Patients considering knee replacements are faced with a steadily increasing number of treatment options.
Which one is best for you?
Learn what to consider when thinking about a knee replacement from a UVA specialist in knee replacement surgery.
How to Determine the Best Knee Replacement Option
Featured Speaker:
Dr. James Browne
Dr. James Browne is a fellowship-trained orthopedic surgeon who specializes in knee and hip replacements. Transcription:
How to Determine the Best Knee Replacement Option
Melanie Cole (Host): Patients considering knee replacements are faced with a steadily increasing number of treatment options. Which one is best for you? Today, we’re speaking with Dr. James Browne. He’s a fellowship-trained orthopedic surgeon who specializes in knee and hip replacements. Welcome to the show, Dr. Browne. So what are some conditions which would prompt or warrant someone to even consider getting a new knee or a knee replacement?
Dr. James Browne (Guest): Sure. Well, first of all, thank you Melanie, for having me on the show. I appreciate the invitation. Knee replacement surgery is really an option for patients who have advanced arthritis of the knee, so advance wear-and-tear of the knee joint and have failed non-operative treatment. Non-operative treatment is always the first line of treatment for knee arthritis, and knee replacement may be an option for those patients who have failed those treatment options.
Melanie: What are some questions that people should ask the surgeon when they’re considering to have a knee replacement?
Dr. Browne: Well, I think the first and probably the most important question that the patient should ask their doctor is whether or not they’re a good candidate for surgery. As I mentioned, knee replacement surgery is an option for some patients with advanced arthritis who have failed non-operative treatment, but certainly not all patients with knee pain need surgery. I think, furthermore, for some patients with advanced medical problems, knee replacement surgery may not be a safe option, so it’s important to really dive into these questions with your surgeon. It’s also a very important to discuss appropriate expectations in terms of outcome with your surgeon before you decide to proceed with knee replacement surgery. I think probably the most common question that I get from my patients is whether or not the time is right for them to have surgery. There are many factors that are important to think about when it comes to planning a knee replacement surgery: patient’s general health, their time away from work, some family commitments, the time it takes to get better afterwards. These are things that I think patients want to discuss with their surgeon. I think most people decide the time that’s right for them when their hip or knee pain prevents them from living comfortably and that interferes with their daily activities. But at the end of the day, it’s really up to the individual patient to make the decision about whether or not surgery is right for them and if the time is right to proceed.
Melanie: What conditions might preclude somebody from getting knee surgery? I mean if they are a heart patient or if they have diabetes, is there anything that really makes somebody not a candidate?
Dr. Browne: Certainly, medical conditions such as you list there are our concerns. What we try to do is address any modifiable risk factors patients may have for a poor outcome. Some factors that patients come into the office with are already optimized, we can’t do anything about it, and then we discuss the risk of surgery. But there are a lot of factors such as diabetes, as you mentioned, and patient weight, for example, smoking, that we know are risk factors to poor outcome and are areas we can potentially intervene ahead of surgery to improve the chances of a good outcome.
Melanie: Dr. Browne, are there some non-surgical options available?
Dr. Browne: Yeah, absolutely. So as I mentioned earlier, the treatment of arthritis really starts without surgery. Pain relievers are often the first choice of therapy for osteoarthritis of the knee. Simple pain reliever such as over-the-counter Tylenol and non-steroidal anti-inflammatory such as Motrin, which is Ibuprofen or Aleve can reduce pain and swelling in the joint. There are more potent types of pain reliever that are prescription strength, non-steroidal anti-inflammatories, and those can be discussed with your doctor as well. Exercise and physical therapy can help strengthen the muscles around the knee and this can lead to reduced pain, swelling and stiffness. Braces can also be a helpful treatment option for certain types of arthritis. Many people with osteoarthritis, particularly of the knee, are overweight. We know that simple weight loss can reduce the stress on weight-bearing joints, such as the knee, and that given the physics of the hip and knee joints, you end up putting about three to five times your body weight across these joints throughout the day, so even the loss of a relatively modest amount of weight, say, 10 pounds or so, can really reduce the stress that the joints see substantially. About 10 pounds of weight loss can result in about 50 pounds of weight reduction on the knees, so losing weight, I think, is really key for certain patients. Then finally, there are some other treatment interventions that we have such as injections, they can also help. Steroid injections in particular have been shown to be very effective at providing pain relief and reducing inflammation.
