Stopping knee pain: When should I consider knee surgery?
Many people suffer from knee pain, but if you are living with painful knees every day, could surgery be the right choice for you? We consider non-invasive methods of managing knee pain and ask the experts when it’s time to say yes to surgery
For many, knee pain becomes debilitating. It can stop you doing simple everyday activities like bathing or walking around the home and can make sleeping difficult. If knee pain is stopping you from living life to the full, you might be wondering whether a knee replacement operation could help you feel better.
Knee replacement is a highly successful type of surgery with many benefits, but it’s not for everyone, and it shouldn’t be your first port of call. We take a look at the common causes of chronic knee pain, consider the available treatment options, and explain how to find out if knee replacement surgery is right for you.
What is causing your knee pain?
If you are considering knee replacement surgery it can help to understand what is causing your knee pain. Most people who have a total knee replacement are over 65 years old and in the vast majority of cases the pain is caused by osteoarthritis, although sports injury and rheumatoid arthritis can also result in the need for surgery.
Natural wear and tear of the knee
Walking, bending, jumping, running: over a lifetime, your knees have to withstand a lot of action. Normally the body can naturally repair itself, but in some cases it can’t, ultimately leading to damage in your joint – also known as osteoarthritis.
In a healthy joint the cartilage (the natural cushioning in your joints) protects the bone ends and keeps them working smoothly. In a joint with osteoarthritis, the cartilage has worn away so the bone ends in the joint rub against each other, causing pain, stiffness and reduced mobility. In some case this friction can also cause bone spurs to form.
Osteoarthritis most commonly develops naturally over time as we age, which is why it is often known as wear and tear arthritis. Osteoarthritis is far more common the older we get, however if you’re a keen sportsperson or carrying extra weight, this damage to your joints can be accelerated, so it’s absolutely possible for young people to show symptoms.
Other types of arthritis
Two other types of arthritis that can lead to the need for a knee replacement are rheumatoid arthritis and gout. These both have the potential to cause chronic knee pain and long-term damage to the joint, though they are much less common than osteoarthritis.
Knee injury
Occasionally a traumatic accident or injury can lead to a pressing need for a knee replacement operation.
More commonly, a knee injury will develop over time into osteoarthritis of the knee, speeding up the normal rate of wear and tear and necessitating knee replacement surgery.
A small percentage of patients will benefit from surgery for knee pain, but this is a decision that should only be taken once other avenues have been exhausted.
Who needs knee replacement surgery?
If your knee pain makes even the simplest tasks like walking up and down stairs difficult, or if it interferes with your sleep, then knee replacement surgery could be an option.
“However, surgery is not the only treatment option for patients who have problems of the knee,” explains Consultant Orthopaedic Surgeon Mr Bobby Anand from Shirley Oaks Hospital.
There are various other treatment options that might be considered first. Painkillers, corticosteroid injections and physiotherapy can be very effective in managing pain and increasing your mobility. However, these alternatives do become less effective as osteoarthritis progresses, so don’t put off getting advice and treatment.
“The first step is to obtain an accurate diagnosis of the condition, says Mr Anand. “This involves seeing a specialist, having a history taken, a thorough examination and then appropriate imaging.
“A small percentage of patients will benefit from surgery for knee pain, but this is a decision that should only be taken once other avenues have been exhausted and after the surgeon and patient have had an extensive discussion of all options.”
So, in most instances you will be offered conservative methods first, and only once we have confirmed that these treatments don’t work for you will we recommend surgery.
Diagnosing your knee problems
There are many possible causes of knee pain, and if you are living with chronic pain and seeking treatment to improve your quality of life, it’s vital to speak to an expert, such as an orthopaedic consultant specialising in knees.
Your consultant may be able to diagnose what is causing your pain with a physical examination alone, or they may need to send you for tests such as X-ray or an MRI scan. Sometimes they may even perform a type of minimally invasive surgery called an arthroscopy to look inside your knee and locate the source of your problems.
Only once they have a good idea of what is at the root of your knee pain problems will your consultant start recommending treatments for you.
Non-surgical treatments
Injections are a common type of treatment for joint pain and there are several different types that could help your knee feel better. For example, steroid injections deliver corticosteroid medications into painful joints or soft tissues to reduce pain and inflammation in that area.
Platelet-rich plasma (PRP) injections are a form of platelet therapy that harnesses the healing power of your platelets. It involves injecting plasma taken from your own blood platelets directly into the knee for speedy pain relief.
