Total Knee Replacement Expectations:
This is an important blog topic on total knee replacement to be aware of. While most patients are ultimately satisfied with their new knees, our AAOS academy has done survey studies that show that 10 to 20% of all total knee patients feel their total knee replacement did not “meet their high expectations” for function.
Patients tend to expect “perfection” including unlimited range of motion and pain-free function. This doesnt mean that their knees are failures, just that their initial expectations were too high. Many patients do have some discomfort after having total knees. Artificial knee “machines” have moving parts and are subjected to very high weight bearing and activity stress. Some patient’s expectations of what their future total knee can do is not always accurate. This is particulary evident in the younger group of patients (age 40-60) who expect to participate in sports and heavier work activities.
It is natural for patients to be optimistic, particularly with the increase in consumer marketing associated with total knee products. Sometimes, after years of chronic pain, patients have built up expectations that their new knee will be a miracle cure with zero drawbacks. While still the best procedure option to reduce chronic disability and pain from bone on bone arthritis in many patients, there are no quarantees of complete success. Many knees will still swell a little with overactivity, and it can take over two years for full healing of the soft tissues around a total knee. This includes full healing of the collateral ligaments. We also see range of motion gains in some patients for up to two years after surgery.
If you are younger, you must understand that all total knees may eventually fail after years of function and need to be revised. It is also possible that your range of motion of your total knee may not be as good as your opposite knee. This is because it is not always possible to get both full stability of the knee, and also full range of motion. (One of those “can’t eat your cake and have it too” situations. ) The patella (kneecap) is an extremely “sensitive” bone, and the number one source of anterior pains around the total knee. Sitting with the knee flexed, and certainly kneeling down, puts pressure on the kneecap that can be uncomfortable at times. There may be no effective treatment for this except activity modification and muscle strengthening. Most patients do feel that their new knee is “better” than their old worn out knee, but you should expect there will still be some aches and pains, associated with certain activities, even after your total knee. You will know when it is time to have total knee surgery, based on how disabled you are when you make the decision to proceed. Most patients will have tried many non-surgical options before proceeding with total knee replacement. It is a good operation for appropriate candidates with bone on bone grinding.