Tens of millions of Americans are afflicted with knee arthritis and live with daily pain. Knee replacement surgery has been shown as one of the top five quality-of-life procedures in the world. However, the procedure is not meant to last forever and should be looked at as a last resort, elective procedure.
Here are the ways to avoid total knee replacement procedure.
- Activity Avoidance
The first method of treatment is known as activity avoidance. If you are an avid downhill ski year and the activity causes knee pain for three days afterwards, it’s probably best to avoid skiing. It would probably be a better idea to switch to an activity that is not so stressful. Also, if you are an avid runner, it would be best to switch to a lower impact activity such as swimming or cycling (cross-train).
First-line treatment should consist of over-the-counter pain medicines such as Tylenol and anti-inflammatories (Naproxen, Ibuprofen). These should be taken according to the manufacturers recommended dosing, and may be exceptionally helpful to relieve mild to moderate pain from the arthritis.
For those times when the arthritis pain exacerbates, short term narcotics may be helpful. Taking them over the long-term is not a good idea as there can be significant risks with this approach.
- Physical Therapy, TENS, Acupuncture, Cane
Physical therapy can help avoid or prolong the need for a knee replacement. Strengthening up the muscles around the knee can help take pressure off of the arthritic areas. This may also include ultrasound and electrical stimulation treatment. Using a TENS unit may also help with pain relief, which involves placing small foam pads over the knee and providing a small electrical stimulus. This can alter the way that the brain perceives pain signals.
Several studies have been done looking at acupuncture for arthritis pain. They show that the effectiveness of acupuncture is significant, and may provide lasting relief for the problem.
Bracing for an arthritic knee can help as well. There is a type of knee brace called and off-loader that pushes on the less painful side to open up the arthritic area. These braces are slightly bulky and may be uncomfortable, but also may provide significant alleviation of the arthritis discomfort.
There are even studies showing that a knee sleeve may provide symptomatic relief for those suffering from knee arthritis (Segal, PM R. 2012 May;4(5 Suppl):S89-96).
One gold standard treatment for the arthritis pain are steroid injections. These are done as an outpatient in a physicians office, and involve placing numbing medicine and steroid into the joint for relief. Over 75% of patients achieve substantial pain relief that lasts for weeks to months (Cheng et al, Pain Med. 2012 Jun;13(6):740-53). Steroid injections may be repeated a few times a year.
Decades ago, studies of steroid injection into small animals showed cartilage degradation from the steroid injected. Subsequent studies and larger animals showed no such ill effect, so steroid injections remain very popular for arthritis to this day.
Hyaluronic acid injections have become very popular and are known as Synvisc and
Hyalgan. Hyaluronic acid is a natural component of the knee, and these injections are made from rooster combs. CHA injected helps provide the natural lubricant along with theoretically increasing the knees desire to produce cartilage.
The FDA has approved the use of these injections, and multiple studies have shown beneficial effects that may last for 6 to 12 months. The working theory is that if an individual has some cartilage remaining, these injections are indicated. However, if an individual is down to bone on bone arthritis, then it does not make a lot of sense to perform them.
The newest type of injections for knee arthritis are platelet rich plasma and stem cell injections. Platelet rich plasma involves taking a simple blood draw from a patient and spinning it down in a centrifuge machine to obtain platelets and growth factors. There are some small studies showing that injecting the substance into an arthritic knee can help repair some of the damage (AAOS). Pain relief may be substantial, and the substance has been shown to call in stem cells from a persons body.
The newest stem cell injections involve obtaining material from either a persons iliac crest, fat, or an external source such as donated amniotic fluid. It is unclear to what extent arthritic pain can be reduced with the substances. Current studies are ongoing.
There are quite a few treatment options for avoiding or delaying knee replacement surgery at modern pain management clinics such as Arizona Pain Specialists. If you or a loved one is suffering from knee pain in the greater Phoenix or Scottsdale areas, call today at (602) 507-6550.