Total knee replacement: Are there any alternatives?

Dr Siddharth Shah, a Joint Replacement Surgeon, S.L. Raheja Hospital, Mahim, shares his insights about various alternative treatments that a patient can opt instead of a total knee replacement

Image Source: Google
Image Source: Google

Millions of Indians suffer from Knee Osteoarthritis (OA) which adversely affects their quality of life. In India, its prevalence is estimated to be around 29% (Pal, et. al., Indian Journal of Orthopaedics, 2016).

The OA is characterised by joint degeneration commonly due to wear and tear. Generally, initial management involves activity modification (avoidance of squatting, cross-legged sitting, and others), weight management, regular healthy exercise, muscle strengthening Physiotherapy, and pain-relieving medications.

Additional treatment is required if symptoms are not controlled by the above measures.

It is known that the Total Knee Replacement (TKR) can manage advanced cases of knee OA. However, awareness about other treatment options for knee OA is limited.

Alternatives to TKR for knee OA include biological & regenerative treatments, Partial Knee Replacement (PKR), and leg realignment surgery.

Biological & Regenerative Treatments: These are novel, non-surgical treatment options for knee OA. Substances found in the human body are used to facilitate healing of a worn-out joint.

They help relieve symptoms and reduce or avoid the use of pain-killers altogether. Because of their biological nature, these treatments are generally considered safe. The following treatments have demonstrated beneficial effects in patients with knee OA.

Platelet Rich Plasma (PRP): Platelet cells are present in human blood, and is packed with growth factors. They can help reduce inflammation and promote healing of an arthritic joint. PRP is prepared by withdrawing a small amount of patients blood and centrifuging it. A carefully separated portion of the centrifuged material which has a high concentration of platelets is injected into the arthritic knee joint. Scientific literature shows that PRP injection improves symptoms of knee OA and can help delay surgery (TKR).

Bone Marrow Aspirate Concentrate (BMAC): BMAC is prepared by extracting Bone Marrow from the patient’s pelvic bone using a special needle. A centrifuged fraction rich in Stem Cells is injected into the arthritic joint. Stem cells can transform into different tissues, including Cartilage and have regenerative potential. Researches show that BMAC injections help improve pain and activity levels in patients suffering from knee OA.

Hyaluronic Acid (HA): Synovial Fluid present in the knee joint provides lubrication, nourishment, and act as a shock absorber. HA is an essential component of synovial fluid. The quality of HA deteriorates in knee OA which affects synovial fluid function resulting in symptoms. HA injection can help improve the quality of knee joint fluid and thus relieve symptoms.

Autologous Protein Solution (APS): This utilises a fraction of the patient’s blood which is rich in anti-inflammatory substances and growth factors. It counteracts the ongoing process of cartilage damage and promotes healing in the joint. Evidence shows that APS injection helps relieve pain, stiffness, and aid function in patients suffering from knee OA.

Partial knee replacement (PKR): PKR means replacing only the damaged portion of the knee as against TKR, which involves replacing the entire knee joint. Thus, the rest of your healthy knee joint is preserved. PKR is minimally invasive with a smaller incision and usually results in lesser pain. It is a muscle, ligament and bone-preserving procedure which allows a quicker recovery. Patients frequently state that the knee feels more natural and may also bend better as compared to TKR. They are often more satisfied and return to normal activities faster. It is particularly suitable for those who want to return to an active lifestyle.

Leg Realignment Surgery (Osteotomy): Realignment surgery involves controlled alteration of the patient’s leg alignment in order to transfer body weight from the arthritic part to the healthy normal part of the knee. Consequently, reduced loading of the arthritic part helps relieve patient’s symptoms and can avoid knee replacement surgery.

While choosing a treatment for your knee arthritis, discuss all possible alternatives with your surgeon in order to select the best treatment suited to your lifestyle and needs.