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There are many things to consider before you make the big decision to have knee replacement. I spent considerable time agonizing over whether to have the surgery and when to have it.
I ended up putting the surgery off for 15 years because I thought that I could still participate in the activities that I enjoyed at an acceptable level. I also felt that the pain I had to endure was something I could handle.
In this article I will discuss these two reasons and nine more that were meaningful to me.
Your reasons may differ from mine but I hope my experience will aide you in making the decision for TKR that best suits your needs.
How I Came Up With A List Of Considerations
Forty years is a long time to live with a “bad” knee. It gives you plenty of time to think and consider what options are available to improve the function of your knee and to lessen the pain that you are enduring.
First, you begin to think of things that you can do personally to make your knee work and feel better. Second, you surrender to the fact that you can use some help without visiting a doctor.
Finally you give up and seek medical evaluations, opinions and treatment. It’s a process that took me a long time to complete.
As I aged, swimming became a regular part of my exercise routine. One thing you do a lot while swimming is think and that’s where I made many decisions to try new things to help my knee.
Some decisions took several years to make, others were made over night when the pain told me to seek help immediately.
Your knee will talk to you over a period of forty years and sooner or later you begin to listen. The last decision I made (and I hope the final decision) was to have TKR.
No. 1 Your Current Pain Level
What is your pain threshold? Fifteen years ago I made an appointment with an orthopedic surgeon. After x-rays and an MRI he advised me that I was a candidate for TKR.
He explained that every patient has a different pain threshold and when the pain became intolerable I should return for a TKR. Since I told him I was willingly to live with the pain at this time, he suggested some non-surgical options.
Fifteen years later, I had moved and visited another surgeon. He was surprised that I was able to walk without excruciating pain let alone participate in the activities that I was involved in.
Having lived with some form of pain in my knee for over 40 years the pain increase was gradual. The pain did not all come on at once.
I had learned to live with the pain, my biggest concern was that my knee was just not functioning at a level that I could hike, bike, swim and play pickleball. For me, it was time to take the last step, TKR.
No. 2 Your Weight
The heavier you are the more weight and stress you put on your knee. One of the things I knew that I could do myself to alleviate pain and improve knee function was to keep weight off.
In order to do this I watched my diet and exercised regularly for over 40 years. All the doctors that I saw commented that this was a plus for living with knee pain and also a plus for successful knee replacement and recovery.
If you are considering TKR and are overweight it is time to revise your diet and begin to exercise.
I’m not saying that the surgery will go badly if you’re overweight – in fact, you might be just fine (or you may not have a choice). But I know that less pressure on the knee will help reduce pain and make for a faster, healthier recovery.
No. 3 Help / Assistance (For Recovery)
A major consideration before TKR is that you have a support system set up for recovery and rehabilitation. If you live alone you need to call on family or friends that can dedicate at least a few weeks to help with your recovery.
If you have family living in the home they will need to assist you with meals, driving and meeting your daily needs until you “get back on your feet” again. You might think you can do it on your own but you will need a great deal of help after the surgery.
No. 4 Your Insurance
Check with your insurance company to make sure the surgery, aftercare and prescription medicines are covered. In my case Medicare and my supplemental insurance took care of everything.
There are many products that can make your recovery easier (I mention them in other articles) that you will probably have to pay out of pocket. Good insurance is a must.
No. 5 Your Current Activity Level
Your level of fitness prior to TKR will improve your chances for a successful operation as well as a successful recovery. I mentioned that your weight is important, but your general fitness, including the muscles around your knee should be in optimal condition prior to surgery.
One of my concerns was that after TKR I would be able to resume the activities I was involved with prior to surgery. My doctor assured me I would be able to return to my activities but not to expect a knee that would allow me to jog and play basketball.
No. 6 Your Schedule (1-6 months after TKR surgery)
When scheduling your surgery, give yourself plenty of time to recover and to work hard at rehabbing your knee. I postponed family functions, trips and vacations for six months.
Even though I expected to be back to my old self earlier than that, I wanted to be sure. Planning a cruise or flight and losing your deposit or other fees is not something you want to happen.
Plan some extended reading, computer work or other minor household chores and gardening that you can do around the house. Plan on being a homebody for 3 to 6 months after surgery so that you improve the chances for a good recovery.
Make the recovery and rehab your number one priority!
