Artificial knee replacement is a medical marvel. It’s one of our oldest and most common joint operations, and the satisfaction rates are reassuringly high – some 87% of patients report their post-surgery results to be somewhere between “good” and “excellent”, according to recent data from the NHS.
But if you know anything about artificial knee implants, you’ll also know they’re not for everyone. Joint replacement is major surgery. The recovery period is significant. And there are long-term implications for the things you can and can’t do afterwards. That’s why, unless you’re suffering severe symptoms caused by bone-on-bone arthritis, doctors will usually advise you to avoid or delay the procedure.
But if you do find yourself in this “early-stage” arthritis situation, what should you do? Let’s say you’ve had the scans. Your consultant has detected mild or moderate arthritis damage. You’ve been getting intermittent symptoms, such as pain and swelling. What can you do instead of knee replacement? What are the alternatives?
1. Reduce the symptoms
With early-stage arthritis, the first line of treatment is really about managing your arthritis and getting on top of the symptoms – particularly pain. Fortunately, the range of options for this is now pretty extensive. For short-term use, over-the-counter painkillers can help you through the cycles of aching pain that osteoarthritis brings on. Capsaicin cream – derived from chilli peppers – has been shown to modulate nerve pain. Ibuprofen and aspirin have anti-inflammatory properties (“NSAIDs”). Studies have found that ice and heat treatments and even humble paracetamol can be effective at reducing arthritis pain. Beyond simple analgesics, you could explore the possibility of painkilling injections. Hydrocortisone injections target pain and swelling by releasing a steroid slowly into your knee (see the NHS’s guidance on these). Some patients find that injections of hyaluronic acid (a lubricating chemical that our bodies produce naturally) also provide effective medium-term relief. For more on this, see Do hyaluronic acid injections work for knees?
2. Protect the joint surfaces
The second approach is about protection. That means: a) preserving the healthy cartilage in your knee joint and b) preventing damaged areas from getting worse. If you’re active and sporty, it may be time to think about activity modification. Certain activities subject your joints to a higher “focal load”: things like high-impact running, jumping, crouching, squatting, climbing. It’s not about stopping exercise, because healthy exercise is essential for your health (joints included). But it may be worth changing the exercise type. So consider swapping things like running and contact sports for swimming, cycling, cross-training or rowing. Beyond sport, it’s also worth thinking about weight. Carrying excess bodyweight puts significant strain on our joints. Experts calculate that every pound we carry translates into 4lbs of load-bearing pressure on our knees. So the more you can do to reach a healthy bodyweight, the better. But if sport feels like a thing of the past and mobility itself is becoming a problem, you may want to explore the idea of walking aids. Again, the range of help available is extensive. It starts with things like shoe inserts (orthotics) and progresses up through braces, canes, walking frames and mobility scooters. The NHS has a useful guide to some of these.
3. Consider alternative surgery
When it comes to arthritis, of course, knee replacement isn’t the only game in town. If you have “mechanical” symptoms, such as catching or locking in your knee, we may look at an arthroscopy (keyhole surgery). It might be that a piece of frayed cartilage (a “loose body”) has come away from your joint and lodged in the joint. A key treatment option here is debridement, which aims to locate and remove the loose bodies, and smooth the frayed edges of cartilage. Another option is microfracture, which is often performed at the same time. Here the idea is to create tiny holes in the bone surface, which encourages the marrow to build new fibrocartilage within the joint. Beyond these procedures, there’s also osteotomy. This is an operation for people whose arthritis has been caused by an alignment problem in their leg. It works by making cuts in the bone to adjust the leg alignment. This moves pressure away from the “pinch-point” in your joint, protecting it from further pain and damage. You can find out more about the procedure here: What is an osteotomy of the knee?
Are you suffering from persistent knee pain? If so, it’s important to have it properly investigated. You can do that here in the clinic by booking an appointment with us. We’ll make sure you’re seen, examined and treated as soon as possible.