Knee Replacement Surgery - Are There Alternative Treatments?

Adapted and updated 2019

Before you have any kind of surgery, it is important to inform yourself about the procedure, its advantages and disadvantages, and about whether there are any alternatives treatments.

We have compiled the following general information for people considering knee replacement surgery, but for further or specific information please discuss with your doctor or surgeon.

CORE NON-SURGICAL TREATMENTS

You should discuss with your doctor non-surgical (conservative) treatments before deciding to have a knee replacement. Regardless of how commonly it's performed and the safety of modern knee replacement surgery, it is still major surgery, and all surgical procedures (however big or small) carry risks. 

Core non-surgical treatments of osteoarthritis include: exercise therapy (e.g. physiotherapy) and weight loss for people who are overweight. Learning more about the condition and its treatments is also a key conservative approach to osteoarthritis management. 

In Australia, current guidelines involving the treatment of osteoarthritis recommend that surgery should only be offered when, and only when, these core non-surgical treatments have been unsuccessful. 

EXAMPLES OF NON-SURGICAL TREATMENTS FOR OSTEOARTHRITIS

Weight loss - losing even a small amount of weight will reduce the strain on your knees. Did you know that every time you take a step, the stress you put on your knees is three to four times your body weight?

Healthy eating and exercise play a key role in weight loss. By working with your healthcare team on ways you can manage your weight you may be able to delay or hopefully avoid the need to have surgery. 

Exercise - might be a good option for you, even though this may be difficult because of the pain. There is usually some form of low-impact exercise (for example swimming or cycling) that you can start gently and which will improve the strength and flexibility of your knee.

Physiotherapists and exercise physiologists can prescribe exercises for you to help you manage your osteoarthritis. If you have been diagnosed with osteoarthritis, speak to your GP about getting a GP Managment Plan. These plans can help you access physiotherapists and exercise physiologists at a reduced cost and keep any treatments focused on your osteoarthritis. 

DO I NEED A KNEE REPLACEMENT?

If your arthritis isn’t responding to non-surgical treatments, you may consider undergoing knee replacement surgery.  You may need a knee replacement if your knee gives you pain, stiffness, instability or loss of function that affects your daily life and activities.  Knee replacements are most common surgery for osteoarthritis.

If your symptoms are still manageable through conservative therapies and/or your medication is effective, then you may choose to not undergo surgery.

Your orthopaedic surgeon will be able to advise you on the surgical options and on the potential pros and cons of having or delaying surgery, taking into account your age, health and level of activity.

Most people who have a knee replacement are over 60 years of age.  If you’re under the age of 50 and decide to go ahead with a knee replacement, then you’re more likely to need a repeat operation in later life.  However, there is evidence that the surgical outcome may be better if you don’t wait until the knee becomes very stiff or deformed.

Unfortunately, some people may not be able to have a knee replacement even though their arthritis may be severe:

  • If the thigh muscles (quadriceps) are very weak they may not be able to support the new knee joint;
  • If there are deep or long lasting open sores (ulcers) in the skin below the knee the risk of infection may be too great to consider surgery.
  • However, there may be other options available to help.  This includes:
    • Joint injections of Viscosupplementation agents
    • Knee braces


TYPES OF KNEE REPLACEMENTS

Unicompartmental (partial) knee replacement

If arthritis only affects one side of your knee (usually the inner side) it may be possible to have a half-knee replacement (a unicompartmental or partial knee replacement).  This surgery can be carried out through a smaller cut (incision) than a total knee replacement, which may reduce recovery time.  Partial knee replacement isn’t recommended for everyone because you need to have strong, healthy ligaments within your knee.  This surgery is preferred for younger patients, who are more likely to need further surgery at some point, but it may be used in some older patients because it is a less stressful operation.  The outcome of the surgery, however, depends on the type of arthritis and not the age of the patient.

Kneecap replacement (patellofemoral arthroplasty)

It’s possible to replace just the under-surface of the kneecap and its groove (the trochlea) if these are the only parts of your knee affected by arthritis.  This is also called a patellofemoral replacement or patellofemoral joint arthroplasty.  The operation has a slightly higher rate of failure than total knee replacement, usually caused by the arthritis progressing to other parts of the knee.  However, the outcome of kneecap replacement can be good if the arthritis doesn’t progress, and it’s a less major operation offering speedier recovery times.


Complex or revision knee replacement

Some people need a more complex type of knee replacement.  This is usually due to major bone loss due to arthritis or fracture, major deformity of the knee, or weakness of the main knee ligaments.  A complex knee replacement could be better from the start if you have very severe arthritis and may be necessary if you’re having revision surgery (a second or third joint replacement in the same knee).

ADVANTAGES

If you decide to have knee replacement surgery, you are likely to experience pain relief, improved mobility and improved quality of life.

DISADVANTAGES

Some possible disadvantages of the surgery can include some limitations to movement; finding kneeling uncomfortable; and risks associated with surgery, including pain that won’t go away.

ASK YOUR DOCTOR

Armed with this information, you should consider asking your general practitioner (GP) some questions.  These can include:

  • What can I expect from surgery?
  • What can I expect if I don’t have surgery?
  • What are the alternatives?
  • What are the risks?


Adapted by James Bayliss, 2019,  Arthritis Queensland.

Reproduced with the permission of Arthritis & Osteoporosis Western Australia and Arthritis Research UK.

Reference: White, Steve, 2013. Knee Replacement Surgery. 1st ed. United Kingdom: Arthritis Research UK, http://www.arthritisresearchuk.org/

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