Knee Replacement (aka Arthroplasty)

By Barbara Hale, M.D.
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Doctor Examining Male Patient With Knee Pain

Overview

Knee replacement or arthroplasty, is a surgical process to replace, or remodel the joint surface of the knee. It is performed to alleviate pain and restore function after joint damage.

Knee replacement procedures exchange the damaged parts of the knee with artificial implants.  At present, technology has improved to create better porous-coated prosthesis (implants) with stronger bonding to the body and even 3D printing for customized implants.

Several million Americans now adjust to a new life with knee replacements.

Causes of knee and joint damage include:

  • Arthritis
  • Osteoporosis
  • Twisting, sudden changes in direction and bending from high-impact sports
  • Falls
  • Overuse

Indications for Knee Replacement

Consider surgery if you have:

  • Constant knee pain keeping you from resting or sleeping
  • Chronic knee swelling
  • Severe pain and stiffness
  • Difficulty climbing up stairs, walking or rising from sitting
  • Bowed knee
  • Failed medication and physical therapy

Surgery for Knee Replacements

Prior to having a knee replacement, a comprehensive medical history and physical examination will be done including X-rays to see the damage within the knee.

The surgery may be performed under general anesthesia or a spinal/epidural anesthesia to numb you below the waist and takes 1-2 hours. 

Typically surgery is done in one of two ways:

  1. Incision is made in front of the knee, damaged joint parts are removed along with thighbone and shin surfaces adjacent to the joint and then the artificial knee is inserted.
  2. Minimally invasive technique where the incision is smaller but the rest of the procedure is the same.

After surgery:

  • Within one day, get on your feet.  Crutches, walker or cane may be needed.
  • Exercise to strengthen muscles and lessen swelling
  • Flexibility and less pain occurs within 30 days

Arthroscopic surgery is the process of removing pieces of bone, torn meniscus or damaged cartilage while repairing ligaments. It is less invasive and recuperation is much shorter and less painful.  This may be offered before knee replacements.

Alternative Treatments

Knee replacement should not be the first choice for treating knee pain since there are less invasive ways to relieve pain that should be tried first. There are several alternatives to knee replacement surgery.

  • Acupuncture involves insertion of sharp, thin needles to affect nerves and change the flow of energy (chi) in the body. Studies shows that acupuncture can dramatically lessen knee pain. 
  • Lifestyle changes involve losing weight.  According to a report issued by the John Hopkins Arthritis Center, even 10 pounds over the ideal weight can give 60 pounds of force on the knee with each step. Exercise will strengthen the muscles, help with weight loss and lessen pain.
  • Work with a Chiropractor or Physical Therapist. These professionals will:
  • Customize exercises to decrease pain and strengthen the specific muscles that affect your knee. They will work with you to ensure that they are done correctly
  • Apply heat and ice
  • Offer electrical stimulation therapy
  • Perform ultrasound therapy to improve blood flow to the skin
  • Use low level laser therapy to reduce pain and inflammation

Medical physicians, most often orthopedic surgeons, may use injections to lubricate the knee joint for better shock absorption and mobility by injecting hyaluronic acid.

Two therapies, which are still considered experimental while studies are being amassed, include:

  1. Stem cell therapy using bone marrow from the hip is reported to help regenerate knee cartilage which repairs the knee and decreases pain
  2. Plasma-rich proteins (PRP) are obtained from platelets with growth factors and injected into the knee joint to relieve pain.  However it does not regenerate cartilage.
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It is crucial to explore all available options and consider alternatives to surgery when possible as additional risks are involved.  If surgery is the only resort left, don’t reject it as doing so can create additional long-term symptoms.

Stausholm MB, Naterstad IF, Joensen J, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebocontrolled trials. BMJ Open 2019;9:e031142. doi:10.1136/ bmjopen-2019-031142