Melanie: Tell us about some of the major differences and outcomes between different surgical approaches. Mention what the surgical approaches that you use in somebody getting a knee replacement.
Dr. Browne: Sure. There are number of different minimally invasive techniques and various technologies that have been developed, such as computer navigation, custom cutting guides and robotics that have been implemented in knee replacement. I would say that today, there appears to be both pros and cons to each of these technologies but I think really more research is required to determine what advantage, if any, these may offer. We offer these approaches for certain select patients and in certain situations, but we really can’t claim any major long-term differences in outcomes at the moment. I think if there are benefits between these different techniques, they’re likely to be relatively small and not dramatic in most cases. I think probably the major improvements that we have seen in the past decade or so really have been in the areas of anesthesia and pain management. The advances we’ve seen in these areas have really led to a rapidly improved recovery and quicker return to function.
Melanie: Tell us a little bit about the knee implants themselves, Dr. Browne. Are they going to set off alarms at the airport? Are people expecting full range of motion once you’ve done this? Once they’ve gotten a new knee and you’ve replaced all the ligaments, re-attached all the ligaments and gotten everything back in working order, what can they expect from those implants?
Dr. Browne: Sure. Well, to answer your first question about setting off metal detectors, most patients with hip or knee replacements will set off metal detectors. There’s no security card that patients need to carry with them, although we do provide a card for them, if they’d like, and patient should expect to set off metal detectors. The newer type detectors are less of a problem, but certainly the older metal detectors in many of the smaller airports remain an issue for folks with artificial joints. There are so many people now in the United States that do have artificial joints that this has become fairly routine for screening at airports and so on. The other issue about what to expect after surgery is a good one, and I would tell you that each patient is different. We know that the best predictor of post-operative range of motion is pre-operative range of motion. What that means is that patients who go into surgery with really compromised function, with a very stiff knee, have lack of flexion, well, they may have some improvements in those categories, tend to still have some limitations. The patients who go into surgery with functioning at very high level, who have good range of motion, tend to preserve the range of motion after surgery as well. The ultimate goal of knee replacement is to reduce pain and improve function, and the goal of knee replacement surgery in many cases is not solely to improve range of motion.
Melanie: What about after that? How long does a new knee last? Is this something that they can expect they’re never going to have to worry about again? Can you still get pain in the knee that’s had a replacement?
Dr. Browne: Certainly. In terms of the life expectancy of knee replacement, we know that a knee replacement is mechanical device, just like your television, your microwave, your car, and like any mechanical device, parts can wear out, they can break, and they can fail. The failure rate of knee replacement is about 1% per year. What that means is that patients have about a 90% chance of getting a good 10-year result with their knee replacement. That number drops down to about 75 to 80% at 20 years, so about 75 to 80% of our patients, we expect to get 20 years more out of their knee replacement. A lot of knee replacements do start wearing out between your 20 and your 30 and that’s often where we see re-do surgeries come into play. So, patients should expect that if they live long enough, they may need further surgery on their knee.
Melanie: Dr. Browne, in just the last two minutes or so, give your best advice about people considering a knee replacement and why patients should come to UVA for their knee replacement.
Dr. Browne: Sure. Knee replacement is an excellent operation. It’s very successful in most patients. Most patients are very satisfied they had the procedure. It is important though to know to make sure that you’re a good candidate, and I think this requires good, thoughtful discussion with both yourself as well as with your family, your loved ones, and your surgeon as well. You certainly want to try all non-operative measures before jumping in the knee replacement surgery, and it is important to have a good expectation about what knee replacement surgery can offer for you, so it’s a very individual decision that each patients needs to make for themselves. Here at UVA, we are unique in that we’re the only Joint Commission Certified Joint Replacement Program in the area. We’re awarded the States and Nations by the Joint Commission for our commitment to quality and our use of evidence-based clinical practice guidelines. We have a comprehensive Joint Replacement Program here at UVA that includes a dedicated team of nurse coordinators, outpatient and inpatient nurses and physical therapies, and I think importantly, all of our surgeons are fellowship-trained in joint replacement; what that means is that we have expert training and we’re really true specialists in knee replacement. Those of us doing knee replacement and hip replacement only do joint replacement surgery here at UVA. I think, as with many things in life, volume matters and we are one of the highest volume centers in Virginia. Finally, at UVA, we’re involved in a number of innovative endeavors and pioneering research that’s been recognized nationally. I think we have a very special place here and a very special team to get the patients through the operation successfully.
