Knee Replacement alternative relieves pain, retains mobility
This is an excellent and comprehensive article on nonsurgical & surgical options for knee arthritis. (I am trained in and perform many cartilage restoration procedures surgically.)
What it omits is the emerging treatment of platelet plasma/PRP and stem cell as a non-operative alternative to surgery.
More and more patients in my practice are choosing this option of non-surgical “cartilage restoration” instead of steroid or lubricant injections. – Kelly Cunningham, MD
If you’ve been told you need a knee replacement due to arthritis, it can feel like you’re caught between a rock and a hard place. On one hand, walking around and being active is painful. But while a total or partial knee replacement can relieve the pain and return your mobility, it also means you may no longer be able to participate in high-impact activities like running, jumping and skiing.
I see many patients with knee problems who don’t want to give up these activities. Though they have painful, degenerative conditions that gradually wear down parts of the knee, they don’t want to transition to a more sedentary lifestyle. They want an alternative to total knee replacement that will let them enjoy being active without pain or discomfort.
Thanks to a number of medical advancements, we now have an alternative option to treat arthritic knees: cartilage restoration.
How we treat arthritis with knee replacement
To understand whether you may be a candidate for a knee replacement alternative such as cartilage restoration, it’s good to know a bit about arthritis and how we treat it with standard knee replacement surgery.
The knee joint connects your femur (thighbone) to your tibia (shinbone). Cartilage covers the areas where these bones come together, allowing them to move against each other as you bend and straighten your leg without too much friction.
Unlike bones, cartilage does not receive blood flow, so it doesn’t heal as easily. As we grow older, cartilage tends to wear down, causing inflammation and pain as bones rub against each other without the protective padding of cartilage. This “wear and tear” is called osteoarthritis, and it’s most common among people older than 50.
Osteoarthritis is often treated with knee replacement surgery — also known as knee arthroplasty. In this procedure, a surgeon replaces arthritic parts of the knee with prosthetic parts. With total knee replacement, a surgeon basically installs an entire artificial knee, removing arthritis in the process.
We perform hundreds of knee replacements each year, and the demand for this surgery is growing. A 2007 study found that U.S. surgeons performed about 700,000 knee replacements every year, but that’s expected to rise to nearly 3.5 million procedures by 2030!
Unfortunately, most people with osteoarthritis will eventually need a total knee replacement. So here’s the million-dollar-question for orthopedic surgeons: How long is it worth it to maintain a patient’s knee function with partial replacement, given that they’ll likely need total knee replacement in the future?
Until recently, that was a hard question to answer. But for people with certain kinds of arthritis, we now have an alternative to total knee replacement that makes a temporary fix more worthwhile. By combining aspects of sports medicine with partial knee replacement procedures, we hope to give these patients as many active years as possible.
How cartilage restoration relieves pain and retains mobility
Ligaments connect bones together in a joint. A standard knee replacement removes two ligaments: the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Losing these ligaments means your body loses its ability to know exactly where the knee joint is in relation to its other parts – a sort of “sixth sense” known as proprioception. Proprioception is key to movement. It lets you perform motor tasks like walking without having to think about them. Removing the ligaments in your knee throws that sense out of whack.
In cartilage restoration, we replace arthritic knee cartilage with cartilage from a healthy part of the joint or with a synthetic cartilage-like substance. This way we can patch problematic areas without removing the ligaments. It’s like fixing a pothole on your knee. This procedure, called an autograft arthroplasty or an osteochondral autograft transplant, allows people with arthritis in a certain part of their knee to remain active without the mobility restrictions of a full knee replacement. Surgeons can even reconstruct ligaments that have been damaged by trauma alongside cartilage restoration, giving people with torn ligaments–a common sports injury–new hope of being active again.
Who is a candidate for cartilage restoration?
Whether someone is a good fit for cartilage restoration depends on the extent of their arthritis and how well they’ve responded to previous treatment.
If multiple parts of the knee are arthritic, as is often the case with osteoarthritis, cartilage restoration isn’t likely to help for very long. These patients would only have a brief period of reduced pain and improved mobility before needing another surgery. Instead, we would recommend a total knee replacement.
For someone to be a good candidate for cartilage restoration, they should only have arthritis in one area of the knee, making it easier to replace and more likely to succeed.
We prefer to treat knee problems with noninvasive methods before recommending surgery. This can include:
- Braces: These supportive wraps take weight off arthritic areas
- Orthotics: Changes how you distribute weight or the alignment of your foot to reduce stress on your knee
- Physical therapy: Strengthens muscles and helps mitigate further damage by increasing the knee’s flexibility
- Steroid injections/medication: Medications taken orally or by injection can reduce inflammation in the knee joint, relieving pain.
Not everyone will benefit from cartilage restoration. Some people have arthritis so severe that it can only be successfully treated with a total replacement. But if you’re young (or young at heart), eligible for a replacement alternative and want to run, ski or play sports for years to come, this kind of procedure can help you live an active life without an arthritic knee getting in the way.
By Evan Argintar, MD, orthopedic surgeon and assistant director of Sports Medicine with MedStar Orthopaedic Institute at MedStar Washington Hospital Center