Considering Knee Replacement Surgery? Timing is Everything!

For millions of Americans, knee replacements have enabled people who would have been incapacitated by painful arthritis to enjoy years of active life – walking, swimming, cycling, and more.   No wonder almost 1 million knee replacements are performed every year in the United States.  As baby boomers age, that number is expected to climb rapidly.

However, the timing of this life changing procedure is critical.  If you wait too long, you may suffer needless discomfort and lose function in your knee, and you may not reap the benefits of knee replacement that you would if you’d had it done earlier.  But if you get a knee replacement too early, the risks may outweigh the benefits.  In an article published in the University of California Berkeley Health After 50 Journal * and in a  study published in the Journal of Bone & Joint Surgery  * in January 2020 of 8,002 participants, ages 45 to 79, found that only 9 percent of the knees for which joint replacement was considered appropriate were replaced in a timely fashion (defined as within two years of the procedure becoming potentially appropriate).  For the remaining knees about 91 percent were classified as potentially appropriated but not replaced, and about 26 percent were classified as premature (replaced even though the procedure was likely inappropriate).

Risks in Waiting Too Long

If you delay surgery, stiff and painful knees may cause you to limit or even give up activities like walking or cycling.  And the less active you are, the greater your risk for cardiovascular disease, type 2 diabetes, obesity and other chronic diseases.

In addition, the muscles around your knee joint may become weaker and your bones thinner if you have to restrict your activities because of painful knees.  That could mean that when you do decide to have replacement surgery, your recovery will take longer.  And when arthritis damage becomes bad enough, your knees can become deformed.  Then walking may put undue wear and tear on other parts of the body, such as the hips.

Some people put off the surgery because they may fear the surgery itself because they have an outdated notion of its risks and think the recovery period will be long and painful. However, advances in surgical techniques and modern anesthesia, pain management, and postoperative physical therapy allow for a more rapid recovery.  Most people full recover within six to eight weeks.  Once recovered, people with knee replacements can walk long distances and enjoy recreational activities like golf, pickleball and tennis.

Risks in Acting Too Soon

A premature knee replacement puts you at an unnecessary risk with minimal benefit.  The surgery might not provide the satisfaction expected because the knee wasn’t in bad enough shape to begin with.  It’s the people with the worst knees who benefit the most.

Also, artificial knees have a life span of between 15 and 20 years, so if you have the surgery too soon, it’s possible you may need revision surgery (a second knee replacement).  Revision surgery typically doesn’t have as good an outcome as the original surgery, but if knee replacement is timed right, most older adults will not require further surgery.

Making the Decision

It’s important that you are part of the decision to have knee replacement surgery.

If your arthritis has reached a stage where your knee pain is not responding to conservative treatments, your mobility is significantly impacted, and x-rays reveal moderate to severe joint deterioration, it’s likely time to discuss your options with your doctor.

Timing is everything!


*University of California, Berkeley

Health after 50

Health Advice from the School of Public Health

April 2020

Pages 1 – 2


*Journal of Bone & Joint Surgery

January 2020

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