Getting a Knee Replaced? Here Are Four Things You Need to KnowPosted by Medicare Made Clear
If you need a knee replacement, you have plenty of company. Some 2.5 million Americans, including 3 percent of people over the age of 60, have a knee they weren’t born with.
Knee replacement surgery is common, but it’s still a major procedure. The weeks and months leading up to the operation may be a bit nerve-racking. The good news is that you can take steps to help you feel prepared and to support a smooth surgery and recovery.
1. Evaluate Your Needs
How do you know if you need surgery in the first place? Steven Stern, MD, vice president of cardiology, radiology, orthopedics and neuroscience at UnitedHealthcare, says that there’s a different tipping point for each person. Still, he says there are general guidelines about when surgery may be indicated.
“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 gets worse over many years. Other times the symptoms come on suddenly. Everyone is different.
2. Get Healthy
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 is to try to stop smoking. Studies show that smokers have less successful knee replacements than nonsmokers. Part of the reason for that, scientists suspect, is that smoking makes it harder for the body to heal itself.
Your doctor may advise you to try to shed a few pounds if you’re overweight. This can help avoid potential problems during surgery. People with a body mass index (BMI) over 40 may be especially encouraged to drop some weight. (Use this calculator to figure out your BMI.)
Do the best you can if your doctor asks you to try to lose some weight before surgery, and be realistic in your expectations. Some people may have difficulty losing weight because their knee pain makes it tough to exercise, Stern said.
3. Find the Right Surgeon
The surgeon and hospital you choose can have a major impact on both your costs and your post-surgery outcome. That’s why Robert De Haven, a product director with the Spine and Joint Solution program at Optum, recommends doing some homework before making any decisions.
“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.”
Look for a “Center of Excellence” facility. Hospitals and other facilities earn this designation by providing high-quality, cost-efficient care. Knee replacement surgeries performed at Centers of Excellence, for example, have 23 percent lower costs than those done at other facilities. This is largely due to their superior post-surgery outcomes, including 19 percent lower complication rates and 20 percent fewer redo procedures.ⁱ
Use the Hospital Compare tool on Medicare.gov to research facilities in your area. Enter your ZIP code and select from the list. You’ll be able to see how different facilities compare in terms of the rate of complications with surgery, cost and other factors.
You can have your surgery wherever you choose if you have Original Medicare (Parts A & B). But keep in mind that you may have to choose from a provider network in you have a Medicare Advantage or employer plan. Most plans require you to pay more if you get care outside the network.
4. Think Ahead to Recovery
It may be tempting to get right back into the swing of things after surgery. Be realistic about your recovery time. You may be using crutches or a walker for a few weeks, which can make daily activities like walking the dog or doing laundry more difficult. Make plans ahead of time for help with household chores and errands.
“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.”
Surgery may be performed in an outpatient or inpatient setting, and people generally are able to go home afterward rather than to a rehabilitation facility. 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 exercises as directed soon after surgery to strengthen your muscles and improve your range of motion. While some doctors may recommend that patients see a physical therapist, 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 your plan network to keep your costs under control
The Bottom Line
Usually with knee surgery you have time to consider your options and prepare yourself mentally, physically and financially for the procedure. Think of it this way: How much effort do you put in when you are buying a TV or computer or car? Shouldn’t you be doing at least as much for something as important as surgery?
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
ⁱ UnitedHealthcare data: https://www.uhc.com/valuebasedcare/about-value-based-care/results