Let’s face it; you are being lied to by the medical establishment in league with marketing departments and newspapers. It wasn’t a good idea to get a knee replacement at 40 twenty years ago and it still isn’t .

Recently a Spokane Newspaper ran a story about a mother who received a knee replacement at 40 in glowing terms. Let’s dissect this article to find the mischaracterizations and errors being promoted that could really cause you harm down the road.’

Lie Number One

It’s really common now for younger people to get knee replacements so it’s no big deal  

“Twenty years ago, the median age in the class was over 80,” said Payne, a registered nurse. “If you were 50, they wouldn’t even look at you. Now, it’s not uncommon to see younger people in the class,” she said.

While it might be more common now, it is still very unwise. From the article you can learn that people younger than 65 represent the fastest growing group of patients and we are told specifically that this increase is NOT because that demographic is being targeted with marketing. Really?

You are told that the majority of these patients have had previous athletic injuries and that some have had previous surgeries. Having arthroscopic surgery has been linked with an increased likelihood of eventually having knee replacement surgery, which should tell you something about the wisdom of seekng surgical interventions to your knee problem in the first place.

The story’s surgical hero shopped around until she found a someone who would perform the surgery on a 40 year old, so we know that there are still other surgeons with common sense who will not perform the surgery for those under 50. The other surgical hero had her replacement at 45 after being finally convinced by her husband to go ahead with the procedure.

Under the headline, ‘It was definitely worth it’  we read that “the life expectancy of artificial knees has increased”, and that our surgical superhero expects to get at least 20 years from her new knees.

According to the American Association of Hip and Knee Surgeons,  “Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years.

That sounds great right? However that data has been compiled on a population of 60-80 year olds who are much more sedentary than the young surgical candidates being discussed in the article.

Lie Number Two

The rehabilitation is no big deal. 

From the article’s sidebar more cheerleading can be found: “Ten years ago, people would spend at least three or four days in the hospital after a total knee replacement.

Advanceknee replacement madnesss in care have cut a typical stay to one or two days, [mostly because of cost saving measures for the insurances/hospital not because it’s the best thing for the patient] said Dr. Jonathan Linthicum, co-medical director of Kootenal Health’s total joint replacement unit.  In some cases, patients are cleared to leave the hospital within 23 hours. [This isn’t the hard part because early pain relief is generally quite good. It’s switching over to oral formulations that can be difficult.]

Better pain control [There is no magic bullet pain control method and most being used have been around for a while] allows patients to stand on their new knee joint the day of surgery, which reduces the risk of blood clots, Linthicum said. [We have been standing patients the day of surgery to prevent blood clots for a long time.]

Post-surgery recovery takes three to five weeks, but it varies by patient. [This is a very rose colored view and in fact our surgical hero had her second knee replacement surgery March 1 and according to the article is still ” moving carefully” about 9 weeks later.]

“Some people come walking in at two weeks and say, ‘Thanks Doc. That was great, ‘Linthicum said. “Others are still getting their range of motion back at six to eight weeks.”

Don’t be fooled, this puff piece could have been written by the marketing department of the hospital and would be more appropriate on the hospital’s website than a newspaper. There is no critical reporting at all.

If you or someone you know has been told that you are a candidate for knee replacement at 40, don’t just blindly trust they have your best interests at heart.

Consider the following scenarios:

You have a knee replacement at 40 years old and need to have a revision within 5 years because of an implant failure. At 50 you need a third surgery because your activity levels are much higher than previous knee replacement recipients. Will you be a candidate for a 4th surgery at 70 and how well will the implant take? Will you have any bone left?

Knee replacement surgeries soar to over 3 million a year in 2030 as projected but the government no longer has the money to perform them at such a high volume; you are required to fork out a 50% co-pay for your revision or even worse are denied surgery.


