As an aging population, many of us are familiar with knee pain and joint problems. We want to stay active and maintain our quality of life, but knee pain can be debilitating. Knee replacement surgery has become a popular solution, with rates doubling from 1999 to 2008 and an estimated 3.5 million procedures a year expected by 2030.But are we getting carried away with knee replacement surgery? Doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold.
Research suggests that up to one-third of those who have their knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results.A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.
One-third of patients who undergo knee replacement may not even be appropriate candidates for the procedure because their arthritis symptoms aren’t severe enough to merit aggressive intervention, according to a 2014 study in Arthritis & Rheumatology.“We do too many knee replacements,” said James Rickert, president of the Society for Patient Centered Orthopedics. “People will argue about the exact amount. But hardly anyone would argue that we don’t do too many.”
So why are knee replacement rates skyrocketing? The increase may be fueled by a higher rate of injuries among younger patients and doctors’ greater willingness to operate on younger people, such as those in their 50s and early 60s. New implants can last longer — perhaps 20 years — before wearing out, making the procedure more attractive to younger patients.
But even the newest models don’t last forever. Over time, implants can loosen and detach from the bone, causing pain. Plastic components of the artificial knee slowly wear out, creating debris that can cause inflammation. Patients who remain obese after surgery can put extra pressure on implants, further shortening their lifespan. The younger patients are, the more likely they are to “outlive” their knee implants and require a second surgery.
Such “revision” procedures are more difficult to perform for many reasons, including the presence of scar tissue from the original surgery. Bone cement used in the first surgery also can be difficult to extract, and bones can fracture as the older artificial knee is removed.
It’s important to note that some patients are offered surgery they don’t need, and that money can be a factor. Knee replacements, which cost $31,000 on average, are “really crucial to the financial health of hospitals.”
But surgery isn’t the only way to treat arthritis. In fact, many patients can often benefit from non-surgical options. Studies show that these approaches can even help people with more severe arthritis.
In a study published in Osteoarthritis and Cartilage in April, researchers compared surgical and non-surgical treatments in 100 older patients eligible for knee replacement. Over two years, all of the patients improved, whether they were offered surgery or a combination of non-surgical therapies. Patients randomly assigned to undergo immediate knee replacement did better, improving twice as much as those given combination therapy, as measured on standard medical tests of pain and functioning.
But surgery also carried risks. Surgical patients developed four times as many complications, including infections, blood clots, or knee stiffness severe enough to require another medical procedure under anesthesia.
Significantly, most of those treated with non-surgical therapies were satisfied with their progress. Although all were eligible to have knee replacement later, two-thirds chose not to do it.
In conclusion, knee or joint replacement surgery should be a last resort for those with severe arthritis symptoms that have not resolved with conservative treatment options. Patients should weigh the risks and benefits and explore non-surgical joint pain solutions such as those offered at Buffalo Arthritis & Joint Pain Solutions
BMJ study on knee replacement and quality of life: https://www.bmj.com/content/354/bmj.i3868
Arthritis & Rheumatology study on knee replacement appropriateness: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.38500
Osteoarthritis and Cartilage study on surgical vs. non-surgical treatments for knee osteoarthritis: https://www.sciencedirect.com/science/article/pii/S106345841930525X
