article in the Boston Globe. She reviewed a study published in the journal Health Affairs about decision aids (i.e., videos, handouts, booklets, evidence-based information and treatment options given by orthopedic surgeons to increase patient knowledge to help individuals make informed choices) which led to 38 percent fewer knee replacements. The study examined the role of communication and shared decision-making between doctors and patients in determining who gets knee replacements.

What is the main cause for knee replacement (or total knee arthroplasty, or TKA)? According to the Arthritis Foundation, more than 27 million people in the U.S. have osteoarthritis (also called degenerative joint disease or “wear and tear” arthritis), with the knee being one of the most commonly affected areas. And most knee pain is caused by three arthritic types: osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.

Know the risks before you sign informed consent forms for surgery. According to Arthritis Research UK, about 1 patient in 1,000 suffers damage to arteries that usually need further surgery to repair, and in about 1 in 5,000 cases, blood flow in the muscles around the new joint is reduced, which also needs corrective surgery. The risks and side-effects of knee replacement surgery include infection, nerve damage, chronic stiffness or pain, blood clots in legs, bleeding in knee joint, urinary tract infection, blood vessel injury and general loss of range of motion. Although rare, neurovascular injury (damage to nerves or blood vessels) around the knee can occur during surgery.

A 2016 article in Consumer Reports, “Your Risk of Infection After Knee Replacement Depends on Your Hospital,” lists eight tips for staying safe before, during and after the procedure. The article includes eightquestions you should ask before surgery:

1. What’s the hospital’s infection rate?

2. What’s the surgeon’s complication rate?

3. How many knee replacements do the surgeon and hospital perform each year?

4. How does the hospital prevent infections?

5. How does the surgeon cover the incision?

6. How long do patients stay in the hospital?

7. Has the device been the subject of a recall?

8. Am I a good candidate for surgery?

In reference to knee replacement surgery, “Getting specific information on individual physicians can be difficult, but your surgeon should know his or her overall complication rate, which includes not only infections, but also things such as developing a blood clot or pneumonia soon after the procedure.”

Read the article, “Acute Arterial Occlusion after Total Knee Arthroplasty: A Case Report” in the 2017 journal Clinical Case Reports. Discuss assessment by Doppler ultrasound and ankle brachial pressure index (ABPI) measurement before and after surgery with your surgeon and treating physician.

According to the American Academy of Orthopedic Surgeons, about 90 percent of patients who have a knee replacement experience reduction of knee pain and improvement. But, what about the other 10 percent?

To summarize, I want you to be informed consumers before knee replacement surgery. Read about the pros and cons of knee surgery, research the surgeon’s and the hospital’s reputation, and rely on information and feedback from trusted others before your decision — read, research reputations and rely.

Melissa Martin, Ph.D.

Melissa Martin, Ph.D., is an author, self-syndicated columnist, educator and therapist. She resides in Scioto County, Ohio. Contact her at

Melissa Martin, Ph.D., is an author, self-syndicated columnist, educator and therapist. She resides in Scioto County, Ohio. Contact her at