Michelle, PT
Michelle, PT

Michelle Stiles called "the no nonsense" therapist, by her patients, created a company called Cowboy Up Recovery after recognizing the bankruptcy of the present medical model. Too many people regard conventional medical wisdom as gospel, ignoring the subversive influences of Big Pharma and Big Medicine. She believes, Americans in general are being trained from an early age to defer to experts in numerous areas of life and losing the impulses for self-responsibility and self-reliance in the process. Over-diagnosis and over-medicating has become endemic. While thankful for the best miracles of modern medicine, she encourages people of all persuasions to listen to their bodies and seek out answers to maintain not just an absence of disease but optimal health. Her advice is: Cowboy Up, no one cares more about your health than you do.

    31 replies to "It Wasn’t A Good Idea 20 Years Ago and It Still Isn’t"

    • Sandy

      So just be in horrible pain and not have quaility of life instead…much better option for an active 44 year old right?!

      • Michelle, PT

        No Sandy
        That is not the answer. The latest research implicates low grade inflammation as a driver of OA. I just finished writing my latest book Bone on Bone Under Age 65: A Wake Up Call, Not a Prescription for Surgery. If you email me I will provide you a complimentary digital copy. It may give you insight to other things that you can try first. I’d love for you to read and give me your honest feedback.

        • Ali

          Hi Michelle, I’ve just turned 41 and have a lot of knee pain when I move fast, go down a set of stairs and take exercise classes. I want to be more active but it does hurt. I’m not overweight (normal BMI) and just had R hand surgery 3 months ago to fix the bone on bone issue (left hand pending). I couldn’t believe how such a short surgery on my hand became so debilitating for so long. I’m afraid I’m unfortunately headed down the surgical path for my knees and I’m so bummed about it. Until then I’ll withstand the pain for as many years as I can before undergoing any procedure for knees.

          • Michelle, PT

            Thanks for reaching out. Instead of try to respond in detail here. I am going to send you a digital copy of my new book Bone on Bone Under Age 65: A Wake Up Call Not a Prescription for Surgery. I really believe there is some great information in there that will help people just like you. The latest research implicates low grade whole body inflammation as a driver of OA. Please read the book and let me know what you think. I would love to have your feedback! Thanks

    • Ronni

      I was 46 for first tkr and 4 yrs later it failed
      Had revision but took a yr plus medical intervention to gain acceptable range of motion
      PT was worthless. Swimming did help. Plus exercise in pool
      I’m now .post 20 yrs on knee and it’s in bad shape
      Thinking about doing it again. Or just getting a scooter. !

    • P Gray

      Great article and agree with majority of it. I’m 43 had a failed osteotomy and told require full knee replacement.

      Thing is what are we meant to do..so much pain, lack of mobility, government dont want to assist regarding disability. There aren’t many options to be fair?

    • Brandon

      At age 39 I have been through the gambit of options, PT, cortisone, uflexa, CBD, acupuncture, and probably a few I haven’t thought of. I have spiraled into a constant state of pain and am planning to have TKR next year, but am scared as hell of that too. I just have lost hope in any other option, so am hoping for relief, but know there are risks

      • Michelle, PT

        Brandon,
        I sent you an email please check that for some information.

    • Teesha Mott

      Ok so what about people like my husband he is turning 42 and can’t do regular daily things like grocery shopping. After wearing full body armor during 2 tours overseas, jumping in and out of trucks daily, his knees are shot and his VA doctors have done it all. They have already told him you need you knees replaced BUT you have to wait until your 50. 8 years doesn’t seem long right? Wrong! Now because of his lack of mobility he is over weight, so they want him to lose the weight by getting up and walking, riding a bike, exercise. But his knees are the reason things have gotten this way. So why are they still making him wait?

