Q: Thirty years ago I had torn cartilage in my knee and I had the old-time surgery with a big scar and they removed the cartilage. I did really well for about 25 years, but over the last five years I have developed a lot of pain and it has begun to limit my ability to get around.

When it started to hurt five years ago I had arthroscopic surgery that helped a little bit for about six months but it wore off. I have a lot of difficulty going up and down stairs, and getting up out of a chair and out of a car.

I saw an orthopedic surgeon who said that I need a knee replacement. I am only 55 years old and wonder: if I had a knee replacement now, how soon I would have to redo it and does it work well in people my age?

A: Generally, the indication for a knee replacement is not based on X-ray or an MRI scan but on the patient's symptoms. When a patient reaches the point that they can no longer live with the pain, sleep at night or function with the activities that they need to do, this is the point that a knee replacement is usually indicated.

When patients come to my office asking if they need a knee replacement, my answer is, you and your knee will tell me when it is time. That is the point when a knee replacement should be performed.

We tell patients that the average knee replacement lasts approximately 10 years before it wears out or loosens to the point that it may need to be replaced.

However, with newer operative techniques that are less invasive and the improved quality of the implants, the knees being put in today may in most circumstances last a lot longer. However, only time will tell whether these advances can allow the knees to last many, many more years. Your activity demands, age, weight, degree of deformity and surgical technique all affect the longevity of the knee replacement as well.

If you have failed at other, more conservative treatments such as anti-inflammatory medication, cortisone injections, Visco supplementation or rehabilitation, and have reached the point in which pain has seriously impacted your lifestyle, then you would be a candidate for knee replacement surgery.

If you are still unsure you might also want to get a second orthopedic opinion as to best treatment options.

The Jock Doc column runs every other week.

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