Are you afraid of your knee pain and complications it may lead to particularly as you grow older? Are you afraid of hearing the word Knee Replacement, thinking that it might lead to surgery in your case too?
Well, it is important to understand the causes of your knee pain and what may lead to a Knee Replacement Surgery which is a final treatment option left out after all possible treatment options. Let’s explore the key causes of knee pain and different treatment alternatives to knee replacement that can be followed depending on the health condition that is causing the knee pain and its stage.
What can cause knee pain and ultimately lead to Knee Surgery?
Knee Pain is one of the common health compliant reported by many patients of all age groups. There are many conditions that may lead to knee pain ranging from simple accidental injury which can lead to a tear in knee ligaments or cartilage. Other clinical conditions that result in knee pain may include infections, gout, bursitis, and arthritis. Knee pain that is caused due to simple injury or strain can be well treated with some self-manageable remedies.
Read More: 10 common causes for chronic knee pain
In contrast to simple injuries and strains, chronic health conditions such as arthritis can lead to severe and long term knee pain. When knee pain is felt for a long time along with sensitivity or swelling in one knee or both knees, it is referred to as chronic knee pain. Mentioned below are the possible causes of chronic knee pain.
- Rheumatoid arthritis (RA)
- Chondromalacia patella
- Baker’s cyst
- Meniscus tear
- Ligament tears
- Bone tumors
Knee pain caused as a result of any of these conditions can be treated with some treatment options that can be alternatives to knee replacement particularly if the conditions are at their initial stages. Knee Replacement should be the final option once all the possible treatment options are exhausted. Let’s look into some knee replacement alternatives advised based on the stage of the medical condition and severity of the issue.
What are the health issues that lead to Knee Replacement ultimately?
Osteoarthritis is one of the leading causes of disability in even developed countries like the United States where age and obesity being the main two causes that trigger the condition. Osteoarthritis (OA) is one of the most possible health conditions that lead to knee replacement if not treated well on time. Osteoarthritis is a degenerative disease that affects major joints in the body especially knee joints which are known to be the largest bone joint in the human body.
Apart from Osteoarthritis, Rheumatoid Arthritis, Arthritis, fractures, ligament tears or cartilage tears caused due to some trauma may also lead to irreversible knee joint degeneration over years which may lead to severe knee pains. Several alternative methods to treat knee pain can be tried instead of going for a knee replacement surgery which should be a final option. Let’s explore the available options as an alternative to knee replacement surgery.
What are the Stages of Osteoarthritis?
Osteoarthritis can be split into different stages depending on the severity and symptoms felt by the patient.
Stage 0 or Normal Stage
In fact, this is the stage with no pain and no symptoms of Osteoarthritis and no damage to the knee joint which doesn’t require any treatment.
Stage 1 or Minor Stage of Osteoarthritis
This can be considered as the actual initial stage of OA. Minor bone spurs or damage to knee joints begins at this stage, but there is very little chance of experiencing the symptoms, like pain and discomfort.
At this stage of OA, doctors, in general, recommend a regular exercise to benefit knee joints and some supplementary medication like glucosamine and chondroitin if required based on the patient’s condition.
Read More: Top 10 Home Remedies For Knee Pain
Stage 2 or Mild Stage of Osteoarthritis
This stage is referred to as the mild stage of OA and there might be significant growth of bone spurs which can be revealed X-rays. Still, there would be a normal gap between the knee bone joints and there is no scraping or rubbing of bones on each other. The synovial fluid which helps to keep a natural joint motion is also being at a normal level. A patient may experience symptoms like –
- Pain after walking or running
- Heavy stiffness in knee joints when they are not used for several hours
- Tenderness in knee joints while bending or kneeling
Read More: 5 Simple Exercises for Knee Pain Relief
Treatment options at Stage 2 Osteoarthritis:
This is the right stage to begin the treatment to avoid further complications. Doctors might be able to detect the symptoms and diagnose the condition. If the condition is concluded as early stages of Osteoarthritis, a treatment plan would be designed based on the patient’s condition.
Weight Loss as Alternatives to Knee Replacement:
Obesity and degenerative diseases like Osteoarthritis have a complex relationship. It is believed that overweight or obesity can act as both a trigger for osteoarthritis and a risk factor for the faster degeneration of the joint. Excess weight puts greater pressure on a joint that is already undergoing damage due to Osteoarthritis.
Weight loss by following a controlled diet plan and regular exercise is recommended in the case of overweight patients. Regular exercise not only benefits overweight patients but also benefits that are at normal body weight.
