By Joseph Konopka, MD

On 11/13/14 the New York Times ran a piece entitled “Think Twice Before Knee Replacement.” This article raises concerns about the degree to which the demand for this procedure is increasing, particularly in younger patients ages 45-64. Certain medical centers have begun to investigate specific criteria that are used to judge when patients are a suitable candidate for this procedure versus when continued nonoperative care or other less invasive methods are still possible.

The results suggest that patients whose arthritis is not yet too bad, stand to gain less benefit from knee replacement. These are also often the same patients whose young age places them at a higher risk for needing a revision surgery. The studies also suggest that patients with severe pain, severe joint degeneration and significant physical limitation, benefit greatly from knee replacement.

The message from these studies is that patients and physicians alike need to carefully consider the margin for improvement that is likely to be gained from the surgery relative to the degree of actual disability experience by the patient. The smaller this margin, the more likely it is that the patient will be dissatisfied with the results of surgery. Thus, every effort to maximize conservative care and optimize joint function should be exhausted prior to undertaking knee replacement. Patients with modifiable risk factors like obesity who are a higher risk for complications from surgery, are better off addressing these potential causes and risk for arthritis pain rather than pursuing a surgical cure in the setting of the same unaddressed risk.