Undergoing a knee replacement for knee arthritis can be a very effective quality-of-life decision. Patients are able to get back to recreational activities and a severely reduced painful lifestyle. However, a knee replacement is not without its risks. There are risks of surgery, there are risks post-operatively, and it is very important to look at the future. Knee replacements often last 10 to 15 years, at which point they may need a revision. The outcomes for revision are not nearly as successful as that from a primary surgery. So the patient may end up having future significant problems despite having an initially satisfactory result.
The answer to this is to try and avoid surgery if at all possible until it becomes truly necessary. It is in fact a quality-of-life decision and is not one that patients have to have done. Here are 8 non-surgical methods of avoiding the replacement with the arthritis.
1. Benign neglect - This treatment option is really not a very active one. From its name you can surmise that it really does involve ignoring the situation. What is meant by this is that if the knee arthritis pain is tolerable, and the patient is able to do most of the things that he or she wants to do, the most appropriate answer at that point may be to simply ignore the problem. One additional aspect to consider may be to modify one's activities. This may include switching from jogging to fast walking, or shifting from skiing to an activity that is less stressful on the joints such as swimming. Those kinds of considerations are what is meant.
2. Weight loss - Over 65% of Americans are either overweight or obese. The problem with this is that a lot of stress goes through the joint during ambulation. If that joint has arthritis, this excess weight can lead to increased pain and/or increased arthritis. Losing weight may allow the patient to see decreased joint pain from decreased stress, and an increased ability to perform activities of daily living, along with other substantial health benefits such as lower blood sugars and lowered blood pressure.
3. Physical therapy - Undergoing physical therapy may have significant benefits. Therapy can strengthen up the muscles around the knee joint, which may have the beneficial effect of unloading the pressure from the knee joint and dissipating it into the surrounding musculature. This can reduce pain.
4. Acetaminophen and NSAIDS - These medications are predominantly available without prescription and they can be extremely beneficial for alleviating the pain. They have a low risk profile, as long as patients stick to the manufacturers dosing on the box, and don't combine those medications that can have an additive effect and lead to a bleeding ulcer.
5. Knee injections - Injections into one's arthritic knee can help substantially with pain reduction. Presently the bulk of these injections consist of cortisone, which is a hefty anti-inflammatory substance, but not one that is going to alter the course of the disease. There are some newer types of medications consisting of regenerative substances, which contain components such as stem cells, hyaluronic acid, and cytokines. These may in fact alter the course of the arthritis.
6. Bracing - Treating patients with a neoprene sleeve is not going to alter the course of arthritis and research does not back up their usage. However, there are off-loading braces which have in fact been shown to take pressure off of the arthritic area of the knee joint and promote pain relief. These braces are typically custom fit after seeing your doctor, and should be worn whenever the patient is up and about when the pain would typically be felt. Utilizing this may also decrease the amount of pain and aching felt at night.
7. Narcotic medications - Opiate medications should not be used on a chronic basis. They should be utilized only for an acute type of situation where patients are having an exacerbation of their arthritis pain. Narcotic medication on a chronic basis for arthritis maintains substantial risks. These include the risk of tolerance, addiction, constipation, etc. So it should be avoided. Utilizing them for exacerbations can however be very effective.
8. Non-narcotic medications - Medications that are non-addictive such as Tramadol can be very effective for knee pain. In addition there are modulating medications such as gabapentin that can help a lot with decreasing the pain that is coming into the arthritic knee joint from the surrounding nerve endings.
With these 8 methods of non-surgical arthritis treatment, patients may be able to either push back the need for a knee replacement or avoid it altogether. With it being a quality-of-life decision, all non-surgical options should be attempted prior to undergoing the knife.
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