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Cameron Dixon
Malcolm Campbell
Uwrit 1103
April 12, 2016
Knee Replacement Is it Worth the Trouble?
As Americas population ages (particularly the Baby Boomers), there is more of a
need for joint replacement surgeries than ever before. Older adults are not willing to
become couch potatoes and they want their joints to let them enjoy the activities they are
used to doing. According to a 2006 study presented at the American Academy of
Orthopedic Surgeons, hip replacements are expected to increase 174% in the next 30
years and knee replacements will rise more than 600%. (Journal of Bone & Joint
Surgery) Humans are not meant to live as long as we are living now. Therefore, our joints
certainly wont last that long, and it is inevitable that many of us will end up having some
sort of joint replacement surgery. There are many causes of chronic knee pain but the
most common cause is arthritis. There are several types of arthritis but most knee pain is
caused by osteoarthritis which is wear and tear on the joints that usually occurs in older
people. Rheumatoid arthritis is a disease that impacts the membrane around the knee joint
and causes extreme inflammation. This disease can hit young or old people. There is also
post traumatic arthritis which usually occurs as a result of a serious injury or accident.
Any one of these can be enough to warrant knee replacement. However, now adults as
young as their 40s and 50s are having the surgery in order to deal with arthritis or wear
and tear on their joints. Often obesity is a cause of severe joint damage and as we all
know, America has a problem with obesity. We are for the most part, a physically active

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society and this particular kind of surgery allows people to live a pain free life and gives
them back the ability to be active again.
According to the National Institutes of Health, joint replacement surgery is
defined as removing a damaged joint (where two or more bones come together - for
example, the knee or hip) and putting in a new one. The knee is the largest joint in the
body and having strong healthy knees makes it easy to do most everyday activities.
Sometimes, the orthopedic surgeon will replace or fix only the damaged parts and not
have to remove the whole joint. Joint replacement surgery can make the difference
between living in constant pain or being able to go back to the activities the patient once
enjoyed. There are many risks and long term problems that can result from this, or any
surgery, and obviously they need to be evaluated before the decision is made to proceed.
There are many different types of joint replacement surgeries that doctors are doing now
including the use of artificial bones or even using parts from animals as well. The surgery
continues to evolve and improve and better outcomes can be expected than in the past.
Doctors and researchers are studying which techniques are the most effective and long
lasting. According to Dennis Armstrong, due to the new advancements in joint
replacement surgery, 90-95% of the time it has been successful and lasting. The most
common joint replacement surgeries are hip, knee, and shoulder. Some of the less
common joint replacements include the ankle and elbow. I will be focusing on knee
replacement surgery in this paper.
At the age of thirteen I had double knee surgery. I was lucky enough to qualify for
outpatient laparoscopic surgery, but my recovery literally took the entire summer before
my freshman year of high school. There were grueling physical therapy sessions several

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times a week, anti-inflammatory drugs, knee braces and crutches that aided me in my
recovery. I had relief from the pain I had been in, but not complete relief. I remember my
doctor telling me that I will likely be a candidate for knee replacement at some point in
my life, probably in my 40s. I am glad to know there is something to help me when I get
older, should I need it. However, are there other less invasive treatments being
researched? Are the techniques improving to the point where patients will only need one
joint replacement in their lifespan? Is the recovery process less demanding?
Physicians tend to recommend knee replacement surgery more now because of the
advances in technology and computer-aided surgery. Robotic surgery is becoming more
commonplace. Artificial joints are built better now than they were even five years ago.
The surgery has been around for decades and doctors are very comfortable with it.
Patients are desperate for pain relief and are concerned over the safety of the pain
medications they may have been taking for extended periods of time. "People don't want
to take medications," said Paul Lachiewicz, MD, professor of orthopedics at the
University of North Carolina at Chapel Hill. "They want it fixed." Nowadays, you see
advertisements on television and in magazines for artificial joints which further increases
the awareness of the procedure. Doctors are confident with the devices now on the
market and know they will last longer and allow patients to return to active lifestyles
much sooner. Even though this surgery is very effective, it should always be seen as a
last resort simply because it is surgery and any surgery carries risks.
There are downsides to all these advances. Cost is a major concern. Even though
this surgery is quite expensive, most insurance plans including Medicare pay for it.
However estimates show that joint replacements cost hospitals over $9 billion in 2004

