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5 Knee Replacement Questions to Ask Before Surgery

POSTED ON IN Knee BY Chris Centeno

knee replacement questions

One third of knee replacements in America today are done with no medical basis. Why? Because few patients know the key knee replacement questions to ask before pulling the trigger on the surgery.

We live in a “disposable” world, where we’re expected to replace our cell phones with each new iteration. Things are simply discarded rather than repaired, so it’s easy to see why the notion of “replacing a knee” with a brand new model seems reasonable. The problem is, knee replacements require the amputation of your knee joint and the insertion of a prosthesis in a very traumatic surgery with many potential risks and complications.

Answering these 5 simple questions may help you avoid an unnecessary joint replacement surgery.

  1. ARE WE SURE THAT THE KNEE JOINT IS THE SOURCE OF PAIN?

One of the most alarming and discouraging things as a physician is to examine a joint replacement patient and discover that the joint that was amputated was NOT the source of their pain. I can’t tell you how many hips I’ve seen replaced when the problem was actually originating from the lumbar spine, or shoulders amputated when the problem was in the cervical spine.

Believe it or not, recent research has shown that the lost cartilage you may have seen on your MRI isn’t necessarily associated with pain, meaning patients with more lost cartilage on MRI don’t necessarily have more pain than those with less cartilage loss.

There are tests that can and need to be performed to determine the source of pain before anyone considers the irreversible step of knee replacement. One of the simplest is to perform a numbing injection under precise imaging guidance using an anesthetic that’s cartilage friendly. If this gets rid of the pain, then the pain is from the knee arthritis.

  1. DO YOU HAVE ANY ALLERGIES OR KNOWN METAL SENSITIVITIES?

stem cell alternative to knee replacementThere are two groups of people who are at significantly higher risk for problems like rejection or loosening of the device and/or toxicity from the wear particles.

People with any type of allergy – That’s right, even patients with simple allergies like pollen or cat dander should avoid a knee replacement based on recent research!  People with allergies simply have a hyperactive immune system and inappropriately secrete antibodies to rid themselves of the thing they have mistaken as dangerous. If that thing is a joint replacement device, obviously that drastically affects the outcome.

People with metal sensitivities – There are also people who have more specific allergies who can only wear real gold, silver or platinum jewelry because the cheap stuff causes a rash. These people will likely have problems with the metals used in joint replacement prostheses.

Even if you don’t have allergies, metal Ions and wear particles in the blood and tissues of joint replacement patients have been the subject of many studies and even some class action suits in the last few years. The trend towards smaller joint replacement devices which should have allowed for less invasive surgery actually made it worse as the smaller devices require more metal than the larger ones to withstand the concentrated forces. Plus, the use of new plastics have added a whole new type of wear particles to the mix. These particles can harm the body by causing metal toxicity as well as create psuedotumors and tissue damage at the genetic level.

These two groups of individuals include an alarming percentage of the population.

  1. DO YOU HAVE DIABETES, OR PRE-DIABETES?

Blood sugar control is a much bigger health issue than most people realize as it affects so many systems of the body. Patients with diabetes have a higher risk of chronic pain after a joint replacement. What’s crazy about that statistic is that diabetes and pre-diabetes also destroys the cartilage in the joint independently of weight, which means a good deal of knee replacement patients are in this category.

  1. HAVE YOU TRIED ALL OF THE SUPPLEMENTS THAT MAY HELP THE JOINT?

Glucosamine and Chondroitin are common supplements that have been shown to reduce cartilage loss on MRI studies. Another helpful one is Curcumin, which has been shown to be as effective as Motrin for reducing pain and inflammation. Why would you want to change from NSAID drugs like Motrin, Aleve, Celebrex, Mobic, and Naprosyn? These drugs all dramatically increase the risk of sudden cardiac death. Surprised? Check out the warning from the American Heart Association about NSAID risks.

For Glucosamine, take 500mg twice a day of a brand that has both the sulfate and HCL forms of this natural compound. For Chondroitin, it’s 1,200 mg a day, usually taken 600mg twice. For Curcumin, it’s 750 mg 2-3 pills a day, make sure it has BioPerine to increase absorption (a natural black pepper extract). Click here to see supplements we recommend.

  1. HAVE YOU BEEN TREATED WITH LESS INVASIVE ADVANCED INJECTION THERAPIES FIRST?

scp_vs_prp
+ Click the Image to Learn Why it Matters

Many patients have tried steroid injections or gel shots to lubricate the knee joint. Steroid shots actually kill off cartilage cells, so this isn’t a good plan to help your knees. If you have mild arthritis, precise injections of highly concentrated platelet rich plasma works well in our experience. These natural growth factors from your platelets can support cartilage health. If your arthritis is moderate or severe, precise guided injections of your own stem cells may do the trick. Both of these should be tried before amputating the joint as both are much safer alternatives to joint replacement.

