How do you know, and find, the right technique for knee replacement?

The process of choosing a surgeon and a surgery is not unlike deciding which car, boat or ATV to buy - except it is the body you have to live in, so you need to decide whether to accept "good enough" or work to find "the very best for me."

Whether to have partial or full replacement, and which technique, is a question for your physician. None of the rest of us have seen your x-rays, or know your complete health history and would not be qualified to make the determination anyway.

If the doctor says "it's up to you", the read all the pros and cons of each type of surgery, written by doctors, on medically respected sites. Make a list of your own pros & cons for each type, and a list of still unanswered questions. Then it's time to come back here to ask other people what their experiences were, and you can formulate questions for the doctor. Go back to the doctor with any questions, and if they won't answer, you need to consider whether to find a different surgeon.

And remember, the surgery itself is only part of the whole. If anyone tells you recovery takes 4-8 weeks, run the other way. Surgical recovery maybe, but complete healing and full function takes 6 months to a year or longer. Allow nobody to convince you there won't be pain - there will - it varies by individual, but once you have surgery you have to deal with it while pursuing recovery, if you quit the knee will never be "right". Being in the best possible condition before surgery, strengthening your quads, losing excess weight and/or stopping smoking will have a big effect on recovery. Not waiting too long, or until a crisis like a fracture or loss of critical bone mass forces immediate surgery is also important. Finally, committing fully to home PT daily for at least 8 months, possibly longer is crucial.

Are you to the point of finding a surgeon yet?

If the injections are working, my advice is to continue on that path.

A TKR can have a multitude of varied outcomes. 6-10% having knee replacement will develop excessive scarring ( Arthrofibrosis) which can be crippling, by limiting your range of motion, causing permanent inflammation and pain. If I had know what I know now, I never would have had the procedure. I was getting along OK with Corticone injections, although I couldn’t do anything with impact. At 73, I had been involved in CrossFit and was sprinting in State & National Games. My doctor felt that within a year, post surgery, that I might be able to compete once a year, if I did very minimal & light impact training. After my surgery, I had very limited ROM, severe inflammation and lots of pain because of the excessive scarring that my body laid down. Post TKR, I had a Manipulation under anesthesia, then arthroscopic debridement, then an Open Debridement. All were aimed to get rid of scar tissue but after each procedure it got worse. Because of my limited flex, I get tripped up easily and still encounter pain. It has been 7 months since my last procedure. After which my PA (not even the doctor!) apologized, saying that “we’re very sorry for how this turned out” and washed their hands of me. I then took it upon myself to travel to The Hospital For Special Surgery (Manhattan) for a second opinion. HSS is the #1 Ortho hospital worldwide. My Dr. there recommended a revision to a hinged knee replacement. They say that a considerable amount of the scar tissue forms around the tendons. In a Hinged Knee Replacement, they remove all tendons around the knee and the hinge takes their place. I then found out that HSS does not accept Medicare, so my next choice is The Mayo Clinic in Rochester, Mn.. They are #2 for Orthopedics Worldwide and accept Medicare. I can’t be seen there until April of next year because I had to change insurance to assure coverage there and there is a 3 month wait after Jan.1 to be seen for pre-existing conditions. I assume that they will make the same diagnosis, so if I get it done, I still have another year of suffering to endure. I had been warned prior to my TKR in May’23 that there was a small chance of complications and I won the lottery. Most people have good luck. Probably 80-90%. So you will probably benefit from it. But 10-15% ending in problems is Hugh. I never thought I would fall into that category but many many thousands do every year and once you are part of that group, you are largely on your own to navigate/investigate and find answers. For many, they just have to endure the lack of mobility and other complications for a lifetime.
At this time there is no test available to see if you would develop excessive scarring from a TKR but I was told at HSS that their researchers were close to developing such a test. I would definitely investigate whether such a test has yet become available before having the surgery. I heard that Mayo and perhaps others are also working on developing such a test. Good luck, proceed with caution. It turned NYT life upside down!

Thanks for the feedback and sorry about your journey! I’ve read that ~10% don’t work out and that seems high…which is making me really want to be sure. My doctor, who repaired my ACL in both knees has told me to wait until I can’t bear the pain before getting an TKE (He’s retired now). He suggested I make lifestyle changes and explore the shots….although he did tell me about allergic reaction risks.

I’m interested in the research that you referenced on the scarring risk as have heard that is a problem from a few of my friends. Thanks for that information. Good luck on your journey.

This is the million dollar question. For the lay person it can be very confusing because with all the information available (hype or otherwise), without a medical background it's difficult to make an informed decision. The other option is relying on your doctor who will ususally be bias for the technique he/she is trained in. The sad part is many patients have a deference for their doctor based on personality (bed side maner) rather than expertise. I like many others had different doctors, techniques, and hospitals, all with different out-comes. I have no recommendations other than hope for a good out-come.

I cringe when I read what you have experienced. As arthrofibrosis set into my new knee quite quickly, I too experienced some of your journey and I questioned why I went through the surgery. A MUA has helped, and it’s only been over 6 months now, so it remains to be seen how it will turn out.
Every day I have to start slow. Stretches in bed upon arising, Ibuprofen, extra strength Tylenol, upright stationary bike warm up, then all the exercises I learned in PT. Then daily walks. It never feels to the point I don’t remember it’s a replacement. Hope it does one day. Going down stairs is awful still. Difficult to get off the floor or ground- how would I ever be able to do knee #2? I’d be so limited.

I really thought it would be much smoother. I was extremely active, healthy ( aside from arthritis) and preemptively did PT to strengthen.

I truly believe the stats are not realistic, and the surveys sent to patients to measure their recovery blow over many important details of real recovery.

Anxiously awaiting the testing ability for arthrofibrosis as well. Best wishes.

Your outcome sounds identical to mine. But I’m over 2 years post right total knee replacement. I’m considering a revision but concerned the outcome may leave me no better off or worse.

I suggest find out about and take a test for excessive scarring reaction before any further surgeries. Top orthopedic hospitals are working to develop a test which may be available now. Eggen I was at HSS 7 months ago, they said that their test would be released in about 3 months. I have not investigated this.