Postponing TKR

Each of us sets our own criteria for when to get TKR, of course. For me, I decided that I was going to go ahead in 2025 when my knee pain started interfering with my sleep at night and that I was starting to avoid walking down stairs in addition to limiting other activities. I was willing to accept the risks at that point. Sleep interference and avoiding activities is still my own personal threshold for going ahead with TKR, but others live with that a long time before going through with TKR.

But when I went to schedule the procedure my surgeon told me about HA knee injections and that his uncle had put off TKR another 5 years by getting the injections. My years-outdated information was only about steroid knee injections which I had decided against in the past. My first set of HA injections was amazing - like getting my old knee back. But by the second set the benefit was already more muted.

Reading people's challenges on this site has been very helpful. Some small percentage of us will not have a good outcome for TKR. Some people who had a great first TKR are reporting issues with the second knee. If a year after TKR my knee is not as good as before the surgery, then will I feel that I had made the right bet with the information that I had at the time? I will delay knee surgery until I believe that in the face of a bad outcome I can look at myself in the mirror and say "yes, it was the best choice that I could make with what I knew then".

I have significant knee pain often, and my x-rays are bone-on-bone. My downhill skiing is very limited but my cross-country skiing is fine and at night I can always find a comfortable knee position to sleep. So, for now, I enjoy what my knee can do for me and I postpone TKR. If my knee regresses back to sleep interference and/or stair avoidance then then I will get the surgery. If I was 85 as you are, I might think that maybe my natural knee has a good chance to see me out so there is even more reason to postpone.

Not sure if that was helpful, but you asked for opinions!

@kfhoz Yes, that is helpful. You make very good points and give me more things to think about. Thank you very much!

I am only 81 and had my right TKR at 80. I had a great surgeon and I had no post surgery pain and returned to driving after one week (cleared by my surgeon's PA) and golf after 27 days. I had sharp nerve pain from a severe misalignment so doing the surgery was pretty much required for me.

But @kfhoz poses an interesting alternative for you. My concern with putting it off is if you need it, you will be older still and less able to handle major surgery. My first knee surgeon (before I found my current one) was at the Mayo Clinic and he told me he had recently replaced a knee for a 103 year old woman. So age may not be a big issue.

Steroid and other injections are often only temporary. I have spinal and lumbar stenosis and at the beginning of 2025 it became symptomatic radiating pain down each leg. After a few months my pain doctor gave me a caudal epidural steroid injection almost 1.5 years ago and it is still working.

On the other hand, my surgeon tried a steroid injection on my knee and it did nothing.

Discuss a six month delay in your surgery with your surgeon and what he considers the risks and rewards of trying these alternatives during those six months.

Have you discussed this with your surgeon? Is he concerned about putting off surgery? Does he have any experience with hyuralonic acid injections? Or other alternatives?