Caring Medical - Where the world comes for ProlotherapyBeing forced to wait for knee replacement is painful, significantly deteriorates your condition, worsens your knee pain

This article gives options for patients in pain who are given various reasons why knee replacement cannot be performed for them at this time. Researchers have noted that patients who are too young, do not have sufficient structural damage to get a knee replacement at this time, or are simply waiting a few months until their doctor can be available for the surgery, suffer from severe symptoms and pain. Most of these patients rely on painkillers and cortisone to get them through until surgery. We know that pain is a progressive disorder, which means that by not doing anything you are still doing something…you allow the joint to continue to degenerate. While this may not affect the surgeon who is waiting for one reason or another to perform a replacement surgery (as explored below), it can be devastating for patients who are suffering and becoming more disabled, taking excessive medication to get by, and dealing with the depression and isolation that comes with battling chronic pain. However, this does not have to be the fate of all patients who were told they eventually need a knee/joint replacement. Degenerative conditions (osteoarthritis, for instance) need regenerative treatments. Thus, in many cases, the ideal intervention is actually not surgery but regenerative options that can repair the joint non-surgically.

Patients waiting for knee replacement are usually waiting because:

  1. They have no insurance. A typical total knee replacement surgery can run $50,000. That is for the surgery alone. There is also rehab, physical therapy, medicines, and hopefully no complications.
  2. They have great insurance or medicare. They just have to wait until the doctors are available. Waiting list times can vary depending on the doctor’s office. After the initial appointment and an agreement is made to have the knee replacement it could take 1 to 3 to 6 months to complete the “countdown to surgery.”
  3. They have insurance but are told by their doctors that they are too young, they need to hold out until they get older so they will not need another knee replacement later in life. This is covered at length below. They have a lot of health issues that make the knee replacement riskier. Those health issues have to be dealt with. Heart disease, diabetes, and obesity are among the known risk factors, especially in the aging group.

Waiting for knee replacement – the burden excessive wait times had on patients

In one study, doctors from Laval University in Quebec wrote in the medical journal Rheumatology about 153 patients who had been given a date far in advance for their total knee replacement. What the doctors wanted to study were the changes in pain, function, and quality of life and the burden excessive wait times had on these patients.

Here is what they published:

Overall, subjects suffered a significant deterioration of their condition while waiting, in terms of knee pain, contralateral knee pain, functional limitations, and quality of life.(1)

The problem is compounded because one of the factors that will give a patient pain after knee replacement, is the poor management of their pain before the surgery. Read more Pain After Knee Replacement.

Waiting for knee replacement because you are too young is painful and may lead to lost time at work.

A study we frequently reference from doctors in the United Kingdom examined various patient experiences leading to and after knee replacement surgery. The research appeared in the British Medical Journal.

The British doctors found patients were frustrated with lack of treatment:

  • The majority of younger patients perceived that their “young” age to be a major barrier to getting a knee replacement. This despite the severity of symptoms and the subsequent impact on their quality of life.
  • Patients reported that they needed to adapt to prolonged periods of worsening physical function, limited mobility, and instability. Others reported the psychological impact of living with severe constant pain as a dominant factor.
  • As symptoms persisted and increased in severity, patients reporting having no choice but to take time off from work.(2)

Please see our article How fast can I return to work after knee replacement?

Researchers in the Journal of Arthroplasty wanted to know if insurance coverage was a determining factor FOR THE DOCTOR

Researchers in the Journal of Arthroplasty wanted to know if insurance coverage was a determining factor FOR THE DOCTOR, as a deciding factor for who would be prioritized to replacement surgery:

“Our objective was to compare the availability of hip and knee arthroplasty (replacement) to an adult insured by Medicaid and by private insurance.

All orthopedic surgeons’ offices in a South Florida county were contacted by telephone and presented with a hypothetical patient that needed either a hip or a knee arthroplasty for end-stage arthritis.”

The average time until the appointment was longer for patients with Medicaid when compared with private insurance

Two scenarios were presented.
The hypothetical patient was presented as either having private insurance or Medicaid.

  • 14.3% of all offices contacted offered an appointment to patients with Medicaid coverage for hip and knee arthroplasty, respectively. All offices offered an appointment to patients with private insurance.

“The mean time until appointment was longer for patients with Medicaid when compared with private insurance. Adults insured with Medicaid currently have limited access to total joint arthroplasty within the studied community.”(3)

In another study, researchers noted in The Journal of arthroplasty: “A total of 1120 consecutive patients were asked what they believed a surgeon should be paid for performing hip and knee replacement surgeries….Most of the patients stated that Medicare reimbursement was “much lower” than what it should be. Many patients commented that given this discrepancy, surgeons may drop Medicare, which may decrease access to quality hip and knee arthroplasties.”(4)

Waiting for knee replacement because of out-of-pocket costs

Total Knee Replacement procedures can cost an uninsured patient in the tens of thousands of dollars, for the Medicare patient out of pocket costs may reach into the hundreds of dollars, for the privately insured patient the out-of-pocket costs depends on your insurance coverage and can range from the thousands to tens of thousands. Patients are always recommended to check with their insurance carrier prior to surgery to get estimated out-of-pocket expenses.

Patient education – the longer you wait for knee replacement the less likely you will want it.

Researchers from four universities including the University of Ottawa, the University of Montreal, the University of Toronto, and the University of Chicago, published research in the medical journal Osteoarthritis and Cartilage. In this study, the researchers say more patients, when given educational aids and time to think about the benefits and side effects and complications of knee replacement, opted out of getting the knee replacement (compared to a control group). 

Please read Research on Alternatives to Knee Replacement Surgery for more on that research.

If you have a question about knee replacement options, get help and information from our Caring Medical staff.


1. Desmeules F. The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery. Rheumatology (2010) 49 (5): 945-954. [Google Scholar]

2 Bardgett M, Lally J, Malviya A, Deehan D. Return to work after knee replacement: a qualitative study of patient experiences. BMJ open. 2016 Jan 1;6(2):e007912. [Google Scholar]

3. Lavernia CJ, Contreras JS, Alcerro JC. Access to arthroplasty in South Florida. J Arthroplasty. 2012 Oct;27(9):1585-8. doi: 10.1016/j.arth.2012.03.014. Epub 2012 May 2. [Google Scholar]

4. Foran JR, Sheth NP, Ward SR, Della Valle CJ, Levine BR, Sporer SM, Paprosky WG. Patient perception of physician reimbursement in elective total hip and knee arthroplasty. J Arthroplasty. 2012 May;27(5):703-9. [Google Scholar]

5. Perruccio A, Power J, Evans H, Mahomed S, Gandhi R, Mahomed N, Davis A. Multiple joint involvement in total knee replacement for osteoarthritis – effects on patient-reported outcomes.Arthritis Care Res (Hoboken). 2012 May 8. [Google Scholar]

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