The knee is a hinge joint that connects the femur bone to the tibia and fibula bones. Over time the meeting place of these bones can get worn out, causing pain and swelling. One option is total knee replacement to restore full function to a knee with arthritis. Commonly knee replacements are done because other treatments have not worked. They can be done on people of all ages, except for children. But there are alternatives for knee replacement. Read on to find out more about the other options available.
Nonsurgical Knee Replacement Alternatives
While there are certain cases where the best option is a total knee replacement, there are other times when alternatives are better options. Risks and benefits of any treatment should be discussed with your doctor. Alternatives to a total knee replacement can include:
1. Weight Loss
The knee gets about four pounds of pressure for every pound of body weight so a small amount of weight loss makes a big difference and can lead to a reduction in pain levels.
2. Exercise or Physical Therapy
Strengthening the muscles around the knee can help to take some of the pressure off of the knee joint. Keeping a range of motion will keep the joint from getting stiff.
3. Medications
This can include anything from over-the-counter pain relievers like acetaminophen or anti-inflammatories like ibuprofen or naproxen to prescription pain relievers. Always discuss any medications you plan on taking with your doctor prior to starting the medication to talk about any risks or side effects.
4. Braces and Shoe Inserts
Either one of these can help keep the knee joint aligned and balances the weight of the joint.
5. Injections
Drugs like cortisone can be injected directly in the area of the knee to help relieve pain. A special kind of lubricant called Hyaluronan Gel is injected into the area between the bones of the knee joints. The treatment has been very successful with patients who were not ideal candidates for surgery.
Surgical Alternatives to Knee Replacement
1. Arthroscopy
This is a minimally invasive surgery in which the doctor examines the joint from the inside with an arthroscope. The joint can be repaired through small incisions made in the skin. This is only a helpful procedure for certain knee problems.
2. Osteotomy
This procedure is done by cutting the leg bone and realigning it and letting it heal. This is done to shift weight off of a damaged part of the knee to a less damaged one. This is not recommended for patients over 60 years of age or patients with inflammatory arthritis.
3. Partial Knee Replacement
A unicompartmental knee replacement is a procedure where only one part of the joint is replaced. It is debated whether there is a benefit to only replacing part of the joint. Certain studies have shown that there are benefits but you should consult your doctor about the possible benefits and risks.
4. Cartilage Transplantation
Another option is transplanting healthy cartilage to portions of the knee where there is damaged cartilage. This works best for patients with localized damage to their knee joint. This means that patients with conditions like rheumatoid arthritis and osteoarthritis will not benefit from this procedure.
5. Knee Fusion
Also called arthrodesis, this procedure is performed when the risk for a total knee replacement failure is too high. The procedure cuts the ends of the femur and tibia flat and secures them together with pins. After the bones have healed, they will grow together fusing the leg straight. The joint is no longer able to bend and the patient will walk with a limp, but they will no longer experience pain.
6. Stem Cell Therapy
This is quickly becoming one of the best knee replacement alternatives. It uses stem cells that are found naturally in bone marrow and fat. These are different from embryonic stem cells. These cells have the ability to repair damaged tissue like the type of damage that causes knee pain. The problem for people with a degenerative disease like osteoarthritis is that they have stem cells that are not released as often as required to repair the damaged tissue. Therapy can fix this problem and the risks are relatively low.
7. Platelet Rich Plasma (PRP)
PRP has been used for some time in the sports industry to help athletes with conditions like ACL, MCL, and LCL tears in the knee. For this treatment your own blood is used with a high level of growth hormones, enzymes, and other cells that aid in the healing process. A small amount of blood is taken and all the important nutrients removed. The nutrients are then injected back into the body which will then work to repair damage. These are not like cortisone shots that work immediately, they take time to work.
8. Medical Ozone Treatments
Unlike some of the treatments listed above, medical ozone treatments permanently repair damaged areas in the knee. It is relatively safe and causes minimal pain or discomfort. It uses the elements in the ozone to help repair the knee. Proper circulation is required for the knee to heal properly, ozone treatments help reduce inflammation in the knee and promotes circulation and faster healing. This treatment is not ideal for all knee problems so it is important to talk to your doctor about your options.
When Do You Need Knee Replacement?
There are times when knee replacement alternatives are not the best option. You could need knee replacement surgery if:
- Your pain is persistent and continues over time
- Your knee hurts during or after exercising
- Your mobility is limited
- Medication of other treatment options like a cane do not provide enough relief
- Your knee gets stiff after sitting for long periods of time
- Your knee hurts during wet weather
- Pain keeps you up at night
- Your range of motion is limited
- You have stiffness or swelling in your knee
- Walking or climbing stairs is difficult
- Getting in and out of a chair or bathtub is difficult
- You wake up in the morning with stiffness that lasts for less than 30 minutes (any time longer than 45 and you may have rheumatoid arthritis)
- There’s a grating sensation in your joint
- You have had a previous knee injury to the ACL