[ photo by Anna Auza]

Is knee replacement right for me?

As some of you may have figured out by now, I am a big proponent of quality over quantity of life. This is especially true in the later years of life. As a rehabilitation physician that currently sees patients in long term care facilities, I have numerous patients that have undergone various lower extremity orthopedic procedures.

The majority of these are done because someone has suffered a fracture, usually of the hip. There are multiple published studies that show the 1-year mortality rate after a hip fracture to range from 14-58%. That is such a high rate. There are several factors that come into play when looking at that mortality rate, and that is something I will write about at a later date.

Elective joint replacement.

Today, though, I wanted to talk about a patient I had recently who underwent an elective orthopedic surgery. There are many risks involved with surgeries, in general. Add that the surgical candidate is someone who is 85+ years of age with multiple comorbidities, and those risks are just amplified. Beyond the surgical procedure itself, I like to pay attention to the outcome of the surgery. Was that elective hip or knee replacement worth the risk of the surgery and then the recovery process? Did he or she gain any improvement in her quality of life? 

Mary’s story.

So let me tell you about my patient I met recently. I will call her Mary. Mary was 87 with a long history of rheumatoid arthritis (RA) and hypertension. That was it for her medical diagnoses. Mary lived alone in a single level house. She had two adult children that lived near her who helped her intermittently, but for the most part, Mary was independent.

She still cleaned her own house, cooked her own meals, and drove. About 2 years prior, she slipped on the ice and broke her hip. This was repaired surgically. The only difference from pre-hip fracture and post-hip fracture was that she now did all ambulation with a rolling walker.

Well, because of her long history of RA, Mary was having constant pain in her right knee. She was beginning to be limited in how long she was able to be up moving around in her home. Activities of daily living were becoming a struggle. She was having trouble completing her grocery shopping because she just could not handle the pain of walking through the grocery story. Her grocery trips now involved the use of the motorized carts, something she had sworn she would never do.

Due to her more limited mobility, she felt like her endurance and strength were declining. She knew it was so important to maintain her physical activity, but it just hurt so much! She was taking Tylenol and using various creams to help with the pain. Physical therapy, including doing the prescribed home exercises, had not really helped. Her knee had been injected with steroids on a few different occasions, but the injections did not provide any relief. The medications were not really helping either.

Her surgeon told her that based on her pain reports and the imaging studies, she was a candidate for a knee replacement. “At 87?!?,” she had exclaimed when it was recommended. She certainly did not see herself as “elderly” but she also knew that these procedures did not always have the desired outcomes in her age group. After much consideration and in talking with her family, though, she decided to go through with the surgery. 

Proceeding with knee replacement surgery.

Well I met Mary after the surgery. She ended up going to subacute rehab following the surgery just because she wanted to jump start her rehab. She did not want to be a burden on her family, either, so she knew some daily therapy and a little extra help from the nursing home staff would help her to get back on her feet pretty quickly. Mary was doing great from a pain control standpoint. She was using Tylenol and an occasional low dose of hydrocodone just prior to her PT sessions. She was icing her knee multiple times a day too, which added great pain relief without having to rely so much on the medications.

She had been there about five days when I met her and was already tentatively scheduled to go home the following week, giving her a total of 10 days in rehab. When I asked her if she was happy with her decision to go through with the surgery, she told me that despite it being a hard decision, she was so glad to have done it because she knows this short term pain and hassle is going to add a lot more pain-free moments to her life. 

When should you have a knee replacement?

I want to point out that Mary was an ideal candidate for this procedure because of her limited comorbidities and because of how active she was leading up to the surgery. This is something that should definitely be taken into account before making such a big decision. If you or a loved one are trying to decide whether or not to have a knee replacement surgery, look at the risks and benefits. Will this surgery not just add time to my life, but will it also improve my quality of life? These are big, important questions that you need answered prior to proceeding with joint replacement.

Please leave a comment if you have a question or experience to share about joint replacement.

© 2020 Jessica Kluetz, DO