Chronic knee pain? Here’s how to know when to consider knee replacement surgery

If medication and physiotherapy haven’t eased your aches, you may be considering your options and wondering whether knee replacement surgery is the answer. Dr Gurpal Singh, orthopaedic surgeon at the Centre for Orthopaedics and Hip and Knee Surgery, explains more about this procedure and why more young people are resorting to it.

Anyone suffering from chronic knee pain knows that it’s not a fun time. While knee pain is a common complaint, chronic knee pain - commonly caused by osteoarthritis - can make it difficult to walk and function in everyday life.

Osteoarthritis, a degenerative musculoskeletal condition accompanied by inflammation in the joints, is one of the leading contributors to disability worldwide1.  Osteoarthritis is caused by wear and tear of the cartilage that lines the bone of joints - and while this tends to be more prevalent among seniors, sporting injuries can also lead to premature osteoarthritis among those below age 50.

Depending on your unique situation and degree of pain, there is a time and a place where knee replacement surgery becomes an option. But how do you know when it might be the right time for you?

According to Dr Singh, who has treated patients with osteoarthritis for more than 15 years, there are various treatment options to consider. Majority of the knee replacement surgeries Dr Singh performs are a result of osteoarthritis.

Treatment options for osteoarthritis

Doctors usually recommend conservative or non-surgical pain management measures first.

Non-surgical

• Physiotherapy

• Medication

• Lifestyle modifications, e.g. weight management

• Injections to reduce inflammation

Surgical

• Partial knee replacement surgery

• Total knee replacement surgery

So, when is the right time for a knee replacement?

When non-surgical methods don’t deliver the desired outcome - and only after detailed analysis of the patient’s condition and medical history has been explored - an orthopaedic surgeon may recommend joint replacement.

Here, we help to outline the key considerations for knee replacement surgery as a treatment option for chronic knee pain due to advanced osteoarthritis. 

Why are more people, especially the young, turning to knee replacement surgery?

  • It’s reliable

• Patients with end-stage osteoarthritis can go on to lead an independent life.

  • They can stay active for longer

• The notion of gradually losing the ability to do daily activities due to joint pain is no longer an accepted part of ageing, as many want to remain active in their 60s, 70s & beyond.

  • Advances in implant materials and surgical techniques

• Patients have greater confidence in surgical intervention, especially those who not only want to reduce pain, but also to return to sports.

When should it be considered?

Knee replacement surgery is performed to relieve pain and restore function – usually after detailed diagnosis by an orthopaedic surgeon to rule out other causes of the pain and justify the surgery.

It should only be considered when:

  • Other options are no longer viable
  • The pain is affecting your daily life
  • Joint-preserving surgical procedures, like key-hole surgery (knee arthroscopy), are unlikely to help.

Risks and limitations

Your orthopaedic surgeon will counsel you on your individual risk-benefit profile.

  • Blood clots, stroke, heart attack, nerve damage or infection

• These are some of the serious complications, but they’re rare.

  • New joint may not last patient’s lifetime

• Artificial knee joints may wear out over time. Joint registry data show that more than 80% of total knee replacements last 25 years.

• Robotic-assisted surgery may help ensure optimal positioning of the artificial knee, thus reducing the risk of accelerated wearing out due to mechanical malalignment of implant components.

What’s the recovery process like?

Every individual’s recovery will be different, but most patients regain functional mobility 6 weeks after surgery. Some patients even resume light sports 3 months after surgery.

While there’s no real cure for arthritis and no definite way to prevent this common chronic illness, you can still take charge of your life and reduce the odds of getting advanced arthritis or slow its progression through:

  • Leading a healthy lifestyle and doing regular low-impact exercises
  • Keeping your weight in check, stopping smoking, and getting advice for infection or injury, which may damage joints

As Singaporeans continue to live longer and our window for developing chronic illnesses like arthritis widens, the best thing we can do to lead active lives is to watch our health and when necessary, seek medical attention early.

1https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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