Is Knee Surgery Inevitable for Women?
I have a neighbor who’s about five feet tall and possesses the energy five women in her small body. She’s in her sixties, but she moves around like she’s twenty years younger and has one of those bright, sunny attitudes that people love to be around.
A few months ago, she told me she was scheduled to undergo double knee surgery. I was surprised. With all her energy, I hadn’t noticed that she was struggling with knee pain, but turns out she had been suffering for awhile. Her job requires her to stand on her feet on a cement floor for much of the day, and years of doing that had taken their toll on her joints.
Her surgeries went well and when I saw her only about a month later, she was walking and even managing stairs, but her story got me thinking. My own knees have let me know now and then, particularly after a jog, that they’re not as young as they used to be. Is knee surgery inevitable for women these days, or is there a way we can protect our knees well enough to keep the ones we were born with?
Women More Likely than Men to Go Through Knee Replacement Surgery
Data from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) shows that between 2000 and 2010, knee replacement rates nearly doubled in the U.S. In 2010 alone, surgeons performed an estimated 693,000 total knee replacements in adults aged 45 years and older. In fact, in that year (and in 2008 and 2009), total knee replacements were the most frequently performed inpatient procedure for this age group.
When researchers looked at the statistics again in terms of gender, they found that the rate increased more for women than for men. On average, the rate of total knee replacement was 50 percent higher in women than men for each year from 2000 to 2010.
The average age for these replacements is dropping, as well. Over the course of the study, the average age for women receiving a knee replacement dropped by nearly 4 percent from 68.9 years to 66.2 years. What happens after knee surgery also differs between men and women. Most adults were discharged home, but the percentage was lower for women in 2000 and in 2010. In other words, more women had to spend time in a long-term care facility than men did.
A 2014 Mayo Clinic study also found that prevalence of knee replacement surgery is higher in women than in men—3 million women are living with a knee implant, while 1.7 million men are.
The good news is that knee implants allow women who are suffering from arthritis to enjoy less pain, improved mobility, and a better quality of life. Studies indicate that nine out of 10 knee replacement patients experience immediate pain relief, and 95 percent report they’re satisfied with the procedure.
But advanced as our medical technology is, it’s still not perfect. Knee replacements are built to last 10-20 years, and where a woman may fall on that scale depends on a lot of things, including her health, activity levels, quality of the original surgery, the success of rehabilitation after the surgery, and other factors. Whereas about 90 percent of knee replacements last 10 years, 80 percent last 20 years.
If long-term wear and tear loosen the implant, revision surgery to remove and replace it may be necessary. This surgery is more complicated and risky than the original.
Why Are Women More at Risk for Knee Surgery?
Arthritis is the biggest factor causing knee joint damage extensive enough that a replacement is warranted, and women are more likely to suffer arthritis than men. The CDC notes that between 2013 and 2015, about 26 percent of women reported being diagnosed with arthritis, compared to 19.1 percent of men.
Other factors such as obesity, genetics, and age also increase risk for osteoarthritis, but just being a woman automatically puts you at risk for the disease, especially after the age of 50. The knee is particularly vulnerable—while men are more likely to experience arthritis in their hips, women are more susceptible in their knees and hands.
One reason is biology. Women’s tendons in the lower body are more elastic, which tends to make the knee joints less stable than men’s. Women’s hips are wider than the knees, so their joints aren’t aligned as straight as men’s, putting more stress on the joints and making them more prone to arthritis and to knee injuries, as well. In fact, according to researchers from the University of Texas, female athletes are 1.5 to 2 times more likely than their male counterparts to injure their knee ligaments.
Another reason is hormones. Osteoarthritis is much more common among postmenopausal women than younger women, leading researchers to believe that the hormone estrogen affects risks somehow. Though they don’t have all the answers yet, they believe that estrogen protects cartilage in the joints from inflammation, and that once estrogen levels drop after menopause, that protective effect dwindles.
Finally, body weight plays a role. Obesity increases risk because the excess weight puts pressure on the joints and increases the rate of wear and tear. Unfortunately, statistics show that more women than men are obese or severely obese, with belly fat being the worst for knee joints.
