When to get the knee looked at

When to make a regular appointment

Arrange a regular visit when repeated aching limits ordinary movement. Soreness at night, swelling, weakness, or repeated giving way all deserve a check. Walking doesn't need to become impossible before you call. Write down when the ache started, what brings it on, what eases it, and how the knee feels after rest.

When not to keep waiting

Don't keep putting off care while sleep, walking, or time outside the house keeps shrinking. Repeating care that failed may only stretch out a hard spell. Surgery isn't right for everyone, but waiting isn't harmless for everyone either. Ask why you're waiting and what change means it's time to stop.

When to get same-day care

Get same-day care if your knee becomes hot, red, and swollen while you also have a fever or feel very ill. Go that day after an injury if swelling comes fast and you can't stand. A numb, weak, cold, or pale foot may mean trouble with nerves or blood flow. Don't wait through the weekend when redness or drainage spreads after a procedure.

What to do while you wait

Cut back on the task that brought on the ache, but don't spend several days without moving. A cold pack may calm swelling, while gentle movement can limit stiffness. Put a thin towel between the cold pack and your skin. If any warning sign appears, stop home care and get medical help.

Sources

1. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

2. Pooling the OAI and MOST cohorts (8,002 participants followed up to 8 years, 3,417 classifiable knees), validated appropriateness criteria classified only 290 knees (8%) as receiving a TIMELY total knee replacement, 2,833 knees (83%) as potentially appropriate but not replaced more than 2 years after replacement became appropriate, and 294 knees (9% of all knees, 26% of the 1,114 replacements actually performed) as PREMATURE. Of the potentially-appropriate-but-not-replaced knees, 1,204 (42.5%) had severe symptoms.

   Ghomrawi HMK, Mushlin AI, Kang R, et al. — Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.. Journal of Bone and Joint Surgery (American), 2020. DOI: 10.2106/JBJS.19.00432.

3. Acute bacterial septic arthritis of the knee is an orthopaedic emergency that can cause substantial joint destruction if untreated. Diagnosis rests primarily on history and the clinical presentation of a red, warm, swollen, painful joint with limited range of motion. Risk factors include age over 60, recent bacteremia, diabetes, cancer, cirrhosis, renal disease, drug or alcohol abuse, a HISTORY OF CORTICOSTEROID INJECTION, recent injury or surgery, a prosthetic joint, and rheumatoid arthritis.

   Elsissy JG, Liu JN, Wilton PJ, et al. — Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review.. JBJS Reviews, 2020. DOI: 10.2106/JBJS.RVW.19.00059.

4. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

5. FDA states directly that regenerative medicine therapies - including stem cells, stromal vascular fraction, umbilical cord blood, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes - have NOT been approved for the treatment of any orthopedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain. FDA further states that being charged for these products, or being offered them outside an FDA-overseen clinical trial, means a patient is likely being deceived and offered a product illegally, and that a product's presence on clinicaltrials.gov or a firm's FDA registration does not mean the product is legally marketed. Reported harms include blindness, tumor formation, neurological events and life-threatening bacterial infections.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA.gov, 2021.