      • Michelle, PT

        Hi Teesha,
        Sorry about the delay in reply but I have been very busy lately. I did want to respond to you however. You mentioned that “after wearing full body armor during 2 tours overseas etc your husbands knees are shot. Here is a thought… were the WWII guys knees “shot” when they got back? I’m not trying to be snarky either. Our knees are meant to take a beating and still be able to keep up with the needed repair. I am going to send you a link to my pre-publication book as a jumping off point for other thinking about other alternatives and I would like to recommend Andreas Moritz book The Amazing Liver and GB Flush. You can find it on Amazon. Military personnel are subjected to many many toxins. A liver cleanse is one of the first things I would do if I were in your husbands shoes. It will help kick start wt loss as well without exercises. Watch your email for digital book. Best Regards

    • Tim Fulmer

      I am curious about you thoughts. Please send me a copy of your paper on Bone on Bone Under Age 65. I am 52 and generally very healthy. The exceptions being my left knee (bone on bone) and my left shoulder (which is in need of reverse total shoulder replacement – to early in life however – MD wants to wait until I am at least 60). I can deal with the shoulder as it just hurts. As for the knee, it is becoming very limiting and, therefore, very frustrating. I play golf, snow ski and surf. It is particularly limiting as in terms of the first two activities. I used to run and now my doctor says do not even use the eliptical (which I replaced running with 5 years or so ago).

      Any thoughts would be appreciated

      • Michelle, PT

        Hi Tim,
        Please check you email as I am sending you a copy of the pre-publication Bone on Bone Manuscript. It should be a great jumping off point for you to explore other options.

    • Lou Hoskins

      Would like your advice: Im 65, fighting osteoarthritis a decade, did all the conservative things( wt loss, knjections, stem cells, PT). Ive lost 40 of 80 lb overweight. My rt leg valgus is geting worse. Im bone on bone and knee stiff. Weird thing is my pain is less now than a yr ago but doc saying I need TKR and not doing surgery will cause more harm. Is this true?

    • Zach

      Michelle- I am a 44 year old active male who is doing everything I can to avoid an early-age TKR. I have had 5 arthroscopic surgeries on my right knee due to infection complications from an original ACL reconstruction. I’m interested to hear your opinion about subchondroplasty procedures. Any thoughts?

      • Michelle, PT

        My concern Zach would be twofold. Will the subchondroplasty endanger the TKR result later and will it endanger longevity. Here is a very small study (22 subjects) with limited follow up (2-5 years) https://www.ncbi.nlm.nih.gov/pubmed/27430180 so I think the jury is still out for this procedure, perhaps your surgeon would have access to other trials but it may just be too early to tell. Partial knee replacements are known to increase the complexity of TKR later on and is the reason I rarely recommend them. I sympathize with your situation as injury related knee damage is less amenable to correction via dietary changes as is osteoarthritis related to metabolic syndrome. I wish I had better news for you.

      • Nicole Sullivan

        Zach , I unfortunately have the same story . Four surgeries in a year with two infections . Initial surgery was from tearing my ACL while skiing . What did you end up doing? I limp and can’t walk well , I’m in hell . I need a knee replacement but I’m freaked out to do it . Just wanted to know how your journey is going ?

    • Rajat Grover

      Hi Michelle
      My cousin brother who is just 42 has been diagnosed with OA grade 4. He is a bit overweight bmi 30. Doctors have recommended for a TKR but we don’t want to go for a surgery because of the foresaid complications at such a young age. Please suggest alternatives

      • Michelle, PT

        Rajat,
        Having early OA is a wake up call. Essentially the whole body is aging too fast. There are many diet and lifestyle changes that can help reverse this trend.
        Please check your email.

    • Justin Richter

      Hello Michelle,

      I’m been reading your articles and comments and I would like some guidance.
      I’m a 43 yr old man who is quite active. I trail run a few times a week, crossfit and powerlift 4 times a week. My knee has been in pain for over 5 years and I thought it was just a meniscus tear. After x-ray and MRI, Dr. said bone on bone with little cartilage left and a tkr recommended after 50, any advice would be greatly appreciated.

