Age does play a role if you are a candidate for TKR, but how much?
Orthopedic surgeons get this question a lot. Many potential candidates for total knee replacement (TKR) feel they are too old for the surgery & simply tolerate the discomfort. However, now more than ever people are opting to have the procedure done. In 2017, over 700,000 patients had knee surgery in the USA. In Iran, that number was 100,000 in 2017. Generally speaking, worldwide the number of patients seeking this specific operation has, and still is, increasing.
More often than not, patients who suffer from severe osteoarthritis wait till the pain is so unbearable they cannot walk unassisted any longer before coming in for a consultation. Having a TKR procedure helps people of all ages return back to their daily routine, without the nagging knee pain of course.
Osteoarthritis and Knee Deformities
Osteoarthritis is when the cartilage in the knee starts to breakdown or wear-down, usually becomes apparent in the middle ages. The cartilage acts as a kind of pillow between the bones that keeps the bone moving smoothly. That way, when you move you have a painless gliding motion when bending the knee. Arthritis inevitably occurs & the cartilage wears down. The beloved, aforementioned pillow starts to thin and wear away. That is when the pain begins because bone is actually rubbing against bare bone. This is what leads to pain & stiffness in the knee. Think of gears grinding without any lubrication or spacers.
Another issue are knee deformities such as valgus and varus knee. Valgus knee is better known as bowlegged. Varus knee is better known as knock-kneed. You may have seen toddlers that suffer from some form of malalignment when they wobble around, but they usually grow out of it as they get older.
In middle-aged adults, these knee deformities could be caused by many factors such as various forms of arthritis, some sort of injury (brute force trauma to the knee), or a birth defect that was left untreated.
Total Knee Replacement Surgery
TKR surgery is when the orthopedic surgeon goes in & essentially removes the damaged bone & cartilage that has worn away. (Click here for more info about TKR.) The surgeon spends time finding the perfect metal prosthesis fit that re-connects the femur & tibia bone together with an artificial joint separated by a plastic-type composite. This prosthesis allows the leg to bend smoothly again like new; pain free.
Keep in mind, the entire knee is not replaced, the ligaments & tendons remain intact. Just the damaged surface of the bone where the cartilage has worn away is removed.
Each year surgeons are trained in new methods, with new equipment. Therefore, although the surgery is fairly common, doctors are constantly improving. New equipment is introduced & the procedure becomes more efficient & effective. Furthermore, patients can rest assured that the chance of success is extremely high and complication are far less common.
Am I too old for TKR?
First of all, your orthopedic surgeon must make that assessment. The orthopedist assesses many factors before making his decision such as standing x-ray, medical history & a general physical exam. Based on these preliminary examinations, the surgeon will make the decision to move forward for more tests & plan for the procedure to take place. In America, surgeons are much more conservative due to malpractice concerns. Although the patient may be at fault for not doing the recommended physical therapy afterwards or other issues that depend on the patient, American surgeons typically remain prudent when selecting the right candidate.
This is why you can see 80 and 90 year old patients having successful simultaneous bi-lateral knee replacements on a regular basis in other countries. Despite this, orthopedic surgeons in North America would never operate on these same patients.
The main objective is to have the patient, regardless of age, return to normal. This is so they can once again become active & productive without any pain.