Knee Replacement Alternatives without Surgery?

Knee Pain

Dr. McCluskey reduces chronic knee pain with safe, natural, and non-invasive treatments.

Knee replacement surgery can be a frightening decision.

Is is safe?

Will your capabilities be limited with no chance of improving?

Is there a risk of permanent disability?

Before going under the knife, consider possible alternative solutions.

Knee replacement surgery involves removal of damaged and distorted cartilage by excision of knee joint connective tissue (that may or may not include knee cap or patella, parts of shin bone, parts of thigh bone) and replacement of damaged tissue by artificial/synthetic prosthesis. Most prosthetic joints are made up of polymers of plastic or metal (the choice of prosthetic joint material is usually made by both patient and surgeon depending upon individual expectations, weight of the person, degree of physical activity, weight and joint condition). The overall prevalence of knee issues (pain, discomfort and disability) increases with advancing age with 12.1% in adults over 55 years and 20.2 to 46.7% in elderly over 75 years (1)

Even after surgery, you cannot perform a number of independent physical activities (any vigorous or strenuous physical activity is generally contraindicated) that only increases the risk of damage to prosthetic joint. Imagine the unpleasant feeling of not being able to enjoy a functional life even after spending a large sum of money and bearing a great deal of discomfort after knee surgery?

What are other alternative options?

Surgical management may not be an effective, long term or permanent solution. It is very important to take your decisions after deliberate thought and research (and after evaluating possible risks and benefits of alternative options).

Most common alternatives to knee surgery are:

Bracing:

Knee braces are frequently utilized to resume some degree of physical mobility in patients with extensive osteoarthritis. However, the efficacy is limited because:

  • Bracing can only be performed in individuals who have healthy cartilage. The aim of bracing is to divert the pressure of joint cavity on the normal and un-inflamed cartilage (to minimize pain and discomfort).
  • The side effect can be long term stress and pressure on healthy cartilage aggravates the process of wear and tear that ultimately leads to inflammation in healthy cartilage as well.

Steroid injections:

Steroid injections are introduced directly in the inflamed tissue and can reduce pain and swelling for a period of a few months. The limitations are:

  • No more than 3-5 injections can be administered during 1-year period due to risk of steroid-induced complications like osteoporosis, higher risk of systemic infections due to impaired immunity and muscle wasting. 
  • Steroid injection suppresses inflammatory responses but does not improve the joint health or inflammation causing elements.

Non- steroidal anti-inflammatory medications:

The third and most common non-surgical variety of treatment for the management of knee pain is NSAIDs (or anti-inflammatory medications). Once again, the limitations include:

  • No improvement in the cause of inflammation or pain
  • Damage to kidney, liver and other vital tissue due to long-term therapy associated complications of NSAIDs like gastric bleeding, liver failure, renal failure, clotting disorders, gastric ulcers etc

Weight loss and physical therapy:

  • Moderate weight loss improves 40 to 70% symptoms with exercise.
  • Physical therapy further enhance the benefits by promoting blood flow and ensuring gentle stretch and traction but is less suitable as the sole/ isolated modality for knee joint pain.

Chiropractic strategies as a potential non-surgical option:

Research and statistics indicate that about 21% of all chronic knee cases are treated with complementary medicine these days (4) and the prevalence is on the rise with increasing awareness among people about holistic methods of treatment. This includes osteopaths (4.8%), chiropractors (7.7%) and acupuncture (6.2%).

When knee pain is due to muscle or soft tissue damage:

Muscle spasm as a result of injury or tissue damage can lead to trigger point formation as a result of adhesions. This can be due to acute abuse or chronic misuse of muscles. Knee pain or back pain can be a consequence of trigger points that can be managed by chiropractic strategies like:

  • Dry needling (also known as laser acupuncture) is another method that allow chiropractors to introduce fine needles at pressure points
  • Spray stretch techniques involves stretching of inflamed and stiff tissues under spray to minimize stiffness.
  • Manual pressure by fingers
  • Stretching exercises to relieve edema and pressure from the connective tissue elements and to enhance the flow of blood across tissues. Stretching exercises vary according to the site and severity of tissue involved. Your chiropractor can modify the stretches to satisfy your individual body need

Pain/discomfort due to joint/bone issues:

Chiropractors identify the cause of pain and discomfort by utilizing a series of investigations like DEXA scan and other bone scans to rule out any infectious or neoplastic cause. Depending upon the cause of bone pain or joint discomfort, chiropractors utilize methods like:

  • Laser therapy that can effectively manage a wide variety of bone conditions that may produce knee pain (like sprain, nerve pain, inflammatory pain due to osteoarthritis, rheumatoid arthritis, trauma or other injuries). The mode of action is stimulation of collagen synthesis by fibroblast growth to hasten recovery and repair processes
  • Nutritional management to strengthen bones and tissues
  • Ultrasound waves to stimulate repair by stimulating protein synthesis, regeneration of connective tissue and regulation of circulation in damaged tissues. Ultrasound therapy also reduces the formation of scar formation (or formation of fibrous tissue) that may interfere with normal functioning. Levent Özgönenel (5) reported one study in which 67 patients (with average age of about 55 years) received ultrasound therapy for knee pain.  The study concluded: “Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA.”
  • Posture monitoring and correction by use of insoles and orthotics to stabilize posture and reduce stress/ strain on knee joint (or other weight bearing joints of the body).

The benefits of chiropractic care are far more superior to other common modalities that are traditionally used for the management of knee pain. Pollard (2) suggests that even mild treatments like manual therapy can reduce symptoms of long term pain and discomfort in knee joint for period as long as 2 months to 2 years. To sum up, there are a number of functional chiropractic alternatives to manage chronic knee pain instead of choosing surgical methods that further hampers your life.

References:

1. Tennant, A., Fear, J., Pickering, A., Hillman, M., Cutts, A., & Chamberlain, M. A. (1995). Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ, 310(6990), 1291-1293.

2. Pollard, H., Ward, G., Hoskins, W., & Hardy, K. (2008). The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association, 52(4), 229.

3. Morrey, B. F., Adams, R. A., Ilstrup, D. M., & Bryan, R. S. (1987). Complications and mortality associated with bilateral or unilateral total knee arthroplasty. The Journal of bone and joint surgery. American volume, 69(4), 484-488.

4. Jordan, K. M., Sawyer, S., Coakley, P., Smith, H. E., Cooper, C., & Arden, N. K. (2004). The use of conventional and complementary treatments for knee osteoarthritis in the community. Rheumatology, 43(3), 381-384.

5. Özgönenel, L., Aytekin, E., & Durmuşoǧlu, G. (2009). A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Ultrasound in medicine & biology, 35(1), 44-49.

Knee Replacement Alternatives without Surgery? was last modified: November 25th, 2013 by Dr. Patrick McCluskey