Melanie: Thank you so much, Dr. James Browne, fellowship-trained orthopedic surgeon with the UVA Health Systems. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
How to Determine the Best Knee Replacement Option
Melanie Cole (Host): Patients considering knee replacements are faced with a steadily increasing number of treatment options. Which one is best for you? Today, we’re speaking with Dr. James Browne. He’s a fellowship-trained orthopedic surgeon who specializes in knee and hip replacements. Welcome to the show, Dr. Browne. So what are some conditions which would prompt or warrant someone to even consider getting a new knee or a knee replacement?
Dr. James Browne (Guest): Sure. Well, first of all, thank you Melanie, for having me on the show. I appreciate the invitation. Knee replacement surgery is really an option for patients who have advanced arthritis of the knee, so advance wear-and-tear of the knee joint and have failed non-operative treatment. Non-operative treatment is always the first line of treatment for knee arthritis, and knee replacement may be an option for those patients who have failed those treatment options.
Melanie: What are some questions that people should ask the surgeon when they’re considering to have a knee replacement?
Dr. Browne: Well, I think the first and probably the most important question that the patient should ask their doctor is whether or not they’re a good candidate for surgery. As I mentioned, knee replacement surgery is an option for some patients with advanced arthritis who have failed non-operative treatment, but certainly not all patients with knee pain need surgery. I think, furthermore, for some patients with advanced medical problems, knee replacement surgery may not be a safe option, so it’s important to really dive into these questions with your surgeon. It’s also a very important to discuss appropriate expectations in terms of outcome with your surgeon before you decide to proceed with knee replacement surgery. I think probably the most common question that I get from my patients is whether or not the time is right for them to have surgery. There are many factors that are important to think about when it comes to planning a knee replacement surgery: patient’s general health, their time away from work, some family commitments, the time it takes to get better afterwards. These are things that I think patients want to discuss with their surgeon. I think most people decide the time that’s right for them when their hip or knee pain prevents them from living comfortably and that interferes with their daily activities. But at the end of the day, it’s really up to the individual patient to make the decision about whether or not surgery is right for them and if the time is right to proceed.
Melanie: What conditions might preclude somebody from getting knee surgery? I mean if they are a heart patient or if they have diabetes, is there anything that really makes somebody not a candidate?
Dr. Browne: Certainly, medical conditions such as you list there are our concerns. What we try to do is address any modifiable risk factors patients may have for a poor outcome. Some factors that patients come into the office with are already optimized, we can’t do anything about it, and then we discuss the risk of surgery. But there are a lot of factors such as diabetes, as you mentioned, and patient weight, for example, smoking, that we know are risk factors to poor outcome and are areas we can potentially intervene ahead of surgery to improve the chances of a good outcome.
Melanie: Dr. Browne, are there some non-surgical options available?
Dr. Browne: Yeah, absolutely. So as I mentioned earlier, the treatment of arthritis really starts without surgery. Pain relievers are often the first choice of therapy for osteoarthritis of the knee. Simple pain reliever such as over-the-counter Tylenol and non-steroidal anti-inflammatory such as Motrin, which is Ibuprofen or Aleve can reduce pain and swelling in the joint. There are more potent types of pain reliever that are prescription strength, non-steroidal anti-inflammatories, and those can be discussed with your doctor as well. Exercise and physical therapy can help strengthen the muscles around the knee and this can lead to reduced pain, swelling and stiffness. Braces can also be a helpful treatment option for certain types of arthritis. Many people with osteoarthritis, particularly of the knee, are overweight. We know that simple weight loss can reduce the stress on weight-bearing joints, such as the knee, and that given the physics of the hip and knee joints, you end up putting about three to five times your body weight across these joints throughout the day, so even the loss of a relatively modest amount of weight, say, 10 pounds or so, can really reduce the stress that the joints see substantially. About 10 pounds of weight loss can result in about 50 pounds of weight reduction on the knees, so losing weight, I think, is really key for certain patients. Then finally, there are some other treatment interventions that we have such as injections, they can also help. Steroid injections in particular have been shown to be very effective at providing pain relief and reducing inflammation.
Melanie: Tell us about some of the major differences and outcomes between different surgical approaches. Mention what the surgical approaches that you use in somebody getting a knee replacement.
