Have you been told by your doctor or orthopaedic surgeon that your only option to treat your knee arthritis is joint replacement surgery?
Are you worried about the growing number of research reports showing the negative short and long-term effects of this type of invasive surgery?
Or maybe you’ve been told that you need knee replacement surgery but are too young to be offered one yet?
Fortunately, there are many safer knee replacement alternatives out there that have been proven to reverse the effects of knee arthritis and significantly reduce your pain.
Unfortunately, many doctors and consultants in the UK aren’t taught about these alternatives during medical school. Part of this reason is also that the NHS is many years behind the medical advances being adopted in private medicine.
This article will help to equip you with knowledge on how best to approach treating your knee arthritis without surgery.
The following information will be covered:
- What is a knee replacement?
- Negative effects of knee replacements
- Why does knee cartilage break down?
- Non-surgical alternatives to knee replacements
Treatments that repair cartilage:
- Prolozone Therapy
- Dextrose Prolotherapy
- Stem cell injection
- PRP injection
Treatments that don’t repair cartilage:
- Hyaluronic acid injections
- Steroid injection
- Exercise and Weight loss
Surgical alternatives to knee replacement:
- Knee osteotomy
What is knee replacement surgery?
Knee replacement surgery is a procedure that involves replacing an osteoarthritic knee joint with artificial material. The surgery is also known as a ‘knee arthroplasty.’ There are two types of knee replacements:
- Full or total knee replacement – this surgical procedure is only recommended for severely degenerated knee joints that have worn down in more than one part of the knee (medial, lateral, kneecap). It is usually carried out on individuals between the age of 55 and 60 years old.
- Partial knee replacement – this surgical procedure is recommended for knee joints that have only worn down in one compartment of the knee. It is usually carried out on people between the age of 55 and 60 years old.
Negative effects of knee replacements
- A 200-300_ increase in the risk of bleeding stomach ulcers.
- A 3100% increase in heart attack risk for the two weeks after knee replacement surgery.
- Shedding of metal and other wear particles into the surrounding tissue and bloodstream. The long-term effects of these particles are unknown.
- Most patients have pain levels between 2 out of 10 and 5 out of 10 after the surgery.
- Only 50% of patients report significant knee pain relief after surgery.
- It takes between 4 and 6 months to make a full recovery. For some individuals, it can be up to a whole year.
- According to research conducted by Virginia Commonwealth University in America, one-third of knee replacements aren’t necessary. Their research concluded that only 44 percent of procedures are fully justified, after analysing 205 cases of total knee replacements.
These are just a handful of risks associated with knee replacement surgery. One of the other main issues is that material only lasts a decade before needing to be replaced again, a much shorter time than hip replacement surgery. The second knee surgery comes with many more risks than the first. The good news is that there avenues to be explored before having to consider this type of surgery. To be able to fully understand how some of the safer alternatives work, it’s important to first understand how knee arthritis develops and how cartilage breaks down in the first place.
Why does cartilage break down?
Cartilage is a smooth elastic tissue that covers the ends of the bones in the knee.
The primary reason is due to its lack of blood flow. Cartilage is one of the only structures in the body that doesn’t have a direct blood supply. It is the oxygen and nutrients in our blood that help to repair and regenerate damaged tissue in other parts of the body. To maintain it’s health, cartilage relies on the nutrients within the fluid in the knee, commonly known as ‘synovial fluid.’ The problem is, the levels of this fluid start to reduce with age which causes the cartilage to become brittle. As you can imagine, a brittle structure struggles to absorb force as efficiently as a soft structure. This means over time, the cartilage starts to wear down to the point an individual is diagnosed with knee osteoarthritis.
There is another form of arthritis called Rheumatoid arthritis, which is classed as an auto-immune condition. It involves the immune system attacking cartilage to the point of it breaking down.
Non-surgical treatments for knee arthritis
There are two types of non-surgical treatments for knee arthritis, ones that repair cartilage and ones that don’t repair cartilage. The treatments that repair cartilage tend to produce more significant, longer last results, as they are helping to address the root cause of the condition. The treatments that don’t repair cartilage, only help an individual to manage their symptoms.
Treatment options that repair cartilage
Prolozone therapy is a natural treatment that involves the injection of an activated form of oxygen combined with nutrients. As described earlier in this article, cartilage lacks oxygen and nutrients due to the fact that it doesn’t have a blood supply. The activated form of oxygen in Prolozone is called ‘medical ozone,’ which has been shown in studies to stimulate the production of chondrocytes. Chondrocytes are the building blocks of cartilage that help it to repair and regenerate. Alongside enhancing the health of cartilage, Prolozone Therapy also helps to strengthen the ligaments and menisci within the knee joint. Best results are achieved when combined with physical therapy. The treatment is also effective for meniscus tears.
