Knee Replacements: The Good, Bad & Ugly

Total knee arthroplasty (TKA)

Cue the theme song music to Law & Order as I deliver this disclaimer, “Nothing written here should be construed as medical advice. Always seek the counsel of your physician.”

In my twenties, the trend was wearing mini skirts & platform shoes. In my thirties, the trends included wearing leg warmers to the gym or putting the Jane Fonda Workout video into the VHS at home. In my sixties, the trend is knee replacements. In the past two years, I have known ten people who had the surgery or are scheduling the procedure.

According to a UC Health publication, Cultivating Health, nearly 1.3 million knee replacements are performed in America annually. TKA is one of the most common elective surgeries in the country.

Photo by Jonathan Borba on Unsplash

For people in agonizing pain sitting or sleeping, the surgery feels mandatory. Patti had the surgery in mid-November 2024 because her knee pain was becoming intolerable. She was using a cane for stability and knee pain was beginning to dictate her activities.

After visiting several orthopedic surgeons, she researched the procedure and joined Total Knee Warriors, a Facebook support network site for total knee replacement recovery before surgery. Before surgery, Patti practiced post-op exercises, lost some weight, and stopped smoking after 50+ years. “I felt like I was prepared as anyone could be for the procedure,” she explained. Now she joins the group of patients who regret the surgery.

The regret rate for knee replacement surgery fluctuates from a 2019 Journal of Rheumatology study estimating 5-20%. While a 2023 National Institute of Health article says dissatisfaction has often been reported as 20% or more. Their systemic review of literature from 2010-2022 determined the average rate of patient dissatisfaction is 10% and excluding patients with complications, the dissatisfaction rate drops to 7.3%.

Photo by Claudia Wolff on Unsplash

Pain and anxiety/depression, which the study refers to as ‘poor patient coping skills’ is a common cause of dissatisfaction. Patti agrees, “No one prepared me for the emotional rollercoaster of recovery.” The in-home physical therapy, followed by outpatient physical therapy with daily exercises at home was intense. She thinks her level of dissatisfaction may come from the total focus required post-op to obtain a positive outcome. “My entire day centered around exercises, therapy visits, RICE (rest, ice, compression, elevation.) I learned the recovery process could take up to 12 months, that’s a long time to put everything else on hold.”

Everyone is different and if there are one million patients annually, there are one million outcomes and none are the same. Here are 3 tips to discuss with your care team as you manage expectations and increase your odds of being satisfied after surgery.

1. Talk to friends who had the surgery for recommendations. Interview several physicians if you can afford it. Remember you are not partnering with just the orthopedic surgeon; you are partnering with their entire practice. Patti recommends you find out what type of pre-op and post-op support or classes are offered. She also suggested before surgery learn how often you will visit the surgeon for follow-up. Also, learn how accessible the office is for questions.

2. Prepare for surgery as much as possible. Talk to your care team about their recommendations. Also, remember to prepare your home for the return from the hospital or rehabilitation center. Who is going to be there to help you? Who will drive you to outpatient physical therapy? Patti provided her inpatient therapist with a floor plan of her home with photos, so they could advise her on the best ways to navigate her home. She also recommends practicing walking with a cane or walker before the surgery.

3. Physically it is surgery, however, there is an emotional, mental, and psychological component that plays a key role according to the NIH study. Be prepared to ask for help. Patti suggests, “If you’re independent, asking for help may be a hurdle. Find your circle, they want to assist you.”

Will Patti’s satisfaction improve over time? We will find out when we talk on the 1st anniversary of her surgery. When asked what she could have done to improve her outcomes, she quickly answered, “I should have spent more time exercising before the surgery.” Although she was in pain before the surgery. She also realizes that “patience as a patient is a critical success factor for recovery.”