      • Michelle, PT

        Here is a quote from recent article about arthroscopy surgery
        https://www.baxterbulletin.com/story/life/health/2019/03/26/arthroscopic-surgery-and-osteoarthritis-knee/3270529002/
        “The second study focused on the effectiveness of arthroscopic surgery in repairing a torn or damaged meniscus. Researchers performed an MRI the right knee of 1,000 subjects between the ages of 50 and 90. Thirty-five percent of participants had significant meniscal tears that increased with age. The tears were more common in men.
        Remarkably, 61 percent of those with significant tears reported no pain at all, thus indicating that the mensical tears may not be caused by injury, but rather by the usual wear and tear on the knee that accompanies advancing age. Simply put, the tear in the meniscus may not be related to any arthritic pain and therefore arthroscopic surgery will likely be of little value in treatment.”

        The conundrum that abnormal imaging studies can’t predict pain is not well known but a widely repeatable finding by many researchers studying different joints. If an imaging study can’t predict pain in the first place you CAN’T use it to explain pain after the fact. Follow the logic?
        I have more in my book that I will send you.

        In short, for some reason thought you thought you had a meniscal tear (symptoms, “the PT told you”, imaging study?) and have had pain x 5 years following this regime trail run a few times a week, crossfit, and powerlift 4x/wk.

        Perhaps you are bone on bone, but I wouldn’t put too much stock in it. I would treat it like a meniscal tear..which for me means to baby it and let the thing heal. So off loading it is super important even to the extend of using a cane for a period of time. I don’t know if it hurts all the time or just after workouts and that would make a difference in what I recommend.

        Compression and aggravation of the joint space should be limited during this period. Don’t use the that leg as your power leg on stairs, of course you are going to have to cut out your routine. Remember this is only for a period of time. You want to see if lowering the stress will allow the delicate structures the freedom to heal and you should notice the difference gradually.
        I injured my own meniscus about 10 years ago and it healed very well by following that approach. It took about 6-8 weeks. I have no ongoing pain problems with that knee.

        I understand that stopping exercise will seem awful but you can do your own test on whether given a true rest, things could improve. That scenario is much preferred over an early TKR.

        I hope that helps a little. Look for an email from me.

    • Mark

      Hello Michelle,
      56 year old male, BMI in “healthy” range (22.1). Had meniscus surgery 38 years ago at 18.
      Reading that wasn’t the right thing, but back then they thought it was.
      I try to stay active and have set routine of
      day 1 cardio -45 minutes stair climer, day 2 cardio 3-5 miles on treadmill, day 3 resistance weights. day 4 – rest.
      Seen doc today. Bone on bone. Asked how the pain was. It varies. Said I’ll need knee replacement inevitably (5-7 years) What can I do to postpone/eliminate the need for the surgery? Thanks in advance for any advice.
      Mark

      • Michelle, PT

        Mark, are there any exercises that make your knee hurt more than others? Eliminate them at least for a time period to assess overall pain levels.
        Generally things that involve a deeper knee bend are more stressful on the cartilage. The stair climber might be an issue depending how deep your step is. Also the resistance training.. are there any squats or deeper knee flexion movements? Avoid those. Look for all sources of pain like improper footgear, running on the side of the road, hill running.

        The other thing to address is an inflammatory diet which is not helpful to overall knee health. Now generally this is more an issue for those with bilateral knee pain but I still would try to see if you could coax some knee improvement out of a better diet as well.
        My comments on the last post apply as well Imaging studies are not destiny. Look for an email

    • Penny

      I had a snow skiing accident when I was 17. Since I have had multiple surgeries with the last being in 2012 when I had an ACL reconstruction with an allograft. My knee was hurting a little so I went in for a check up. I was told I had stage 3 osteoarthritis and the only thing for me is a total knee replacement. I am 48. Yes, I have some pain but it is tolerable. I received a corticosteroid injection as I want time to think about it. Please advise as I really would love to have other options.