Physiotherapy as Alternatives to Knee Replacement:
Physiotherapy can be considered as the first line of defense in Osteoarthritis management. Osteoarthritis is such a condition that weakens the knee joints if overused but at the same time, the condition gets worse if the joints are used very less. Physical therapy helps teach certain exercises that strengthen the supporting muscle groups surrounding the knee joint. Chances of avoiding knee replacement are high if the physical activity is started at the right time well before the condition worsens. Physiotherapy teaches to do flexibility and stability exercises along with some physical therapy treatments like cold therapy, heat therapy, and hydrotherapy. Swimming is one more helpful activity that helps to maintain healthy joints without putting much pressure on the joints.
Low Impact Exercises as Alternatives to Knee Replacement:
Low impact aerobic exercises and strength training may be advised to strengthen the muscle groups that support the knee joint. This would help to increase stability and minimize the possibility of further damage to the knee joint.
Knee Braces as Alternatives to Knee Replacement:
Patients at this stage may be advised to avoid activities like jumping, kneeling, and squatting. Further doctors may recommend knee braces to stabilize the knee joint, and also recommend using insoles to minimize the pressure that is put on the joints.
Read More: Knee Brace for Osteoarthritis
NSAIDs as Alternatives to Knee Replacement:
Doctors may recommend NSAIDs temporarily to relieve knee pains in some patients along with other treatment plans like exercise, weight loss. NSAIDs are not recommended for prolonged usage as they may lead to other health complications like peptic ulcers, liver damage, kidney damage, and cardiac issues.
Stage 3 or Moderate Stage of Osteoarthritis
This stage of Osteoarthritis is referred to as the moderate stage. Significant bone damage at the knee joint is noticed along with narrowing space between the two bones of the knee joint. Patients at this stage experience frequent knee pain while doing activities like running, walking, kneeling and bending. Joint stiffness after long sitting may also be experienced at this stage of OA. For example, they may feel joint stiffness in the morning after waking up. Some patients may also have joint swelling also after extended periods of motion activities.
Treatment options at this stage as an Alternatives to Knee Replacement
Non-medication therapies may not give relief to the patients at this stage, typically in many cases. Doctors may recommend medications like NSAIDs, Narcotics, Corticosteroids or Viscosupplements for such patients to whom the treatment methods that worked earlier are no longer benefitting them.
NSAIDs as an Alternatives to Knee Replacement
Depending on the severity of the patient’s condition the doctor may prescribe medications like NSAIDs to relieve the knee pain on a temporary basis. Even though the NSAIDs are over-the-counter medications they are not recommended to use for the long term due to the possibilities of side effects and other health issues such as stomach irritation, GI bleeding, risk of heart attack and blood clots.
Narcotics or Opioids as Alternatives to Knee Replacement
If the patient is no longer getting benefitted by the NSAID drugs, the doctor may prescribe the next level medications like narcotics such as Codeine and Oxycodone. These medicines are also recommended to use on a short term basis only and can help relieve moderate to severe knee pain caused at this stage of Osteoarthritis. Long term usage of these medicines may result in addiction, hormonal problems, cardiac issues, depression, mood swings. Hence they are not advised for long term usage.
Corticosteroids as an Alternatives to Knee Replacement
Corticosteroid medication includes a hormone called Cortisone. Cortisone is also produced in our body as a natural hormone by the adrenal glands that are situated at the top of each kidney. This hormone has certain actions to take part in our body and also may result in some issues if the production of this hormone is in imbalance. Corticosteroids are prescribed for two reasons in the case of Osteoarthritis; they are anti-inflammatory and immunosuppressant in nature. Anti-inflammatory property is one among its benefits which led to the discovery of synthetic Cortisones called Corticosteroid drugs. They are known to benefit the inflammation when injected at the OA affected area. Corticosteroids are available in several types like –
Even though they benefit in reducing the inflammation of the knee joints in the case of Osteoarthritis, the administration of these medications has to be limited as it can cause more damage to the cartilage if used more frequently. Depending on the patient’s condition and severity of the Osteoarthritis doctors suggest the dosage and frequency. It is not advised to take more than three to four shots in a year and not more than one shot in a period of 6 weeks. Long term usage of these medications is not recommended due to the possibility of severe side effects.
Viscosupplements as an Alternative to Knee Replacement Surgery
Viscosupplements are another option available in the form of injections to benefit the patients who are at a moderate stage of Osteoarthritis. The available options are intra-articular injection of hyaluronic acid which is injected at the knee joints. Hyaluronic Acid is a natural substance available in synovial fluid that surrounds the knee joint which acts as a lubricant and as a shock absorber to enable smooth motion the joint bones. The patient affected by Osteoarthritis would have a low level of this substance in their joints; in the case of Knee Osteoarthritis, they lack it at the knee joint. Injection of this fluid at the affected joint would ease the movement and pain.
