3 science-backed ways to avoid a knee replacement

Every year, more than 700,000 Americans undergo knee replacement surgery. And researchers expect the procedure will only become more common as people strive for an active, pain-free life as they age.

People usually get a total knee replacement when they’re no longer able to move through their daily life without constant pain. But, how can you build healthy, strong knees today that power you through walks and workouts for decades?

The Washington Post spoke with physicians and researchers in rheumatology, orthopedic surgery and physical therapy about ways to reduce your risk of knee osteoarthritis, the painful, degenerative disease that is the most common reason for replacing the joint. You develop osteoarthritis when the smooth cartilage, or tissue, covering the ends of the bones in a joint gets damaged and erodes over time.

Some things are out of your control, such as the shape and angle of your joint or your family history of osteoarthritis or rheumatoid arthritis, experts said. And a traumatic knee injury such as an ACL tear can dramatically raise your risk of arthritis later in life.

There are medications to treat the inflammation and pain, and knee braces can be used to shift the load on the joint. But experts agreed that one of the most effective ways to lower your risk of osteoarthritis is to reduce the load on your knees by maintaining a healthy weight.

“Your weight has a huge impact,” said Andrew Pearle, a sports medicine surgeon at Hospital for Special Surgery in New York. “You lose 10 pounds — that’s 100, 150 pounds off your knee when you’re running.”

Here are a few other steps you can take to keep your joints healthy as you age.

Stay active and keep moving those knees

“Motion is lotion,” Pearle said. The best way to keep the joints healthy as you age is by bending your knees. The movement helps to circulate fluid around the joints, Pearle said. “The more you move it, the better,” he said.

Walk around periodically throughout the day, said Daniel White, an associate professor of physical therapy at the University of Delaware. “Walking is the most commonly employed exercise people can do to become stronger and reduce pain,” he said.

Even if you already have early-stage osteoarthritis, studies show walking can help.

White is the lead author of a 2015 study of people mostly in their 60s who were at risk for or already had knee arthritis. He and his colleagues concluded that walking 3,000 steps a day should be the minimum goal and increasing it to 6,000 steps a day is ideal in terms of maintaining greater overall physical function. (In broad terms, about 2,000 steps is the equivalent of walking a mile.) And, every additional 1,000 steps a day seems to help, as well.

“This is really magnified if you combine the exercise with weight loss,” White said. “It’s that one-two punch that really sets people up to mitigate the pain and difficulty walking.”

The way you walk and how you point your toes can add to the load on your knees. But there’s no perfect gait, and you need to consult a physical therapist to determine whether or how to change your gait.

Strengthen the muscles that support your knees

Our risk for knee pain and osteoarthritis rises as we get older, said Leena Sharma, the Chang-Lee professor of preventive rheumatology at Northwestern University. And “it becomes critically important to do strengthening exercises,” she said.

Your hip and leg muscles help support the load on the knees, said Ewa Maria Roos, a professor of physiotherapy and musculoskeletal function at the University of Southern Denmark. Simple weight-bearing exercises such as squats or lunges maintain or build the muscles to stabilize the joint.

All the experts we interviewed said they regularly do some form of strength training to build and maintain their muscles. Roos said you can do strength training workouts during the week so you have the muscles to support the activities you enjoy on the weekend.

Try low-impact sports

People are often afraid that recreational sports and physical activity will make their knee pain worse, Sharma said. But the movement will do more good than harm, she said.

Despite what you may think, “osteoarthritis is not a ‘wear and tear’ disease,” said Steve Messier, professor of biomechanics at Wake Forest University.

Loading the knees through physical activity provides “the mechanical stimulus” required to consistently rebuild the cartilage in the knee, Roos said. And avoiding movement out of fear only exacerbates the problem with your joints, she said.

For athletes playing sports such as basketball and soccer, where you’re often changing directions, there are drills to rehearse agile movements performed in competition with the correct form and control, Pearle said.

Exercises include single-leg hops, squat jumps, tuck jumps and skater hops — movements where you’re practicing how to land and change direction, Pearle said.

Pearle helps patients with early knee arthritis to transition to low-impact sports such as biking or swimming, so they can keep moving on vulnerable joints. He considers a sport “high-impact” if the activity requires both legs to be off the ground at any point of time — when jumping or running, for example.

“The people with the healthiest knees are the Europeans who are biking up and down the Alps,” Pearle said. “You see 90-year-old guys with huge quads and great looking knees.”

When you start moving your knees more, your joints might feel sore after you exercise, Sharma said, and you may ask yourself: “Am I making it worse?”

Sharma has asked herself that question as she navigated her own knee trouble, she said. And a physical therapist can be “an outstanding guide” to help you determine what’s normal and when to push ahead, she added.

Knee pain comes and goes, but it’s important to not be afraid when you do feel pain or stiffness, Roos said.

“There are days when I feel a little swelling or a little bit of pain,” she said. “What I typically do on such days is some strength training — and that helps.”