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Every step is a reminder of your knee pain.  Physical therapy and steroid injections did not help.  Your doctor is referring you for surgery.  What is knee replacement surgery?  What are the disadvantages of knee replacement surgery? What is the success rate of knee replacement surgery?  What are the alternatives to knee replacement surgery?  Let’s dig in.

What is Knee Replacement Surgery?

Unlike replacing a worn-out part in your car, knee replacement is a major surgery in which the natural knee joint is amputated and a metal or plastic prosthesis is inserted.  The surgery is performed at a hospital or outpatient ambulatory surgery center.  Anesthesia is required which can be either a general anesthetic or spinal block.  Then comes the extensive physical therapy, the time required, and the pain involved.   Do you remember the dreamy advertisements in the doctor’s office and on the internet of patients who have undergone knee replacement?  They are full of smiles, loving expressions, and varying levels of activity from skiing to running.  Are they truthful? Have you looked into the disadvantages of knee replacement surgery?

 

 

Disadvantages of Knee Replacement Surgery

 

1. Replacement Joints Wear Out Requiring Additional Surgery

The truth is artificial knee joints ( prosthesis)  do not last forever.  The younger you are at the time of the knee replacement the more likely you will wear out the artificial joint (1).   This most often requiring additional surgery.  The risks of your knee replacement wearing out increase if you are overweight, do heavy manual labor, run, or play vigorous sports.  Revision rates of about 6% after five years and 12% after ten years are to be expected (2)

2. Deep Vein Thrombosis (DVT)  

This is a serious medical condition in which a blood clot forms in one or more of the deep veins in your body.
This typically occurs in the legs.  The blood clot can travel through the bloodstream into the lungs causing blockage of blood flow.  This is called a pulmonary embolism.   3% of DVT cases are reported during the hospital stay.

3. Anesthesia Complications  

Common side effects include vomiting, dizziness, and breathing difficulties.  Cognitive dysfunction can occur in patients over 60 years of age.

4. Infection

Infection is a serious condition and may involve the skin, muscles, or artificial joint.  Often times the artificial joint must be surgically removed and replaced at a later time after antibiotics.

5. Artificial Joint Becomes Loose or Dislocates

After your ” arthritic” knee is surgically amputated, the artificial joint is inserted and cemented into place.  Unfortunately, the cement does not always hold.  The result is an artificial joint that becomes loose or dislocated.  The treatment often requires another surgery.

6. Differences in Leg Length

Conditions such as knock-kneed and bow-legged are corrected at the time of surgery.  The unfortunate result is a difference in leg length which can aggravate low back, hip, and ankle problems.

7. Allergic Reactions

Artificial knee joints may contain titanium or a cobalt-chromium-based alloy.  The bone cement is a composite epoxy.  Patients can be allergic to the prosthesis, the cement, or both.  Additional surgery is often required.

8. Nerve Damage

Nerve damage can and does occur during knee replacement surgery.  It is estimated to occur in up to 10% of cases.   Common symptoms include numbness, foot drop, weakness, tingling, burning or prickling sensation

9. Damage to Tendons and Ligaments

Ligaments and tendons provide important stability for the knee.  These can be injured during surgery causing pain, restricted movement, and instability.

10. Knee Stiffness and Loss of Motion

Many patients after knee replacement complain of knee stiffness and loss of motion.  Both of which limit activities like walking and playing sports.

11. Wound and Bleeding Complications

A wound may be slow to heal which is common in patients with diabetes or compromised immune responses.

12. Persistent Pain

Despite knee replacement, up to 40 % of patients continue to have ongoing pain (3).

13. Increased Risk of a Heart Attack

Knee replacement patients are 9 times more likely to have a heart attack (4).

14. A Buildup of Toxic Metal Ions in the Blood

Knee prostheses are composed of metals which with wear and tear can leak into the blood creating illness (5).

 

What Is the Success Rate of Knee Replacement Surgery

The best study to date performed on knee replacement is a 2015 RCT that compared knee replacement to physical therapy.   100 patients with moderate to severe knee osteoarthritis were randomized to undergo total knee replacement, or, 12 weeks of conservative treatment including PT, exercises, and diet modification. This showed some interesting things, none of which really support that 90% number (6):

  • 3 in 4 patients in the physical therapy group decided not to get a knee replacement
  • About half of the knee replacement group reported some sort of serious complication
  • While the knee replacement group had better functional improvement than physical therapy in some tests, in others there was no difference
  • You needed to perform 6 knee replacements before one person reported that they had at least 15% better function (this is called an NTT of 6).