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(Grelsamer).Other concerns are will there be enough qualified surgeons to meet the
demand in the future. According to Dr. Stephen Hurst, an orthopedic surgeon in San
Mateo, CA, the number of orthopedic surgeons is not growing at the rate that the need for
joint replacement is increasing. Anyone who has tried to make an appointment with an
orthopedic surgeon recently knows that it can take several weeks to be seen, even for
something urgent. The growing number of younger people (people in their 40s and 50s)
having this procedure also increases the likelihood that they will probably outlive their
artificial knee and have to have it replaced with another one at some point. With every
surgery comes more cost and more risk for the patient. The American Academy of
Orthopedic Surgeons is aware of these concerns and are doing things to ensure there will
be minimal complications in the future such as establishing a registry to identify which
implants last longer and things that can be done to lengthen their life even more. They are
working with vendors of the artificial joints to gather this information. Other countries
such as Great Britain and Canada already have these registries.
So who is a candidate for knee replacement surgery? Obviously this is something
the patient and their surgeon must decide together. The typical patient profile is someone
between the ages of 55 and 74 who has obviously been suffering knee pain for a while.
However, as I have mentioned, people in their 40s are having the replacement surgery
also. All other causes of knee pain have been ruled out such as severe sprains or infection.
They most likely have had all the xrays, MRIs, and other tests. They have also tried
physical therapy and pain medication or anti-inflammatory drugs. Many have tried
alternative medicine anything to relieve the pain including weight loss, acupuncture,

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and steroid injections. This procedure should be the last resort as it is the most expensive,
most invasive and carries the highest risk, but it also carries a very high success rate.
According to an article by the American Association of Hip and Knee Surgeons,
total knee replacement lasts 15-20 years. To look at it in a different perspective, both hip
and knee replacements have an annual failure rate between 0.5-1.0%. Which means if
you have your total joint replaced today you have a 90-95% chance that your joint will
last ten years, and a 80-85% that it will last 20 years. These are pretty impressive figures.
With the technology improving in joint replacement surgery, these numbers will no doubt
improve. It can take up to three months for patients to return to most activities, and most
likely six months to a year to fully recover to maximal strength and endurance following
a total knee replacement. Although everyone recovers differently, it could be shorter or
longer, but this is the average recovery time. You have to plan accordingly after having
surgery because you may not be able to drive, kneel, or do other activities you do on a
regular basis. There will also be months of physical therapy necessary to build up
strength in and around the new joint. Most people continue therapy on the own for
months or even years after surgery.
I have three people very close to me who have had knee replacement surgery in
the last two years. Each case is different but all outcomes have been positive. My
mothers cousin suffered severe knee pain for years after a bad automobile accident while
she was in her 20s left her with virtually no cartilage in her knee. She had tried
everything until the surgeon said knee replacement was the only option left. She was in
her late 40s at the time of her surgery. They left her go in pain for so long, hoping she

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would be old enough that she would not outlive her knee replacement. Surgery was
successful but recovery was long and painful. She worked very hard in rehab and has
finally gotten back to normal within the last six months. Now she says the surgery was
worth it. A few months after the procedure she had her doubts because she was still
having pain and rehab was so intense.
My great aunt just had knee replacement six weeks ago. She is in her late 70s and
is very overweight. She had tried everything to relieve the pain but nothing was working.
The surgeon was hesitant with her, not because of her age but given her weight problem.
But he did the surgery. She already claims to be pain free but is having a hard time with
the rehab. The extra weight she is carrying is probably putting more stress on the knee
replacement. Therefore physical therapy should be taken very serious for her. If you do
what your therapist says you will most likely have a successful recovery. It will be
interesting to see how she is feeling in a few more months.
A close family friend had knee replacement exactly one year ago. He was in his
mid 50s at the time and had been an avid tennis player up until about five years ago when
his knee started bothering him. He also did everything he could to avoid the surgery
including taking steroid injections directly into the knee. Surgery was successful for him
although he claims to still not be back to normal. He is still doing rehab on his own.
These three cases are just a few examples of the hundreds of thousands of knee
replacement surgeries that take place each year. As I stated before, this number is
expected to grow enormously in the next 20 years, with more young people choosing to
have the procedure.

