If you're considering a knee replacement (or any other surgery) the first step is to undergo a thorough medical evaluation. This is typically a multi-stage process that involves a detailed questionnaire, x-rays, and a physical evaluation.
A questionnaire will cover your medical history, pain level, limitations, and the progression of your knee pain and problems. Although questionnaires vary by doctor and clinic, the evaluation typically centers on factors such as whether you're able to:
- get in and out of a car
- walk without a limp
- walk up and down stairs
- sleep at night without pain
- move without your knee feeling as if it's going to "give way" at any given moment
It will also ask about your overall health and any existing conditions you have. These might include:
Your doctor will also want to know how any of these conditions have changed in the recent past. Some of these existing health conditions, such as diabetes, anemia and obesity, can impact the treatment choices your doctor might suggest. It is important to mention any and all health problems during your evaluation.
The orthopedic surgeon uses all this information to diagnose your knee problems and determine the best treatment approach, including whether a knee replacement is a viable option. If so, the surgeon then performs a physical evaluation.
An Orthopedic EvaluationDuring this process, your doctor will measure your knee's range of motion using a protractor-like instrument. This reveals how far you can extend your leg in front of you (maximum extension angle) and flex it behind you (maximum flexion angle). These distances add up to equal your knee's total range of motion and flexibility. Learn more about how your knee works and moves using Healthline’s Body Maps.
Also during the evaluation, the surgeon will check to see if you've become bowlegged or knocked-kneed, test your muscle strength and observe your overall ability to move about—sitting, standing, taking steps, walking, bending, and performing other basic activities.
The doctor will also request a set of X-rays in order to view your knee joint and—in combination with reviewing the results of your evaluation—determine whether you are a candidate for surgery, and if a knee replacement will likely improve your knee pain and function. The orthopedic surgeon may also want to review past X-rays in order to understand how your knees have changed or deteriorated over time. X-rays provide the surgeon with details about the bone health of your knee. Some surgeons will also request an MRI, so that they can view images of the soft tissues that surround your knee. This is in order to better understand the current state of your knee, and to determine if any other complications (such as infections or tendon problems) exist. In many cases, a doctor will also require a sample of fluid from the knee to verify that you do not have an infection.
Finally, the surgeon will consult with you about your options. If your evaluation indicates that your joint is severely damaged and other treatments aren't likely to provide relief, your surgeon may recommend a knee replacement procedure. During knee replacement surgery, the damaged portions of your joint and bones are replaced with an artificial knee, which is designed to mimic your native knee and provide you with long-term pain relief.
Questions to Ask Your Surgeon
Alternative to Surgery
- What are my alternatives to surgery?
- What are the pros and cons associated with these alternatives?
Knee Replacement Surgery
- Will you perform traditional surgery or a newer approach? Tell the surgeon you have heard that minimally invasive and computer-assisted approach surgeries are becoming more common and discuss if they are right for you.
- How large will the incision be and where will it be located?
- What is the potential level of pain reduction and mobility gain associated with a knee replacement? What benefits am I likely to experience?
- How will the knee function in the future if the procedure isn't done? What limitations and problems are likely?
- What activities will I be able to resume and which activities will no longer be possible?
Surgeon Expertise and Safety
- Are you board-certified and have you served a fellowship? What was your specialty?
- What is your experience with this procedure? How many of these operations do you do each year? What outcomes have you experienced?
For more information, read Important Factors to Consider When Choosing an Orthopedic Surgeon.
- Have you had to preform revision surgery on your knee replacement patients? If so, how often and what are the typical reasons?
- What steps do you and your staff take to ensure the best possible outcome?
- How long should I expect to be in the hospital?
- Are you available after surgery to answer questions and address concerns?
- Where would you perform the surgery?
- Is knee replacement a common surgery performed at this hospital?
Risks & Complications
- What specific risks are associated with this procedure?
- What type of anesthesia is used during this procedure? What are the risks?
- Do I have any health conditions that would make my surgery more complicated or risky?
- What are the most common post-surgery complications?
- Why are you choosing the prosthetic device you're recommending?
- What are the pros and cons of other devices you're familiar with?
- How can I learn more about the implant you are selecting for my knee replacement?
- How long is this device going to last?
Recovery and Rehabilitation
- What is the typical recovery process like? What should I expect?
- What does the typical rehabilitation involve and what is a reasonable time for recovery?
- How much will this procedure cost?
In the end, asking the right questions improves the odds that you will make the right decision. A knee replacement is a complicated procedure and you should be comfortable with the decision you make.