Alternative To Knee Replacement Offers Potential Relief For Patients Who Have Not Been Candidates For Surgery
During the genicular artery embolization, Dr. Sid Padia uses an angiogram to identify the abnormal genicular artery that supplies the area of pain in the knee. Image: ABC7
UCLA is among the first medical centers to offer a minimally invasive alternative to knee replacement surgery, providing potential relief to individuals who are experiencing debilitating pain from knee arthritis but havent been candidates for surgery or were deterred by the lengthy recovery time.
Osteoarthritis of the knee can cause significant pain and limit physical activity, hindering quality of life. Most people can obtain relief from medications or injections of a steroid or hyaluronic acid, but the benefits often are temporary and the effects may diminish with repeated treatments.
When these conservative approaches are inadequate, the only option has been knee replacement surgery. More than 600,000 people in the U.S. receive knee replacements each year, and the surgery produces excellent overall outcomes with a relatively low complication rate. But many people are not candidates, either because their advanced age or other medical conditions that place them at high risk. Additionally, many people at a relatively young age may delay the operation, given the likelihood that they might need a second replacement or revision after 15- to-20 years. Others decide to live with their discomfort rather than undergo a procedure that requires a prolonged period of recovery.
Lose Weight To Reduce The Stress On Your Knees
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.
How Do I Get Ready For Total Knee Replacement
Ask your provider how you should plan to get ready for your surgery.
Tell your provider about any medicines you are taking, including:
All prescription medicines
Over-the-counter medicines such as aspirin or ibuprofen
Herbs, vitamins, and other supplements
Ask if there are any medicines you should stop taking ahead of time, like blood thinners.
If you smoke, try to quit before your surgery.
If you are overweight, your provider may advise you to try to lose weight before your surgery.
Donât eat or drink after midnight the night before your procedure.
You may want to make some changes to your house, to make your recovery smoother. This includes things like adding a handrail in your shower.
In some cases, your provider might want additional tests before you have your surgery. These might include:
X-rays, to get information about your hip
MRI, to get more detailed information about your hip
Electrocardiogram , to make sure your heart rhythm is normal
Follow any other instructions from your healthcare provider.
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Stem Cell Knee Replacement Alternative
An interesting medical advancement is the stem cell alternative to knee replacement. In theory, this type of therapy uses the bodys natural healing abilities to repair cartilage damage. The goal is to:
- Slow and repair damage
- Reduce pain and inflammation
- Prevent knee replacement surgery
The procedure involves taking blood from the patient, concentrating the stem cells, and injecting those cells into the knee.
At this time, the Arthritis Foundation, the American College of Rheumatology, and the FDA do not recommend this form of treatment. It is considered investigational because there is not enough evidence to prove it is safe or effective. These entities will not endorse a treatment simply based on anecdotal evidence. However, as of August 5, 2020, a new clinical study was underway to test whether stem cells are effective for patients with osteoarthritis of the knee.
What Can I Do If I Have Knee Pain
If you have knee pain, you can do the following things to reduce the pain:
- Regular;exercise; although you may tend to avoid doing exercise when you have knee pain, regular exercise and staying active can help reduce your pain. Exercises such as swimming, cycling or walking are particularly good for your knee. They are low impact and don’t stress the joint but help keep your muscles healthy and strong.;
- Lose weight; being overweight can put extra strain on your knees, increasing your pain and make it harder to exercise. Losing even a small amount of weight can greatly reduce knee pain.
- Physiotherapy or occupational therapy; a physiotherapist can help plan and recommend suitable exercises for you to lessen your knee pain. An occupational therapist can teach you things such as how to pace your activities and spread hard jobs throughout the day to reduce extra strain on your knee.;
- Pain relief medicines; pain relief medicines or painkillers;are often recommended by your doctor or pharmacist to reduce pain and stiffness.;All medicines should be used at appropriate doses and for the shortest duration possible. Examples of pain relief medicines include paracetamol, NSAIDs or capsaicin creams and gels. Ask your doctor or pharmacist if you are unsure about which type of pain relief medicines is suitable for you.;
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Gold Injections We Bet You Didnt Know About This
This new gold microbeads injection is a drug-delivery system devised by US & Danish scientists. After many animal and human-based studies, it was launched in 2017. A pilot study also showcases the success of this therapy.
