This is one of the most common questions asked in the rooms, and the answer surprises people. There is no upper age limit for joint replacement. Knee and hip replacements are performed routinely and successfully in people in their eighties and nineties.
What actually matters.
Three things, none of which is chronological age.
Medical fitness for an anaesthetic. This is assessed by an anaesthetist, not guessed at. Heart and lung function, kidney function, diabetes control and frailty all matter. Many conditions that sound prohibitive are manageable with planning: the question is whether the risk is acceptable, and that is a specific assessment rather than a general impression.
The ability to participate in rehabilitation. A knee replacement demands more of the patient afterwards than a hip replacement does. Someone who can follow a programme and has support at home will do better than someone who cannot, and that is more predictive than age.
Whether the symptoms justify it. The operation is offered for pain and loss of function that matter to you. If walking to the letterbox is your world and you can no longer do it, that is as legitimate an indication as being unable to play golf.
The question runs the other way too.
Younger patients ask whether they are too young, and that question has more substance to it. A knee replacement in a 55-year-old will be exposed to more years and more demand than one in an 80-year-old, so the chance of eventually needing a revision is higher. That is a reason to exhaust non-operative options thoroughly and to consider whether a partial replacement is appropriate. It is not a reason to endure years of symptoms that are genuinely limiting your life.
Being honest about risk in older patients.
Older patients do carry higher rates of some complications: delirium after surgery, medical complications, and a longer stay. Those risks are real and they are discussed specifically rather than glossed over.
Several are reducible. Spinal rather than general anaesthesia where appropriate, avoiding unnecessary sedatives and opioids, maintaining hydration, restoring glasses and hearing aids promptly, and getting patients up and moving early all reduce the rate of delirium. Treating iron deficiency beforehand reduces the chance of needing a transfusion.
The risk of doing nothing.
The comparison that gets left out is the alternative. Chronic pain in an older person is not neutral. It reduces activity, and reduced activity leads to loss of muscle, loss of balance, weight gain, poorer cardiovascular fitness and social isolation. Falls risk rises, not falls. The question is not whether surgery carries risk, but how that risk compares with continuing as you are.
How the decision is made.
Together, and with your GP and an anaesthetist involved rather than by a surgeon alone. If the assessment is that the risks outweigh the likely benefit, you will be told that plainly and given the alternatives. Being told an operation is not advisable is a legitimate outcome of a consultation, and a more useful one than being booked for something that should not go ahead.
Common questions.
Is 85 too old for a knee replacement?
Not on its own. Knee replacement is routinely performed in people in their eighties and nineties. The assessment is of medical fitness for an anaesthetic and the ability to participate in rehabilitation, made with your GP and an anaesthetist.
Am I too young for a knee replacement?
Age matters more in this direction. A younger patient places more demand on the implant over more years, so the lifetime chance of needing a revision is higher. It is a reason to exhaust other options and consider a partial replacement, not a reason to live with symptoms that are limiting your life.
What if I have heart or lung problems?
Many conditions that sound prohibitive are manageable with planning. The anaesthetist assesses this specifically. Sometimes optimisation beforehand changes the answer, and occasionally the assessment is that surgery is not advisable, which you will be told plainly.
Will I get confused after the anaesthetic?
Postoperative delirium is more common in older patients and in those with existing cognitive impairment, and it is usually temporary. Risk is reduced by using spinal anaesthesia where appropriate, minimising sedatives and opioids, and getting you up and moving early.
Is it safer to just live with it?
Not necessarily. Chronic pain reduces activity, and reduced activity costs muscle, balance, fitness and independence. The comparison is between the risk of surgery and the consequences of continuing as you are, not between risk and no risk.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.