If you need a knee replacement, you’re not alone. Some 2.5 million Americans, including 3 percent of people over the age of 60, have a knee they weren’t born with.
Even though knee replacement surgery is common, it’s still a major procedure—and can be a bit nerve-racking in the weeks and months leading up to the operation. The good news is, there are steps you can take to help you feel as prepared as possible and to increase the odds of a smooth surgery and recovery period.
Evaluate your needs
How do you know if you need surgery in the first place? Steven Stern, M.D., vice president of cardiology, radiology, orthopedics and neuroscience at UnitedHealthcare, says that while every individual has a different tipping point for initiating surgery, there are some general guidelines about when it is an appropriate step. Earlier in his career, Stern completed a fellowship focused on knee surgery before working as a practicing orthopedic surgeon and authoring papers and book chapters on knee replacement surgery.
“In general, you would know you’re a candidate for surgery if you’re having pain with activities of daily living, and those symptoms have not been responsive to treatments such as anti-inflammatory medications, exercise and strengthening protocols, weight loss if appropriate or even injections in the knee,” Stern said.
Sometimes, he added, patients have endured knee pain that gradually gets worse for several years, but other times the symptoms come on suddenly. Everyone is different.
Surgery can be hard on your body, so it’s important to get in the best shape you can before you get on the operating table. Step 1? Try to stop smoking. Studies show that smokers have less successful knee replacements than their smoke-free counterparts. Part of the reason for that, scientists suspect, is that smoking interferes with the body’s ability to heal itself.
If you’re overweight, your doctor may advise you to try to shed a few pounds to avoid potential complications during surgery, particularly if your body mass index (BMI) is above 40. (Use this calculator to figure out your BMI.) But be realistic in your expectations: Some patients have difficulty losing weight because their knee pain makes it tough to exercise, Stern said.
If your doctor does recommend you try to lose some weight before surgery, check out these tips to get started, and do the best you can.
Find the right surgeon
The surgeon and hospital you choose can have a major impact on both your costs and your outcomes post-surgery. That’s why Robert De Haven, a product director with Optum’s Spine and Joint Solution program, recommends that patients spend some time researching surgeons in their area to find one who provides high-quality care at a reasonable price.
“These surgeries are expensive, and there’s a ton of variability in both cost and quality,” De Haven said. “You can go to location A and pay a certain amount or go across town to location B and pay a very different amount for the same results.”
Optum’s Spine and Joint Solution program has established Centers of Excellence across the country. Hospitals and other facilities that have earned this designation provide the highest-quality, most cost-efficient orthopedic care for procedures such as knee and hip replacements. Knee replacement surgeries performed at Centers of Excellence, for example, have 23 percent lower costs than at other hospitals, largely attributed to their superior post-surgery outcomes — 19 percent lower complication rates and 20 percent fewer redo procedures.ⁱ
If you have benefits through your job or through a Medicare Advantage plan, check with your health insurance company to find doctors and surgical facilities in your plan’s network. Most plans require you to pay a larger portion of your treatment cost if you see an out-of-network doctor. You may also want to check with your insurance company to see if they have any information about the quality ratings of different doctors in your network.
Regardless of whether your health plan offers programs or rankings to help plan members find high-quality doctors, quality of care is so important that it’s something you should also research on your own. While it might seem like an overwhelming undertaking, it doesn’t have to be — and it’s well worth a small investment of time.
To put it in perspective, consider how you might select a handyman or car mechanic. You’d likely spend some time researching consumer feedback and satisfaction surveys online. Shouldn’t you be doing at least as much research when preparing for something as important as surgery?
To research the quality of the hospital or facility where you plan to have your operation, check out the Hospital Compare tool on Medicare.gov. Simply type in your ZIP code, and you’ll see a list of hospitals in your area. Click on the hospital you’re interested in, and then click on the “Complications” tab. Scroll down and click on “Surgical Complications.” From there, you can see whether the hospital scores better, worse or about the same as the national average in terms of the rate of complications with knee or hip replacement surgeries.
Think ahead to recovery
While it may be tempting to get right back into the swing of things shortly after your surgery, be realistic about your recovery time. Don’t plan any walking tours or intense StairMaster sessions in the weeks following your surgery.
You may be hobbling around with crutches or a walker for a few weeks after the surgery, and that can make things that used to be a breeze—doing laundry or walking the dog, for example—a painful ordeal. Identify people who can help you with ordinary household chores and errands before booking your surgery.
“Patients have to be prepared,” Stern said. “There is nothing worse than a patient trying to figure out who is going to help them or what their housing situation is going to be two days after surgery.”
Most people are able to go home after surgery, rather than to a rehabilitation facility, and Stern noted that it helps to modify your home in advance to make it easier to get around. That might mean sleeping on a sofa bed in the family room for a few weeks after surgery to avoid climbing up and down stairs. Putting a waterproof seat in the shower and clearing away loose cords and rugs that could trip you up could also help you avoid accidents at home while you recover.
Finally, plan to start an exercise program soon after surgery to strengthen your muscles and improve your range of motion. While some doctors may recommend that patients see a physical therapist, either in their homes or at a freestanding facility, others may simply give patients exercises to do at home.
If you do end up seeing a physical therapist, figure out beforehand where you will receive therapy and for approximately how long you’ll have to continue. And don’t forget to make sure your physical therapy provider is in-network to keep your costs under control.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.
ⁱ UnitedHealthcare data: https://www.uhc.com/valuebasedcare/about-value-based-care/results