Other types of knee surgery
There are a variety of other types of knee surgery that can be used to help knee pain, most of which are performed using a method of keyhole surgery called an arthroscopy. A very small incision is made into your knee and a camera is passed inside so that your surgeon can see what damage or inflammation is causing your knee pain.
Often this same procedure can be used to treat the cause of your pain, and tiny surgical tools will be inserted through further small incisions. A knee arthroscopy can be used to repair or remove torn or damaged ligaments, clear loose cartilage and other debris from your joint, or remove inflamed tissue that is causing problems.
An arthroscopy can be used to treat knee injuries including a torn ACL or a meniscal tear. It is also used to treat arthritis.
Other treatments for knee pain
Knee replacement is just one treatment for chronic knee pain, and it is rarely the first one you will try. Your consultant might first recommend:
Lifestyle changes and self-care
Many people find significant relief from knee pain after making certain lifestyle changes. These could include:
- Increasing activity levels
- Prioritising good sleep
- Looking after your mental wellbeing
- Eating well
- Reducing or avoiding alcohol
- Maintaining a healthy weight
Find out more about reducing arthritis symptoms through lifestyle changes.
Physiotherapy for knee pain
Increasing your exercise levels is one of the best things you can do to look after your joints – and your health in general. If you would like to know how to safely begin and build up your exercise regime to help strengthen your knee and reduce your pain, one of our chartered physiotherapists can show you how. You don’t need a GP referral to visit one of our team, just call our advisors and they’ll help you find an experienced physiotherapist like you.
How exercise helps reduce knee pain
Our physiotherapist Lucy Hughes from Thornbury Hospital says:
“Exercise helps to increase strength and flexibility around joints, promotes bone growth, and encourages a feeling of wellbeing through stimulating the release of our natural feel good hormones, endorphins.
“Before starting any new exercise regime it is always wise to seek clearance from your doctor. You are not trying to win a race, but rather an exercise regime that will help ease your pain and ensure that you maintain a healthy weight.
“Non-impact exercise such as swimming, cycling and walking, even tai chi and yoga, are an excellent place to start. Too much exercise, especially initially, can cause problems especially when the muscles surrounding the sore joints are weak.
“Exercise more than 5 times per week vastly increase the chance of further injury, so a programme 20-30 minutes, three times a week, or split into 10 minute blocks if needed, is seen to be the most beneficial.
“If weight is an issue, controlling your calorie input whilst increasing exercise can help. Losing five pounds is the equivalent of taking 20 pounds of stress off your knees.”
Although knee replacement surgery has a 99% success rate it is still a major operation, so it’s important to carefully consider whether you really need it.
Knee replacement surgery
Knee replacement surgery is a routine operation that involves replacing a damaged, worn or diseased knee with an artificial joint. It’s a very common procedure, with tens of thousands performed each year in the UK.
During the operation your surgeon will remove the damaged surfaces at the ends of your thigh and shin bones. These ends will then be replaced with plastic, ceramic or metal parts, which act like the lost cartilage and make movement easier. The kneecap can also be resurfaced and replaced. An acrylic cement will be used to attach the new parts to your bone.
Depending on the condition of your knee you may need a total knee replacement, where both sides of your knee joint are replaced or a partial (half) knee replacement, where only one side is replaced.
After surgery you should experience a lot less pain in your knee and find walking and performing simple tasks a lot easier.
Weighing up the knee replacement benefits vs the risks
Although knee replacement surgery has a 99% success rate it is still a major operation, so it’s important to carefully consider whether you really need it.
Just like any major operation there are certain risks to be weighed up against the benefits, including pain, blood clots and infections. There are also some specific slight risks associated with knee replacement surgery, including damage to nerves and blood vessels, knee infection and severe pain, stiffness and the loss of use of the knee (Complex Regional Pain Syndrome).
Speak to your consultant about all the ways it could affect you, and about how the potential complications relate to your personal circumstances: everyone has different risk levels.
Pain can be very subjective and it’s important to think over how the pain you experience affects you and your overall quality of life. It’s also worth bearing in mind that as well as dealing with the pain itself, if you feel it is holding you back from enjoying life it can have a big impact on your mental health and wellbeing.
Don’t let knee pain stop you
Your Circle Health Group consultant can discuss all the pros and cons of knee replacement surgery with you to help you to make an informed decision and get back to living life to the full, sooner. They can advise you on all the treatment options available and if you do decide to opt for surgery, they will help you to understand exactly what to expect.
If you think it’s time to speak to a specialist about your knee pain, give us a call today or book online to arrange an appointment with one of our talented orthopaedic consultants.
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If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.