Is it time for Total Knee Replacement (TKR) surgery?
Nearly 1 million knee replacements (TKR) are performed annually in United States. Rates of TKR surgery tripled in the last 20 years and projections in US show further increase in demand by 6 fold (673%) by 2030.(1,2) A similar rise in TKR surgery is also expected in Ireland.
Since 1970’s, when first performed, TKR surgery has been a successful procedure that gives mobility and independence back to people suffering with knee arthritis. However TKR surgery comes with risks. The risks of clot formation, pulmonary embolus, infection, and fracture range from 0.1 to 1.0%, with higher risks among older persons and those with a higher number of coexisting conditions.(3,4) Also, the procedure is not always successful; approximately 20% of patients after TKR have residual pain 6 or more months after surgery.(5)
THE SCIENTIFIC EVIDENCE
Recently (October 2015), New England Journal of Medicine, a highly esteemed medical journal, published a study entitled “A Randomized, Controlled Trial of Knee Replacement”. Interestingly, prior to this publication NEJM published only 4 original articles on arthroscopic knee surgery and all with ‘negative’ results. I have made reference to those articles in one of my previous article (“The Young Arthritic Knee”).
IS TKR SURGERY BETTER THAN NON-OPERATIVE TREATMENT FOR MODERATE KNEE ARTHRITIS?
TKR surgery proved markedly superior to non-surgical treatment alone in terms of pain relief and functional improvement. The percentage of patients who had a significant improvement in pain after 1 year was 85% in the total-knee-replacement group and 68% in the nonsurgical-treatment group. In fact, one in four patients in the nonsurgical-treatment group elected to have TKR before in the first year, and more patients are likely to cross over as follow-up extends further.
It is noteworthy that more than two thirds of the patients in the nonsurgical-treatment group had clinically meaningful improvements in pain and that this group had a lower risk of complications compared with the TKR surgery-treatment group.
TAKE HOME MESSAGE
|When compared with non-operative treatment, TKR surgery gives better pain control and better function despite the inherent higher risk of adverse events.|
The right time to have knee replacement surgery is when the patient is having symptoms that are affecting his or her quality of life and they want something done about it. This is a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them.
I certainly stress to my patients that surgery of any kind carries risks and it is important for them to fully understand what they are. However, in the hands of a good surgeon, experienced nursing staff and in an excellent hospital facility, complications are unlikely.
With modern technology, implant design, materials and surgical techniques, knee replacement surgery has become one of the most successful operations available to patients with moderate or severe knee arthritis. Successful knee replacement surgery reduces or eliminates knee pain and improves joint function, enabling patients to get back to a normal active lifestyle.