Alternatives to Knee Replacement Surgery – Are They Really Effective?

On January 14, 2021, an orthopedic surgeon in Vancouver, Canada, performed a knee replacement surgery outside of a hospital setting.

The procedure was done in an outpatient surgery center and allowed the patient to go home the very same day.

Technology is allowing medical professionals to accomplish amazing things through the use of AI and robotics.

Still, many wonder: are there alternatives to knee replacement surgery?

It is a valid question since even minimally invasive surgeries put the body through a lot of stress. Fortunately, technology has advanced to the point where, for some people, surgery may not be necessary.

Common Knee Surgery Alternatives a Doctor May Recommend

Most orthopedic surgeons are going to recommend knee replacement surgery to their patients. They feel that even the best alternatives to knee replacement are just temporary. Eventually, their patients will need to have a partial or total knee replacement.

And right now, surgeons are excited to recommend surgery because of the many advancements that make the procedure less time-consuming and more comfortable for the patients. AI and robotics scientists are producing incredible surgical tools and aids.

However, if a patient wants to avoid surgery – or at least put it off – a surgeon will likely recommend the following options.

Anti-Inflammatory Medications

Various conditions and certain injuries can cause inflammation of the knee. When the knee is inflamed, it becomes:

• Stiff
• Swollen
• Painful
• Difficult to move (extend or flex the leg)
• Weak

In this situation, a doctor might recommend anti-inflammatory medications as the first course of action.

• Over-the-counter medications: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) include high-dose aspirin, naproxen (Naprosyn and Aleve), and ibuprofen (Advil and Motrin)
• Prescription medications: A doctor might recommend prescription strength doses of the above NSAIDs, or COX-2 inhibitors, which are prescription-strength NSAIDs that may be better at fighting inflammation.

Reducing inflammation takes pressure off the knee joint, as well as the surrounding muscles, nerves, tendons, and ligaments. Relief from inflammation can improve mobility, allowing knee pain sufferers to live a healthier, more active lifestyle.

In fact, in addition to taking NSAIDs regularly, your doctor will likely recommend physical therapy. The treatment plan of your therapist will help strengthen your leg muscles, reducing your risk of falls and pain.

Unfortunately, these are just temporary solutions. If the root cause of the pain is not addressed, the inflammation will return. Patients will have to continue taking these medications (which can have long-term side effects) or other alternatives to knee replacement surgery.

Joint Injections: Knee Replacement Alternative Gel

Another alternative recommended by doctors and surgeons is gel knee injections, also known as viscosupplementation.

The injectables contain hyaluronic acid, a naturally occurring compound found in the synovial fluid of the joints. The gel-like substance aids in joint lubrication, reduces inflammation, and promotes bone and cartilage growth.

Knee replacement alternative gel injections have been used for decades and are often a recommended course of action before a doctor recommends surgical therapy. A 2019 study found that newer monoinjections of hyaluronic acid gel can be just as effective as older options that require multiple once-per-week injections. This is great news as it means fewer trips to the doctor, less money out of pocket, and less pain.

Unfortunately, this, too, is often just a temporary solution. If a patient has osteoarthritis, the disease will continue to progress, and eventually surgery will be recommended by the patient’s doctor.

NSAIDs and gel injections can be effective. Oftentimes, though, they are just temporary solutions.

What are the Latest Alternatives to Knee Replacement?

Medical scientists are constantly looking for new ways to treat diseases like osteoarthritis. Here are just a couple of the current non-surgical therapies for knee pain that seniors swear by.

Stem Cell Knee Replacement Alternative

An interesting medical advancement is the stem cell alternative to knee replacement. In theory, this type of therapy uses the body’s natural healing abilities to repair cartilage damage. The goal is to:

• Slow and repair damage
• Reduce pain and inflammation
• Prevent knee replacement surgery

The procedure involves taking blood from the patient, concentrating the stem cells, and injecting those cells into the knee.

At this time, the Arthritis Foundation, the American College of Rheumatology, and the FDA do not recommend this form of treatment. It is considered “investigational” because there is not enough evidence to prove it is safe or effective. These entities will not endorse a treatment simply based on anecdotal evidence. However, as of August 5, 2020, a new clinical study was underway to test whether stem cells are effective for patients with osteoarthritis of the knee.

Unispacer Knee Replacement Alternative

When a patient has osteoarthritis, their knee cartilage progressively wears away, leaving the femur and tibia bones to rub against each other without a cushion. The result is pain, stiffness, inflammation, and bone spur development.

Scientists have developed a device called the Unicondylar Interpositional Spacer – or Unispacer. The device is inserted into the knee joint. It acts as a spacer to separate the two leg bones. The procedure is less invasive than knee replacement surgery but is not as effective for most patients with advanced arthritis.

Genicular Artery Embolization (GAE): New Knee Replacement Technology in 2021

There is exciting news for patients looking for an alternative to knee replacement surgery in 2021. It is a procedure called genicular artery embolization, and it is used to treat osteoarthritis.