The upshot? You need to be an advocate for your own health. All too often, patients get pushed into knee replacements because the companies that manufacture these devices aggressively advertise on the behalf of the surgeons implanting them.

Joints can be amputated and prostheses inserted, but joints can never truly be replaced. Given the profound risks and complications of joint replacement, we need to change the focus from replacing joints, as if they were disposable, to saving joints, because they’re not.

 

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Allison Suddard says

    I'm so glad I didn't!!
    I had an appointment with my orthopedic surgeon and Dr. Centeno in the same afternoon this past spring (2015). After discussing knee replacement options with my surgeon and deciding if one more round of Synvisc didn't work, we'd replace the joint, I headed over to the Centeno-Schultz Clinic for my next appointment. I hadn't really thought about stem cells, but to my delight they were beginning a new trial on the knee.
    I was accepted into this study and received the treatment in May 2015. Within a month I was markedly better. I'm now 6 + months out thrilled with the results. Having been in that place where I was ready to camp outside the surgeon's office for a new knee, I can relate to the feeling of desperation a painful joint can create. The best thing I can say is DON'T DO IT until you've tried stem cells with Dr. Centeno or one of his trained physicians. You cannot go backwards once you let someone remove part of your body. The cost of the procedure would be worth it 100 times over once you've realized your replacement didn't replace your pain as well.
    Thank you Dr. Centeno for all you do!!

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    Regenexx Team says

    Allison,
    Thankyou! So thankful for the opportunity to help - we wish we could see and treat all knee replacement patients before they have the surgery! I have passed your message along to Dr. Centeno.

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    Bob says

    I WOULD HAVE GLADLY HAD THE STEM CELL TREATMENT INSTEAD OF NOW BEING IN CONSTANT PAIN SINCE MY KNEE REPLACEMENT....But WHO COULD POSSIBLY AFFORD THE HUGE COSTS....UNFORTUNATELY NOT ME...BY A LONG WAY....

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    Regenexx Team says

    Bob,
    So sorry the knee replacement has left you in pain. Sadly that's not uncommon, which is why we do our best to give people the information they need. The fact that insurance and medicare does not cover stem cell procedures is a big problem, unfortunately it's in the hands of the insurance industry and all we can do is to continue to do and publish research, so that at some point they will get the message that this works, is cheaper by far, and is better for the patient. Take care of your other joints. There are supplements suggested in the blog that help greatly, and fix issues that come up when they can be addressed with Prolotherapy or PRP, which are significantly less expensive. Please let your doctor know about the pain and ask what is causing it. Really hoping you feel better!

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    nick says

    I'm about to make an appointment to get my knee replaced, but I'm not 100% sold on it, I live in CT is there stem cell treatment near by and what is the approximant cost for something like that, and am I even a candidate for that treatment my knees have been bone on bone for years is that repairable with stem cell?

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    Regenexx Team says

    Nick,
    There is not a Regenexx Provider in CT yet, however there are several in the 75 mile range. This link allows you to put in your city and state to see what is nearest to you: http://www.regenexx.com/find-a-physician/ Bone on Bone knees are something we treat regularly.http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ To get an idea of how we can help with your particular knee, you can upload your latest MRI, and speak to one if our physicians by filling out the Regenexx Candidate Form on that page. It is a very good idea to get their opinion and get your questions answered about what their treatment plan would be before proceeding with a knee replacement, as saving the joint if possible is always a better idea. They would also be able to speak about cost based on the treatment plan, but average for knee would be $4-6000 range if nothing else needed to be treated.

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    JR says

    Hi - I have bilateral hip osteoarthritis - that is shown on x-rays and MRIs. Everyone is telling me to get my hips replaced (well almost - my wife and one of my doctors are not keen on it), however, I have multiple food allergies (many), chemical allergy (especially coal-tar), and do react to the cheap metals - any wire framed glasses have to be gold plated or my face breaks out. I've been trying Stemfit and Jusuru, which is a liquid-biocell collagen/hyaluronic acid product, but had to go to a cheaper alternative as my expenses are rather high these days. It was helping, but am now adjusting to less expensive products. I do recommend both Stemfit and Jusuru if you can afford them.

    Based on what you have said above, I should be wary of medical implants due to my allergies. Also I have noted that a lot of the pain is due to chronic inflammation - I notice that when I am out of the country (Japan) my pain greatly reduces and when I'm back in the US, the pain all comes back. Also a couple of weeks ago I got sick and just quit eating - after about 1.5 days, the pain and inflammation was greatly reduced and my muzziness in my brain went away. After I started eating again, the pain and inflammation returns.

