Don't Count on a Knee Replacement to Improve Pain or Function
POSTED ON 4/5/2018 IN Knee BY Christopher Centeno
I see these ads on buses in my town with pictures of middle-aged people rock climbing with their new knee replacements. However, is this reality? For example, I've blogged before on research showing that many patients feel no better or have no greater function after knee replacement. And it isn't just this one study; many other studies have shown that knee replacement outcomes are not as good as the public and surgeons believe them to be (many included later in this post). So let's take a look at a new study that continues to support this trend.
Low Chance Knee Replacement Will Improve Pain
The new study analyzed both pain and function following knee replacement in 223 patients at six weeks and again at six months following the surgery. There were two categories of both pain and dysfunction in which patients could be placed: none-mild and moderate-severe. The results? On the pain side, only 20% of patients experienced an improvement in their pain (moving from the moderate-severe category into the none-mild category). The majority of the patients (75%) had no improvement in their pain, and the other 5% actually experienced a worsening of their pain (moving from the none-mild category into the moderate-severe category). As for function, the percentages weren't much better, with only 31% improving, 65% having no improvement, and 5% worsening. While things could improve at one year and likely do somewhat, even if that were the case, that's often not the expectations of patients that I speak with who are contemplating knee replacement. They believe that by 6-months out they will be "fixed". So what do other studies say about knee replacement outcomes?
Will Knee Replacement Fix Your Knee Pain?
While the study calls these improvement percentages “notable,” having your knee amputated and an artificial one installed is a huge and risky surgery for only a 20% chance of pain improvement by 6-months, especially when pain is the number-one reason patient's give for undergoing knee replacement in the first place. Ongoing pain following knee replacement isn't new to this study—let's review some of the many studies we've covered over the years:
I have also covered a study that's the only true randomized controlled trial that I know of for knee replacement. Watching the video below, you'll see the results were unimpressive:
So what might cause you to still be in pain following a knee replacement?
What Might Cause Pain Following a Knee Replacement?
First, big surgeries, as I've mentioned many times, equal big complications. With a knee replacement, these big complications could be anything from allergies to the artificial knee device to wear particles leading metal ions in the blood to even parts breaking off of the artificial knee (more rare, but possible). Perhaps the bigger issue might be that it wasn't even your knee in the first place that was actually causing your knee pain; it could have stemmed from a problem in your low back such as a pinched or injured nerve. In fact, one study found that one-third of knee replacements are performed on patients whose knee isn't the actual source of their knee pain. If the knee pain is due to an injured nerve in your low back (these nerves branch into the legs and feet and can refer pain anywhere along the nerve branch), clearly unnecessarily replacing your knee isn't going to address your knee pain. The upshot? Those ads on the local buses paint a different picture than the reality discussed in these studies. In the meantime, if othobiologics like platelet-rich plasma, A2M, or precise high-dose stem cell injections don't work and you still want to replace your knee joint, follow these simple rules:
- Older is better, up to a point. The optimal age for a knee replacement is in the 60s-70s. While we're seeing these surgeries offered to younger patients, that's not optimal.
- The more active you are, the sooner the prostheses will wear out.
- Make sure you have no metal allergies! If you react to cheap jewelry, consider getting allergy tested before your procedure.
Whatever works for you is fine, but be an informed patient! Always go into any major surgery like this with eyes wide open.
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