The below video is of a patient of ours who came to the clinic suffering from knee arthritis. They talk about how Prolozone injections prevented them from having to get a knee replacement.
To watch more video testimonials like this one, head over to the review page of this website.
The treatment works in a similar way to Prolozone therapy. The main difference is that it uses a sugar solution (dextrose) instead of ‘medical ozone’ to stimulate healing. Dextrose does this by creating mild inflammation in the injected area to encourage the production of healing compounds. Like Prolozone, dextrose prolotherapy can also improve the health of ligaments and tendons in the knee.
PRP (Platelet-rich-plasma) injection
This type of injection involves the injection of an individual’s own plasma taken from their blood. Plasma is a liquid that helps red and white blood cells move through your bloodstream. The injected plasma contains platelets and growth factors, which express and release substances that promote tissue repair.
The procedure involves your doctor drawing between 15 and 50ml of blood from your vein. The amount taken will depend on the size of the area or the number of areas that need treatment during the procedure. The blood is drawn into special tubes that are placed in a centrifuge. The blood is spun for between 5 and 10 minutes. This process helps to separate the platelet-rich-plasma from the rest of the blood.
Platelet-rich-plasma helps to stimulate cartilage growth through increasing chondrocyte production. It achieves a similar level of results to Prolozone therapy but it is much more expensive for the patient.
Stem cell therapy
A stem cell is a specialised human cell that has the ability to develop into different types of cells and divide. Stem cell therapy is slightly more invasive compared to the other three treatments described above. This is because stem cells need to be extracted from either your bone marrow from your pelvis or from fat cells in your abdomen. The most common and most researched form of extraction is from bone marrow. The harvested stem cells are then injected into the knee to help to grow cartilage. Due to the nature of the procedure, it is the most expensive non-surgical treatment approach which has the most risks attached to it. It can take up to six months to experience knee pain relief.
Treatments that don’t repair cartilage
Hyaluronic acid injections
Hyaluronic acid is a component of our synovial fluid, the fluid that helps to lubricate and nourish our joints. As we age, the levels of hyaluronic acid decrease. As a result, our joints aren’t able to move as freely. A simple injection of hyaluronic acid is able to boost the levels back up to reduce the amount of friction within the joint during movement. Top-up injections are needed to maintain the results. The frequency will be dependant on the severity of arthritis and the age of the patient. Younger patients will experience better outcomes with this treatment. Best results are achieved when it is combined with physical therapy.
A physical therapist will prescribe strengthening exercises for the muscles that attach into the knee, particularly the quadriceps. The aim would be to help provide support and stability during weight-bearing activities such as walking. Strong muscles around the knee can also help to protect other structures from damage such as ligaments, tendons and the meniscus. They may also recommend taking certain supplements such as glucosamine.
Exercise and Weight loss
Non-weight bearing exercises such as swimming and cycling can help to maintain the health of the muscles around the knee and also flush out inflammation. A by-product of exercise can be weight loss which can take pressure and load of the knee joints.
Corticosteroid injections (cortisone)
A corticosteroid injection involves the injection fo anti-inflammatory medication to help to reduce swelling and inflammation in the knee joint. The effect is only temporary and an individual may have to have multiple injections each year. Recent studies at Boston University have shown that cortisone injections can further weaken cartilage and cause damage to the bone. It is important that this treatment should be used as a last resort.
Over-the-counter pain medication or NSAIDs can help with knee pain and inflammation experienced with knee osteoarthritis. Medication should be used as a last resort for joint pain due to the side effects associated with painkillers and anti-inflammatory medication.
Surgical alternatives to knee replacement
A type of knee surgery that involves an orthopedic surgeon cutting and reshaping either the tibia (shinbone) or femur (thigh bone) to take the pressure off the knee. The part of the knee that is cut is filled with bone graft and then fixed in place with a plate and screws. There are two types of osteotomy surgery: an ‘opening wedge’ or ‘closing wedge’ osteotomy.
It takes an individual between 3 and 6 months to walk normally again after the surgery.
The risks associated with a knee osteotomy include:
- Bone infection
- The wedge not healing properly
- Nerve or blood vessel damage
This type of arthroscopic surgery can be used for a range of different orthopaedic conditions. It involves small incisions being made to insert a small camera called an arthroscope and a trimming instrument. When it comes to knee arthritis, it is primarily used to assess the severity of the condition and to cut away damaged parts of the joint alongside remove floating pieces of cartilage. Cutting and trimming the cartilage can often cause imbalances in the biomechanics of the joint during movement. These imbalances can often put pressure on the ligaments of the joint as they are having to work harder to stabilise the joint.
Other risks associated with knee arthroscopy include:
- Blood clot
- Stiffness from scar tissue formation
- Damage to nerves in the knee
- Progression of cartilage damage