Are There Disadvantages of Knee Replacement Surgery?

Knee replacement is one of the most common orthopaedic surgeries. Nearly 800,000 people in the U.S. have the procedure each year, most often to treat knee arthritis. Surgeons can replace the entire joint or just the damaged parts. The goal is to reduce knee pain and improve movement.

“Knee replacement surgery has been refined over the years so that we now have a more accurate recreation of the soft tissue tension and balance, part sizes and alignment of the knee joint,” says orthopaedic surgeon Carlos Higuera Rueda, MD.

“We now have better quality materials that last longer. We can use cementless implants, robotics and advanced tools to perform surgery with greater precision.”

Like any surgical procedure, knee replacement carries some short- and long-term risks. Here’s what to know before deciding if it’s right for you.

Disadvantages of knee replacement surgery

When your knee is injured or hard to move, your healthcare team weighs the risks to decide if knee replacement surgery is best for you.

“We only do surgery if we believe someone is going to get a significant benefit from it,” says Dr. Higuera Rueda. “The main purpose of knee replacements is to improve pain and function.”

Some of the short-term risks people are most concerned about include:

Infection and blood clots

Knee replacement has a high success rate. But surgery always comes with some risk of infection. Because surgery breaks the skin, bacteria can enter your body. Surgeons follow strict safety protocols to lower that risk.

“Infection rates vary between 1% and 2%, so it’s pretty rare for that to happen,” says Dr. Higuera Rueda. “The risk of blood clots is slightly higher, but we’re talking about 3% to 4%.”

Your risk of blood clots may be higher if you:

• Have a prior history of blood clots and are using blood-thinning medications

• Smoke

• Have limited mobility

• Have obesity

Recovery time

Pain is a common concern, and it’s normal to have some in the first two to three weeks after surgery.

“About 20 years ago, people would stay in a hospital for three to four days after a knee replacement,” notes Dr. Higuera Rueda. “At times, it would have taken three to six months for them to return to their normal jobs.”

Today, Dr. Higuera Rueda says almost half of all knee replacements are outpatient surgeries, where people can go home the same day as the procedure. “The whole process takes about six to eight hours, and most people start returning to their normal activities in six to eight weeks.”

Your care team will manage your knee pain with medication and physical therapy. As you heal, pain and other symptoms should improve, including:

• Swelling

• Numbness or tingling

• Loss of appetite

• Difficulty sleeping

“We try to make it tolerable, but the first three to four weeks can be a little bit rough,” he adds. “Recovery takes patience, but most people steadily improve week by week.”

Cost

Knee replacement is a major procedure, and cost is an important consideration. You may need to pay a higher out-of-pocket cost depending on where you have your surgery and what your insurance covers. That said, research shows the cost of knee replacements continues to decline even as more people get them.

“Musculoskeletal conditions can be very limiting. They can keep people from working and increase the risk of other health problems like obesity and heart disease,” says Dr. Higuera Rueda. “Knee replacement surgery is invaluable because it can greatly improve quality of life and help people stay active.”

Permanent restrictions after knee replacement

Knee replacement can significantly improve knee pain and mobility. But your new joint won’t feel exactly like your natural knee. Some high-impact activities, like running or jumping, may not be recommended, as they can put added stress on your joint. In some cases, range of motion may also be limited.

Here’s what you might expect over the long term.

Long-term pain and other symptoms

Some people have a longer recovery and may experience ongoing discomfort after surgery. How you heal depends on factors like your:

• Overall health

• Physical fitness

• Pain tolerance

• Range of motion before surgery

“The severity of your symptoms really depends on how things were before surgery,” clarifies Dr. Higuera Rueda. “Recovery can be more involved for individuals who use a wheelchair or have muscle weakness and additional joint concerns.”

But physical and occupational therapists can guide you through recovery. They’ll help you adjust to changes and stay as active as possible.

Limited range of motion

Kneeling may feel uncomfortable after knee replacement. High-impact activities like running, jumping or pivoting may not be recommended. Staying active before surgery can improve your chances of returning to certain sports.

“Even with today’s advances, metal and plastic are still not as fine-tuned as the knee we’re born with,” notes Dr. Higuera Rueda. “If you haven’t been active for two or more years before surgery, the chance of returning to high-impact sports is about 30%.”

Replacement implants

Knee implants are durable, but they don’t last forever. Most last 15 to 20 years, and many last longer.

“If there are no complications, most people still have their implant after two decades,” says Dr. Higuera Rueda. “We need more data to look further than 20 years. But for most people, it lasts a lifetime.”

Younger, highly active people may wear out an implant sooner. Extra weight can also increase wear by putting added pressure on the joint.

Final thoughts

Knee replacement isn’t right for everyone. Your provider can help you decide whether it’s the best option based on your symptoms, health and goals.

If surgery isn’t recommended, other treatments may help, including anti-inflammatory medications, injections or orthobiologics, which are regenerative medicines to support healing.

“Knee replacement is most successful when you stop smoking, work on weight management and try to optimize your health before the procedure,” says Dr. Higuera Rueda. “More than 90% of people are satisfied one year after surgery.”