A recent study (2020) shows that the procedure is effective at significantly reducing patients’ knee pain, particularly those dealing with moderate-to-severe knee pain. The study showed continued improvement at each of the one-month, three-month, and six-month checkups, which included an MRI scan. Patients felt the increased improvement over time, and the MRI showed it.

Another 2020 study tested 10 patients that received GAE treatment. At the 12-month mark, patients reported:

• Median pain: 15.4% improvement
• Knee/leg function: 21.3% improvement
• Quality of life: 100% improvement

Follow-up tests were completed, namely a six-minute walk and 30-second chair stand test. Scores for walk and chair stand tests improved by 26% and 43% respectively.

No adverse reactions were reported as well.

 

What is Genicular Artery Embolization?

Abnormal blood vessel formation, also known as angiogenesis, is one of the causes of knee pain in osteoarthritis patients. Angiogenesis is a key step in the initiation and maintenance of inflammation in the joint capsule. Abnormal vessels that breach into avascular cartilage in the knee is a hallmark of osteoarthritis, so much so that it is one of the diagnostic features of the disease.

GAE is an interventional radiology treatment that can relieve osteoarthritis pain by treating the offending abnormal blood vessels. The procedure blocks the abnormal blood vessels. Doing this reduces inflammation and its resultant pain.

An interventional radiologist (IR) performs the procedure. An IR is trained to perform minimally invasive vascular procedures to treat multiple conditions. They treat their patients using procedures such as angioplasty (widening narrow or blocked blood vessels to improve blood flow) and embolization (blocking blood flow from blood vessels).

An IR is a medical doctor that has obtained at least six additional years of specialized training in radiology and interventional radiology.

What Happens During a GAE Procedure?

GAE is an outpatient procedure that typically takes one hour to perform. The patient is provided with “twilight” sedation, which leaves them in a conscious yet sedated state. They are completely relaxed and will not feel any pain.

After the patient has been anesthetized, the IR will insert a catheter (a hollow tube) into the patient’s leg (the upper thigh) and into the blood vessels supplying the knee joint. X-ray technology will be utilized to guide the doctor to the correct vessels.

Once the catheter is positioned properly, the doctor will inject microsphere particles. The tiny particles will slow down blood flow into the angiogenesis vessels, which in turn reduces inflammation and pain.

What Happens After the Procedure?

Patients who undergo GAE treatment can go home the same day.

In most cases, pain relief begins to occur within two weeks, as the inflammation in the knee’s joint capsule is reduced, relieving the knee pain associated with osteoarthritis.

 

Who is a Good Candidate for GAE?

Genicular artery embolization is ideal for patients who have tried NSAIDs or knee injections without results or long-term relief. It’s also ideal for patients who do not want to go through an invasive surgical procedure or are not a good candidate for surgery.

Other indications that GAE is a good option for a patient:

• They experience moderate-to-severe knee pain
• They have localized tenderness
• An osteoarthritis diagnosis has been confirmed with an x-ray
• The patient does not have any bone deformities
• Other conservative treatments have failed to give the patient positive results

Knee pain sufferers who are not good candidates include patients with end-stage osteoarthritis, a malignancy, an infection, or an autoimmune disease such as rheumatoid arthritis.

Why Do Doctors Recommend Knee Replacement Surgery?

Doctors typically recommend a patient undergo a partial- or full-knee replacement surgery if they have advanced osteoarthritis. Another reason they would recommend surgery is if the patient has tried multiple conservative treatment options without success. They are still in pain or the pain has worsened.

The most common condition that requires knee replacement surgery is advanced osteoarthritis. However, there are other conditions that can lead to this type of surgery, including:

• Gout
• Rheumatoid arthritis
• Knee deformities
• Injury
• Unusual bone growth
• Death of one of the leg bones (caused by inadequate blood supply)

How Patients Can Reduce Painful Symptoms Between Now and Their Treatment Date

If a patient has tried multiple non-invasive treatments without success and their next step is surgery, they can take steps to reduce their pain until their surgery date.

Some ways to ease knee pain:

• Exercise/physical therapy: If a patient has a degenerative condition like osteoarthritis, it is best if they seek the assistance of an exercise professional like a physical therapist. They can create a treatment plan that will strengthen the leg and promote flexibility without increasing the risk of pain or joint damage.
• Supplements: In addition to NSAIDs, supplements like glucosamine and chondroitin can reduce pain and increase mobility in some patients.
• Bracing: A knee brace provides stability and properly aligns the joint, easing pressure and reducing pain.

Choose Non-Invasive Options Whenever Possible

Sometimes, the best option for a patient is surgery. If possible, though, surgery should be a last resort.

Every part of the knee surgery puts stress on the body – from the general anesthesia medications to the surgery itself.

Then, after the surgery, the body has to heal. Even the healthiest people can take up to a year to fully recover.

Often, postponing surgery is the best option – or taking it off the table completely. Thankfully, there are more alternatives to knee replacement surgery today than ever before. Patients are urged to discuss all their options with their doctor and get a second opinion before making their treatment decision.

Would you like to learn more about the GAE procedure? Contact us to schedule a consultation.