What can I do to delay knee surgery if I have advanced arthritis?

​For aging adults, this can be a tough situation as the term "advanced" is more of a subjective conclusion and not well tied to objective data. Many people are told they have the dreaded "bone-on-bone" on X rays and feel consigned to having surgery as though all hope is lost. There is some research though to show that bone-on-bone imaging results do not always correlate with pain levels experienced, and decisions related to knee surgery are typically driven by pain.

We need to be clear here. Even as physical therapists, we know that sometimes surgery is appropriate. “If you are limiting the things you like to do because of your knee pain, and you have tried PT and your imaging shows end stage arthritis then it may be time to consider surgery.” says Francisco Quinones, DPT. “However, it should be noted that outcomes for total knee replacements are heavily influenced by how much you were able to do pre-surgery.” 

In other words, whether you're committed to the idea of a total knee surgery or not, a physical therapist can play a critical role in either your post-surgical outcomes or avoiding surgery all together. 

“We have seen people who thought they had no other option but surgery realize that with a little guidance and the right combination of exercise, they could do everything they want to do, eliminating the need for surgery at that time.” says Leah Versteegen, DPT. “Of course I am biased as a PT, but I would tell everyone to consult with a PT before deciding on the timing for a total joint replacement. Even if you end up needing surgery in the end, a course of PT prior to surgery will prepare you for better outcomes after the procedure. It is a win - win situation.”

You’ve decided surgery is right for you. How can you improve your outcome?

“One of the fastest growing and most successful trends for those considering total joint replacement over the past 5 years has been the concept of pre-operative rehabilitation. With this model, patients attend PT before deciding on surgery, sometimes for just a few sessions and other times for a full course of care lasting 8-12 weeks. The goal is to see what movement and strength can be regained to either avoid surgery all together or improve post-operative outcomes.” says Versteegen. 

“If you end up having surgery anyway then the time you spend on PT will not be lost. The stronger you are and the more you are able to do going into surgery, typically the better your recovery will go.” says Quinones.

What can I do right now to decrease my chances of needing surgery in the future?

​“My advice for people looking to delay knee surgery is to stay active.  Research has shown that both a regular walking program or cycling program can improve function and reduce pain for people with Arthritis.  It may seem counterintuitive when your knee is hurting, but joints need motion to stay healthy, and all of our systems, including cardiovascular, benefit from regular exercise.” says Jess Kehoe, DPT. “My advice if you haven't been active like this for a while would be to start by finding a tolerable amount of time on either the bike or walking and work toward doing this 5-7 days per week.  Then slowly increasing the time up to 30-60 minutes per day, 5-7 days a week.”

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