How To Postpone Or Avoid A Total Knee Replacement
A knee replacement is a significant and potentially painful surgery with a lengthy rehabilitation process. This surgery should be considered as a last resort and performed only after all other management options have been exhausted. It is, however, a very effective treatment for relieving pain in the significant majority of patients who have it done.
There are several non-surgical management options for knee osteoarthritis that are scientifically proven to be effective. These include:
- Weight Loss – Weight loss decreases the pressure on the knee with normal daily activities and can not only reduce the symptoms of knee osteoarthritis but also slow the progression of the disease.
- Activity Modification – This is very simple. If something causes you severe pain, then you should not do it, or change the way you do it, to make it less painful. This is particularly important for those who have heavy physical jobs. If your work continues to aggravate your knee especially as you head into your 50’s and 60’s it might be worth considering changing your line of work to something less physically demanding.
- Exercise – An appropriate exercise program will help to strengthen the muscles around your knee, reduce your symptoms and will also aid in a faster recovery if you do eventually go on to have knee replacement surgery.
- Non-steroidal Anti-inflammatory Medication – can be quite effective for controlling knee arthritis pain but be aware of the short-term and long-term side effects. Discuss this with your Doctor or Surgeon.
- Injection – An injection of local anaesthetic and corticosteroid can sometimes be helpful for reducing symptoms but be aware of the short-term and long-term side effects. Typically I reserve it for patients who are about to embark on trips, or about to walk their daughter down the aisle (yes this still happens!). Discuss this with your Doctor or Surgeon.
There are many remedies and treatments on the market that claim to cure or relieve knee osteoarthritis, but there is no strong scientific evidence for these management options. We discuss this evidence in detail in our blog post labelled “Joint Health Supplements – Fact or Fiction”.
Some of these include:
- Nutritional supplements such as glucosamine sulphate
- Synthetic joint surfacing injection such as Synvisc
- Rub on anti-inflammatory creams
What about other surgical options? There is no strong evidence that knee arthroscopies are helpful for those with degenerative knee arthritis but they may be helpful in specific cases:
- if there is a loose fragment aggravating the knee within the joint,
- if there is a severe and unstable meniscal tear or
- if you are simply too young for a knee replacement, and your surgeon is examining the surfaces of the knee to see if there is any place for a less invasive treatment.
Partial knee replacements or knee re-surfacing surgeries are sometimes used to avoid a total knee replacement or in those who only have arthritis in one side of their knee, as are osteotomies i.e. breaking the bone to reset it and take weight off the section that is worn out, and place it on the healthy part of the joint.