5 Knee Replacement Questions to Ask Before Surgery
POSTED ON 12/8/2015 IN Research BY Christopher Centeno
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.
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 amputated 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 drastic and irreversible step of joint 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.
DO YOU HAVE ANY ALLERGIES OR KNOWN METAL SENSITIVITIES?
There 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.
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!
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.
HAVE YOU BEEN TREATED WITH LESS INVASIVE ADVANCED INJECTION THERAPIES FIRST?
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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.
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