If you’ve been procrastinating, making excuses or otherwise putting off total knee replacement surgery, chances are the longer you put it off the better. New findings suggest knee pain alone is insufficient evidence of the need for knee replacement surgery, especially if you are younger. This is based on results showing that younger patients had only a 2-percentage point improvement in pain after knee replacement. The younger age group receives less benefit from the procedure. This is not the case for appropriately selected patients, typically being older and meeting specific criteria like pronounced degeneration of the articular cartilage to the extent that walking or going upstairs and downstairs is difficult. It’s however younger patients with less evidence of extensive degeneration that are the very group receiving knee replacements at faster growing rates. According to data from the American Academy of Orthopedic Surgeons, knee replacement surgery is up 205 percent over the previous decade for persons 45 to 64 years of age.
A study by the American College of Rheumatology examined the varying levels of appropriateness of knee replacement surgery across multiple centers in the US. Of the 205 persons receiving knee replacement, 34% or one-third were deemed inappropriate. This compares to 44% who were judged to have appropriately received the procedure, just a 10% difference. The criteria used to establish appropriateness was based on a validated appropriateness classification system.
Another concern of total knee replacement in younger patients is that the devices may breakdown by the time a patient reaches their later years, necessitating a second knee replacement 20 years later. In most cases more conservative approaches such as natural anti-inflammatory and connective tissue building nutrition and supplements can adequately retard the progression of further degeneration allowing for postponement of surgery. If more aggressive support is needed, regenerative injection techniques like Prolotherapy or Platelet-Rich Plasma can be used to stimulate tissue regeneration, restore mobility and remove pain. Fortunately, knee replacement surgery isn’t an emergency. Acting at the earliest signs of knee pain provides time to benefit from alternative approaches.
American Academy of Orthopedic Surgeons
Riddle DL, Jiranek WA, Hayes CW. Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatol. 2014 Aug;66(8):2134-43.