All in the Timing: Many Get Knee Replacement Too Late or Too Soon

Measures such as pain, joint function, age and X-ray assessment are used to determine the best time to have knee replacement.

One specialist agreed that discussions about timing are crucial.

“I have a very strict criteria for patients whom I offer total knee replacement, and I completely agree that performing the operation too early is a mistake for many reasons,” said Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City.

“Subjecting somebody to the possible complications of a procedure of this magnitude without adequate clinical justification is dangerous,” he said.

And there’s another important factor to consider, he said: expectations.

If a patient has minimal or moderate knee pain, their appreciation of how much they have gained from getting the new knee will be less than if their pain had already been at a high level.

“It’s a similar concept to going away to the Caribbean after a cold winter in New York for a holiday. If it’s 15 degrees, freezing and snowing in the city and three hours later you’re on a tropical beach, you notice the difference dramatically,” Schildhorn said. “It’s emotionally pleasing. But the same trip planned in the spring, with a more narrow change in climate, will rarely yield the same level of satisfaction.”

According to Schildhorn, who had no role in the new study, “patients should be encouraged to undergo their knee replacement surgeries only when certain criteria are met.”

For example, X-rays should clearly show “degenerative joint disease of significance, where the cartilage is truly absent or nearly absent from at least one compartment of the knee,” Schildhorn said.

If a patient still complains of a high level of pain, despite no sign of significant degenerative joint disease on X-rays, the pain might have its origin elsewhere, he said.

But if all the necessary criteria are met, “there is absolutely no reason to delay a knee replacement any longer,” Schildhorn stressed. “There is no rationale in allowing further deformity, contractures of joints, and simple pain to prevent living with vitality and vigor. There is no reason to allow a person to lose hope and subject themselves to a lower level of function disabling them from the enjoyment of their work, hobbies, and family life.”