- How does the new gold injection treat osteoarthritic pain?
Gold injections interfere with the zinc-based pain pathways, which lead to reduced pain. Still, this injection does not just provide symptomatic relief! It actually works on the underlying condition causing pain.
Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections
Doctors wrote in a January 2019 study that while;PRP;injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the;PRP;injections delivered significantly better results.
A July 2020 study published in the;Journal of Pain Research;also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The studys conclusions were: Besides significantly higher satisfaction belonging to the group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections
In research published in the;Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, PRP was shown to provide significant healing of the meniscus;;as well as out out-perform hyaluronic acid in patients with knee joint cartilage degeneration. Similar results were documented in the journal Archives of physical medicine and rehabilitation.
In our article;Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not, we point to more research on when the treatment can be successful and when the treatment may not help you.
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Research: Prolotherapy Treatments For Patients With Knee Osteoarthritis Showed Significant Improvement In Scores For Pain Function And Range Of Motion
Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you are presented here and intermingled with our own 27+ years of empirical observation of patient benefit.
In research from June 2017, doctors publishing in the;British Medical Bulletin;;reviewed and evaluated Prolotherapy findings and determined Prolotherapy treatments for patients with knee osteoarthritis showed significant improvement in scores for pain, function, and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients .
Researchers found that Prolotherapy treatments;in female patients with knee osteoarthritis resulted in significant improvement in pain, function, and range-of-motion scores.;
- In this study, they took 24 female patients with an average age of 58 and gave them three monthly Prolotherapy injections.
- At the end of week 24 of the study, knee range of motion increased, pain severity in rest and activity decreased. Improvements of all parameters were considerable until week 8 and were maintained throughout the study period.
Exercising & Losing Weight
The first step toward repairing a damaged knee joint is to reduce the pain, stiffness, and swelling in order to prevent the loss of function.
Obesity has pronounced effects on joint stress. For every 10 pound weight gain, there is an associated increase in strain on joints, as much as 3 to 5 fold.
Conversely, weight loss will help with pressure on joints as well as have a beneficial effect on systemic diseases and inflammatory products. In addition, patients with high blood pressure or diabetes often reduce or eliminate their medications after weight loss.
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Our Goal Of Treatment Is To Help The Person With Knee Pain And Osteoarthritis Who Has Been Told That Knee Replacement Is Their Only Option To Avoid That Surgery
While covering studies above in this article which clearly shows the detrimental effects of some conservative care, treatments on a knee, deep in degenerative disease, it can not be emphasized enough how damaging nonsteroidal anti-inflammatory medications and corticosteroid injections are to the joint, especially the articular cartilage.
These treatments make it more difficult in the long run for the patient to walk. Besides independence and mobility, your knee needs to walk because that is how;nutrients reach the articular cartilage to help it heal.
Our goal of treatment is to help the person with knee pain and osteoarthritis who has been told that knee replacement is their only option, stop destructive treatments, and stabilize their knee to prevent the destructive stress forces from further damaging their knee.
How Patients Can Reduce Painful Symptoms Between Now And Their Treatment Date
If a patient has tried multiple non-invasive treatments without success and their next step is surgery, they can take steps to reduce their pain until their surgery date.
Some ways to ease knee pain:
- Exercise/physical therapy: If a patient has a degenerative condition like osteoarthritis, it is best if they seek the assistance of an exercise professional like a physical therapist. They can create a treatment plan that will strengthen the leg and promote flexibility without increasing the risk of pain or joint damage.
- Supplements: In addition to NSAIDs, supplements like glucosamine and chondroitin can reduce pain and increase mobility in some patients.
- Bracing: A knee brace provides stability and properly aligns the joint, easing pressure and reducing pain.
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What Are Knee Replacement Alternatives In Treating Knee Arthritis
When steroid injections no longer work, another option would be viscosupplementation, which is a lubricant-type injection that we actually inject into the knees in a series of five shots. If all of these measures fail, then the other option would be a total knee replacement.