Does knee replacement surgery provide a significant reduction in pain?  No!

In one recent study, about a year after knee replacement, 4 in 10 patients still reported a 3-5/10 pain in the knee (7).  In another study, 44% of knee replacement patients reported persistent pain with 15% of those patients having severe pain (8).

Answering these 5 simple questions may help you avoid unnecessary joint replacement surgery with significant complications.

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Alternatives to Knee Replacement Surgery

The Centeno-Schultz Clinic has been using image-guided bone marrow-derived stem cell injections for 15 years to help patients avoid knee replacement. We are experts in the treatment of knee injuries.   We recently published the results of our randomized control study.  48 patients with symptomatic knee osteoarthritis were randomized to exercise therapy or bone marrow-derived stem cell treatment.   More than 2/3rds of the patients treated with stem cells met the functional criteria for success at 2 years out (9). So that procedure has helped many patients avoid big surgery.

Summing up Disadvantages of Knee Replacement Surgery

Knee replacement surgery is a major surgery where the natural knee joint is amputated and a metal or plastic prosthesis is inserted.  There are 14 disadvantages of knee replacement surgery which include the prosthesis wearing out, deep vein thrombosis, anesthesia complications, infection, loosening of the prosthesis, differences in leg length, allergic reactions, nerve damage, damage to tendons and ligaments, persistent pain, increased risk of heart attack and buildup of toxic metal ions. A recent randomized control study demonstrated knee replacement surgery is no better than physical therapy.  Persistent pain after surgery is common. Stem cell treatment is an effective non-surgical treatment option for patients with knee osteoarthritis.

If you are committed to living a life without dependence on additive medication or the risks associated with knee replacement the good news is you have options.  To learn if you are a candidate for stem cell or PRP treatments.  Speak with a board-certified, fellowship-trained physician who will review your history, imaging, and provide you with a candidacy rating. Schedule an in-office evaluation or telemedicine visit.  Knee pain if left untreated gets worse.  Act now before it is too late.

 

References

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1.Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M. Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum. 2012 Feb;41(4):568-75. doi: 10.1016/j.semarthrit.2011.07.002. Epub 2011 Aug 24. PMID: 21868060.

2.Labek G, Thaler M, Janda W, Agreiter M, Stöckl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011 Mar;93(3):293-7. doi: 10.1302/0301-620X.93B3.25467. Erratum in: J Bone Joint Surg Br. 2011 Jul;93(7):998. PMID: 21357948.

3. Sakellariou VI, Poultsides LA, Ma Y, Bae J, Liu S, Sculco TP. Risk Assessment for Chronic Pain and Patient Satisfaction After Total Knee Arthroplasty. Orthopedics. 2016 Jan-Feb;39(1):55-62. doi: 10.3928/01477447-20151228-06. Epub 2016 Jan 5. PMID: 26730683.

4. Lu N, Misra D, Neogi T, Choi HK, Zhang Y. Total joint arthroplasty and the risk of myocardial infarction: a general population, propensity score-matched cohort study. Arthritis Rheumatol. 2015;67(10):2771–2779. doi: 10.1002/art.39246.

5. Savarino L, Tigani D, Greco M, Baldini N, Giunti A. The potential role of metal ion release as a marker of loosening in patients with total knee replacement: a cohort study. J Bone Joint Surg Br. 2010 May;92(5):634-8. doi: 10.1302/0301-620X.92B5.23452.

6. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015 Oct 22;373(17):1597-606. doi: 10.1056/NEJMoa1505467

7. Sakellariou VI, Poultsides LA, Ma Y, Bae J, Liu S, Sculco TP. Risk Assessment for Chronic Pain and Patient Satisfaction After Total Knee Arthroplasty. Orthopedics. 2016 Jan-Feb;39(1):55-62. doi: 10.3928/01477447-20151228-06.

8. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011 Mar;152(3):566-72. doi: 10.1016/j.pain.2010.11.023.

9. Centeno C, Sheinkop M, Dodson E, et al. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018;16(1):355. Published 2018 Dec 13. doi:10.1186/s12967-018-1736-8