A Third of Total Knee Replacements (TKR) have Poor Results

Knee Exercises (NIA-Go4Life)

Osteoarthritis of the knees can be a painful disabling condition that can affect quality of life depending on how severe it is. Many people opt for a surgical total knee replacement (TKR), but a study published March 17, 2017 in the BMJ showed that about a third of people still experienced chronic pain after the TKR operation and many were not satisfied with the results. In fact, there was not a major improvement in quality of life to justify the cost of the operation. Also, more younger people are having a TKR and many of them are not happy with the results. The researchers discovered, however, that for people who had severe knee osteoarthritis the total knee replacement had better results for improving quality of life. In fact, the researchers suggest that total knee replacement surgeries will be more effective if they are only performed on people who have very severe knee osteoarthritis.

The Researchers used Data from Two Studies

Osteoarthritis Initiative (OAI)

The Osteoarthritis Initiative (OAI) is a multi-center large cohort study of 4796 people with knee osteoarthritis or who were at risk for knee osteoarthritis. These participants were recruited in 2005-6 from four centers in the United States and were followed for nine years. Knee osteoarthritis was defined by:

Pain, stiffness or aching in or around the knee that persisted for most days throughout one month during the past year.

Also, x-ray or other scans had to show evidence of osteoarthritis.

Multicenter Osteoarthritis Study (MOST)

The Multicenter Osteoarthritis Study (MOST) included 4498 participants ages 45-79 who had osteoarthritis of the knees or who were at high risk for knee osteoarthritis. They were also followed for nine years.

Non-surgical Treatment

The researchers also examined the incidence of patients who were on pain killing meds like non-steroidal anti-inflammatory drugs (NSAIDs) and those that used non pharmacological treatments like:

  • Massage
  • Chiropractic adjustments
  • Acupuncture treatments
  • Acupressure
  • Chelation therapy
  • Homeopathic remedies
  • Folk medicine


The total knee replacements in the studies of people with knee osteoarthritis showed only a minimal positive effect on the quality of life. However, the researchers conclude that if the TKR operation was used for patients with more severe osteoarthritis, then it would be more effective and more economically useful.

Study Compared Surgical to Non-surgical Treatment

A different study published April 30, 2018, in Osteoarthritis and Cartilage compared surgical versus non-surgical treatment in 100 seniors who were eligible for a TKR.

Non-surgical treatment meant 12 weeks of supervised physical exercise, nutrition advice, pain medicines, special insoles in shoes and educational advice. To see more about preventing the need for knee replacement surgery see our blog post from February 20, 2018.

Those that had a TKR showed better results than those who only followed non-surgical treatment. However, those who had a TKR followed by non-surgical treatment had the best results. This backs up other research that has shown that people who follow a 12 week rehabilitation program of physical therapy after total knee replacement surgery have the most success from their TKR operations.

The AARP reports about serious risks and complications from TKR surgery such as:

  • Infections
  • Blood clots
  • Severe knee stiffness that requires another medical procedure under anesthesia.
  • Last but no least; one in every 100-200 patients who have a TKR die within 90 days of surgery.

Also, the AARP notes that since more younger people are having TKR surgery they may outlive their implants and might need a second TKR in the future. However, this is by no means a simple procedure, according to James Rickert, president of the Society for Patient Centered Orthopedics, as there may be scar tissue left from the first surgery that will make a second TKR more difficult to perform. Also, it may be very hard to extract the bone cement used in the first surgery and there is also a risk of bones breaking when the old artificial knee is removed. Rickert suggests that some patients are being offered unnecessary surgery. On the average a knee replacement costs $31,000.

Rehabilitation after a Total Knee Replacement (TKR)

Research has shown that the best results from a total knee replacement (TKR) are to people who follow a 12 week rehabilitation program of physical exercises after the operation. Royal suites Healthcare and Rehabilitation in Galloway Township, New Jersey offers excellent post knee replacement surgery rehabilitation and they have a state-of-the-art gym.


Since total knee replacement surgery is not without risk, and since a third of those who have a TKR still experience chronic pain, it pays to try some of the preventive techniques including 12 weeks of physical exercises to try to avoid TKR surgery. However, if you opt for the TKR be certain to line up a rehab before you do the operation, as the best results from a TKR are to people who follow a 12 weeks program of physical exercises.

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