Do I Need a Knee Replacement?

Your 55 year-old knee is hurting and your brain immediately asks the question, “Do I need a knee replacement?”

An x-ray demonstrates moderate to severe osteoarthritis and thus, it’s time for a knee replacement, right? Not necessarily. It’s amazing how many patients have severe findings on their x-rays but minimal to mild pain and excellent function. Therefore, we always say, “Treat the patient, not the x-ray.”

Ok, now your pain has been running 5-7 out of 10 for weeks to months. Therefore, it’s time for a knee replacement, right? Well, pain is certainly a factor in this decision; however, we have many nonsurgical tools in the toolbox that will reduce or eliminate pain for extended periods of time.

Finally, you’ve been episodically limping now for several weeks. You suppose it’s time for a replacement, right? Persistent dysfunction is another reason to have a knee replacement, but function can often be significantly improved without the need for surgery.

To overcome the symptoms and dysfunction of knee arthritis, three factors can be addressed: the environment, the biomechanics and the structure. Only surgery can change the structure, yet significant improvements in the environment and biomechanics can often delay or eliminate the need for knee replacement.

How do we do this? The environment is best changed by injections such as platelet-rich plasma, an anti-inflammatory pattern of eating, supplements and occasionally medications.

The biomechanics can be improved through physical therapy, certain forms of exercise, bracing and changes in footwear.

So in summary, knee replacement can be the right option for many patients and produce successful outcomes in most patients, yet in 80-90% of the patients that walk (or limp) into our office, nonsurgical treatment will be quite effective.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

When It Comes to Osteoarthritis, PRP is the Winner!

Although platelet-rich plasma (PRP) injections remain innovative and the science behind and techniques when using them are evolving, they are trending towards the injection of choice, especially in the case of osteoarthritis. Once considered “experimental,” there are now at least 45 studies validating the success of PRP in the treatment of knee osteoarthritis. So simply put, why would you choose PRP over a steroid injection or hyaluronic acid for knee osteoarthritis?

-Safer and more natural

-Longer-lasting relief of pain with often 6 months to 2 years of benefit for knee OA

-Most likely PRP is disease-modifying, meaning it is slowing the deterioration of cartilage in your knee

How about a study or two demonstrating these points made above:

PRP and Knee OA- Article 1

PRP and Knee OA- Article 2

Want to know more? Here are a couple of our previous blogs on the topic:

https://www.impactsportsnashville.com/blog/2024/2/16/7826kg4vvyebmp8bt2aph72i704hmc

https://www.impactsportsnashville.com/blog/2023/6/17/insurance-companies-say-prp-is-experimentalwe-sigh

As always, we are here to help! Let us know if we can be of assistance to you.

F. Clarke Holmes, M.D.

Knee Replacement Soon? Hit the Pause Button...

So many patients with knee osteoarthritis ask me the question “well, if I’m eventually going to require knee replacement, shouldn’t I go ahead and have it done now?”

Well, there’s not just one answer to that question, but here are some of my replies:

-Most knee replacements only last 15 to 25 years. After that, the implants start to loosen, creating pain, swelling or a sense of instability.

-Most patients are at higher risk for surgical complications at the time of a second surgery, known as a “revision,” simply due to their age and likelihood of having more significant medical conditions.

-Surgical techniques are improving with breakthroughs every two or three years. Robotically-assisted replacements and having replacements as an outpatient surgery are two recent examples. More advancements are sure to come.

-One should never base the need to have knee replacement on the appearance of the x-rays. Some patients with “bone-on-bone” arthritis have minimal pain and excellent function. These patients don’t need a replacement.

-What often produces the most pain is an unhealthy environment within the knee joint, some of which may be controlled with injections like platelet-rich plasma (PRP).

-We also believe that PRP may put a stop sign or at least a yellow light on cartilage deterioration. We do not make guarantees about cartilage regrowth, but if we can stabilize a patient’s current cartilage and slow or stop the deterioration, then we are slowing the process of osteoarthritis and perhaps delaying the need for knee replacement.

-For a joint condition like arthritis, we often think of PRP as a maintenance treatment, not just a one-time application. Much like the maintenance for your car, you don’t just take it to the mechanic once or twice and then get a new car. This is an ongoing process.

-Assuming a patient is in that 80% success group with PRP treatments, one should plan on likely having repeat PRP injections every 1 to 2 years. This is a great long-term investment in the health of your knee.

-Want to know more about PRP? Check out this blog:

Five Simple Reasons You Should Consider Platelet-Rich Plasma — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

In summary, for some individuals, knee replacement is inevitable, but there can be great value in delaying this surgery to increase the odds that it is required just once in a patient’s lifetime. For others, treatments like PRP can eliminate the need to have a replacement.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.