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Tuesday, September 27, 2022

What to Try Before Getting Knee Replacement Surgery

Surgery is stressful for anyone, and some older adults are unable to undergo surgical procedures. Before you get a knee replacement, try these less-invasive alternatives. 

Anyone who has thought twice about walking somewhere because of knee pain knows how disabling it can be. Osteoarthritis is often the culprit, although other conditions or even an injury can cause nagging knee pain. Your doctor may have brought up the possibility of knee replacement surgery, but you want to put that off for a while, or preferably, forever. Is there anything you can try?

In fact, there are several strategies that may help you postpone knee replacement surgery or eliminate it altogether. As always, consult your doctor before trying any of these methods to make sure they are right for you. You may need to try just one or use a combination of tools to attack your knee pain. 

  • Lose weight. Nobody likes losing weight, but it can sure benefit a sore knee. Why? Research gathered at Johns Hopkins Arthritis Center demonstrates that not only does carrying excess pounds speed up the destruction of cartilage that cushions the knee joint, it also increases your chance of developing arthritis in the first place. For every pound of weight you lose, you’re taking four pounds of pressure off your knees. And extra weight also adds to inflammation throughout your body, leading to more pain in that swollen knee.

How Prevalent is Knee Surgery?

It seems like everyone knows someone who has had a knee replacement. Just how many people are getting them? A 2021 survey of the US population found that more women (3 million) than men (1.7 million) had the procedure, and prevalence increased with age. Among the total population, 1.52% had a knee replacement, but that number rose to a high of 10.38% at age 80, after which it declined. These numbers are likely to be higher in 2022. 

  • Move. The last thing you may feel like doing is exercising, but low-impact movement can help reduce your knee pain in several ways. Exercise stimulates fluid flow around the knee joint and improves flexibility. Building up the muscles around your knee will help stabilize the joint, giving it added support. It is normal to feel some pain, at least at first. That doesn’t mean you should quit, unless it is intense. Which exercise is best? Try swimming, cycling, strength training, yoga, or good old walking to minimize impact.
  • Try anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen, and ibuprofen are a good place to start. Check with your doctor first since these do have side effects and may interact with other drugs. If they’re not helping your pain, ask your doctor about prescription meds such as a higher-dose NSAID, or COX-2 inhibitors that are NSAIDs that may be more effective at reducing inflammation. 
  • Gel joint injections. You may be a candidate for gel injections called viscosupplementation. These contain hyaluronic acid, a fluid found naturally in knee joints that increases lubrication, reduces swelling, and promotes the growth of bone and new cartilage. Better yet, a 2019 study found that recently developed mono injections of the gel could be as useful as an older course of weekly shots. However, the effects are almost always temporary.
  • Steroid injections. Corticosteroids can be delivered to your knee joint via cortisol, a substance naturally produced in the adrenal glands. These offer quick (as little as 24 hours to several days) relief by reducing inflammation, and the effect can last for three to six months. However, there are side effects that you will want to discuss with your doctor. 
  • Physical therapy. Also known as rehab, physical therapy features trained therapists guiding you through specialized exercises to strengthen muscles and loosen stiff knee joints. You may visit a therapist two or three times a week and do specified exercises at home on other days. Therapy can also include treatments such as massage.
  • Radiofrequency ablation (RFA). RFA eliminates knee pain by using heat to destroy the nerves that are responsible for telling your brain that your knees hurt. RFA is also a temporary fix since the nerves regenerate anywhere from six months to two years. 
  • Stem cell injections. This form of treatment, which involves injecting stem cells into the knee to regenerate tissue, is considered investigational and not recommended by the Arthritis Foundation, the American College of Rheumatology, or the FDA as of 2019. However, new studies could change that opinion at any time. Check here if you’d like to be considered for inclusion in an upcoming trial.
  • Unispacer. Also known as a Unicondylar Interpositional Spacer, the device cushions the space between the two leg bones that are grinding together. While being considerably less invasive than getting a new joint, it may not be effective for seniors whose arthritis is advanced. 
  • Genicular artery embolization (GAE). One of the causes of pain for older adults with osteoarthritis is the development of abnormal blood vessels. GAE blocks these blood vessels, reducing both inflammation and pain. 
  • Orthobiologics. An emerging field, orthobiolobics, or regenerative medicine, uses natural, tissue-derived product to help the body heal itself. These are often used in conjunction with other treatment(s). Some of these alternatives use platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), or placental tissue matrix therapy (PTMT). 

It is important to listen to your doctor before deciding on a therapy regimen. As always, it’s unwise to latch on to a course of action solely based on internet research. Start there, but rely on trained medical professionals to answer your questions and guide you through personalized therapy. It could be that knee replacement is still the best option for you now, or will be in the future. However, it doesn’t hurt to check if some of the methods listed above could help delay that day, or possibly even make it unnecessary.