Getting Disability Benefits After Knee Replacement Surgery

Orthopedic surgeons perform over 700,000 knee replacements per year in the U.S., and the vast majority are successful. In partial or total knee replacement surgery, plastic and metal parts replace damaged tissues and bone of the knee joint. Recovery time generally varies from a few weeks to a few months, but complications may make recovery take longer. If you've had knee replacement surgery on a knee with degenerative joint disease—or after a bad knee injury—and it wasn't successful, you may be able to get Social Security disability benefits.

When Knee Replacement Surgery Is Unsuccessful

Most people under 55 or 60 recover from knee replacement surgery sufficiently enough to go back to work within a year (which means they won't qualify for Social Security disability benefits). But there are cases where the surgery wasn't successful and the patient was left with a knee that is still painful or still doesn't function well. Most patients with chronic knee problems who go through surgery do benefit from reduced symptoms, but sometimes the improvement isn't enough to return to work.

Other times, complications from knee surgery prevent a person from working. Difficulties following total or partial knee replacement surgery can include chronic pain, loss of range of motion, locking/clicking, stiffness, and reduced mobility. These problems can be caused by infection in the joint, a defective prosthetic (artificial) joint, or loosening of the bond attaching the implant to the bone. Often these types of complications require a second surgery, called a "revision," which can add many months to the time off work.

How Social Security Determines If You Were Disabled by Knee Replacement Surgery

In deciding your claim, Social Security will look to see if you meet the criteria for one of its "medical listings," in which case you'll automatically get disability benefits, or whether it needs to look at vocational factors, like the type of work you can do. In either case, you need to be off work for at least 12 months, though this can include time leading up to the surgery as well as the recovery time.

Qualifying Under the Medical Listing for Surgery of a Major Joint

Social Security evaluates knee surgery complications by looking at the following medical "listings" from its listings of impairments:

• reconstructive surgery of a major weight-bearing joint, or
• abnormality of a major joint in any extremity.

To meet either of these listings, your knee problems must cause you extreme difficulty walking or climbing stairs.

Specifically, to be found disabled under the reconstructive surgery listing, listing 1.17, you must submit the following evidence to Social Security:

• documentation that you had knee surgery on one or both knees (partial or total)
• evidence from your doctor that you have difficulty moving because of your knee problems, and
• documentation that you can't walk without the assistance of a walker, crutches, two canes, or a wheelchair.

Note that this listing doesn't apply to knee replacements that fail years after surgery. Many knee replacements do loosen or deteriorate over time, sometimes requiring a second surgery, but this often doesn't happen until years after the first surgery. To qualify under this listing, you have to be able to show that your difficulty walking started soon after your knee replacement surgery (following a reasonable period of recovery and rehabilitation).

If you have pain and trouble walking years after surgery, you could qualify for benefits under the second listing, listing 1.18, for abnormality of a major joint. This listing requires you to have:

• some type of abnormality in your knee that's seen at a physical exam or on x-rays or MRIs
• a history of joint pain or stiffness
• instability or a loss of normal motion in the joint, and
• an inability to walk without a walker, crutches, two canes, or a wheelchair.

Qualifying Under the Medical-Vocational Guidelines for Knee Problems

Many people with knee problems—even those with failed knee replacement surgery—won't meet the requirements of the listings above, even if they feel unable to work because of severe pain. For instance, if you need one cane to walk, but not two, or you don't use a cane to walk but you have severe pain when climbing stairs, you're unlikely to meet Social Security's listings. But that's not the end of the disability determination. Social Security must then look to whether you can go back to your prior job in your present condition.

To determine your current capabilities, Social Security will create an RFC ("residual functional capacity") for you—what you can do physically despite your limitations. For example, if you have serious knee problems, your RFC might say that you can't:

• stand for more than two hours a day
• climb a few stairs at a reasonable pace while using a handrail, and
• walk on rough or uneven surfaces at a reasonable pace.

Social Security will compare the limitations in your RFC to your past job requirements to see if you can still do the work.

Whether You Can Return to Your Prior Line of Work

If your prior job was sedentary (an office job, for instance), it's more difficult to receive benefits, since it's less likely that your knee problems prevent you from going back to sedentary work. However, even work that is labeled sedentary can require up to two hours a day of walking or standing, so you may not be able to go back to your prior job if your doctor says you can't walk or stand for up to two hours every day. If Social Security agrees, it will grant you benefits.

On the other hand, if your past job required lifting 50 pounds or more, kneeling, squatting, crouching, and/or crawling—or standing for up to six hours a day— Social Security is more likely to agree that your knee pain or instability will prevent you from returning to your former job. In that case, Social Security will consider your exact age, skills, and education to see if you could be retrained for a more sedentary job—that is, if the agency thinks you can do sit-down work. For more information on this subject, see our article on how to prove you are too disabled to do a sedentary job.

How Timing Issues Affect the Disability Decision

When you file a disability claim after knee replacement surgery, Social Security will generally assume that the outcome of your surgery will be positive and that you'll be out of work for six months at most. As a result, Social Security denies many knee replacement claims for not meeting the 12-month duration requirement. However, if your knee impairment or pain prevented you from working in the time leading up to surgery, the time you were unable to work pre- and post-surgery could easily add up to a year. Or, if you are still recovering from a difficult surgery or surgeries nine or ten months later, Social Security may accept that you're going to meet the 12-month requirement.

If you do recover from knee surgery enough to work while you're still waiting for a hearing, but after being off work for 12 months, you could get benefits for a "closed period"—a period with a fixed end.

In any case, Social Security will wait to make a disability decision until you have had ample time to recover from the surgery and attempt to rehabilitate your knee. If you are approved for benefits, your case may be labeled "expected to improve." This means your case will likely be reviewed within a year or two after your benefits start.

What Evidence Does Social Security Need?

You or your doctor will need to submit medical records showing your knee diagnoses, any x-rays or MRIs, and surgical and post-surgical notes. It also helps to have your doctor fill out a "medical source statement," or an RFC form stating which movements you have difficulty with. Your RFC form should cover the following issues:

• how long you can walk and whether you need to use a cane, crutches, or walker
• whether you can walk on uneven surfaces
• how long you can stand
• whether you need to elevate your legs while sitting
• whether you can crouch, stoop, kneel, or bend
• whether you can lift or carry heavy objects, and
• whether you can climb stairs alone or with the use of a railing.

Social Security will also want to see what treatments you have tried post-surgery, such as pain medication, physical therapy/rehabilitation, and therapeutic injections. It's important to let the agency know whether there are any medications you can't take because the side effects affect your ability to function well.

Make sure that you also provide a report or diary about how your chronic pain impacts your activities of daily living—such as driving, housekeeping, grocery shopping, or socializing—as well as activities that require concentration, so that the SSA can consider these limitations when deciding your claim. And if you take suffer from anxiety or depression due to chronic pain, Social Security should consider this in combination with your knee impairment.

How to Apply for Disability After a Failed Knee Surgery

If you're applying for Social Security disability insurance (SSDI), you can file your claim online on Social Security's website. Applying online is generally the fastest way to apply for benefits, but you can fill out the application at your own speed. Most individuals filing for SSI only can't file the entire application online, but they can get started on Social Security's website.

If you're not comfortable online, you can call Social Security at 800-772-1213 to start your claim. For more information, see our article on applying for Social Security disability benefits.

If you'd like help with your application, consider working with an SSDI expert. According to a survey of our readers, applicants who filed an initial application without expert help were denied 80% of the time. Most disability lawyers and advocates will give you a free phone consultation to determine whether your knee problems are severe enough to qualify for benefits.

_{Updated September 24, 2021}