Does a painful knee get better if you simply put up with it? More likely, the delay costs patients their last chance to save their own joint. Pain at first appears only when walking or climbing stairs, but as arthritis advances it persists even at rest, and the knee can suddenly give way while walking. Miss the window for treatment, and joint replacement surgery may become unavoidable.
Dr. Jung Ho-won, director of the Joint and Sports Center at Yonsei Geonwoo Hospital, said on the 17th that knee arthritis divides into a stage when recovery is possible and a stage when it is not. He spoke on Seoul Economic Daily TV's program "Top Doctors Now," which aired at 9:25 p.m.
"What saddens me most is seeing patients who endured the pain until they reached a point of no return and had to undergo joint replacement surgery," he said.
Knee Gives Way While Walking? A Sign Arthritis Is Advancing
Degenerative knee arthritis is a condition in which the cartilage protecting the joint gradually wears down and deteriorates, causing pain and loss of mobility. It occurs mainly in people in their 50s and 60s and older, and prevalence is known to rise particularly among women aged 65 and over.
In the early stage, pain often appears during walking or movement and eases with rest. As the disease progresses, however, even a short walk can hurt, and the pain may persist despite rest. Weakening thigh muscles can cause the leg to suddenly lose strength or buckle while walking. In the late stage, patients may develop joint stiffness and contracture, leaving the knee unable to straighten or bend properly.
Diagnosis begins with an X-ray, which shows whether the space between the joint has narrowed and whether bone spurs have formed. An MRI scan may be added when damage to the cartilage or meniscus is suspected or when aggressive treatment is required.
Treatment depends on the extent of joint damage. For some patients in the early or middle stages, joint-preserving options can be considered, such as suturing a torn meniscus, treating localized cartilage damage, or correcting misaligned joints. When cartilage damage is extensive and recovery is unlikely, doctors manage the pain with medication or injections, then consider joint replacement surgery if joint function and quality of life deteriorate sharply.
Delaying Joint Replacement as Long as Possible Is Not Always Best
Not every patient with severe knee arthritis needs joint replacement surgery. But surgery should be considered when cartilage damage is extensive and pain has made daily life difficult. The most important criteria are the extent of joint damage, joint function and quality of life, rather than the patient's age.
"Many patients believe joint replacement surgery should be put off as long as possible, but if joint function and quality of life have deteriorated sharply, delaying it unconditionally is not a good choice," Jung said. "Even someone in their early 60s can be a candidate for surgery if the joint damage is severe and daily life is significantly impaired."
Joint replacement surgery replaces the damaged part of the joint with an artificial implant. If only the inner or outer compartment of the knee is damaged, a partial replacement of that section alone can be considered. If both sides of the joint are severely damaged, a total replacement may be necessary. Before surgery, doctors use X-rays and, when needed, MRI scans to assess joint damage and bone deformity, then plan the extent of resection and the joint alignment.
Rehabilitation matters as much as the operation itself. After surgery, pain can occur as muscles, ligaments and tendons that have long been stiff adapt to the new joint alignment. Patients generally begin walking with a walker and performing knee flexion and extension exercises the day after surgery, and depending on their condition, some walk without a walker roughly two to six weeks later.
The complication requiring the most caution after surgery is infection. An infection around the implant can require additional surgery or replacement of the artificial joint, making wound care and infection prevention important. For invasive dental procedures such as implants, patients should discuss the timing with their medical team in light of their recovery.
"The factors that matter most to surgical outcomes are the degree of joint deformity and the patient's commitment to rehabilitation," Jung said. "Even if joint replacement surgery is frightening, rather than simply enduring severe pain, it is important to work with your medical team to find a way to restore joint function and quality of life."
Stair Exercises Can Backfire; Muscle Strength and Weight Control Are Key
Exercise and weight management are essential to protecting knee health. Patients whose degenerative arthritis has already advanced, however, should be careful with activities that strain the knee, such as climbing stairs or hiking. Walking on flat ground or exercises that strengthen the thigh muscles can help instead.
One common exercise is the straight leg raise, performed by lying down and lifting the leg with the knee extended. Patients tighten the thigh, raise the leg about 45 to 60 degrees and hold for 10 seconds. Weight control matters as well. Losing one kilogram of body weight can reduce the load on the knee by about three kilograms while walking.
"Cartilage that is already severely damaged cannot be regenerated with supplements," Jung said. "Rather than relying on particular foods or supplements, it is important to maintain muscle strength through appropriate exercise and manage your weight."
He added: "It is natural to fear joint replacement surgery, but if severe pain is making daily life difficult, it is better to work with your medical team to find a way to restore joint function and quality of life than to put it off unconditionally."