Do you need that knee replacement, or is there another way?

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By the year 2023, total knee replacement surgeries are projected to grow by more than 600 percent to 3.5 million procedures per year.

While nearly half of all American adults develop knee osteoarthritis in at least one knee during their lifetime, is replacement surgery the only answer?

How can you determine if you’ve reached the point of requiring knee replacement surgery? Some experts are now questioning if knee replacement surgery is being done too soon on patients, before they’ve had a chance to explore other options.

“We’re seeing arthritis at an earlier age," orthopedic surgeon Dr. Mathew Pombo said. "So, having alternatives and ways to treat arthritis is important.”

One option is losing weight. Sometimes, this can significantly decrease knee pain. Pain relievers, anti-inflammatory drugs, or corticosteriods are all less invasive treatment options than surgery.

If these aren’t giving you results, get gel injections directly into the knee joint to lubricate it. Exercise and physical therapy should also be tried if you want to exhaust all other options first.

“I think people have to weigh every option and what’s best for themselves,” Pombo said.

Up to 20 percent of patients end up dissatisfied with the outcome of their surgical procedure. This is why it’s vital you understand the clear benefits and harms of knee replacement surgery, because the recovery is no walk in the park.

Currently, around 12 percent of adults in the U.S. have painful arthritic knees that limit mobility, and each year more than 640,000 have them replaced at a cost of well over $10 billion a year.

Experts say knee replacements last between 10 and 20 years, so delaying your surgery is sometimes your best option.

REPORT #2598

BACKGROUND: By 2030, total knee replacement surgeries are projected to grow 673% to 3.5 million procedures per year. Nearly 1/2 of American adults develop knee osteoarthritis in at least one knee in their lifetime. Knee replacement surgery is one of the most common bone surgeries in the United States. It can help ease the pain caused by severe arthritis. It also may help you move more freely. U.S. doctors perform more than 600,000 knee replacement surgeries each year. During surgery, an orthopedic surgeon carves away the damaged part of the knee and replaces it with an artificial joint made of metal or plastic. The artificial joint is then attached to the thigh bone, shin, and kneecap with a special material such as acrylic cement. Osteoarthritis is the main reason why people go for knee replacement surgery. The age-related condition is very common and occurs when cartilage, or the cushion between the knee and the bone joints, breaks down.
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ALTERNATIVES TO SURGERY: According to the John Hopkins Arthritis Center, being just 10 pounds overweight can add up to 60 pounds of force on your knee with each step. A physical therapist can design a regimen that reduces pain and strengthens the key muscles that affect your knees. They might also try electrical stimulation, ultrasound therapy, or other procedures that can increase blood flow to the skin, helping to reduce pain. Knee injections of hyaluronic acid lubricate the knee joint and help improve shock absorption. Prolotherapy is an approach that uses an irritant solution, most commonly dextrose, injected into the ligament or tendon to increase blood flow and supply of nutrients. This treatment aims to irritate the tissue to stimulate the healing process. A surgeon may suggest arthroscopic surgery to remove bone fragments, pieces of torn meniscus, or damaged cartilage, as well as repair ligaments. Injection of an osteoarthritic knee with plasma-rich protein (PRP) is an experimental treatment. Platelets containing growth factors are separated via centrifuge from blood supplied by the person undergoing the procedure. These platelets are then injected into the knee joint. It has been reported to help with pain relief, but not to regenerate cartilage. Mathew Pombo, MD, Orthopedic Surgeon at Emory Orthopaedics and Spine Center says, “Stem cell injections and platelet rich plasma as emerging biologics injections in the world of regenerative medicine are being studied at Emory as promising options.”

ADVANCES IN SURGERY: “Even with tiny incisions, replacing a knee means cutting bone and inserting implants,” notes Kristoffer Breien, MD, knee surgeon with Summit Orthopedics in Minnesota. “We dislocate the knee, cut multiple ligaments and bone, and remove unnecessary meniscus.” The move toward smaller incisions began to reduce pain. Today, anesthesiologists use a nerve block approach for even more pain control. “Selective longer-lasting nerve blocks around the knee can last up to two days following surgery,” explains Dr. Breien. “These blocks interrupt the message sent by angry nerves to the brain. During surgery, we also have longer-acting Novocain to numb all of the tissues that we cut.” This multimodal pain management approach reduces use of morphine for pain relief. “Morphine is effective,” says Dr. Breien, “but it comes with unpleasant side effects.” The first 24 to 48 hours following surgery are fairly pain-free. Patients benefit from local anesthetic in the tissues and nerve blocks. Multimodal pain management make the first one or two days of recovery a much more comfortable experience.