Alternatives to Knee Surgery

Loud crunching when climbing stairs, chronic pain and constant swelling: osteoarthritis in the knee is a very uncomfortable type of pain. If you suffer from knee problems like the ones described, knee surgery is one option. But is that really always necessary? What therapeutic alternatives are there? In this post, we'll give you a few options that might help with your knee pain.

Knee pain caused by osteoarthritis is a serious disease and needs therapy. Surgery to replace the knee entirely or partially is a common therapeutic measure.

A full knee replacement is like a resurfacing of the bones in the knee: the end of the femur (thigh bone), the top of the tibia (the thicker of the two bones in the shinbone), and the inward-facing surface of the patella or kneecap. The surgeon removes the bony surfaces and replaces them with metal and plastic implants.

The plastic serves the same purpose as the cartilage and helps the implants slide smoothly against each other.

A complete knee replacement is achieved through a very invasive procedure, which results in relatively long regeneration times and can be associated with side effects. However, surgery can also provide a better quality of life and improved mobility that will last for many years.

There are constant innovations in the field of knee replacement surgery. For example, more and more surgeons are using a local anesthetic during the procedure, which can mean a shorter hospital stay compared to procedures which employ general anesthesia.

Even so, this surgery remains a very invasive method with a long rehabilitation period, and not all patients require this type of therapy.

Does an operation always have to be carried out? Knee replacement is a potential treatment option. But you may not need an operation, at least not right away. Some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young to have a knee replacement - the artificial knee will likely only last 15 or 20 years, after which the person is likely to have to have another operation.

For these reasons, for some patients, alternatives to surgery may be a better solution.

There is an opportunity to reduce knee pain and delay knee replacement surgery by reducing the weight that is on the knees. This requires reaching and maintaining a healthy weight.

Extra weight puts pressure on the knees, adding stress to the joint, increasing pain and making exercise difficult. Research compiled by the Johns Hopkins Arthritis Center confirms that being overweight increases the risk of developing knee arthritis and accelerates the destruction of the cartilage that cushions the joint.

Physiotherapy and low-impact exercises

To increase strength and mobility in the knees, so-called low-impact exercises can work wonders. Strengthening the quadriceps and thigh muscles in the leg can help relieve pain and improve range of motion. Examples of regular low-impact exercises are cycling or running on a treadmill.

Physiotherapy can also help. A physical therapist can work with you and put together a customized program that aims at the best outcome for you.

There is a lot of scientifically proven evidence that cortisone and hyaluronic acid injections “lubricate” the inner workings of the knee and thus alleviate arthritis pain. Such injections can provide temporary relief – usually for a few months - and help you stay on your feet and postpone the surgery. Unfortunately, they don't offer a long-term solution.

Cellular therapies, above all stem cell therapy, are a relatively new treatment option for symptoms of degeneration of the knee or knee joints. There are several ways to treat the knee with stem cells, from BMC or PRP injections to intravenous stem cell secretome therapy. We have already written a detailed article on this. Click here to read the article: Does Stem Cell Therapy for knees work?

Arthroscopic surgery is a minimally invasive type of knee surgery that is performed with a camera inserted through a small incision. The surgery can be performed to repair a torn cartilage or meniscus in the knee, or to remove fragments of bone or cartilage. This type of surgery could delay or eliminate the need for knee replacement surgery.

Another option is an osteotomy. This is a surgical procedure in which the surgeon makes an incision in your shinbone or thighbone to divert the load away from the arthritic area of ​​the knee. This is usually recommended to younger patients with deformities or damage on only one side of the knee. While this is viewed as an alternative to knee replacement surgery, osteotomy can make it difficult for patients to undergo successful knee replacement surgery at a later time if necessary.

For knees with incipient arthritis, it may be possible to replace the degenerated cartilage rather than the entire joint. There are several cartilage regeneration techniques that you can consider and discuss with an orthopedic surgeon.

In the case of autologous chondrocyte implantation (ACI), for example, a sample of your cartilage cells is taken, grown in a laboratory and then surgically transplanted into your knee. This procedure is not the best option for every patient, but young people and athletes affected by cartilage loss could potentially benefit from it.

If all other methods don't relieve your knee pain caused by osteoarthritis, other options still exist. Radiofrequency ablation (RFA) destroys the sensory nerves in the knees that carry the pain signal from the knee to the brain. RFA, while invasive, is only a temporary solution because the nerves can grow back and the pain can return in six months to two years.

Most doctors advise against using opioid drugs for knee osteoarthritis, except in very rare cases. Painkillers based on opiates are not only addictive, but have also been shown to have no better long-term effect against knee pain than non-steroidal anti-inflammatory drugs, or NSAIDs for short.

While NSAIDs are safer than opioids, they are not for everyone and you should be cautious when using them. Even over-the-counter drugs like ibuprofen can cause long-term side effects.