Osteoarthritis and Knee Pain -- Knowing When to Consider Total Knee Replacement

Osteoarthritis and knee pain are quite prevalent these days for many of us including myself and my friends, family and acquaintances. Frances is one of those friends and here is her story. It seems to describe the usual chain of events leading up to total knee replacement.

Frances has suffered with osteoarthritis and knee pain for many years but in recent years it has worsened. I was shocked when she told me about the mega-doses of Ibuprofen she once took daily. She tried other over the counter medications as well but to no avail. Therefore she graduated to the prescription medications which provided minimal and short-term relief.

Frances is a strong and determined 54 year old woman who refused to allow this condition to get the best of her. She suffered in silence most of the time and maintained her usual activities, despite the persistent pain. Her doctor gave her periodic steroid injections in her knees, which alleviated the knee pain but only for about one week.

One day I gave her a ride home from work and wondered why it was taking her so long to get out of her seat. She slowly inched her body around facing the opened door and just sat there. I asked her what was wrong and she said it was her osteoarthritis and knee pain; that she has to wait a few minutes before she can straighten her legs. She said her knees become temporarily contracted in a spasm and prevent movement. I had no idea how problematic this condition could be.

Finally Frances held on to the car door with her left hand and with the right hand, grasped the side of the seat. Slowly she pulled and pushed herself up using her arms, to a standing position. Holding on to the door with both hands, she was motionless for another few minutes, taking deep breaths in blowing it out. Very slowly she was able to begin walking with a limp towards her door. She said this was her usual routine. I felt so sorry for her.

Soon she had the arthroscopic surgeries (A minimally invasive operation to repair a damaged joint; the surgeon examines the joint with an arthroscope while making repairs through a small incision) of both knees to diagnose her condition. She had the very common meniscus (a disk of cartilage that serves as a cushion between the ends of bones that meet at a joint) tear in both knees. Also, both knees have “bone on bone” meaning the cartilage has worn down, contributing to the severe pain and now her knees are swollen and deformed as well.

The orthopedic surgeon was able to “file down” a sharp bone fragment to reduce some of the pain and prescribed yet another super-dooper pain medication, which provided minimal relief. There was nothing more her doctor could do. He told her to inform him when she was ready for total replacement surgery.

Next, she was forced to walk with a cane because she had sustained a number of falls. As of today, she has been scheduled for a total knee replacement in about thirty days. Frances said the decision came when she realized how the quality of her life had become very poor: One day she went to the grocery store, which is a normal activity for us all. When she finished loading her bags, sat down in her car seat, and closed the door, she broke down and cried uncontrollably in extreme pain. That was the last straw!

You may want to consider total knee replacement if:

• Your knee is severely damaged by osteoarthritis or injury

• It is hard to perform simple activities like walking or climbing stairs

• You begin to feel pain while sitting or lying down

• Medication, changing your activity level and using walking supports are no longer helpful

Discuss treatment options with your healthcare provider.

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