Introduction

Total Knee Replacement, also known as knee replacement surgery, is a highly effective procedure that offers significant pain relief and improved function for individuals with severe knee osteoarthritis. This surgery has transformed the lives of many, allowing them to return to daily activities with reduced pain and increased mobility.

However, as the number of knee replacement procedures increases globally, particularly among younger patients, it's important to weigh the benefits against the potential risks. This article breaks down the findings of a 2023 study on knee replacement to help you understand when this surgery might be more risky than beneficial, especially for those under sixty-five.

What is Total Knee Replacement?

Knee replacement involves replacing the damaged parts of the knee joint with artificial components. This surgery is typically recommended for patients with severe knee osteoarthritis who have not found relief from other treatments. The procedure aims to relieve pain, improve joint function, and enhance the quality of life. Many patients experience profound improvements, regaining the ability to perform activities they once thought were lost.

Increasing Knee Replacement Among Younger Patients

The prevalence of knee replacement has significantly increased over the years, particularly among patients under 65. This trend is driven by the aging population and the expansion of surgical indications to include younger, more active individuals. Between 2000 and 2019, the percentage of knee replacement patients younger than 65 nearly doubled, from 13.5% to 24.8%.

Benefits of Knee Replacement

The benefits of knee replacement are well–documented. Patients often report:

• Significant Pain Relief: Many patients experience a dramatic reduction in knee pain, allowing them to participate in daily activities with much more comfort.
• Improved Function: Knee replacement can restore joint function, enabling patients to walk, climb stairs, and even return to low–impact sports.
• Enhanced Quality of Life: With reduced pain and improved mobility, patients often find their overall quality of life significantly enhanced.

Risks and Survival Rates of Knee Replacement

While knee replacement offers significant benefits, younger patients face higher risks of complications and revision surgeries compared to older patients. The study analyzed data from the Italian Regional Register of Orthopaedic Prosthetic Implants to compare the survival rates of knee replacement implants across different age groups:

• Patients younger than 50 years: These patients had a significantly higher risk of implant failure, with a survival rate of 78.7% at 15 years.
• Patients aged 50–65 years: This group also faced higher risks, with a survival rate of 89.4% at 15 years.
• Patients aged 66–79 years: The oldest group had the best outcomes, with a survival rate of 94.8% at 15 years.

Factors Contributing to Higher Risks

Several factors contribute to the higher failure rates in younger patients:

• Higher Activity Levels: Younger patients tend to be more active, which can place additional stress on the artificial joint and lead to earlier wear and tear.
• Longer Life Expectancy: Younger patients will live longer with their implants, increasing the likelihood of needing a revision surgery at some point.
• Higher Expectations: Younger patients often expect to return to a high level of physical activity, which can be challenging to achieve and maintain with an artificial joint.

Alternative Treatments for Younger Patients

Given the higher risks associated with knee replacement in younger patients, exploring alternative treatments is crucial. Some options include:

• Cartilage Restoration Procedures: These aim to repair damaged cartilage and can be effective for patients with early–stage osteoarthritis.
• Osteotomy: This surgical procedure realigns the bones to relieve pressure on the knee joint.
• Injective Biological Solutions: Treatments like Platelet–Rich Plasma and Bone Marrow Aspirate Concentrate injections can help improve knee joint health and delay the need for knee replacement.

Monitoring and Follow–Up

For patients who undergo knee replacement, regular monitoring and follow–up are essential. This helps ensure the implant is functioning correctly and identifies any issues early. The study suggests bone density tests and follow–up appointments every 1–3 years, depending on the individual's risk and response to treatment.

Conclusion

Total Knee Replacement is a highly beneficial procedure for many patients, offering significant pain relief and improved function. However, it is essential to carefully consider the risks, especially for younger patients. Exploring alternative treatments and closely monitoring implant performance can help improve outcomes and extend the lifespan of the artificial joint.

Surgery Is Often A Great Choice, But If You'd Like To Learn More About Physical Therapy…

Contact our physical therapy practice today to discuss your options for managing knee osteoarthritis and to learn more about the best treatment plans tailored to your needs.

References:

Perdisa F, Bordini B, Salerno M, Traina F, Zaffagnini S, Filardo G. Total Knee Arthroplasty: When Do the Risks of Total Knee Arthroplasty Overcome the Benefits? Double Risk of Failure in Patients up to 65 Years Old. Cartilage. 2023;14(3):305–311. Link to the article