The New Benefits of Knee Replacements Joint Surgery for Knee Osteoarthritis May Improve Your Health and Even Lengthen Your Life

No matter how bad your knee osteoarthritis pain gets, you may be too afraid to get joint surgery. But new research suggests knee replacements may improve not just your joints but also your long-term health. Find out why… Lately, your knee osteoarthritis has become so painful that you’ll do just about anything to avoid climbing steps or walking very far. You want to stop the pain but dread knee replacement surgery. So you try to live with it. But new research suggests that joint surgery may have benefits beyond pain relief. It could even extend your life. For example, people with osteoarthritis pain who opted for knee replacements had a 50% lower risk of dying from any cause seven years later than those who didn't have the surgery, according to a 2012 study by Exponent, a scientific consulting firm in Menlo Park, Calif. Researchers gathered data from Medicare records of 135,000 patients diagnosed with knee osteoarthritis between 1997 and 2009. Of those, about 50,000 got implants, many of them women. Women have twice as many knee replacements as men, says Marc DeHart, M.D., clinical assistant professor of orthopaedic surgery at the University of Texas-Galveston and at the College of Medicine at Texas A&M. “They get more arthritis, possibly because their hormones make muscles and joints more flexible so that their cartilage is exposed to more wear and tear,” DeHart says. “Also, the increased load women carry during pregnancy may play a role.” Women also delay joint surgery longer than men do, according to 2008 research at the University of Delaware. The study examined 221 knee-replacement candidates and found that the women had more advanced cases of bone-on-bone knee osteoarthritis, with less knee function and more disability, than the men. Only 9% of women who might benefit from knee replacements actually chose the surgery, compared with 13% of men, according to the National Institutes of Health. “A big problem is that surgeons tell people to wait until they can’t stand [the pain] anymore,” says Lynn Snyder-Mackler, P.T., Sc.D., alumni distinguished professor in the physical therapy department at the University of Delaware in Newark. Some women may delay joint surgery because they bear pain better than men, she says. As with any surgery, knee replacement has risks, and you should discuss your options with your doctor. (For more on those choices, read The New Knee Replacements.) But if you’ve been putting off a decision, despite worsening knee osteoarthritis pain, it may be time to reconsider. Here are 8 ways in which knee replacements may improve your quality of life, and even make it longer. Benefit of knee replacements #1: Reduced pain More than 90% of patients experience a “dramatic reduction” in pain following total knee replacement surgery, according to the American Academy of Orthopaedic Surgeons. Patients' own expectations about what the knee implant can accomplish may affect their level of improvement, according to a 2010 study at the Hospital of Basurto in Bilbao, Spain. Those who had high expectations about pain relief and their ability to walk after joint surgery - and who met those expectations at three or 12 months - had more significant improvements in their quality of life, researchers found. Post-joint surgery tip: “Rehabilitation and motivation are very important,” says biomedical engineer Scott Lovald, Ph.D., lead author of the Exponent study. “A patient needs to know what she’s getting into by having an extensive discussion with her doctor.” Benefit of knee replacements #2: Longer life Why was the risk of dying 50% lower in knee osteoarthritis patients who had joint replacements versus those who didn’t? When they’re no longer inhibited by pain, those with joint implants are likely to be more active, Lovald suggests. “People who are less active and become more obese may have a higher risk of cardiovascular issues and other conditions,” he says. “So the risk of dying may be higher.” Post-joint surgery tip: When the pain in your knee is gone, you should rediscover exercise, Snyder-Mackler says. Even moderate exercise, like walking for half an hour most days, added 1.3 to 1.5 years of life compared to a more sedentary lifestyle, according to a 2005 study at Erasmus M.C. University Medical Center in Rotterdam, the Netherlands. Benefit of knee replacements #3: Improved fitness “If pain is why a patient isn’t exercising, knee replacement can take away pain, and then a patient can maintain more speed and distance and range of motion” when walking or doing other activities, DeHart says. Post-joint surgery tip: “The best thing to ensure that patients get increased health benefits after a knee implant is to get into an exercise routine,” he says. Even with severe arthritis, patients can swim, walk and bike, he adds. Benefit of knee replacements #4: Reduced risk of congestive heart failure “The risk of heart failure was about 10% less after three years in those with implants than in those without,” Lovald says. Once again, the difference is likely due to physical activity, he adds. “Instead of sitting down and giving up exercise, the people with implants are probably walking more,” Lovald says. “Activity of any sort has a positive benefit for cardiovascular health.” Post-joint surgery tip: Again, let your knee replacement pave the way for workouts. Moderate exercise reduced the risk of heart disease by 27% to 41%, according to a 2007 Harvard Medical School study that looked at 10 years of data. Benefit of knee replacements #5: Increased mobility Reduced pain makes it possible for people with knee replacements to perform normal movements and get around more easily, Lovald suggests. Physical function improved in several ways for knee osteoarthritis patients who had joint replacements, according to a 2008 study at Duke University that reviewed Medicare data from 1992-2003. A little more than a year after the surgery, patients experienced a 30% improvement in walking, a nearly 21% improvement in stooping over and an 11% improvement in lifting items. This was true even for patients in their 80s and 90s. For those who didn’t have the surgery, physical function got worse. Post-joint surgery tip: “Follow the rehabilitation protocol and activity levels prescribed by your physician,” says biomedical engineer Kevin Ong, Ph.D., a co-author of the Exponent study. That means not pushing too hard until your knee recovers fully. Benefit of knee replacements #6: Weight loss Almost 20% of patients who had either knee or hip replacement surgery lost 5% or more of their body weight, according to a 2010 study at Mount Sinai Medical Center in New York City. Still, most doctors would prefer that patients get to a healthier weight before joint surgery, DeHart says. “People who are obese at surgery have a higher chance of blood clots and infection,” he warns. Post-joint surgery tip: “Knee replacement allows people to walk more, but replacing a knee doesn’t change the emotional and psychological reasons why people get heavy,” DeHart says. “Get help with those, eat less, move more, and you have a better chance of losing weight.” Benefit of knee replacements #7: Improved mood When depressed patients with back, hip or knee pain had a reduction in pain, the severity of their depression decreased too, according to a 2011 Indiana University study. “If patients have realistic expectations about the surgery and its outcomes, they’d likely have a lower risk of depression,” Ong says. Patients actually had a higher risk of depression a year after their knee replacements, but that could’ve been caused by hospitalization and recovery from the surgery itself, Lovald speculates. It’s also possible that patients were more likely to be diagnosed with depression because they were around doctors so much, he adds. Post-joint surgery tip: Make sure you’ve discussed your recovery and rehabilitation with your physician. “That will help set realistic goals and expectations,” Ong says. Benefit of knee replacements #8: Improved social life With less pain and better mobility, maintaining ties with other people becomes easier, Ong says. “Being active and increasing [physical] function can improve one’s outlook on life and offer more opportunity to socialize,” he adds. Post-joint surgery tip: Use online social networks to connect with others who share your interests, or even other arthritis patients. Facebook users have 9% more close ties than non-users, according to a 2011 Pew Internet and American Life Project study.