I Have Osteoarthritis - Will I Need a Knee Replacement?
Author - Devon Duplain, PA-C
You likely have a friend or relative who has undergone knee replacement at some point, and chances are, they have very strong feelings about the surgery one way or the other. You may even be faced with the decision yourself or wonder if you will have to consider it in the future. Can this be avoided, or is it just the inevitable outcome for someone with arthritis in the knee?
When knee replacement is recommended, it is usually because a patient has osteoarthritis which has progressed to the “bone on bone,” or severe stage of the disease. In the past, treatment plans have focused on relieving pain with interventions such as medications (acetaminophen, ibuprofen, etc.), cortisone injections, knee braces, possibly arthroscopic surgery, and eventually knee replacement. The focus was on relieving pain while the disease continued to progress to the almost inevitable conclusion of becoming “bone on bone.” Thankfully, we now know of treatments that may delay the need for knee replacement, if not eliminate the need entirely.
One such option is a treatment known as viscosupplementation. This is an injection-based treatment that supplements hyaluronic acid (HA) into the joint. HA is a natural component of healthy joint fluid which is important for lubrication and cartilage protection, but joints that suffer from osteoarthritis are unable to produce enough of it. By injecting HA back into the joint, we create a healthier joint fluid that helps protect cartilage from further deterioration and relieves pain. Studies suggest that patients who undergo HA injections delay the need for surgery by up to several years.¹ In our clinic, we have many patients who were told knee replacement was imminent but have been receiving HA injections for several years and now wonder if they will ever even need it.
While HA injections are performed often due to their being covered by most insurance companies, other treatments such as platelet-rich plasma therapy (PRP), physical therapy, and even cellular therapy injections may also delay the need for surgery. Treatments such as these not only seek to relieve pain but to treat the underlying disease. When done correctly, we have seen these treatments show the potential to alter the course of the disease rather than just masking pain while OA continues to progress. In a large majority of our patients, those who have been receiving HA injections or PRP are showing no radiographic signs of arthritis progression, even up to seven years after being diagnosed.
It should be said that knee replacement has its place and is the most definitive option for some patients, though the decision can be very difficult. I generally use three criteria to help someone decide if they are ready for knee replacement:
- Pain that is consistently near 8/10 or higher on the pain scale. A recent study showed that nearly 40% of patients still had between 3/10 and 5/10 pain 12-16 months after surgery.² So if pain before surgery is less than 8/10, is it really worth this minimal improvement?
- Knee pain that is affecting daily activities and quality of life. If you are not able to sleep at night because of pain or are unable to enjoy the things you used to love doing, it may be time to consider surgery to get back to living your life to the fullest.
- Nonsurgical options have been exhausted and are not providing desired relief. Knee replacement surgery is a point of no return – once you have had the surgery you cannot go back and try other treatments if you are unhappy with your results. If it were me going into surgery, I would want to be sure I tried everything I could before making the decision. And as discussed above, there are many options that can relieve pain and get you back to the life you love.
Knee replacement is an option for treating severe osteoarthritis, but it does not have to be an inevitable conclusion. There are alternatives that provide great relief for a growing number of patients. Sadly, these treatments are not utilized enough, and many patients are undergoing knee replacement without even knowing that there are other options available that may delay or eliminate the need for surgery. Ask your provider about the options discussed above if you find yourself debating whether knee replacement may be right for you.
Do you still have questions? Do you want to discuss your diagnosis and specific condition with a professional healthcare provider? Call our office (801-495-3539) to schedule an appointment or fill out the "Get More Information" box above. We at ActiJoint are passionate about helping our patients get reliable, lasting pain relief and improved function of their knees.
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