Osteoarthritis that is at a moderate level can be treated with this treatment option. In general, three to five shots are given in three to five weeks and this will take several weeks to show the results depending on the severity of the condition. Some common possible side effects like pain, swelling, heat, and redness at the injection site may be seen which may be treated with NSAID medication. Rare allergic reactions may also possible like allergic reactions and bursitis at the site of injection which needs immediate medical attention. Usually, it may take four weeks to show the results of the injection.
Use of Knee Braces as Alternatives to Knee Replacement
There are several advanced models of knee braces that help to reduce the load exerted on the damages part of the knee. There are some models of knee braces designed particularly for mild to moderate osteoarthritis condition. Patients preferring a moderate lifestyle and who are not willing to go for knee surgery may prefer this type of knee braces.
Knee braces can be used even from the initial stage of Osteoarthritis or irrespective of the stage you are. Further damage to the knee joint can be reduced to a greater extent if you start using the Knee braces for Osteoarthritis at earlier stages of Osteoarthritis.
Read More: Knee Brace for Osteoarthritis
Stem Cell Therapy as an Alternative to Knee Replacement
This could one of the advanced techniques that can be used as an alternate option for those not willing to go for knee replacement. But this method is still in experimental stages only and there are very few proven examples. This method uses the stem cell culture from the source cells collected from the Mesenchymal stem cell found in the bone marrow. A lot of advancements are yet to come in the future as technology development happens in the medical field too.
What is Stem Cell Therapy?
Stem cells are special cells that have the ability to transform into other types of cells that form specific tissues or organs in our body. Stem cells have the power to regenerate and make more of its copies through cell division. Stem cells are of three primary types depending on their ability to differentiate into specific types of cells.
- Totipotent – a stem cell that can practically grow into a full human being.
- Pluripotent – a stem cell that can differentiate into literally 200+ different cell types.
- Multipotent – a stem cell that can differentiate into a limited number of cell types.
Totipotent and pluripotent are stem cells of the early embryonic and fetus stage respectively. Multipotent stem cells are adult stem cells that live in different parts of our body and continuously regenerate and differentiate into specific cell types which helps the body make up for the lost cells.
There are over seven different types of adult stem cells. For instance, a Hematopoietic stem cell can differentiate into different types of cells in our blood. Hematopoietic stem cell transplantation is the most widely used treatment approach used since over 30 years to treat patients with conditions like leukaemia and lymphoma.
A Mesenchymal stem cell found in the bone marrow stroma is known to differentiate into bone and cartilage tissue, and fat cells. Depending on the type of stem cell used, a stem cell therapy can be of an embryonic type or an adult stem cell therapy.
Embryonic type uses the pluripotent stem cells that were originally extracted from an embryo, while adult stem cell therapy depends on extracting the adult stem cells from the patient’s body or that of a donor. There’s also a third type called induced pluripotent stem cells (iPS) in which normal cells are induced to behave like embryonic stem cells through DNA manipulation.
Total Knee Replacement is a surgical procedure that remains the only alternative when the knee joints become severely damaged due to disease or trauma. At HealthClues, we are contacted for a second opinion by many patients who have been advised to undergo knee replacement surgery and need a second opinion
In many cases, candidates for knee replacement have advanced arthritis. They may have progressed to a stage where even the smallest movements are very painful. The reviews of their medical records including X-rays indicate extensive damage to the knee joint. They might have already visited a few local doctors and been advised to undergo knee replacement.
However, the decision to undergo surgery is not an easy one. Taking a second or third opinion is an appropriate approach towards arriving at the right decision. One should also ensure that these opinions are not influenced by the first; which is sometimes difficult for a patient. The lack of credible information about the success rate of knee replacement surgeries, the downsides of delaying a needed surgery, and the risk of complications make it harder for patients to decide.
In HealthClues, we encourage and support users to take multiple opinions before they plan to undergo surgery. The benefits of taking a second opinion include being well-informed and aware of the entire procedure. In a few cases, patients may also avoid surgery if his or her condition allows trying out other conservative alternatives. While it is always better to opt for conservative treatment methods, avoiding or delaying a necessary surgery can cause unwanted discomfort.
Here are some reasons that can lead to a wrong decision, delay or even to bypass a suggested surgery.
7 Wrong Reasons Why People Avoid Knee Replacement
Most common reasons behind avoiding knee replacement surgery
1. Overstated Fears
An unproven fear is something that has not been backed by any medical research. However, such fears easily perpetuate a well-connected society like ours. While no surgery is completely risk-free, many advances have been made to reduce these risks.
