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I need some help deciding about a knee joint replacement. I have arthritis in several joints. The rheumatologist has not been able to control the pain with medications. She has suggested I have the knee replaced. The orthopedic surgeon is not in favor of doing the surgery. How do I decide what to do?

It's often the case that physicians with different backgrounds make different recommendations for their arthritis patients. But experts say the decision to have a joint replacement shouldn't be made based on the type of physician you are seeing.

It would be much better if patients were selected for joint replacement based on a list of standard criteria that all physicians can agree on. So far patient factors to guide this decision haven’t been identified. Recently a group of doctors at the University of Minnesota tried to pinpoint patient factors that would help guide the decision about who should or shouldn't have a joint replacement.

They found that expert opinion on the need for surgery did vary from physician to physician. Orthopedic surgeons were more likely to suggest ongoing conservative care before doing surgery. They are more likely to know what problems can occur after surgery. They want to make sure the patient should have the operation and that the results will be successful.

If your orthopedic surgeon is not advising surgery, find out what he or she thinks your treatment options are at this time. Perhaps a different drug or combination of medications would help. Physical therapy may be another treatment option. It’s best to try every avenue first before the more permanent surgical approach.

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