      • Michelle, PT

        Hi Penny,
        Imaging studies show very poor coorelation with pain complaints. Since your knee is only “hurting a little,” I would proceed according to your pain levels and not worry about what the x ray said. You may be starting to get some arthritis but there is some research to suggest that lowering saturated fat and omega 6 Fatty acids like those found in vegbtable oils/processed food/fast food while increasing omega 3 fatty acids like those found in oily fish may slow progression of OA. Here is the link to this study which deals specifically with arthritis caused by injury https://www.ncbi.nlm.nih.gov/pubmed/25015373. There are many studies linking dietary change and inflammatory OA.

        They have also done studies with dogs who have OA and they have shown improvement with the change in fatty acid concentration described above. Bacially the omega 6’s are thought to be more inflammatory while the omega 3’s are anti-inflammatory and thus protective for your knee(s). I hope this helps. Keep checking back to site. I will be uploading a lot more information in the weeks to come.

    • Rodney

      Hi Michelle,

      I’m a 43 year old male diagnosed with bilateral, severe, tri-compartmental, OA of the knees. I’m still losing wait to meet the surgeon’s requirement for BMI. Obviously, the only option for me is total knees, right? The x-rays show terrible bone-on-bone. I keep trying to find articles/research/etc online for someone in my situation. Do you have anything you could email me or direct me to? This is awful. I’m using a cane but could actually be using a walker. I use acetaminophen/NSAID’s and diclofenac and ice wraps for pain control. No opioids. Thanks for any input.

      • Michelle, PT

        Hi Rodney,
        I would like to give you a copy of my prepublication book Bone on Bone Under Age 65 a Wake Up Call not a Prescription for Surgery [I emailed him a copy]

        The important thing to know is that xrays do not correlate well with pain or dysfunction, but obviously you are in a lot of pain. What dietary changes have you already made? Really that is the key. It is hard to have a healthy knee in an unhealthy body.

        There is a ton of evidence supporting diet and exercise lowering pain levels and improving function. And plenty more evidence implicating low grade inflammation causing your body to age too quickly.

        The difficult thing for most people is that they think of their knees like brake pads on a car… once they are “worn out” total knee is the only option.

        The body is an amazing healing machine and if we give it the right tools it automatically starts to work back toward health.

        It’s not easy to transition to live unprocessed unboxed food, I think it is worth it to try a 6 -12 month trial in order to save your knees.

        I’m going to be running a yr long program for people like yourself who want to avoid surgery. It focuses on habit change, customized supplementation and Range of motion first and exercises when able to start. if at the end of a year you still need surgery. you’ll be a whole lot healthier.

        Here is a page to learn more. https://procoach.app/michelle-stiles

        I would also recommend the Book Treat Your Own Knees by Robin Mckenzie.
        These are basically the rom exercises we start with especially with someone like yourself who is in so much pain.

        Don’t give up.. if you have a will to try to do it without surgery then try. It won’t be easy but neither will a possible third surgery on that leg in old age.

        I once knew a women who was quite heavy from an early age and she had knee pain in one knee (i was pretty sure it was just a cartilage injury. She went to an orthopedic and he took x rays and told her both her knees were shot and that she needed them both replaced. She was in her late 30’s or early 40’s.

        So of course you would never replace a knee that was asymptomatic. I’m just telling you that story so that you realize the lack of congruence between imaging studies as an explanation for your pain. Maybe your knees look like her knees on the inside but that is not the reason for your pain. Her knee pain eventually resolved like I thgt it would because a cartilage tear does heal on its own. especially in someone so young. She eventually got bariatric surgery and massively changed her diet and is doing very well with her own knees!

        I hope this helps a bit Rodney. I am starting a Natural knee Pain rescue Q & A group on FB. FB Q &A grop

        It’s just getting ramped up so no action right now but hopefully will soon be a place to ask questions and be encouraged by others on the same journey as you!!!!

