Learn About The Leading Options
Elective Total Knee Replacements are on the rise across the country. Dramatic improvements in knee replacement technology and surgical techniques have made it one of the safest and most reliable major procedures on the market. Furthermore, increasing obesity levels in the American public have led to both greater general knee pain and rising diagnoses of osteoarthritis.
But just because you have been told you are bone-on-bone and have been recommended a Total Knee Replacement, doesnt mean you should do it. Its crucial you understand all of the risks of such a surgery and explore all the options available to you. By exploring these leading alternatives, you can possibly avoid or prolong undergoing a major surgical procedure.
What Type Of Anesthesia Should I Use
Your choice of anesthetic depends on many factors, such as the surgery being performed, your risk factors, and your preferences. Your choice may affect the risk of complications, cost, and time spent in the medical facility. It also may affect how quickly you can begin physical therapy.
Always consult with your anesthesiologist on the best option for you.
- Regional anesthesia is a common option for arthroscopic surgery. It numbs only the area of the body that requires surgery. You remain awake and aware. Regional anesthesia includes spinal or epidural anesthesia and peripheral nerve blocks. Some research has found that regional anesthesia can provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
- Local anesthesia may be an option for arthroscopic surgery, although it is less commonly used. A one-time injection numbs just a small area around the surgical site. Advantages to local anesthesia include lower risk of complications, lower cost, and faster release from the medical facility.
- General anesthesia, which renders you unconscious during surgery, is sometimes used for knee replacement. But regional anesthesia can also be an option for this surgery.
Obesity Is More Than Stress From Weight Load It Creates Inflammation Without Wear And Tear And Inflammation In The Knee
Research has shown that not only does obesity cause osteoarthritis because of weight load, but it also causes osteoarthritis in a non-mechanical way in other words by inflammation without wear and tear. This type of research is helping doctors get away from the excessive weight load model of thinking, although weight load does cause obvious problems, and helps them look at the inflammation problems. Research has also shown that obese people have an increased risk to develop not only knee but also hand osteoarthritis, the concept that adipose tissue might be related to osteoarthritis not only through overloading suggests that obesity induces a low grade systemic inflammatory state characterized by the production and secretion of several adipocytokines that may have a role in osteoarthritis development.
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Alternatives To General Anesthesia
David Sherer, MD
David Sherer, MD, is an American physician, author and inventor. He is the lead author of Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out and What Your Doctor Wont Tell You. He is a member of Leading Physicians of the World, and a multitime winner of HealthTaps leading anesthesiologists award. Dr. Sherer has retired from his clinical anesthesiology practice in the suburbs of Washington, DC, and now focuses on patient education, writing and patient advocacy. He holds two US patents in the fields of critical care medicine and telecommunications.
Appearing in all forms of media, he is a tireless advocate for hospitalized patients, and believes that individual responsibility, and not government intervention, is the key to improving the general health and wellbeing of all Americans. His memoir, The House of Black and White: My Life with and Search for Louise Johnson is his first work of non-medically related nonfiction.
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Its becoming more commoneven for fairly complex operations. Instead of general anesthesia, which makes you unaware and immobile during surgery, you stay awake.
Why its happening: Regional -anesthesia, such as nerve blocks and epidurals, are now more accurate, effective and safe.
What Kind Of Anesthesia Is Used During Partial Knee Replacement Surgery
At HSS, patients undergoing partial knee replacement surgery are usually given regional anesthesia, which numbs the lower half of the body and allows the patient to remain awake during the procedure. Nerve blocks are also given to minimize postoperative pain, and the surgeon also injects a local anesthetic cocktail around the knee to minimize pain in the first 48 hours after surgery. This cocktail may contain a local anesthetic plus one or more pain medications, corticosteroids or other agents. Throughout partial knee replacement surgery, patients are carefully monitored to minimize the risk of complications.
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Exercise May Alleviate Knee Osteoarthritis Pain
Elliptical training
Another challenging is helping the patient who wants to exercise be able to exercise. For many patients the sedentary lifestyle cycle of knee pain preventing me from exercising and I cant exercise because of knee pain has made me heavier has occurred. Many doctors suggest that the best way to help these patients may simply be with motivation that exercise may eliminate their need for knee replacement.
Providing research studies like the ones below show that patients may achieve better balance, less pain and the ability to bend their knees again in certain cases.
A study of women between the ages of 40 70 years old revealed that balance and proprioception exercises may have positive effects on dynamic balance and pain.