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According to the National Institutes of Health website, there are several different
types of knee replacement surgeries. In a total knee replacement, the entire knee joint is
replaced. This is obviously the most invasive procedure with the longest recovery time. In
a partial knee replacement, just the damaged part of the knee is replaced. The down side
of this surgery is that after one part of the knee is replaced, arthritis may develop in
another healthy part of the knee. If that happens, additional surgery would be required.
Surgeons can also attach joint components to bone by cementing them to existing bone.
Replacement parts can be made with a porous surface and the patients own bone can
grow into the surface of the joint to secure them. This procedure is newer and continues
to evolve. There is also something called MIS or Minimally Invasive Surgery where there
is a smaller cut needed to do the surgery, therefore speeding up the healing process.
One interesting fact I discovered is the number of total knee replacements is
greater in women than in men, and has been this way for the past fifteen years. According
to sciencedaily.com, one possible reason is that women are more prone to osteoarthritis
than men for a number of reasons including hormones, genetics and obesity. After the
surgery, women tend to heal better and faster than men.
What are some of the alternatives being studied for knee replacement surgery?
Injections of Hyaluronic Acid directly into the knee joint are being used. This is a
substance found in healthy knees. Damaged or arthritic knees stop producing much of the
acid for reasons doctors do not fully understand. These injections are usually well
tolerated and can give relief for up to 12 months, but they do not work for everyone. The
problem here is that relief is only temporary. Then what happens after a year? Another
technology that is being tried is PRP or Platelet Rich Plasma which is basically your own

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blood injected back into your knee. PRP and stem cell injections may be the best
alternative to knee replacement but there is still much research to be done. Most of these
treatments are considered experimental and are therefore not covered by insurance at this
time. That being said, an injection can cost up to $5000 per knee. Obviously this would
eliminate a large majority of patients from being able to afford these injections. More
research needs to be done on solutions such as this to make them more cost-effective and
readily available.
It is exciting that these non-invasive therapies are being developed and are finding
some success. ABC News published an article in 2013 that said there were virtually no
cons to the procedure of injecting stem cells as an alternative to knee replacement other
than the cost. Success was being seen with no complications or side effects. (Neporent).
If scientists work to get the cost down on this procedure and insurance companies
will cover at least part of it, this could be a very viable alternative to the more
invasive knee replacement surgery going forward.
Even though this procedure is expensive and not without risk, there are even more
risks to not having the surgery or delaying it indefinitely. Deformities could develop on
the joint, muscles and surrounding ligaments could become weak and start to lose
function, and/or pain can become unbearable. The longer the surgery is delayed, the more
complicated it could become and the longer the recovery will be.
I hope that by the time my generation will need knee replacement surgery that
these therapies and many other new ones are readily available, approved by the FDA and
are affordable to the masses. The fact that new technologies are being introduced all the

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time is encouraging. I hope their success rates are high and insurance pays for the new
cutting edge procedures.. After all, its almost a sure thing that I will be a patient!

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Works Cited

Armstrong, Dennis. "Learning Article." Learning Article. Web. 05 Apr. 2016.

"American Association of Hip and Knee Surgeons." American
Association of Hip and Knee Surgeons. N.p., n.d. Web. 25 Apr.
2016.

Carr, Andrew J. "Knee Replacement." N.p., n.d. Web. 8 Apr. 2016.

Davies, B. L., Y. Baena, F M Rodriguez, A. R W Barrett, M. P S F Gomes, S. J. Harris,

M. Diseases Orthopaedic Institute. 52.2 (1993): 65. Web. 5 Apr. 2016.

Grelsamer, Ronald P. "Total Knee Replacement." Bulletin of the Hospital for Joint
"Hip, Knee Replacement Surgery Rates Skyrocket over 7 Years." Amednews.com. N.p., n.d. Web. 12 Apr. 2016

"Knee Replacement." NIHSeniorHealth:. N.p., n.d. Web. 10 Apr. 2016.

Neporent, Liz, and Abc Medical Unit. "Stem Cells: Alternative to Knee
Replacement?"
ABC News. ABC News Network, 09 May 2011. Web. 26 Apr. 2016.

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Rushin, Steve. "Hip Replacement." Sports Illustrated 96.6 (2002): n. pag. Web. 6 Apr.
2016.

ScienceDaily. ScienceDaily, n.d. Web. 12 Apr. 2016.

"Total Knee Replacement-OrthoInfo - AAOS." Total Knee Replacement-OrthoInfo AAOS. N.p., n.d. Web. 12 Apr. 2016.

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