No. 7 Your Age and Health (in regards to recovery/bounce back time)
If you are thinking about TKR, consider your age as well as fitness level and weight. At age 66 I felt I could continue to endure the pain for a few more years.
Also I kept hoping that a “miracle cure” was on the horizon. According to my surgeon that “cure” is not looming.
My surgeon and my research agreed that the younger you are the better chance you have for success. They also pointed out that your quality of life would improve now, not later.
According to my doctor most of the knee replacements last for at least 15 years. I decided that it would be in my long-term interest to have the surgery as soon as possible. Check out our tips to avoid or delay knee replacement surgery.
No. 8 Your Location (if you live in the boonies, rehab might be difficult)
The closer you live to your doctor, the hospital and physical therapy the less time you will spend in a car going to and from appointments. Remember you probably will not be able to drive for six weeks.
If you do live far out in the country miles from your care centers, you might consider moving in with a family member or friend who lives closer to the above facilities, at least until you are able to drive yourself to appointments.
No. 9 Your Activity Expectations After TKR
Have realistic expectations. As I mentioned above, you are not going to have a bionic knee that will allow you to resume childhood and young adult activities.
I would love to play basketball, softball and to be able to run on a regular basis. However, I knew that was not going to happen.
As we age even without knee replacement we lose the ability to perform physically. We need to find other activities that conform to our age level and fitness abilities.
Personally, I am happy that I can continue to hike, bike, swim and play pickleball with the added benefit of little or no pain.
No. 10 Finding A Great Doctor (Don’t Go To Any Ole Doc)
Be wise and do your homework. I am sure you are careful to choose a good mechanic for your car. Choosing a doctor for TKR is much more important.
I had just moved to a new area a year ago and I felt like I was at a disadvantage when I began to seek out a doctor for TKR. In my old hometown I had confidence and trust in my primary care doctor and would not hesitate to take his suggestion for an orthopedic surgeon.
I also knew friends who had hip and knee replacements with different doctors in the area. Here at my new home I barely knew my new primary care doctor.
After the first visit with him, I looked for and found another primary care doctor that I felt more comfortable with.
Thanks to the many friends that I made playing pickleball I learned from several people who had hip and knee replacements locally. I picked their brains and began to make a list of possible doctors.
I spent a good deal of time on the Internet looking and finding as much information as possible. Just like mechanics have reviews online you can find reviews of doctors online as well.
One piece of advice that stuck in mind came from a pickleball colleague; “find a doctor that will make you wait several months for surgery, not a doctor who can do the surgery next week”.
The logic being that if there is a significant waiting line he must be good. The doctor I chose took time with me, looked me in the eye and explained the procedure to my satisfaction.
He then took the time to answer my list of questions that I had prepared for him. I left his office with a good feeling and with a date scheduled for my TKR.
No. 11 Medical Innovations For Knee Replacement
When I was in my twenties and had my first two surgeries they were before arthroscopic surgery. My knee was cut open in two places with fairly large incisions that left me with ”zipper” scars.
I was put in a half cast for 6 weeks and rehab did not start until the cast was removed. Two years after my last surgery everyone was having arthroscopic surgery and beginning their rehab immediately.
One of my fears was that if I had TKR, the surgeon would cut off parts of my bone. Then, a year a two later there would be a new innovation that would make that procedure unnecessary.
As I mentioned above I put off surgery for several years thinking I could handle the pain and hoping for a less invasive procedure to fix my knee. I visited several doctors prior to making my decision to have TKR.
All the other non-surgical options for my knee would be temporary and only delay TKR. Based on my research and the opinions of my doctors there are no new innovations and procedures on the horizon.
I felt that I had exhausted all my options and that I was ready to have TKR. I made the decision without any doubts and with great expectations.
As I have said over and over in previous articles, TKR is a big decision! I have listed 11 considerations that were important for me.
There are more considerations that may be important to you. In this article I have shared my concerns over the past 40 plus years as I have been on the slow road to TKR.
All 11 considerations were important for me. However, the biggest relief I felt was when I finally settled on the doctor to do the procedure.
After making the appointment for the surgery I left his office feeling relieved and comfortable that I had made the right choice.
Preparation is the key.
Do your homework, get fit and stay fit, be realistic and make key decisions based on what is best for you and your situation. I hope this article will help you to make one of the biggest decisions of your life. Consider, consider and consider some more.