Never too old for knee surgery

Common scenario: People over the age of 60 are often afraid of undergoing knee surgery as they feel that they are too old.

TOTAL knee replacement (TKR) surgery is an operation with a high degree of success for the treatment of degenerative knee conditions.

The number of TKRs performed annually is increasing worldwide and most patients are relieved of their chronic pain and enjoy an improved quality of life.

I often meet patients with ad­­vanced arthritis of the knees who have failed conservative management (with painkillers and exercises) and warrant a TKR.

Some of them, especially those over the age of 60, are often afraid of undergoing surgery as they feel that they are too old.

While this fear is understandable, this article aims to dispel some of that fear.

A large 2013 study in the United Kingdom titled “Total Knee Arthro­plasty in the Elderly: Does Age Af­­fect Pain, Function or Compli­ca­tions?” published in Clinical Ortho­paedics and Related Research looked at TKR surgery in those aged 80 years and above. The study showed that these patients do enjoy similar benefits in terms of pain relief and improvement of function compared to younger patients – some even up to 10 years following their surgery.

In this age of advanced technology, it is almost criminal to have patients suffer from pain when there are straightforward methods of improving their condition, regardless of how old a person is.

No matter your age, if you have arthritis and knee pain, play it sensibly.

The simple approach would be to modify daily activity, such as avoiding long walks up hills or running, which can help reduce symptoms.

Weight loss is also great to reduce stress on the knee joints and exercises targeting the thigh muscles may improve knee joint function.

Judicial use of painkillers and joint injections may control symptoms when conservative measures are not enough.

There is a good amount of information available on the American Association of Orthopaedic Sur­geons website, which provides evidence for each of these options. Do consult your surgeon regarding this.If conservative methods fail or the arthritis is advanced, a TKR may be the best option.

Many older patients who undergo TKR surgery do suffer common medical problems such as diabetes, hypertension and high cholesterol.

Rather than fearing these problems, adopt a pragmatic approach.

Patients with these medical conditions would normally be referred to a physician to ensure that all pre-­existing conditions are suitably optimised.

Maintaining ideal blood pressure and blood glucose levels before and after TKR surgery would likely lower the risk of complications.

Most TKRs in older patients are performed under spinal or regional anaesthesia.

This reduces potential cardiopulmonary (heart and lung) problems with the added benefit of better pain control immediately after surgery.Following surgery, do adhere to post-operative instructions provided by the surgeon.

Exercise after TKR improves overall joint function and surgical outcomes, age notwithstanding.

There is a happy balance between too little and too much exercise after surgery, and your surgeon or physiotherapist will be able to advise you on this.

Rehabilitation would normally be tailored to the individual (especially in elderly patients) with focus on knee motion, walking/gait and cardiovascular ability.

It is never too late to get fit.

I personally believe that age should not be the determining factor when considering total knee replacement surgery.

I occasionally tell some patients that the oldest person I operated on for a TKR was a 106-year-old Irish lady who walked out of the hospital a few days after.

If a patient has co-morbidities, they should be dealt with pragmatically.

TKRs are, for the most part, successful, and patients do enjoy a great improvement in their quality of life following surgery.

After all, life is for living and we shouldn’t have time for pain.

Good luck.

Dr Gandhi Nathan Solayar is a consultant orthopaedic surgeon at Ara Damansara Medical Centre.