Knee Pain and Injury

  • Are patients expecting too much from their joint replacement?

    Published on August 4, 2015.

    Despite an overall positive view of the end result of a hip or knee replacement, some research suggests that up to 19% of patients are not satisfied with their knee replacement outcomes for various reasons. Mostly the patients could not return to a sport as aniticipated, or they did not lose weight as expected.

    Researchers in France thought that the great amount of joint replacement failures were related to wear and tear – when they went to confirm their theory they found they were wrong. It was surgical technique which lead to the rapid failure of joint replacement failures. 1 But surgical technique is not the only failure.

    When we see patients who have thought of getting knee replacement, two main reasons they give in favor of the procedure is that is can reduce pain, and secondly, it can help them be more active and they can maintain an ideal body weight.

    New research is suggesting that knee replacement patients actually gain more weight after the surgery. Worse, the younger the patient, the greater the risk for substantial weight gain following the surgery! 2

    This new research goes against older research that says the opposite – usually joint replacement patients lost weight. 3

    In other research, it becomes a little more clear “Total hip or knee replacement patients who are overweight or obese often consider their disabling joint disease a cause for their increased weight. . . (our) prospective study investigated weight change in 100 patients after successful total joint replacement to determine whether surgical treatment of hip or knee arthritis leads to weight reduction. Postoperatively, both hip and knee replacement patients gained weight, with no difference in weight gain between hip and knee replacement patients.

    Younger hip patients gained a significant amount of weight.

    Patients a with normal body mass index and obese patients did not lose weight, while overweight patients gained a significant amount of weight after surgery.

    These findings demonstrate successful treatment of lower-extremity arthritis does not lead to weight loss, and obesity should be treated as an independent disease that is not the result of inactivity from arthritis.” 4

    All three studies seemingly confirm the same thing, it is up to the doctor and patient who are predisposed for weight gain, to work together to form a non-weight gaining plain following treatment.

    Weight gain is one of the things that can occur in knee replacement. In our practice we see many patients following a knee replacement who still have pain and other problems.

    Knee and hip replacement patient expectations failure

    Recently the Hospital for Special Surgery released a report “What Patients Need to Know About Revision Surgery After Hip or Knee Replacement” on possible complications in hip and knee surgery – they include:

    • Loosening of the implant. The hip or knee replacement may become painful after many years because the components have begun to wear and loosen.
    • A fracture. A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.
    • Dislocation. If the implant dislocates on repeated occasions, revision surgery is frequently needed to stop this from happening.
    • Infection. This can be a very serious complication. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection and to implant new non-infected components.
    • Implant recall. On occasion, the implant used in joint replacement is found to have a problem and patients who received the implant are advised to be monitored by their physician to make sure it does not need replacement. Revision surgery is sometimes necessary when an implant is recalled.

    In the Journal of Arthroscopy one study said not only complications are a problem – but expectations are sometimes disappointing:

    In this study, patients who had a knee replacement were studied for the frequency, intensity, and duration of actual vs expected leisure activity: “Despite high expectations, there were statistically and clinically significant differences between actual and expected activity at 12 months suggesting that expectations may not have been fulfilled. The differences were equivalent to walking 14 less miles per week than expected, which is more than the amount of activity recommended in national physical activity guidelines. Perhaps an educational intervention could be implemented to help patients establish appropriate and realistic leisure activity expectations before surgery” 5

    What are patient expectations following a knee or hip replacement? In elderly patients who are sports minded, there is a belief that the joint replacement will allow them to participate again in sports. This is not the case in all patients. In one paper doctors found that counselling on sports activities following joint replacement was lacking in  patients with previous sports experience and the patient’s expectation of a successful replacement surgery was not met.6

    This investigation agreed with another paper where researchers showed that a majority of patients do have high expectations regarding joint replacement surgery. As these expectations are not always met, a straight forward physician-patient communication is necessary to prevent patients from potentially unrealistic expectations and dissatisfaction with the surgery outcome.7

    Realistic goals following joint replacement is especially important in patients with existing medical conditions. Researchers in the Journal of Clinical Nursing have offered an opinion that patients with cardiovascular problems do not feel that their quality of life changed regardless of the success of the procedure.

    The research study team sought to evaluate to what degree total hip replacement, or co-morbidities or their progression, influence the health-related quality of life of patients after the operation. They looked for an objective method to reflect the severity of cardiovascular diseases and to better characterize the health-related quality of life of patients with total hip replacement.

    The concluded: “After successful total hip replacement postoperative health awareness is influenced mainly by existing and developing cardiovascular diseases. It seems to be the case that for patients with significant hypertension, ischaemic heart disease or chronic heart failure, even successful surgery will not improve the patients’ overall feeling of health.”8

    We have utilized prolotherapy for decades, PRP is starting to gain traction in the medical community, and we are also now able to unleash the power of the stem cell. While we have these technologies available to help the body help itself heal to prevent surgery, eliminate pain, and restore joint function, it is up to the skill and knowledge of the physician to best utilize these treatments to achieve optimal results.


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    1. Epinette JA, Brunschweiler B, Mertl P, Mole D, Cazenave A; French Society for Hip and Knee. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees. Orthop Traumatol Surg Res. 2012 Oct;98(6 Suppl):S124-30. doi: 10.1016/j.otsr.2012.07.002. Epub 2012 Aug 24.

    2. Riddle DL, Singh JA, Harmsen WS, Schleck CD, Lewallen DG. Clinically important body weight gain following knee arthroplasty: A five-year comparative cohort study. Arthritis Care Res (Hoboken). 2012 Nov 30. doi: 10.1002/acr.21880. [Epub ahead of print]

    3. Stets K, Koehler SM, Bronson W, Chen M, Yang K, Bronson M. Weight and body mass index change after total joint arthroplasty. Orthopedics. 2010 Jun 9;33(6):386. doi: 10.3928/01477447-20100429-13.

    4. Heisel C, Silva M, dela Rosa MA, Schmalzried TP. The effects of lower-extremity total joint replacement for arthritis on obesity. Orthopedics. 2005 Feb;28(2):157-9.

    5. Jones DL, Bhanegaonkar AJ, Billings AA, et al. Differences Between Actual and Expected Leisure Activities After Total Knee Arthroplasty for Osteoarthritis.

    6. Koenen P, Bäthis H, Schneider MM, et al. How do we face patients’ expectations in joint arthroplasty? Arch Orthop Trauma Surg. 2014 Jul;134(7):925-31. doi: 10.1007/s00402-014-2012-x. Epub 2014 May 24.

    7. Zdravkovic V, Jost B, Zumstein MA. [Unnecessary operations in shoulder surgery: "table of confusion" applied to "field of confusion"]. Ther Umsch. 2014 Dec;71(12):713-6. doi: 10.1024/0040-5930/a000616.

    8. Király E, Gondos T. Cardiovascular diseases and the health-related quality of life after total hip replacement. J Clin Nurs. 2012 Jul 11. doi: 10.1111/j.1365-2702.2012.04101.x. [Epub ahead of print]

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