    • SK

      Greetings Michelle,
      I’ve had an incredibly long knee hx. I’m 38 and hyperextended my knee 3.5 years ago. In two scopes they discovered three chondral defects down to the bone-medial, lateral and trochlear. They recommended a MACI, TTO, and lateral retinacular release surgery to replace the cartilage and avoid a knee replacement. I had this done in dec 2016. Unfortunately I had TONS of complications and was significantly worse after the procedure. I’m almost two years post MACI now, and still can barely walk 1-2 miles. The medial lesion overgrew, and I developed a lot of scar tissue. They debrided that last aug. the pain went from a odd the chart pain can barely walk, to about an 8-9. Still very high. Then they suspected scarring around my nerves. So they went in this April and sure enough found scar tissue around my INFP branch so they cut that. Since the neurectomy I can at least do ADLs again and go grocery shopping and manage the pain enough to go for small walks. Prior to MACI I could still walk 3-5 miles, but stairs were basically impossible. The MACI has basically inhibited my walking since I’ve had it and basically disabled me. I’m still working because I have a job where I sit. But my quality of life has been devastated. I used to trail run and hike 5-10 miles every single day before the hyperextension injury 3.5 years ago. Now I can still barely walk one mile. It’s crushed me. I still bike and swim so that’s good. Thankful for it. The docs now are telling me I have a new osteophyte and more arthritic changes on my patella. I never used to have pain on my patella, but I can barely get into full extension due to the sharp pin and crepitus issues- probably more scar tissue from all these stupid surgeries (5). They say they can’t do much more for me and I have to just live this way now. I felt crushed after my last visit. The last thing I want is another surgery- but I don’t know how else to get my patella to track better too. I’ve been with pts for the last 3 years. I go regularly. I see acupuncturists, chiropractors, I do FSM, light therapy, ultrasound, laser, taping, graston on these areas. I do tons of guided imagery, mirror therapy, meditation. I just want my life back. They’re saying I may just need a total joint replacement which I’m also super wary of because apparently I do not respond well to major surgeries. I know some people become completely disabled from TKRs as well. So if you have any other advice, I’d greatly appreciate it. Thank you so very much. ~SK

      • Michelle, PT

        Shannon,
        Sorry to hear your story. I am not at all sure why you would have needed a TTO and lateral retinacular release with an inital hyperextension injury. The MACI makes sense with the noted chondral defects, but as I’ve said elsewhere beware that “defects” found on xray may not be causing the pain being experienced. Unfortunately, the TTO and lateral release have altered your patella mechanics. Ok so what to do? You mentioned having tried most of the available “physical” treatment options. What is your diet like? While there is not much on this topic of inflammation and progression of OA from injury/surgery. There is one article that I know of that discusses the role of dietary Fatty acids, Omega 6 vs omega 3 as a benefit for injury type OA. https://www.ncbi.nlm.nih.gov/pubmed/25015373. I would certainly supplement with fish oil and eat oily fish like salmon but that won’t help much if you diet is full of omega 6’s. I would also test your hs-CRP levels to see if your whole body is inflammed. Fixing that would definitely assist your bodies own self healing mechanisms.

        In combination I would try a 30 day restriction on anything that causes the knee to flare up limiting longer walking biking, stairs etc and sticking only with water therapy. Can you get the persistant pain to lower any little bit with that? If so keep going until you plateau with improvement. It takes time to heal especially a knee so inflammed due to so many surgeries over a relatively short period. I am also checking into something else for you but will not know the outcome of that for a bit. Let me know how things are going.

    • Cherry

      How I wish I had thought more about knee replacements before getting my second. I had the first TKR in my early 50’s because one of my bones at the knee died(?) and broke so I am guessing there was no other option. A year later I had the second knee done when I suffered the same pain but to be honest I am not sure exactly what was wrong. i just took the doctors advise. While it helped the pain I had before the TKRs I have had a different type pain in both ever since with one knee being worse than the other. It’s been 10 years and the pain has gotten worse and I no longer trust myself on steps because it feels unstable. I am really not sure what direction to go in especially because I have had such a bad experience from the initial TKRs. I am terrified to think of more surgery.

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