Alternatives To Knee Replacement

If you have knee pain, knee replacement surgery should always be the final option. Although it is a common and safe procedure, a knee replacement is major surgery which has associated risks and a long recovery period. Before considering a knee replacement it is advisable to discuss non-surgical treatments with your doctor.

Common questions:

What is joint cartilage damage?

The ends of the knee bones are normally covered in shiny white cartilage called joint cartilage that helps to keep the joint movement smooth. Arthritis is termed wear and tear to the cartilage and surgeons can grade the degree of cartilage destruction as:

Grade 0 - cartilage is normal and intact

Grade 1 - some softening of the cartilage

Grade 2 - partial thickness (less than 50%) defect or minor tears in the cartilage surface

Grade 3 - deeper defect (more than 50%)

Grade 4 - full thickness cartilage loss with underlying bone exposure

What is a knee replacement?

In a standard knee replacement the aim is to ‘resurface’ the end of the bone. Small amounts of bone and remaining joint suface cartilage are removed and resurfaced with metal and plastic. Parts of the femur and tibia bone are cut and resurfaced with metal, inbetween a piece of plastic is used. If the kneecap is also degenerated, this can also be resurfaced.

When is a knee replacement considered?

It is important that all patients are given all information regarding other options and that they understand what the indications are for knee replacement surgery. More conservative options can be attempted first before choosing a total knee replacement, which really is the last option. Indictations for knee replacement include:

Pain

This is a primary factor when considering knee replacement surgery. Simply, how severe and how much it is interfering with day-to-day activity. This includes night pain which is a common feature of arthritis. 

A way to measure pain, subjectively, is asking patients to rank their pain on a scale of 0-100, we call this the Visual Analogue System (VAS).

Swelling

Arthritis causes inflammation which in turn causes swelling. An increased amount of fluid in the knee can often accumulate at the back of the joint which can form a Baker’s cyst, which can be painful and tender. People considering knee relacemnt may experience this.

Stiffness

Besides functional stiffness from worn joint surface and accumulated fluid. Arthritis can cause patients to hold the knee in a slightly bent position to avoid pain of the worn joint surfaces touching eachother. This can lead to the flexion of the knee becoming fixed and being unable to straighten the leg. 

Immobility

As pain, swelling and stiffness increase, it is common that people suffering with arthritis will become less active and the muscles around the knee start to waste. The quadriceps (front of the thigh) are essential in the stability of the joint and in standing up. 

Age

Older patients tend to find more success with knee replacements as they are less active. Compared to younger patients, once they recover they hope to return to an active lifestyle which decreases the life expectancy of the joint.

What are the outcomes of a knee replacement?

Recent studies have shown us that there is a significant number of patients who are unhappy with their knee replacement. This is measured by standardised, objective and subjective questions providing knee function scores and quality-of-life scores. 

Good outcomes

10% of patients will have a fantastic result with zero pain. 70% of patients will feel significantly better but are partly dissatisfied because the knee doesn’t feel completely normal (residual swelling and pain). 

Bad outcomes

20% of patients will have a bad result and a small portion having worse pain than before. They may complain of instability and clunking as the knee is straightened. 

Am I too young for a knee replacement?

Many patients are told they have bad arthritis but are too young for joint replacement surgery. Mainly because younger patients return to a more active lifestyle than older patients and decrease the life expectancy of the knee replacement. In this case, lots of non-operative and operative alternatives exist and may be suitable. 

How can the Regenerative Clinic help?

The Regenerative Clinic offers numerous non-operative and surgical alternatives to knee replacement surgery (read below).

Our expert team of consultant surgeons specialise in treating orthopaedic injuries, sports injuries, arthritis and other degenerative conditions using advanced non-surgical techniques including Lipogems® adipose tissue transfer and Platelet Rich Plasma therapy. They can provide traditional orthopaedic surgery but will offer minimally invasive alternatives where suitable.

Book your consultation by calling 0330 2233332. 

What are the non-operative alternatives?

There are a number of alternative interventions that might be able to alleviate symptoms of joint cartilage damage. 

Lipogems® adipose tissue therapy

Is a minimally invasive treatment which uses your own fat tissue to promote healing. It can treat pain and inflammation affecting the tendons, ligaments, joints and muscles, as well as help to heal the underlying cause of the problem. It is particularly beneficial for people with painful knees and a limited range of motion. Find out more.

Platelet Rich Plasma (PRP) injections

Takes advantages of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscle and bone. It can reduce pain and improve joint function.

With PRP, your blood sample is taken and then put in a centrifuge which separates platelets from other blood components. Platelets contain proteins which help wounds to heal. The concentration of platelets is then injected into your knee. Find out more.

Pain Relieving Injections

The Regenerative Clinic offers steroid injections and the latest Viscoelastic Supplements using OESTINEL® PLUS (a long lasting and effective pain relieving injection) and CINGAL® (a unique and highly effective pain relieving injection that combines hyaluronic acid and a fast acting steroid. Find out more.

Unloader braces

Orthopaedic braces stabilize, support and correct injuries or abnormal alignment through the process of rehabilitation and recovery. They are used in osteoarthritic care, injury rehabilitation/prevention and post-operative care. Find out more.

Physiotherapy

Weight loss and exercise as a first step. Losing weight puts less strain on your knee and exercise, such as swimming or cycling, can improve the strength and flexibility of your knee as well as help you lose weight. Being inactive can lead to a stiffer joint as weight tends to go up and muscle lost. A stiffer joint can make arthritic symptoms worse and makes surgery less successful compared to a joint that moves well. A physiotherapist can design a programme to help strengthen the key muscles around your knee and ultimately reduce pain. 

What are the surgical alternatives?

Partial knee replacement

A partial knee replacement is where only one area of the knee joint is resurfaced. The knee has three different areas where the bones move against one another (medial, lateral and patellofemoral), these are called compartments. In a partial or unicompartmental knee replacement the surfaces of the worn compartment are replaced in a similar way with metal and plastic. The advantages of a partial compared to a total knee replacement is that:

  • The remainder of the joint is preserved
  • The ligaments inside (cruciate ligaments) and on the outer side (collateral ligaments) are retained
  • It is relatively easy to convert to a total knee replacement if required therefore it is preferable for younger patients

Arthroscopy

An arthroscopy is a type of keyhole surgery used to diagnose and treat certain conditions. It can be advised to patients with a knee injury to remove bone fragments, pieces of torn meniscus or damaged cartilage. 

Osteotomy

Misalignment of the knee can cause certain areas of the joint surface to become arthritic. Ostetomy is a realignment procedure that involves cutting a wedge into one or both of the bones either side of the knee and altering the alignment of the leg. This can be highly effective in relieving symptoms and the knee joint is preserved.

The Regenerative Clinic’s Professor Adrian Wilson is a leading surgeon in osteotomy and can offer it in combination with other regenerative treatments to his patients.

Knee joint distraction

Knee joint distraction is a relatively new procedure and is increasingly investigated. Joint distraction requires an external frame to be fixed in the femur and tibia. This allows the knee joint to gradually seperate for several weeks. The aim being to reduce menchanical stress on the joint surface, preventing further wear and tear and initiating tissue repair. (link to find out more)

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