The Risk in Delaying Recommended Knee Replacement Surgery

What are the risks associated with delay or outright avoidance of recommended knee joint replacement surgery for someone who has been diagnosed with severe, bone-on-bone osteoarthritis (OA)?  In short, such avoidance or delay may not only be bad for your function, it will likely be detrimental to your overall health.

Knee osteoarthritis is a condition which involves progressive, degenerative wearing of the cartilage of the knee joint.  The diagnosis of OA is generally made based on the patient’s symptoms, which may include pain, stiffness, joint noise (cracking, grinding), joint swelling and tenderness, as well as the appearance of degenerative changes to the joint, which can be observed through X-Ray.  While OA is sometimes the result of traumatic injury, more common contributing factors include advanced age, body mass, genetics, limb structure, and activity level.

Mild and even moderate progression of this degenerative disease can oftentimes be managed conservatively.  Conservative management commonly includes anti-inflammatory medications, injections (either cortisone or gel-type), and physical therapy.  Physical therapy usually focuses on restoring joint range of motion, flexibility, and strength.  In cases of mild to moderate degenerative changes, physical therapy has been found to be very helpful in alleviating the discomfort associated with weight bearing activities and increasing overall tolerance to daily functional activities.

While patients diagnosed with mild to moderate degenerative changes are usually able to avoid or delay the need for surgery by participating in physical therapy, sometimes surgery is recommended for patients who have more severe degenerative changes.

So what happens when the orthopedic surgeon recommends knee replacement surgery and the patient says, “No”? Unfortunately, this response will usually mean that the condition will be left to worsen over time.  This includes muscle atrophy and weakness, joint stiffness, increased pain and a loss of function.  A decline in balance will also occur, increasing the risks of falling and associated injuries.  Patients will begin to develop compensatory movement patterns when getting around, including changes in gait, which will put stress onto other areas of the body, i.e., the other leg/knee, the hips, and low back.  Over time, pain will cause a more significant decrease in activity level and eventually outright activity avoidance.  These changes in function and gradual decrease in activities have a direct and negative impact on one’s quality of life, which will adversely affect emotional well-being and mood.

As function declines, so too does our general health.  A more sedentary lifestyle leads to increased weight gain, increased risk of heart disease, some forms of cancer, and other common health concerns associated with aging.  It can lead to disrupted sleep patterns and a decline in overall cognitive function.

Since having surgery at a younger age has been associated with improved outcomes, why put off the inevitable?  Don’t delay. Don’t put off your health any longer than necessary.