Dr. Browne: Sure. There are number of different minimally invasive techniques and various technologies that have been developed, such as computer navigation, custom cutting guides and robotics that have been implemented in knee replacement. I would say that today, there appears to be both pros and cons to each of these technologies but I think really more research is required to determine what advantage, if any, these may offer. We offer these approaches for certain select patients and in certain situations, but we really can’t claim any major long-term differences in outcomes at the moment. I think if there are benefits between these different techniques, they’re likely to be relatively small and not dramatic in most cases. I think probably the major improvements that we have seen in the past decade or so really have been in the areas of anesthesia and pain management. The advances we’ve seen in these areas have really led to a rapidly improved recovery and quicker return to function.
Melanie: Tell us a little bit about the knee implants themselves, Dr. Browne. Are they going to set off alarms at the airport? Are people expecting full range of motion once you’ve done this? Once they’ve gotten a new knee and you’ve replaced all the ligaments, re-attached all the ligaments and gotten everything back in working order, what can they expect from those implants?
Dr. Browne: Sure. Well, to answer your first question about setting off metal detectors, most patients with hip or knee replacements will set off metal detectors. There’s no security card that patients need to carry with them, although we do provide a card for them, if they’d like, and patient should expect to set off metal detectors. The newer type detectors are less of a problem, but certainly the older metal detectors in many of the smaller airports remain an issue for folks with artificial joints. There are so many people now in the United States that do have artificial joints that this has become fairly routine for screening at airports and so on. The other issue about what to expect after surgery is a good one, and I would tell you that each patient is different. We know that the best predictor of post-operative range of motion is pre-operative range of motion. What that means is that patients who go into surgery with really compromised function, with a very stiff knee, have lack of flexion, well, they may have some improvements in those categories, tend to still have some limitations. The patients who go into surgery with functioning at very high level, who have good range of motion, tend to preserve the range of motion after surgery as well. The ultimate goal of knee replacement is to reduce pain and improve function, and the goal of knee replacement surgery in many cases is not solely to improve range of motion.
Melanie: What about after that? How long does a new knee last? Is this something that they can expect they’re never going to have to worry about again? Can you still get pain in the knee that’s had a replacement?
Dr. Browne: Certainly. In terms of the life expectancy of knee replacement, we know that a knee replacement is mechanical device, just like your television, your microwave, your car, and like any mechanical device, parts can wear out, they can break, and they can fail. The failure rate of knee replacement is about 1% per year. What that means is that patients have about a 90% chance of getting a good 10-year result with their knee replacement. That number drops down to about 75 to 80% at 20 years, so about 75 to 80% of our patients, we expect to get 20 years more out of their knee replacement. A lot of knee replacements do start wearing out between your 20 and your 30 and that’s often where we see re-do surgeries come into play. So, patients should expect that if they live long enough, they may need further surgery on their knee.
Melanie: Dr. Browne, in just the last two minutes or so, give your best advice about people considering a knee replacement and why patients should come to UVA for their knee replacement.
Dr. Browne: Sure. Knee replacement is an excellent operation. It’s very successful in most patients. Most patients are very satisfied they had the procedure. It is important though to know to make sure that you’re a good candidate, and I think this requires good, thoughtful discussion with both yourself as well as with your family, your loved ones, and your surgeon as well. You certainly want to try all non-operative measures before jumping in the knee replacement surgery, and it is important to have a good expectation about what knee replacement surgery can offer for you, so it’s a very individual decision that each patients needs to make for themselves. Here at UVA, we are unique in that we’re the only Joint Commission Certified Joint Replacement Program in the area. We’re awarded the States and Nations by the Joint Commission for our commitment to quality and our use of evidence-based clinical practice guidelines. We have a comprehensive Joint Replacement Program here at UVA that includes a dedicated team of nurse coordinators, outpatient and inpatient nurses and physical therapies, and I think importantly, all of our surgeons are fellowship-trained in joint replacement; what that means is that we have expert training and we’re really true specialists in knee replacement. Those of us doing knee replacement and hip replacement only do joint replacement surgery here at UVA. I think, as with many things in life, volume matters and we are one of the highest volume centers in Virginia. Finally, at UVA, we’re involved in a number of innovative endeavors and pioneering research that’s been recognized nationally. I think we have a very special place here and a very special team to get the patients through the operation successfully.
Melanie: Thank you so much, Dr. James Browne, fellowship-trained orthopedic surgeon with the UVA Health Systems. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.