What are the alternatives for knee replacement?

Osteoarthritis is very common in the UK. It is estimated that 10 million people are affected. Knee osteoarthritis (OA) affects one in five adults over the age of 45.

What is osteoarthritis?

Articular cartilage lines the ends of the bone and allows them to move with low friction. When this becomes damaged this can cause stiffness, pain, and swelling, which is worse with activity. It tends to affect people as they get older, but can also affect younger patients if there is a problem with overall alignment or if they have had previous injuries.

How is osteoarthritis treated?

Treatment should be based on the person’s symptoms, not just on their X-rays or MRI findings. Both total knee replacements and partial knee replacements have excellent outcomes when performed at the appropriate time for the individual. However, not all patients with osteoarthritis require a knee replacement.

What are the non-surgical treatments options?

Non-surgical treatment may be appropriate if someone has early to moderate arthritis or if they would like to delay surgery. It may also be appropriate for those patients who are not fit for surgery or do not want surgery at all.

Non-surgical treatments can be broken down into four categories:

1. Exercise and physiotherapy:

Many patients with early symptoms of knee osteoarthritis will benefit from an exercise-based rehabilitation programme which focuses on strengthening, mobility, and movement training.

2. Weight management:

Weight loss can significantly improve people’s knee pain. Even a small amount of weight reduction can reduce the forces and joint stress.

3. Medications and supplements:

Simple painkillers such as paracetamol or anti-inflammatory medications can help people’s pain and keep them active. There are a number of supplements such as glucosamine that are marketed to help reduce patients’ symptoms. Some people find these very useful, although the scientific evidence is limited. There is also evidence that diets that are high in turmeric can reduce inflammation and therefore reduce pain.

4. Injections:

There are a number of different injection options that can be used:

• Corticosteroid injections provide short-term relief. There is a growing body of evidence that suggests that steroids injected into the joint can affect the articular cartilage and therefore may accelerate the wear process. There is a role for steroid injections in aiding diagnosis and facilitating rehabilitation.

• Hyaluronic acid, which is also referred to as viscosupplementation aims to restore the normal joint fluid and reduce their symptoms. Symptoms relief lasts for approximately six to nine months however some patients do not seem to benefit.

• Platelet-rich plasma (PRP) has also been used over the past decade or so. There is no clear evidence that it provides a significant reduction in symptoms in the long term, however, some patients find that it can be helpful. PRP is commonly referred to as a regenerative option. However, there is no evidence that tissue regenerates following PRP injection. It may, however, affect the amount of inflammation within the joint.

• Stem cell therapy has been used over the past few years. It has been marketed as a treatment that can regenerate damaged tissue. There is no scientific evidence that it regenerates tissue or that it significantly reduces.

• Hydrogel injections are a recent development. The only available injection on the market is Arthrosamid. The gel is injected into the knee and is taken up by the synovium which lines the joint capsule. This then reduces the amount of inflammation that can be produced. It helps approximately 70-80% of people. There is now four years worth of data which shows that if you are in the group where you have significant symptom improvement, it is maintained in the vast majority of patients over four years.

• Bracing and orthotics aim to improve the biomechanics and offload the areas of wear within the joint which can reduce symptoms.

• Lifestyle and activity modifications such as low impact exercises including swimming and cycling can help manage symptoms. 

Will running make my knee OA worse?

This is a common question that people have. There is no evidence that proves that running makes knee OA progress. There is evidence that shows that remaining active can help manage people’s symptoms. 

What to do if you have knee pain

Having knee arthritis should not limit your activity. It is important to continue to stay active and maintain a healthy lifestyle. By having a treatment plan that is tailored to your needs, you should be able to remain active.

If you find that simple methods do not improve your symptoms and are impacting your quality of life, then seeing a specialist knee surgeon can help to understand why you’re having the symptoms and to discuss the treatment options.

At Grosvenor Orthopaedic Partners, both surgical and non-surgical treatment options will be discussed so that you can weigh up the risks and benefits of each so that you can choose the right treatment for you.

Mr Mark Webb MBBS MSc FRCS (Tr & Orth)  Consultant Sports Hip & Knee Surgeon  Grosvenor Orthopaedic Partners LLP  T +44 (0)7980 985 541 E mark@gop.health Secretary: Jenna Edwards  T +44 (0)20 3824 2298 E webbpa@gop.health

References

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