When is knee replacement surgery recommended?

What is the right age for total knee surgery?

Your surgeon's recommendation for knee replacement is based mainly on your level of pain and disability; there are no absolute restrictions on age or weight. Most of the people who have knee replacement surgery are between the ages of 50 and 80. The procedure has a high success rate and is considered relatively safe and effective.1 Women are more likely to undergo the procedure; in 2009, the rate of knee arthroplasty for female patients was 57 percent higher than for males2.

How do I know when it's time to consider surgery?

There are several reasons why your doctor may recommend knee replacement surgery.

People who benefit from knee replacement surgery often have:

  • Knee pain that limits everyday activities, such as walking or bending
  • Knee pain that continues while resting, either day or night
  • Stiffness in a knee that limits the ability to move or bend the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

References

  1. American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: https://orthoinfo.aaos.org/topic.cfm?topic=A00389
  2. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009. Accessed March 7, 2017: https://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

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References

*Journey II BCS.

  1. Hall, et al. Unicompartmental knee arthroplasty (alias uni-knee): an overview with nursing implications. Orthopaedic Nursing. 2004;23(3):163-171. Accessed April 25, 2019.
    • Based on pre-surgical pain levels in UKA patients.
  2. Mayman DJ, Patel AR, Carroll KM. Hospital related clinical and economic outcomes of a bicruciate knee system in total knee arthroplasty patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  3. Nodzo SR, Carroll KM, Mayman DJ. The Bicruciate Substituting Knee Design and Initial Experience. Techniques in Orthopaedics. 2018;33(1):37-41
    • Compared to non-JOURNEY II knees; Based on BCS evidence
  4. 1Short-term Range of Motion is Increased after TKA with an asymmetric bicruciatestabilized implant.AcceptedPoster Presentation, AAOS 2018 New Orleans. Kaitlin M. Carroll, Peter K. Sculco, Brian CMichaels,RichardL. Murphy, Seth A, Jerabek, David J. Mayman
  5. 2J Orthop. 2017 Jan 7;14(1):201- 206. doi: 10.1016/j.jor.2016.12.005. eCollection 2017. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range
  6.  In Vivo Kinematic Comparison of a Bicruciate Stabilized Total Knee Arthroplasty and the Normal Knee Using Fluoroscopy Trevor F. Grieco, MS a, *, Adrija Sharma, PhD a, Garett M. Dessinger, BS a, Harold E. Cates, MD b, Richard D. Komistek, PhD. The Journal of Arthroplasty, September 2017
  7. Testing concluded at 45 million cycles, ISO 14242-1 and 14243-3 define test completion at 5 million cycles. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  8. Iriuchishima T, Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. doi:10.4103/ortho.IJOrtho_392_18.
  9. Smith JR, Picard F, Lonner J, et al. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. Congress of the International Society of Biomechanics. August 4-9, 2013. Natal, Brazil.
  10. Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005

Additional claim statements and support regarding Smith+Nephew implants and Robotics-assisted surgery

  • Implants that are built to last
  • LEGION◊CR Knee with VERILAST◊ technology was lab-tested for 45 million cycles (estimating 30 years of wear performance) and showed 81% less wear than similar 5-million cycle cobalt chrome implant.
    • Learn More
      • ISO 14243-3
      • VERILAST knee wear testing and results apply only to the VERILAST LEGION CR Primary Knee System only. Extended lab-testing for other VERILAST knee systems have not been performed. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  • Smith+Nephew implants may offer a more normal feeling knee
    • Based on JOURNEY◊ II BCS knee implant
    • Learn More
      • Verstaete MA, Van Onsem S, Zambianchi F, et al. Multi-centre evaluation of knee kinematics during different activities for anatomic total knee design. Poster presented at: 2nd World Arthroplasty Congress; 19-21 April, 2018; Rome, Italy.
      • Sharma A, Dessinger G, Cates H, Komistesk R. In vivo kinematic comparison for subjects having a bi-cruciate substituting TKA vs the normal knee. Poster presented at: 2nd World Arthroplasty Congress; 19-21 April, 2018; Rome, Italy.
      • Kosse NM, Heesterbeek PJC, Defoort KC, Wymenga AB, van Hellemondt GG. Improved maximal flexion after minor adaptations in implant design bicruciate-substituted total knee arthroplasty. Poster presented at 19th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT); May 30 – June 1 2018; Barcelona, Spain.
  • 89% of patients were able to take the stairs again after surgery.
    • Based on JOURNEY◊ II BCS knee implant patients
      • Iriuchishima T and Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. DOI:10.4103/ortho.IJOrtho_392_18
  • A robotics-assisted knee replacement with Smith+Nephew implants may get you back in the game six months sooner than traditional knee replacement surgery
    • Based on UKA patients
      • Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg. 2018;138(12):1765-1771
  • Over 90% of patients who had a Smith+Nephew knee replacement surgery returned to work within 6 months.
      • Harris AI, Luo TD, Lang JE, Kopjar B. Short-term safety and effectiveness of a second-generation motion-guided total knee system. Arthroplast Today. 2018;4:240–243. 1
  • Robotics-assisted surgery with Smith+Nephew implants may lead to a faster rehabilitation and shorter recovery time than traditional knee surgery when following your doctor’s recovery plan and physical therapy recommendations.
    • Claim 19 & 20 (PCS REC.015)
  • Due to its improved accuracy, Smith+Nephew robotics-assisted UKA has lower revision rates* compared to conventional techniques
    • Shown in clinical studies with follow-up of up to 5.5 years
      • Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1232-1240.
      • Battenberg AK, Netravali NA, Lonner JH. A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship. J Robot Surg. 2019;14(1):55-60.
      • Gregori A. 5 Yr Experience Semi Active Robotic Partial Knee Replacement: The Financial Impact. Poster presented at: SICOT;October, 2018; Montreal, Canada.
  • A study has shown Smith+Nephew robotic technology has demonstrated faster return to sport (4.2 vs 10.5 months) when compared to conventional techniques*
        • *n= 28 (n=11 robotic procedures), p<0.01
          • Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg. 2018;138(12):1765-1771
  • Robotics-assisted surgery with Smith+Nephew implants may help patient get discharged sooner
    • Study of UKA patients
      • Sephton BM, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.
      • Shearman AD, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.
  • Robotics-assisted surgery with Smith+Nephew implants may provide patients with a smoother recovery
    • Based on JOURNEY II family of implants
      • Mayman DJ, Patel AR, Carroll KM. Hospital Related Clinical and Economic Outcomes of a Bicruciate Knee System in Total Knee Arthroplasty Patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  • Robotics-assisted surgery with Smith+Nephew implants may help patients regain function faster
      • Shearman AD, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.

Additional statements and support regarding Knee Replacement

  • More than 90% of people who have knee replacement surgery experience dramatic relief in knee pain and are better able to perform common activities.
    • Based on pre-surgical pain levels
      • American Academy of Orthopaedic Surgeon website, http://orthoinfo.aaos.org/topic.cfm
  • The majority of patients experience profound improvements in their physical activity after having knee replacement surgery.
    • Based on pre-surgical activity levels
      • Brandes M, et. al., “Changes in physical activity and health-related quality of life during the first year after total knee arthroplasty.” Clin Orthop Relat Res. 1991 Dec;(273):151-6. https://www.ncbi.nlm.nih.gov/pubmed/20981812 Accessed Wednesday, April 17, 2019