The knee joint consists of the distal end of the thigh bone (femur) and the proximal end of the lower leg bone (tibia), with the kneecap (patella) in front. The bone surfaces of the components of the normal knee joint are covered with a smooth, pliable layer of hyaline cartilage that allows the joint to move freely. When diseases such as osteoarthritis and rheumatoid arthritis occur in the knee joint, the articular cartilage degenerates and peels away, bringing the bone underneath the cartilage into direct contact with the bone, resulting in severe pain. In addition, the joints can become deformed, bone redundancy can form, stiffness can occur, daily walking and going up and down stairs can be difficult, and joint pain can be felt even when sitting or lying down. If pain is not effectively relieved by taking pain medication, reducing activity level, or using crutches, artificial joint replacement may be considered. By removing the worn cartilage surface and encasing it with a metal surface, artificial knee replacement can effectively relieve pain, correct deformity, and help patients resume daily activities. It is currently the most effective means of treating advanced arthritis, and one of the most important technological breakthroughs in the field of orthopedics in the 20th century. In recent years, with the rapid advancement of prosthetic materials and surgical techniques, the postoperative effect of arthroplasty has also been significantly improved, and is now commonly carried out at home and abroad, with about 580,000 knee replacements performed in the United States each year. Since artificial knee replacement is so effective, isn’t it true that the earlier the surgery is performed, the better the results? For most diseases, the earlier an effective treatment is applied, the better the outcome. However, unlike artificial knee joints, which have a certain service life, wear and tear, loosening and other problems can usually occur about 15-20 years after surgery, just like the wear and tear of car tires after a certain number of kilometers, which need to be replaced. At this time, the artificial knee joint revision surgery, but the revision surgery is more difficult, and the postoperative effect is inferior to the first surgery, generally only used for a small number of patients with surgical failure. For young patients, due to greater and more intense joint activity, joint wear is also faster; and the life expectancy of young patients exceeds the service life of the prosthesis, which makes revision surgery unavoidable. Therefore, for a long time in the past, most doctors believed in the principle of “one operation, lifelong benefit”, and thought that the appropriate age for joint replacement should be over 55 years old. As a result, some patients with knee degeneration under the age of 55 were rejected for knee replacement because they were “too young”. However, in recent years, with the continuous improvement of artificial joint materials and surgical techniques, the service life of artificial joints and postoperative efficacy have been significantly improved. Some young patients who have undergone total artificial knee replacement due to severe destruction of the knee joint in rheumatoid arthritis have also achieved good long-term outcomes. In the past, pain relief was the main purpose of knee replacement, but in modern life, patients, especially young patients, pay more attention to the function of the joint after replacement, and the function of the joint after surgery should not only meet the needs of daily life, but also be able to engage in sports, leisure and other activities, and it is believed that “Quality of life is more important than quantity of life. They believe that “Quality of life is more important than quantity of life.” (The quality of life is more important than the length of life). Therefore, as long as young patients have a reasonable expectation of the postoperative outcome, understand that strenuous joint activities can accelerate joint wear, and learn to use artificial joints correctly in sports and leisure activities, then young patients should be encouraged to choose artificial joint replacement surgery to improve their quality of life and enjoy a rich and colorful life. There are sometimes heated debates between those who emphasize that “not too young for surgery” and “quality of life is more important”. The following is a request for help from a family member of a patient on the Internet, and the responses of various doctors, patients, or family members, which may be useful to you as you consider the timing of surgery. Helper (Ms. Yang): My husband is 46 years old and has suffered from excruciating pain in his knee since he became ill. He has tried almost all kinds of treatments, such as traditional Chinese medicine, physical therapy, painkillers, cartilage nutrients, joint injections, and so on, but the pain has made every step he takes difficult. The doctor who saw us was a well-known joint surgeon who said that the only way to solve the problem completely was to have an artificial joint replacement surgery, but only when my husband was over 50 years old. We asked if there were any other methods, and the doctor said that we could have an osteotomy and corrective surgery, which means that the bone would be cut off, straightened, and fixed with a steel plate, which would delay the artificial joint surgery by 10 years, but this surgery was much more difficult than the joint replacement surgery. My husband was too scared and