    I have a feeling that I cannot afford the stem cell therapy but I figured I would let others have an idea what I have been battling. Things started out with multiple Lyme infections, heavy oral antibiotics during these times, and most recently a diagnoses of mycoplasma arthriditis. My progression has been akin to rheumatoid arthritis but without any rheumatoid markers showing up in my blood. It's interesting to note that the mycoplasma arthriditis, according to a research paper on it, it progresses in lab rats very similarly to rheumatoid arthritis.

    Cheers.

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    Regenexx Team says

    JR,
    Thank you for sharing your story. Very thankful you are aware of the allergy and metal sensitivity risks of joint replacement. Clearly with everything else going on in addition to that very important issue, you have very good reason to explore every other option available to you. Chronic, or whole body inflammation, does complicate many issues and would be helpful to get under control, as inflammation while designed as part of the healing process, when out of control becomes part of the breakdown process. Perhaps eating the way you eat in Japan would be a good test and if the test affirms your hypothesis, could be adopted. There are supplements in the blog which are also very helpful in dealing with chronic inflammation. You're correct regarding Mycoplasma arthriditis - it does progress in a way very similar to rheumatoid arthritis. Using your own stem cells and platelets are clearly the best way forward longterm. If stem cells are not doable, beginning just with platelets would likely be able get the ball headed in the right direction. http://www.regenexx.com/regenexx-scp-platelet-rich-plasma-prp/

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    Jean says

    My husband had the stem cell therapy on Nov. 23, 2015 in Bradenton with Dr. Amoroso. He needs total knee replacement on both knees and he did not want surgery so we did research and checked out several doctors but kept coming back to Regenexx. He had just his right knee done, bone on bone, torn acl and meniscus. Dr. Amoroso and his son Evan were great. I will say he was in a lot of pain after the procedure, they told us it would be painful but just didn't realize how painful. It was expensive for us, and there were several extra costs we didn't count on, but he is on week #2 and he says he can tell a difference already. I am in the wait and see mode and if it goes well he will have the other knee done asap. Will keep you posted.

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    Regenexx Team says

    Jean,
    It sounds like all is going just as it should! It can be quite painful at first as we are injecting something into very inflamed tissues that have lost the capacity to heal, thankfully what we're delivering are the tools to heal, but it takes time for those to kick in. Thank you for keeping us in the loop!

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    Rena says

    I have read the FDA has not approved these treatments because not enough trials have been conducted, published and witnessed fully. Where does this stand? How does the public even know if this is safe? What treatments are being investigated for those patients who have had total knee replacements?

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    Regenexx Team says

    Rena,
    Good question. FDA approval is not an issue, as everything we do is in compliance with the FDA. The FDA has a problem with the culturing of your stem cells (the same process used daily in Invitro Fertilization), and decided to consider your stem cells, once cultured, a drug. The one procedure that cultured the stem cells to increase the number available to the patient is no longer done in the US. While the FDA does not require approval for the "Practice of Medicine", which is what using stem cells to treat orthopedic conditions and injuries and orthopedic surgeries are, they do require approval for drugs. It is the Insurance industry that considers Stem Cell Therapy experimental, despite the fact that there are more peer reviewed published papers on the effectiveness of stem cells for orthopedic injury than there are that common orthopedic surgeries are effective. There are, however, doctors out there doing things not approved by the FDA, as the particular substance most used to get stem cells out of fat is not FDA approved, and yet it is widely in use by doctors who use adipose stem cells from liposuction.http://www.regenexx.com/fat-chance-top-3-stem-cell-controversies/ We have 3 ongoing RCT's, but also have done 33% of the world's research on the use of bone marrow stem cells to treat orthopedic injuries and conditions, and have the experience of having done more of them than anyone in the world. http://www.regenexx.com/about-regenexx/research-based-stem-cell-procedure/ As far as treatments for post knee replacement, that could only be treatment for tendons and ligaments, which can be treated, as there is no longer a biological joint to treat.

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    Patty pugh says

    I'm very interested..how much is it for both knees?

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    Regenexx Team says

    Prices vary depending on what you need. First, unlike almost everyone else performing these procedures, we measure the cell yield and have minimum dosing requirements per knee based on this research study we have published: http://www.biomedcentral.com/1471-2474/16/258 So the likelihood of getting enough cells for a bilateral procedure for an older patient is only about 1 in 3. For patients younger than 50 this chance goes up with declining age. If we're able to get enough stem cells for both knees at once there is a significant savings.

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    Simone says

    I have a rt knee replacement 4 years ego I'm stil having a lot pain . My lf knee have to be replace , I decide to do Steam cell in Beverly hill in August this is the best décision I make the price and the pain was nothing compare what I have to endure for my rt knee replacement is done !! if I knew before I Never do it . As my lf knee I'm great . Thank you regenexx

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    Regenexx Team says

    Simone,
    Great news! Thanks so much for the update and for sharing it with others. "The price and the pain was nothing compare what I have to endure for my rt knee replacement is done!" I couldn't have said that more accurately or more earnestly...thank you!