A July 2022 study suggested that in knee osteoarthritis, evidence suggests that the benefits of diet and exercise which in addition to reducing body weight and strengthening muscles could reduce systemic inflammation. One of the benefits patients found in weight loss and exercise was their ability to bend their knees better.
The concept behind exercising, beyond the general health benefits, are that if you build up the muscles around the knee, the muscles can help provide stability and lessen the wear and tear effect of degenerative knee disease. Therapists and researchers have recommended non-weight bearing exercises such as Elliptical training, Recumbent cycling, water or pool based exercises.
Patients Are Seeking Their Own Information On An Alternative To Knee Replacements Because They Are Not Getting All The Information They Could From Their Doctor
This is alluded to in numerous research studies which suggest that if given educational tools and time to think about it, many patients opt out of knee replacement.
Examples of this research include a paper from four universities including the University of Ottawa, the University of Montreal, the University of Toronto, and the University of Chicago, published research in the medical journal Osteoarthritis and Cartilage. In this study, the researchers say more patients, when given educational aids and time to think about the benefits and side effects and complications of knee replacement, opted out of getting the knee replacement .
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Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy
Using stem cells taken from a patients bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.
Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including osteoblasts , chondrocytes , myocytes , adipocytes , fibroblasts and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.
When Its Time For Knee Replacement Surgery
Knee arthritis can get worse in spite of treatment. If youve tried these methods and are still dealing with pain, it might be time to discuss knee replacement with an experienced orthopaedic surgeon. Total knee replacement is a major procedure, but it can offer better quality of life and improved mobility that last for many years.
A total knee replacement is more of a resurfacing of the bones in the knee: the end of the femur , the top of the tibia 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, helping the implants glide against each other smoothly.
There are constant innovations in the field of knee replacement. For instance, more surgeons are using regional anesthesia for the procedure, which can mean a shorter hospital stay compared with when general anesthesia is used. New multimodal pain approaches, surgical techniques and physical therapy after these surgeries are all improving a patients knee replacement experience.
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One Injection Stem Cell Treatments Are Not Sustainable Pain Relief
In the video below, Ross Hauser, MD explains the 5 myths we see concerning Stem Cell Therapy. The biggest one is that people believe that one stem cell injection will make all their pains go away. For most this is not true. It is not true for the same reasons outlined above, a single injection will not be comprehensive enough to reverse years and possibly decades worth of damage affecting the entire knee structure. This one-shot thinking leads to an unrealistic expectation of pain relief and joint regeneration.
The Current Literature Demonstrates The Potential Benefits Of Utilizing Concentrated Bone Marrow Aspirate For The Repair Of Cartilaginous Lesions Bony Defects And Tendon Injuries
Doctors in New Jersey at the Department of Orthopedic Surgery, Jersey City Medical Center published their findings in support of this research, in the World Journal of Orthopedics, here is what the paper said:
- The current literature demonstrates the potential benefits of utilizing concentrated bone marrow aspirate for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. The studies have demonstrated using concentrated bone marrow aspirate as an adjunctive procedure can result in cartilage healing similar to that of native hyaline tissue, faster time to bony union, and a lower rate of tendon re-rupture.
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An Alternative To Knee Replacement
ISTOCKPHOTO
For decades, legions of adults enduring the chronic pain and physical limitations of knee osteoarthritis have been offered two treatment paths, both of which have drawbacks.
The more traditional route involves medications, physical therapy and maybe joint injections, and usually brings only temporary relief. The second option has been to substitute artificial material for damaged bone and cartilage the so-called knee replacement. Each year, more than half a million people nationwide opt for the surgery, which generally yields excellent results and has a low rate of complications. However, not everyone is a candidate for knee replacement, with many having to forgo the surgery due to age or medical conditions. Some who would otherwise be candidates balk at the long rehabilitation period. Still others, aware of the 15- to 20-year implant life, put off having surgery as long as possible to avoid needing another operation later on.
Since 2017, UCLA has been among the only U.S. medical centers to offer a middle-ground option. Genicular artery embolization aims to permanently reduce inflammation in the knee joint, widely believed to be the cause of the pain and dysfunction. In the procedure, tiny particles are injected into the enlarged artery, decreasing blood flow to the area. Most patients can resume normal activities by evening on the day of the procedure, with maximum pain relief typically occurring in the first one to three months.
The Risks Of Regional Anesthesia
While safer overall than general anesthesia, regional techniques do have some risks
Sedatives: Drugs such as propofol, fentanyl, midazolam and ketamine are generally safe when used during surgery but can leave you woozy and muddleheaded for a while afterward. Make sure you have someone to drive you home.