confused to have this surgery. But it also meant that he would still have to walk with a limp in severe pain for the next few years. It’s hard to watch him in so much pain…does anyone have any advice? One doctor’s answer: 46 is too young for knee replacement surgery. The reason is that people at this age have a lot of activities, the prosthesis is easy to wear and tear, the service life is shortened, and in the future, they have to do artificial joint revision surgery. However, revision surgery is difficult, the result is not as good as the first surgery, and it is also prone to complications. Personally, I suggest that anti-inflammatory pain medication and intra-articular injection of sodium hyaluronate should be used to relieve the symptoms. The osteotomies and orthopedic procedures that you mentioned are also not effective in all cases of arthritis. So, your husband will have to weigh the joint pain against the possible complications of artificial joint surgery. If artificial joint replacement is chosen, there is no turning back. My opinion is that your husband is too young to be a good candidate for artificial joint replacement surgery. A patient’s response: I would like to talk about this from a patient’s perspective. I am 44 years old and I am just 5 weeks out from artificial knee replacement surgery. I think it depends on the doctor when to have the surgery. Some doctors told me I must wait until after 50, but I was reluctant. At the time, I was losing so much of the joy of life by having to curl up on the couch or in bed after work each day, watching my two children jump around and play, and not being able to spend time with them. I tried intra-articular injections, anti-inflammatory painkillers, physical therapy, etc. None of it really worked, but it did buy me 2 years, and now I’m finally having joint replacement surgery. My doctor told me that the life of an artificial joint depends on how you use it, usually 15 to 20 years. I suggest you find another doctor to look at it. Answer from another patient: I think quality of life is more important than longevity. If your husband is in so much pain that his daily activities are limited, I would recommend an artificial joint replacement. I had an artificial knee replacement at the age of 27 for knee arthrosis and secondary osteoarthritis. At that time, my quality of life was greatly affected, and I also hesitated for a long time before making up my mind to have the surgery. Many specialists told me a great deal about the risks of surgery and advised me against it. But I am glad that I met a doctor who agreed that “the quality of life is more meaningful than the length of life”, supported my decision, and operated on me. I’m not asking for my life to become as exciting as my peers, but I’m very happy that the pain in my joints is significantly reduced. I am considering when to have knee surgery on the other leg. Response from the third patient: I am 43 years old, I had my artificial knee joint replaced 3 months ago, and I am now able to enjoy life again! I think it’s better to get the surgery if the joint hurts to the point where the only thing you do for a living every day is take painkiller pills! I can now ride my bike and go shopping in the street. I have never regretted having the surgery. This shows that once knee arthritis reaches an advanced stage in young patients, artificial total knee replacement is still one of the most effective treatments available. Other alternative treatments such as oral anti-inflammatory painkillers, intra-articular injection of sodium hyaluronate, physical therapy, and even osteotomy and orthopedics are often just “a drop in the bucket”, and can hardly achieve the goal of improving the patient’s quality of life. Some patients who have been treated conservatively for a long period of time even suffer from severe muscle costly atrophy of the lower limbs. However, the higher daily life needs of young patients and the longer use of joints also put forward higher requirements for surgical techniques and artificial joint materials. For this reason, in general, the timing of artificial knee replacement surgery should be considered in terms of the patient’s degree of knee injury, daily life needs, correct understanding of the use of artificial joints, and the surgeon’s mastery of the theory of artificial joints and surgical techniques. In our opinion, age is not an absolute determinant of surgery. Patients who meet the following conditions are eligible for total knee replacement surgery. (1) Age greater than 55 years old, knee pain, ineffective conservative treatment, with obvious joint space narrowing. (2) Patients younger than 55 years old with bilateral knee pain, ineffective conservative treatment, and significant joint space narrowing. (3) Age less than 55 years old, rheumatoid arthritis of the knee joint, ineffective conservative treatment, with obvious joint space narrowing. (4) Age less than 55 years old, traumatic arthritis, ineffective conservative treatment, with obvious joint space narrowing. Young patients should fully understand how to avoid high-intensity knee activities in daily life and sports to prevent excessive wear and destruction of the artificial joint before total knee replacement. At the same time, better wear-resistant artificial joint prosthesis and experienced surgeons should be chosen as much as possible. And follow up regularly in the hospital after the surgery, so that you can get good knee function improvement in a quite long period of time (20-30 years).