Consultant Talking to Female Patient About Knee Replacement

You’ve known for some time that you’re probably going to need a knee replacement. But how can you tell when you’ve reached the tipping point between knowing you’ll need a replacement in the future, and realising the time is now? YKC’s Dave Duffy shares his view.

Osteoarthritis develops. There’s a point when it’s a barely noticeable minor inconvenience. There’s a point when it may be brutally painful, keeps you awake at night, and prevents you from doing the things you want to do during the day. Between those two points, however, there’s a progression. As the condition progresses, we might manage it with painkillers and physiotherapy, with behaviour modification, weight loss and/or a cortisone injection.

Eventually, though, we may reach the point where a knee replacement stops being something “you’re probably going to have to consider in the future” and becomes something you need now.

How do you know when you’ve reached that point?

> Discover more about osteoarthritis, symptoms & treatments


The two tests that say you need a knee replacement now

For me, there are effectively two ‘tests’ for pressing ‘go’ on a knee replacement.

First, you need the clinical diagnosis that there is osteoarthritis and that it is severe enough to warrant consideration for knee replacement. An x-ray is almost always the key tool in diagnosing osteoarthritis and it will tell me what operation may be appropriate. It will, for example, tell me whether a full or partial knee replacement will be appropriate.

> Discover more about partial or total knee replacements


The footprint of life

The second test is based on what I call a patient’s ‘footprint of life’. Think of it as an imaginary line around us, that encircles all the things we do and the places we do them. Perhaps you enjoy a regular round of golf and the occasional hike through the Dales. That’s your footprint. Perhaps you enjoy Himalayan treks and Alpine skiing. That’s your (considerably larger) footprint.

The issue is not how big your footprint is, but how much it shrinks as your osteoarthritis develops, and how the gap between your aspirations and your capability grows. Perhaps you used to be able to walk 15 miles without so much as a twinge in your knee. Now, you find a ten-mile stroll leaves you in the sort of discomfort that only painkillers and an icepack on an elevated leg can alleviate.

Clearly, your footprint of life has shrunk, although I think we’d be struggling to make a risk/benefit case for a knee replacement in someone with this level of activity.

Contrast that with someone who used to play four rounds of golf a week, but now can’t manage more than nine holes a fortnight. Or someone who used to walk the dog for 20 minutes twice a day but can now hardly get out at all.

At this point, the calculation of potential risk versus benefits changes.


Patient choice

The x-ray may confirm the diagnosis, and a discussion about the footprint of life may indicate to me that a knee replacement is appropriate, but it’s important to remember that the choice of whether to have a knee replacement always lies with the patient.

That decision is reached through discussion, examining a patient’s footprint of life, asking about their aspirations and exploring what a successful outcome might look like.

Surgeon and patient do need to be on the same page. If my idea of a successful outcome is that you’re once more able to walk the dog pain-free and yours is that you can run back-to-back marathons, we clearly have a gap to cover.

But as long as the diagnosis and footprint tests are met, the benefits outweigh the risks and we have a common understanding of what the end goal is, then that’s the time to press ahead with your knee replacement.

If you feel you’re approaching the point where you need a new knee, please contact us or phone us on 03453 052 579.

>  Discover more about Dave Duffy
>  Discover more about osteoarthritis, symptoms & treatments
>  Discover more about partial or total knee replacements

Dave Duffy

Dave Duffy

Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds

Private Secretaries

Amanda Hardy
The Duchy Hospital Harrogate
07889 485 579

Lauren Long
Nuffield Leeds
07930 585 744

Email Dave

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Knee replacement x-ray

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