When Is It Time for Knee Replacement Surgery? Part 2

Last updated: March 2022

In the past decade, the journey with my knees has involved multiple steroid injections, two rounds of hyaluronic acid gel injections in each knee, numerous x-rays taken by different doctors to evaluate changes in the knees, and even a trip through the MRI machine that confirmed tri-compartmental osteoarthritis, meaning that there was damage to the cartilage in each of the three compartments in the knee joint. Read Part 1, When Is It Time For Knee Replacement Surgery?

Each time I made an appointment with the orthopedic doctor over the years, I knew I needed help. I never saw the doctor just because things were a little troublesome. The pain was always at a point that something needed to be done.

Avoiding surgery as long as possible

I was fortunate that the OrthoVisc gel injections were successful the first time I tried them. This gave me hope that I could continue to push off surgery into the void of “someday in the future you will need a new knee.”

Osteoarthritis can progress slowly. There were no obvious transition signs when my OA became severe. I had just learned to adapt to the pain and disability over the years. Eventually adaptations became so normal for me that I couldn’t remember things like when alternating steps on the stairs had been normal for me. I was definitely a one-at-a-time stepper on the stairs now.

The pain was becoming more severe

In the last year, the pain in my knees had grown tremendously. I saw my orthopedic doctor and asked for another round of gel injections. They had worked before so I hoped that they would work again now.

My doctor’s reaction to my X-rays and examination was different this time. He clearly warned that the gel injections might not work as well as they had previously, or not at all.

"You will tell me when it's time for knee replacement"

He also said, “You will tell me when it’s time for knee replacement.” I asked him a few questions about surgery and patients with specific comorbidities or concerns, which in my case centered around spasticity, multiple sclerosis, and potential difficulties with recovery. He didn’t really answer my questions directly so I knew at that moment, he would not be my surgeon.

My orthopedic doctor did give me gel injections in both knees as I had asked for. But unfortunately, they didn’t work just as he had warned. Now I needed to find another solution.

Finding a new surgeon

As soon as it was evident the gel injections did not work, I began looking for another surgeon. I asked for recommendations from my neurologist and my rheumatologist. I received five names working out of two large practices in the area. I contacted one of these surgeons who worked in a practice a close friend had recommended and scheduled a consultation.

Our first meeting was lengthy. I provided detailed background information on all of the previous treatments I had previously received over the years. The list was rather long and provided a detailed picture of how my OA had developed over the years. He reviewed my information, took new x-rays, and conducted a thorough examination.

Surgery is more successful before too much damage occurs

During our first meeting, this orthopedic surgeon was straightforward with me about my options. Basically, he recognized that I had already tried many of the typical non-surgical suggestions and what I hadn’t yet tried was not backed by convincing evidence in research studies.

This doctor also suggested that I would let him know when to do surgery. He wouldn’t say that it had to be now. But he did suggest that surgery would be more successful BEFORE too much more damage occurred. I was already walking around on bone-on-bone knees and couldn’t stand long enough to cook scrambled eggs.

Setting the date for total knee replacement surgery

The surgeon gave me his assistant’s phone number to make surgical arrangements when I was ready. I took almost a week to think about it and then made the decision that NOW was indeed the time for the first total knee replacement. I chose to go with my right knee first because it seemed to be the worse of the two knees.

Now that surgery was scheduled, it was time to make plans. I’ll share what considerations I made ahead of surgery that definitely helped make recovery easier in another article.

If you have had any kind of joint replacement, what types of considerations did you make ahead of time? Please share your story in the comments.

Be well,

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