Now We Can Design a Custom Knee if You Need Total Knee Replacement
There have been many advancements in the area of total knee replacements over the last few years. Now we can actually give you a custom knee, whereas previously a surgeon had to rely on standard tools that were made forone-size-fits-all type of procedures. ;Please see our article about the;Vanguard Complete Knee.;
We can take an MRI of your knee, look at your body anatomy and your alignment from your hip, knee to your ankle joint, and send that MRI to a knee implant manufacturer. ;The knee manufacturer builds custom jigs that allow us to map your knee and place the implant according to your anatomy. We hope this will increase the longevity of total knee replacements past the current expected outcome of about 15 years.
A Partial Knee Replacement may be an Option
Left knee-joint from behind, showing interior ligaments.
polyethylene here that allows it to glide and slide. This can significantly help a patients pain and allow her to get back to regular activities. But you can only do this in a patient that has isolated arthritis on the medial side of the knee. ;Heres more information about the partial knee.
What Are The Signs Of Needing A Knee Replacement
Signs that it might be time for a knee replacement:
- Your pain persists or recurs over time.
- Your knee aches during and after exercise.
- Youre no longer as mobile as youd like to be.
- Medication and using a cane arent delivering enough relief.
- Your knee stiffens up from sitting in a car or a movie theater.
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Cortisol And Hyaluronic Acid Injections
There is a lot of scientifically proven evidence that cortisone and hyaluronic acid injections âlubricateâ the inner workings of the knee and thus alleviate arthritis pain. Such injections can provide temporary relief â 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.
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.
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What The Studies Say
GenVisc Plus has been cleared by the FDA and is only able to be administered by medical specialists. The treatment has been scientifically researched and has shown great results in its patients thus far. After three months, nearly 80% of patients have reported a greater reduction of pain . Patients have also reported drastic improvements in daily function and overall pain relief.
For more information about our GenVisc Plus treatments as an alternative to knee replacement surgery, give us a call for a free consultation today.
Is There Anything I Can Do To Prevent Having Knee Surgery
The treatment of knee pain is different for everyone. If you are overweight, weight loss is especially helpful and may mean you no longer need surgery. You may be able to find a combination of the treatment options above that works for you without needing to have surgery. Having support from your family/whnau and friends also help as being anxious and depressed can make your pain worse.;
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In Clinical Observations At Caring Medical Great Benefit Is Seen In Injecting Bone Marrow Directly After Extracting It
The theory is that the number of stem cells is not as important as how long they live in their natural environment. In other words, when the bone marrow is directly injected, the source of stem cells is fresh and has great potential for healing. We also believe that the body knows best it can use these immature cells to regenerate all injured tissues in the joint.
How Can I Fix My Knee Without Surgery
Non-Surgical Alternatives to Knee Surgery
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Do I Need A Knee Replacement
If your arthritis isnt responding to non-surgical treatments, you may consider undergoing knee replacement surgery.; You mayneed a knee replacement if your knee gives you pain, stiffness, instability or loss of function that affects your daily life andactivities.; Knee replacements are most common surgery for osteoarthritis.
If your symptoms are still manageable through conservative therapies and/or your medication is effective, then you may choose to notundergo surgery.
Your orthopaedic surgeon will be able to advise you on the surgical options and on the potential pros and cons of having or delayingsurgery, taking into account your age, health and level of activity.
Most people who have a knee replacement are over 60 years of age.; If youre under the age of 50 and decide to go ahead with aknee replacement, then youre more likely to need a repeat operation in later life.; However, there is evidence that the surgicaloutcome may be better if you dont wait until the knee becomes very stiff or deformed.
Unfortunately, some people may not be able to have a knee replacement even though their arthritis may be severe:
- If the thigh muscles are very weak they may not be able to support the new knee joint;
- If there are deep or long lasting open sores in the skin below the knee the risk of infection may be too great to consider surgery.
- However, there may be other options available to help.; This includes:
- Joint injections of Viscosupplementation agents
- Knee braces