Nerve blocks: Nerve injuries are very rare but can occur. Overdoses and misplaced needles can allow drugs to get into the bloodstream, which might cause confusion and even seizures.
Spinal and epidural anesthesia: Risks include nerve injury, infection, bleeding and headache. These are rare.
To lower your risks: Thoroughly and honestly answer all the questions your anesthesiologist will ask about your medical history. But also ask questions. Not all anesthesiologists are trained in using ultrasound to guide a nerve block, for instance. Ask about your surgical teams experience with using these regional techniques for your specific surgery.
What if you still want general anesthesia? Thats not uncommon or wrong. The idea of being even partially aware during surgery makes some people extremely anxious. Others are poor candidates for regional anesthesia because of medical problems. But if its right for you, youll likely recover faster and get home sooner.
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Find Out If You Are A Candidate
More than 600,000 knee replacements are performed the United States yearly. These include patients that have spent years skiing hard, running marathons, walking golf courses or just suffering from chronic arthritis. Many of these surgeries can be avoided by alternatively undergoing a minimally invasive state-of-the-art stem cell procedure.
By opting for the stem cell route in Colorado and avoiding knee replacement surgery, you may have the potential to avoid the long painful recovery, weeks of missed work, and the potential surgical risks that include infection, bleeding, blood clots and nerve injury.
You may be an excellent candidate to undergo a low-risk stem cell procedure, which is carried out without general anesthesia, minimal postoperative discomfort and virtually no recovery downtime. In addition, stem cell patients are able to return to work in 1-2 days, and sports in 4-6 weeks.
Many knee surgeries can be avoided by alternatively undergoing a minimally invasive state-of-the-art stem cell procedure.
Stem Cells to Avoid Knee Replacement Patient Testimonial Individual patient results may vary. Please contact us today to find out if stem cell therapy may be able to help you.
The Top 4 Knee Replacement Alternatives
Stem Cell Therapy
Stem cell therapy is quickly becoming one of the top knee replacement alternatives. This therapy uses stem cells that are found naturally inside adult bone marrow and fat. They are not be confused with embryonic stem cells. These cells have a unique ability to repair damaged tissues, including the tissues in the knee joints.
The problem is that many people facing a degenerated disease, such as knee osteoarthritis, have stem cells that are not being released as often as is needed to repair the damaged tissue.
Stem cell therapy fixes this problem, by injecting stem cells into the affected area allowing them to naturally make the necessary repairs to the knee joints. The risk of side effects or rejection, especially compared to knee replacement surgery, are minimal.
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Study: What Is The Best Knee Osteoarthritis Treatment To Help Avoid Knee Replacement Researchers Cant Tell Based On The Studies
Lets start with a February 2022 paper from doctors in Norway who published their review of knee osteoarthritis treatments in the journal Osteoarthritis and cartilage open . The researchers of this paper sought to provide evidence for comparing one set of treatments against another in the treatment of knee osteoarthritis. Lets see what they found by comparison.
First, the researchers constructed 17 broad categories, comprising drug treatments, exercise, surgery, herbs, orthotics, passive treatments , regenerative medicine , diet/weight loss, combined treatments, and controls . Then they reviewed previously published reviews encompassing 445 research papers.
Here are some of the result comparisons
The researchers concluded with these statements:
Direct comparison of different available treatment options for osteoarthritis is desirable, however not currently feasible in practice, due to heterogeneous study populations and lack of clear descriptions of control interventions. We found that many treatments were effective, but since the network as a whole was not coherent and lacked high confidence in the treatment comparisons, we could not produce a ranking of effects. Then the answer to the question What is the best knee osteoarthritis treatment? Cannnot be given.
New Quad Sparing Technique May Provide Faster Recovery For Patients With Arthritis Of The Knee
Edited by Seth S. Leopold, M.D., Professor, UW Orthopaedics & Hip & Knee
OverviewKnee replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe knee arthritis. Typically patients undergo this surgery after non-operative treatments have failed to provide relief of arthritic symptoms. Surgeons have performed knee replacements for over three decades generally with excellent results most reports have ten-year success rates in excess of 90 percent.
Broadly speaking there are two types ways to insert a total knee replacement: the traditional approach and the newer minimally-invasive approach.
Traditional total knee replacement involves a roughly 8 incision over the knee a hospital stay of 3-5 days and sometimes an additional stay in an inpatient rehabilitation setting before going home. The recovery period typically lasting from one to three months. The large majority of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.
The main potential benefits of this new technique include:
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