7 Ways to Help Prevent Knee Surgery
If you end up having to have knee replacement surgery, odds are it will be successful and will help you enjoy a high quality of life for years to come. Manufacturers are also paying more attention to women’s needs, and are designing implants that better fit a woman’s unique anatomy.
If you’re not sure if you need surgery, there’s one reliable gauge you can use: your level of pain. Studies show that even though more women than men are getting joint replacements, doctors are less likely to recommend them to women, and women usually wait longer before agreeing to the surgery.
That means it’s up to you to be honest with your doctor about your pain level. If it gets to the point that you can’t control it with pain medications, physical therapy, injections, or weight loss, it’s time to do something to help you enjoy life again.
If you’re not there yet, though, it’s time to think more about taking care of your knees. Sometimes the progression of arthritis makes surgery inevitable, but it’s possible to adopt lifestyle habits that help preserve the health of the knee joint and reduce or at least delay your risk for having to undergo replacement surgery.
- Maintain a healthy weight: We know overweight and obesity increases pressure on joints and accelerates damage. Do your best to maintain a healthy weight. Losing even five pounds can make a difference on your knee joints.
- Build muscle: Women often have weak thighs, which according to a 2017 study, increases their risk of knee osteoarthritis. Lead author Dr. Adam Culvenor stated: “Our results highlight the importance of maintaining thigh muscle strength to reduce the risk of knee osteoarthritis development, particularly in women.” Classic exercises to increase thigh muscle strength include squats and lunges, but if you do them wrong, you can put pressure on the knee. Try instead seated leg presses, leg extensions and curls with ankle weights, step-ups (stairs work well), static squats (where you squat and hold rather than go up and down), and straight-leg raises with or without weights. Biking is also a great exercise for building up thigh muscles.
- Use more joint-sparing exercise: If you’re a runner, you have to weigh the benefits against the risks. Running is one of the best exercises you can do to keep your weight under control and your heart healthy, but it can also be tough on your knees. You don’t need to stop, but you may want to consider making it easier on your joints. Run on soft, flat surfaces, make sure you have well-cushioned shoes, and consider breaking it up with other types of exercise. Run twice a week, for example, and bike three times a week, or swim some of your days. Try to create a more balanced exercise routine.
- Check your feet: Your feet support your entire body. If they are misaligned somehow, that misalignment will travel up to your knee joints and cause damage. Our feet continue to grow and change as we age, so make an appointment with your podiatrist to be sure you’re doing everything you can to keep your body in alignment and the pressure off your knees. Inserts may be helpful in supporting aging arches or painful heels. You may also want to cut back on the amount of time that you wear your heeled shoes—they are a common cause of knee pain.
- Stretch: The muscles in your legs, if they are too tight, will create a taut pressure on your knee joints, leading to pain and long-term damage. Yoga is a great way to stretch these muscles, but any kind of stretching helps to maintain flexibility and keep tight muscles from pulling on your knees. Stretches that focus on the hamstrings, quads, and calves are best for this area.
- Get enough vitamin D: Vitamin D is key to preventing arthritis, but studies show that women aren’t getting enough. Get outside for at least 10 minutes of sun exposure on most days, or consider a supplement. (Read why women need to get their vitamin D levels checked now here.)
- Drink water: Joints are largely made up of water, which is what tends to make them “cushiony.” When you’re even slightly dehydrated, your body can steal the water it needs from your joints, so keep water with you throughout the day and drink regularly.
Megan Brooks, “Knee Replacement Rate Nearly Doubles in U.S. from 2000 to 2010,” Medscape, September 2, 2015, http://www.medscape.com/viewarticle/850467.
“Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000-2010,” CDC, August 2015, https://www.cdc.gov/nchs/data/databriefs/db210.htm.
Hilal Maradit-Kremers, et al., “Prevalence of Total Hip (THA) and Total Knee (TKA) Arthroplasty in the United States,” Presentation at: American Academy of Orthopaedic Surgeons Annual Meeting; 2014; New Orleans, LA, http://www.abstractsonline.com/plan/viewabstract.aspx?sKey=8aee1902-36d1-4626-9e3b-3fb48ce6bb61&cKey=cbe5d81e-5b06-4de5-9dda-7d7b4c599010&mKey=4393d428-d755-4a34-8a63-26b1b7a349a1.
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