Knee Surgery--What You Should Know Before Going Under the Knife

Nearly 25 years ago, an orthopedic surgeon conducted a study in which some osteoarthritis patients got arthroscopic knee surgery, while the others got a “pretend” version, incision and all, no actual procedure.

Over the next two years, patients who underwent the real surgeries reported no less pain and no better function than those who received the fake surgery.

I vividly remember that study because a) at the time, so many people were getting arthroscopic surgery, and b) one man who’d unknowingly had the fake surgery reported that he could now chase his grandkids around without pain. 🤔

That result is theorized to be either a placebo effect or a reduction in his knee inflammation after taking it easy for a few weeks.

More recently, Finnish researchers used a similar protocol and followed their subjects for 10 years.

Their patients who had the real surgery were worse off afterward, even though they’d been chosen as being the most likely to benefit from the surgery. They had more pain, more accelerated osteoarthritis, and higher odds of eventually needing a full knee replacement.

The lead researcher said he couldn’t defend the procedure at all anymore.

What we know now but didn’t know then….

Fifty years ago, if you tore the cartilage in your knee, the fix was simple: cut it out. Doctors viewed the meniscus as useless as an appendix.

Today, we know it provides shock absorption for the joint, but the surgery to shave away torn pieces of it is still one of the most common orthopedic procedures in the country.

People can have degenerative meniscus tears, the wear-and-tear kind common in people over 50, and have no pain. I’ve known clients whose meniscus tears healed over time. There are bound to be many more who tore their meniscus and never knew it.

While arthroscopy rates have dropped 90% in Finland, the decline has been much slower in the U.S., with the surgery being performed far more often in the South than in the Northeast.

Just a hunch, but I doubt it’s because they don’t have those treacherous chipmunk holes that caused one of my clients to tear his meniscus, which eventually healed without intervention.

Follow the money? Arthroscopic knee surgery takes only 30-60 minutes. Medicare allots on average $2,159 to $3,875 for the procedure, and commercial insurers often pay more than double that. It’s fair to wonder…..

The newer approach….

Many orthopedists now initially refer patients with a torn meniscus to physical therapy.

That makes sense because the clients we see with degenerative tears have alignment and positional issues that need to be addressed. In those cases, “fixing the knee” doesn’t change the precipitating factors.

Some cartilage tears can be repaired, depending on the type of tear.

Physical therapy, exercise, and weight management remain the first and best-supported line of treatment. Surgery has a place for the right patient — just make sure that’s you before you agree to it.

The other knee surgery: replacement

Joint replacement is often talked about as if it’s inevitable once osteoarthritis gets bad enough. It isn’t.

I’ve known people who wore their knees completely out and were in a lot of pain.

Some, like my mom, should have had knee replacement surgery sooner than they did.

Others hear “bone on bone” and think the countdown clock to replacement surgery has started ticking. That’s not necessarily the case, as many of our clients can testify.

Knee replacement surgery is not to be taken lightly. I’ve often imagined people in the future looking back at our knee replacement surgeries the way we look back at Civil War battlefield surgeries.

Surgeons saw off the ends of the femur (thigh bone) and tibia (shin bone) to fit the metal components. The trauma of the bone cutting, blood loss, and anesthesia places immense stress on the cardiovascular and immune systems. The recovery extends the process even further.

After all that, roughly 1 in 5 patients is unsatisfied with their total knee replacement.

Here’s an issue I never appreciated until a client’s husband went through it:

A replaced joint is vulnerable to infection. For a lifetime.

My client’s husband fell and skinned his knee—not the replaced one—but the infection showed up in the artificial knee of his other leg. It took weeks of IV antibiotics to beat that infection. Sometimes the replaced joint has to be removed, then redone once the infection is vanquished.

Bacteria can colonize the artificial metal and plastic surfaces via the bloodstream, creating a risk that patients must be aware of for the rest of their lives. That’s why some doctors recommend prophylactic antibiotics before routine dental cleaning.

Knee replacement surgery can be the right choice for people whose severe pain hasn’t responded to non-surgical approaches.

After all, the goal is to be able to stay active, right?

That’s why I was surprised to read that most patients don’t become significantly more active after knee replacement surgery.

Pain goes down. Function scores improve. Activity levels, in study after study, mostly just... stay the same.

Surgery might eventually be appropriate, but before going under the knife, let’s make sure we’ve exhausted the other options.

The client story that haunts me

I had a client who joined TrainSmarter to get in shape for his scheduled knee replacement. We worked on alignment, strengthening stabilizers, recruiting his glutes, and the other approaches we use with people who have knee pain.

A couple of months later, just before his surgery date, I asked him about his knee pain.

“It doesn’t really hurt now,” he told me. “But I’ve had that surgery scheduled for a while. I guess I’ll go ahead and do it.”

His surgery was in July. He got an infection, and the implant had to come out. He didn’t have a knee in his leg until the following January.

I’ve been haunted by it ever since.

My goal isn’t to scare you. I just want you to be SURE that surgery is the best option, if you choose it.

Faulty alignment and movement mechanics that cause knee pain that often leads to surgery will still be faulty alignment and mechanics even after knee surgery.

Rather than simply focusing on making the pain go away, it's smart to address the issues that created the pain.

That way, you address the knee pain issues once and for all. Even a mechanical knee won't tolerate faulty alignment long-term.