Patients not told of non-surgical knee replacement options

The increased availability of medical information has helped many patients predetermine a course of action for their knee osteoarthritis. Typically doctors tell patients that they are one of many people with pain and disability; that the number of knee replacements is growing at an unprecedented level; and that a knee replacement is likely their ultimate medical procedure.

The above statement has now been backed by recent research which says that despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis, management is often confined to the use of painkillers and waiting for eventual total joint replacement.1

An editorial in the Journal of medical internet research says: “Understanding available nonoperative treatment options is critical for physicians who first encounter patients with osteoarthritis of the knee.”  These nonoperative treatment options for patients with osteoarthritis, include weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections.2 

It is of course hard to argue with the common sense value of weight loss for general health. Exercise helps increase blood circulation to troubled areas and the combination of body fat reduction and increase in lean muscle mass has been shown to improve not only pain, but quality of life as well.3

For Prolotherapy, Platelet Rich Plasma Therapy, and stem cell therapy, diet and exercise have never been contradictory to positive knee treatment outcomes and are often a recommendation. The same cannot be said for NSAIDs and cortisone. The medical literature is replete with countless citations advising against long-term and short-term managements with NSAIDs and cortisone.

Fear of movement – End stage knee osteoarthritis

How can a doctor convince a patient to move and exercise when the pain is so bad?

A recent study looked at patients who self-reported disability and were had their physical function measured after controlling pain, personal characteristic factors, and pathophysiological factors. There were 88 patients aged 60-80 years. They were scheduled for primary unilateral total knee arthroplasty (TKA) due to knee osteoarthritis.

Self-reported disability and pain were measured using various indexes. Physical performance tests included a 15-minute walk test and stair performance. Knee isometric muscle strength was measured. A clinical examination included analyses of comorbidity, body mass index (BMI), and a detailed knee examination: The flexion range of motion (ROM) was measured; the presence of varus/valgus malalignments and antero-posterior laxity was assessed. Scans were also analyzed.

Here is what they found: knee laxity, age, and body mass index (BMI) accounted for most of the problems. Another thing they found out was when the patient said they hurt, the scientific tests proved them right! So it was not in their head.4

A skilled Prolotherapist can address two of these three causes of problems. Age is subjective, if you “feel your age,” it is hard to be well. HOWEVER, two main factors of causing the pain, is something a comprehensive Prolotherapy doctor can treat, being overweight with proper nutritional programs, and stabilizing “knee laxity.” This may help a patient with “age,” feel a new vigor. So perhaps all three factors can be addressed and reversed.

Finally, in the one of the most recent studies on Prolotherapy for Knee Osteoarthritis, researchers concluded: “In adults with moderate to severe knee osteoarthritis, dextrose Prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores. Randomized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for knee osteoarthritis.”5

How do you get a patient to move, engage in exercise, strengthen their knee, and possible avoid knee replacement surgery? In our opinion, Comprehensive Prolotherapy.

1. Umapathy H, Bennell K, Dickson C, Dobson F, Fransen M, Jones G, Hunter DJ. The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality  of Care: A Quasi-Experimental Study. J Med Internet Res. 2015 Jul 7;17(7):e167. doi: 10.2196/jmir.4376.

2. Van Manen MD, Nace J, Mont MA. Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. J Am Osteopath Assoc. 2012 Nov;112(11):709-15.

3. Ding C, Stannus O, Cicuttini F, Antony B, Jones G. Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study. Int J Obes (Lond). 2012 Aug 21. doi: 10.1038/ijo.2012.136.

4. Kauppila AM, Kyllonen E, Mikkonen P, Ohtonen P, Laine V, Siira P, Niinimaki J, Arokoski JP. Disability in end-stage knee osteoarthritis. Disabil Rehabil. 2009;31(5):370-80.

5. Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, Grettie J, Patterson JJ. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012 Apr;18(4):408-14. News 826


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