Global research has credibly established the safety of knee replacement surgeries. For instance, the mortality rate remains extremely rare at 0.01%, 90 days post-surgery, which is 1 in 10,000 patients.1 Risks involving infection of the surgical site are kept below one percent and can easily be managed in most instances. There are few other minor and long-term risks that may lead to unsatisfactory outcomes.
It is a good idea to discuss these risks openly with your doctor. However, patients hesitate to discuss such concerns with their doctors. In the absence of credible information, a patient may feel unnecessary fear about undergoing a required procedure.
2. Over Reliance on Alternative Therapies
The desire to avoid surgery at all cost leads a patient to try other treatment modalities that do not involve surgery, some of which may not be scientifically proven. The list of alternative therapies is a long one, including many herbal therapies, Ayurveda, Homeopathy, stem cell therapy, and physiotherapy based approaches. In some cases, these cures may be genuine and might have helped, provided the disease had not already progressed to an advanced stage.
However, once the disease has advanced, there is hardly any relief from treatments mentioned above. Unfortunately, these patients convince themselves otherwise, in the hope for a non-surgical cure. Hence such patients often end up spending money on therapies that have no real benefit.
3. Cost Concerns
If cost is the primary reason for avoiding a knee replacement then perhaps the patient is not aware of various options available. The cost of surgery depends on many different factors such as the doctor’s and hospital’s reputation, choice of implant, preferences for inpatient services (such as the type of room selected during hospitalization), and the cost of physiotherapy.
The surgery fee can vary among doctors and hospitals, with negligible difference in quality. Similarly, it may be possible to go for an equally good implant that is less expensive. It may be important to discuss whether a person requires a costlier knee implant when a simple implant may be enough.
4. Recovery Concerns
Complete recovery from a knee replacement surgery can take time. One of the issues here is that patients are not adequately informed about the recovery period and the procedure. It may be due to lack of communication from both doctor and patient, leading to two major issues.
- The patient is not prepared to go through the rigors of post-surgery rehabilitation, which can extend from 3-4 months to a year. Rehabilitation requires a patient to work together with a physiotherapist and follow instructions, religiously.
- Lack of understanding of the post-recovery process creates a false impression that surgery has not been successful. When a patient is under the belief that he or she would be able to walk painlessly after the initial recovery period of 3-4 weeks; it leads to disappointment and negativity about the whole process.
The right way to address this, for both the patient and doctor, is to have an honest discussion about the post-surgery recovery process.
5. Delay Would Not Harm
One of the primary reasons for a patient to put off a suggested surgery is to assume that delaying it would not cause further harm. Moreover, that all he or she needs to do, is to bear the pain and try out other alternatives in the hope that something may work out. Medical research has proven that as one’s pre-operative condition worsens due to delay, the chances of success of the surgery also diminish. In a research carried out on 1990 patients, it was found that patients who had scored higher in pre-operative evaluation obtained better outcomes.3
As knee joint damage progresses, it causes further damage to the surrounding soft tissues. When the mobility of a patient is reduced, the muscles that provide strength to the knee joint become weak. It may be very evident that when a particular muscle is not used often, it loses its strength. Medical research has shown that when the pre-operative condition of the joint is not good, the outcome of the surgery gets worse.
There is always a right time for deciding when to undergo a surgery, which is not when one has damaged one’s knees to the extent that mobility is severely compromised. Loss of mobility and a sedentary lifestyle due to pain leads to wasting of soft tissues and muscles around the knee joint.
When one delays a surgery, post-surgical recovery becomes tough, because the body has to rebuild the strength in muscles and other soft tissues.
6. Implant Would Not Last
Barring a few cases, knee implants typically last about 20 years or more with normal usage. The lifestyle of an adult Indian male does not expose an artificial joint to great levels of stress. Many patients fear that the implant will need to be replaced in a few years. Usually, these concerns are based on hearsay about exceptional cases where a revision surgery might have been required. These do not reflect the outcome of most cases.
7. Lack of Good Examples
One of the primary challenges is that majority of the cases of successful knee replacement are not easily accessible. A successful knee replacement patient may not like to reveal that he or she has an artificial joint. On the contrary, if a person has had an unsuccessful replacement, the patient would be a vocal critic of the procedure
A patient’s concern towards going under the knife is but natural. However, doctors need to make sure that the patients are well informed and aware of their condition and the disability it may cause if appropriate intervention is neglected or deferred. Patients should avoid relying on unauthorized information, and should frankly discuss their fears with their doctor. Besides, they should surely take a second opinion and a third, if need be, before going for a surgical procedure.