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    Deborah says

    I have bone on bone in right knee and left is almost getting there. I live in Elkmont Alabama just outside of Athens,AL and I'm on Medicare/Medicaid are there any Doctors near this area that are even aware of this procedure or how can I find out? I do not have the money for this due to limited income and I'm at the point where I stay in severe pain with this even interrupting sleep. My leg goes numb from the knee down to my foot. I can't walk very far without severe pain and knee giving on me. Is there any solutions for me? I also have other bone problems-degenerative bone and disc disease,Rheumatoid and Osteoporosis or are they the same? I'm in therapy for my back at this time and my dr gives injections all the time,not between the bones. I have had injections between the bone from another dr. I'm desperate can you help me? Are there anymore trials? Thank you!

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    Regenexx Team says

    Deborah,
    So sorry to hear that! Unfortunately, we don't have any Regenexx Providers in Alabama. The closest is 250 miles away in Louisville, Kentucky, but the closest that can work on the Spine is 433 miles in Lafayette, LA. While we're still recruiting for the Rotator Cuff tear, and Knee ACL trials, neither of those would help in your situation. Importantly though, given what you've shared, the chances are good that your pain and numbness are coming from your back, and concentrating treatment there before your knees might be a better treatment direction because regardless of what you do to treat your knees, the back issue will continue to affect them. Most people (and a lot of doctors!) don't realize that the pain from arthritis has to do with nerves and not structure (ie missing cartilage), http://www.regenexx.com/osteoarthritis-pain-not-related-to-structure-again/, and degenerative disc disease affects nerves which have a direct affect on knees. Regenexx PL (which is what we treat discs with) is billable to health insurance . While neither age, nor weight, nor severity of arthritis affects the outcome of our procedures, the one thing that does tend to negatively affect the robustness of response is arthritis in many joints, as that tends to be an ongoing systemic issue. Hoping this info will be a help!

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    Deborah says

    Also I'm 60 yrs old. What chances are there for this to help me?

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    Diane Saad says

    I had a really bad fall which developed into pain in my right hip. IVE HEARD of your stem cell treatments and before going into surgery would appreciate which location is closest to Atlanta, GA and focused on hip injury that has the bones rubbing against one another. Hip replacement is what has been recommended by three surgeons. Please respond ASAP. I want to avoid surgery if possible.

    Thanks, Diane
    678.546.5113

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    Regenexx Team says

    Diane,
    I have forwarded your number to the appropriate Dept at Regenexx Headquarters and they will contact you. I would recommend setting up a Candidacy phone call, either through them, or by filling out the Regenexx Candidate form so that you can to speak to one of our physicians. Orthopedic surgeons solve problems surgically, but it would take one of our physicians to determine if stem cells are a viable alternative in your case.:http://www.regenexx.com/the-regenexx-procedures/hip-surgery/ In the meantime, here is the Find A Physician link: http://www.regenexx.com/find-a-physician/

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    Scott says

    I had no idea that people who have allergies to pollen or cat dander should avoid getting a knee replacement. I can see why this would be something to ask about before deciding to get surgery. My brother is getting knee surgery in two weeks. Thankfully, he does have any of these allergies.

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    Gerri Dauley says

    I've had several knee replacements, Femore and tibia with the last two. I've also had cervical and lumbar surgeries. I have AS, MGUS, RA, OA, shoulder issues, hip problems, etc. Now I've developed allergies to many metals, cement particals, plus many more. I'm looking for a knee surgeon. Its gotten to where I'm reacting to many metal, cement, hair products, nail polish, materials except cotton and some polyester knits only. I'm so tired, sick and feel horrible. I've sent my reports to a few surgeons. No response so far. Please let me know if you have any suggestions. If this can work for me or if you know of a Dr. I should see for my leg. I saw my spine surgeon today about having plate and screws taken out of my neck. He was not up to date on metal allergies. I wish I knew about this stem cell treatment earlier. ???? I'll be fine just needed to vent.

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    Regenexx Team says

    Gerri,
    Unfortunately, most surgeons are not. Auto-immune diseases are tough because so many of the accepted treatments are really bad for joints. While we don't treat auto-immune diseases, we have been able to sucessfully treat the joints of people who have them in some cases, which depends on many factors. Good joint supplements are important in trying to stay ahead of the curve. Please see: https://www.regenexx.com/avascular-necrosis-treatment-knee/ and https://www.regenexx.com/update-knee-avn-patient/ https://www.regenexx.com/treating-rheumatoid-arthritis-with-stem-cells/ and https://www.regenexx.com/fish-oil-arthritis-pain/

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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