Here are some alternatives for a knee or hip replacement
Here are some alternatives for a knee or hip replacement
Last Reviewed : 12/18/2020
Painful and stiff joints make everyday life very difficult for people suffering from joint pathologies like Arthritis. Though other methods of conservative management are possible, most patients only consider pain killers while waiting for the inevitable joint replacement. Total joint replacement or joint resurfacing is the only option presented to the patient to deal with their debilitating pain. Both these surgical options are associated with pain and discomfort for months after the surgery until the patient regains strength and mobility.
There are other methods to reduce pain, regain the lost function, and restore relatively normal life. It can be achieved by trying to preserve the remaining cartilage or regenerating damaged tissue or by providing some support to the joint and decreasing pressure. Non-surgical treatment options are suggestedfor people in the initial stages of the disease. They help in dealing with the pain and in many cases may delay or prevent the need for surgery.
People with arthritis are often overweight, imparting stress on the weight-bearing joints of the body like a hip and knee joint. The amount of pressure a joint has to deal with is roughly three to six times higher than the actual weight borne by the joint. If 10 pounds weight is appliedon a joint, the total pressure on the joint would be up to 30 pounds. Even a little change in body weight can, therefore, bring about a significant difference in the pain or functioning of the joint. Exercise has the added advantage of strengthening your muscles besides maintaining healthy body weight.
Muscle strengthening provides relief from pain by relieving the pressure the joint has to withstand. Physical therapy requires you to exercise regularly and strengthen your key muscles. Good muscle strength will help in the betterperformance of the joint, with increased flexibility and range of motion. Other methods of physical therapy like heat or cold application, electrical stimulation or ultrasound therapy may also help dealwith the pain. They work by increasing blood supply to the joint.
Use of an assisting device like a cane or walker will decrease the effective pressure on the joint and relieve pain. Splints and braces may be triedif arthritis is more on one side than the other. Braces help stabilize the joint and improve function. Other modalities like Acupuncture, Magnetic-pulse therapy, and Prolotherapy may also be used for dealing with the pain.
Medication like NSAIDs can be used for long-term pain management in patients who wish to delay their surgery and even in people recovering after surgery. Commonly used NSAIDs are Paracetamol, Aspirin, Ibuprofen and less commonly Naproxen. Pain relievers can reasonably improve the quality of life in chronic debilitating illnesses like hip or knee arthritis.
It is a minimally invasive procedure to help deal with joint troubles. Steroids are injected directly into the joint space of the affected hip or knee. Steroids resemble and mimic the naturally occurring hormones in our body. They decrease pain and inflammation in the joint and decrease the disease process in the joint. The effect of these injections may last from a few days to a few weeks.
It is the substance responsible for lubrication and smooth action of the synovial joints like hip and knee joints. In conditions like arthritis, the cartilage of the joint is destroyed, leading to pain whenever the bones rub on each other. Visco-supplementation is a process of injecting hyaluronic acid into the joint space. Hyaluronic acid prevents friction between bones, lubricates the joints, and also acts as a shock absorber. It helps reduce pain and improves joint mobility.
Platelet-rich plasma (PRP):
Human blood contains millions of small cell fragments called platelets. These cell fragments clump together along with some binding substances to form the blood clot which stops bleeding anywhere in the body. Platelets also contain several chemical substances that are released from activated platelets and help in tissue healing and repair– methodslike centrifugation, which separate platelets from blood, can be used to form a concentrated plasma. Platelet-richplasma is produced and then injected into the affectedjoint. Cytokines and other factors released from platelets help in the repairand healing of the inflamed joint. Injecting PRP directly into the joint has been proven to improve pain in patients suffering from hip and knee arthritis or tendon damage and injury. It might be noted that PRP cannot aid the regeneration of lost tissue.
Stem cell therapy:
All cells in the human body are programmed before birth to generate a specific type of cell or organism. But a few cells, which are not programmedin such a way, are capable of differentiating later into various types of cells depending on the necessity or site. Such cells are called pluripotentcells or stem cells. Stem cells are predominantly present in the veryearly stages of fetal life. They are also foundin the umbilical cord of the baby after birth. In an older individual, such cells are present only in fat and bone marrow. Mesenchymal stem cells present in the bone marrow are precursor cells which can form bone, cartilage or other connective tissue. They help in the process of repair and regeneration throughout the body. Stem cells, acquired from the bone marrow of the patient, can be used to treat joint conditions as these cells can regenerate bone, cartilage, or other components of the joint which have been damaged by the disease process. It is still an experimental study, and several trials have shown improvement in people suffering from hip and knee arthritis.
Mesenchymal stem cells also have a few properties that make them advantageous in joint disorders:
Anti-apoptotic property that prevents the death and decline of normal functioning cells in the joint
The anti-fibrotic property which prevents stiffening and restricted movement of joint
Anti-inflammatory property that decreases pain
There is a theoretical risk of developing adverse effects to stem cell injections like infection, cancers, or even death but there are no documented cases yet.
Cartilage transplant therapy:
It is very similar to stem cell therapy but, instead of stem cells being injected, cartilage is grown in test tubes and then transplanted to the joint. Cartilage transplant also stimulates bone to improve cartilage growth. It is presently a part of experimental studies and is better suited for younger patients whose cartilage is more active.
It is a minimally invasive approach commonly known as a key-hole technique used to wash out any bits of bone or debris and debrides any damaged cartilage from the joint. A new approach in arthroscopy is the useof cartilage transplant through the small incision called mosaicplasty. A micro fracture is also an arthroscopic approach where a few holes are made in the exposed bone to stimulate cartilage formation.
It is triedas a way to put off hip replacement surgery. In this surgery, bones around the joint are realigned allowing an even distribution of weight across the joint. It improves the pain factor in many patients but does not impart any effect on the progression of the disease and the hip or knee joint may continue to worsen.
Other surgeries that may be considered as alternatives to hip or knee replacements include partial joint replacement, Arthrodesis or Joint fusion, Resection arthroplasty and Joint resurfacing for the knee or hip.