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I perform more than 700 hip and knee replacements a year at the Bone and Joint Institute of Tennessee. Almost every patient asks me the same question before surgery: what could go wrong?
The disadvantages of knee replacement are real. After more than twenty years doing this operation, I think patients deserve a straight answer, not a sales pitch.
Knee replacement relieves pain and restores function for most people who need it. But it is major surgery, and it comes with real knee replacement risks worth knowing before you schedule a date. Here is what I tell my own patients, risk by risk.
How Common Is Infection After Knee Replacement?
Infection is uncommon after knee replacement. It affects roughly 1 to 2 out of every 100 patients.
Surgery breaks the skin barrier, so bacteria have a path in. Strict sterile technique and antibiotics before and after surgery keep this risk low.
Watch for redness, warmth, drainage, or fever in the days or weeks after surgery. Call my office right away if you notice any of these signs. Caught early, most infections respond well to treatment.
What Is the Blood Clot Risk After Knee Replacement?
Blood clots are among the more serious knee replacement risks. They form in roughly 2 to 4 percent of patients without preventive care.
Your risk climbs if you smoke, have limited mobility, carry extra weight, or have had a clot before. A clot in the leg is uncomfortable. A clot that travels to the lungs is a medical emergency.
We manage this risk actively rather than simply accept it. Most patients go home on a blood thinner for two to six weeks, wear compression devices in the hospital, and get up and walk the same day as surgery.
How Long Is Recovery After Knee Replacement?
Most patients need six to twelve weeks to feel steady on their feet again. A full year usually passes before the knee reaches its final result.
The first three to four weeks are the hardest. Expect swelling, stiffness, and some pain that physical therapy and medication help manage.
You will need someone to drive you home and help around the house for at least the first week. Patients who stay consistent with physical therapy tend to improve steadily after that rough start.
Will My New Knee Feel Like My Own Knee?
No, and I tell every patient this directly. Surgery removes the damaged, arthritic joint surfaces and replaces them with metal and plastic components.
It moves well, and it should hurt far less. But it will not feel exactly like the knee you were born with.
Some numbness around the incision is normal, and it is often permanent, though it matters less over time. Kneeling can feel uncomfortable indefinitely for some patients, even after a technically excellent surgery.
Can I Run, Kneel, or Play Sports After Knee Replacement?
High-impact activities like running, jumping, and pivoting sports are generally not recommended after knee replacement. They put repeated stress on the implant that can speed up wear.
Low-impact activities are usually fine and often encouraged, including walking, cycling, swimming, golf, and doubles tennis.
If you were already inactive for a year or two before surgery, your odds of returning to a demanding sport are lower, regardless of how well the surgery goes. Tell me before we set a surgery date if staying active at a high level matters to you.
How Long Does a Knee Replacement Actually Last?
Most knee implants last 15 to 20 years, and many last well beyond that. Implant materials and surgical technique have both improved a great deal over the past two decades.
It is not a permanent fix, though. Younger, highly active patients, and patients who carry significant extra weight, tend to wear out an implant sooner.
They may eventually need a second surgery, called a revision, to replace worn components. This is one of the honest tradeoffs of having surgery earlier in life rather than later.
What Does Knee Replacement Cost Out of Pocket?
Your out-of-pocket cost depends on your insurance plan, your deductible, and where the surgery happens. Outpatient knee replacement is now common for healthy candidates and generally costs less than an inpatient hospital stay.
Call your insurance company before you schedule surgery. Ask about your specific coverage for joint replacement, including physical therapy visits afterward. My office can help you understand what to expect financially once your insurance details are confirmed.
Do the Benefits Outweigh the Disadvantages of Knee Replacement?
For most people with advanced knee arthritis, yes. About 90 percent of my patients report a significant drop in pain and get back to daily life without the constant ache that brought them to my office.
That benefit is why knee replacement remains one of the most successful procedures in orthopaedic surgery, even with the knee replacement risks we have covered above.
How Robotic-Assisted Surgery Narrows the Disadvantages of Knee Replacement
Technology has narrowed some of those disadvantages of knee replacement further. I use the Mako® robotic-assisted system for many of my knee replacements, and I also serve as a paid consultant to Stryker, the company that manufactures it, helping train other surgeons on the technology.
The system builds a CT-based surgical plan before I make an incision, which supports more precise implant positioning and ligament balance than manual technique alone. Precise positioning matters, because a poorly aligned implant is one of the more common reasons a knee replacement needs revision surgery later. None of that erases the risk. It is one more tool that helps manage it.
When Might Knee Replacement Not Be the Right Choice?
Knee replacement is elective surgery. That means the decision is yours, not an emergency dictated by a scan.
If you have not yet tried conservative treatment, we typically try that first: physical therapy, weight management, anti-inflammatory medication, or injections. If a condition like uncontrolled diabetes or heart disease is not well managed, we address that before surgery to lower your risk.
And if you are not ready to commit to weeks of physical therapy, recovery will be harder than it needs to be. Honest self-assessment on these points goes a long way toward a good outcome.
How I Help My Patients Weigh This Decision
After more than twenty years and over 700 joint replacements a year, my job is not to talk every patient into surgery. It is to make sure you understand both sides clearly enough to decide for yourself.
We will review your imaging, your health history, and your goals together. I will tell you honestly whether surgery makes sense for you now, or whether it can wait.
If you are weighing the disadvantages of knee replacement against the pain you live with today, I would welcome the chance to talk it through with you.
Schedule a consultation with Dr. Calendine at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067, or call (615) 791-2630.
This article is for general patient education and is not a substitute for personalized medical advice. Individual results vary. Talk with Dr. Calendine or another qualified orthopaedic surgeon about whether knee replacement is right for you.
Watch: Knee Replacement Recovery, When Will the Pain Stop?
Dr. Calendine explains what to expect from pain and swelling during knee replacement recovery, and when patients typically notice real improvement.
