Patients with knee osteoarthritis are often told they have two options: total knee arthroplasty (TKA) or living with the pain. This isn’t true. Patients who are considering TKA should always get a second opinion about their treatment options.
“Different orthopedic surgeons can give different opinions on whether a patient needs surgery, depending on their experience, training and practice environment,” says Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center.
Getting a second opinion enables patients to learn about other options and evaluate each surgeon’s experience. After TKA, a second opinion can be helpful if the patient doesn’t feel that he/she is making sufficient progress.
Effective Non-Surgical Treatment
Non-surgical treatments such as physical therapy should be exhausted before considering TKA. While most orthopedic surgeons will recommend physical therapy first, few have systems in place to provide or refer patients to effective physical therapy.
Relieving pain and stiffness from knee OA requires improving range of motion (ROM) first, and only then focusing on strengthening. Yet most physical therapy programs focus only on strengthening.
“At Shelbourne Knee Center, we have a system in place, including a team approach and physical therapists in our office, to facilitate non-surgical treatment of knee arthritis,” says Dr. Benner.
Dr. Benner recommends that patients try physical therapy for 4-6 weeks and see how they feel. For 76% of patients in Shelbourne Knee Center’s research-based Knee Rehabilitation Program for OA, physical therapy relieved pain and stiffness in 4–6 weeks (1).
For the 24% of patients who went on to have a TKA (1), being prepared for surgery and the pre-op improvements made during physical therapy facilitated a better surgical outcome and a faster, easier recovery.
Shelbourne Knee Center Experience
The variable experience orthopedic surgeons have performing TKA and using certain implants is another reason to seek a second opinion. High-volume surgeons and surgeons who consistently use an implant with a good track record have the best outcomes.
If TKA isn’t done right the first time, revision surgery is more complicated. The technically challenging procedure requires meticulous preoperative planning and surgical technique to preserve as much of the bone as possible. Few orthopedic surgeons who perform primary TKA also perform revision surgery.
Dr. Benner regularly performs both primary and revision TKA, consistently using what he considers to be the best implant. He completed a fellowship in knee surgery, adult reconstruction and sports medicine at The Insall Scott Kelly Institute.
2nd Opinion After TKA
If a patient isn’t making sufficient progress recovering from TKA or still has severe pain, he/she should return to the surgeon who performed the procedure. “If the patient isn’t getting the information he/she wants or isn’t comfortable with the surgeon’s assessment, it’s often good to get a second opinion,” says Dr. Benner.
Often, the implant is fine but the patient is under-rehabilitated. With appropriate physical therapy, these patients can maximize their ROM, strength and function.
“Patients should be well informed and understand their options before making a decision about knee replacement surgery. I never mind when patients ask me questions,” says Dr. Benner.
For more information about second opinions or to refer a patient for a second opinion, call 888-FIX-KNEE.
References
- Shelbourne DK. Nonoperative Treatment of Knee Osteoarthritis, presentation at the Herodicus Society Meeting, June 2018.