Facts about Hip and Knee Replacement

Facts about Hip & Knee Replacement

  1. Unrelieved Chronic Pain
  • Most patients believe there is a 90% chance they will be pain free after joint replacement.
  • 44% of knee-replacement patients have pain (15% severe to extreme persistent pain) three to four years after surgery.
  • Up to 54% have pain five years after knee replacement, showing an increase in patients with pain from year to year.

REFERENCE- Metsna, V., S. Vorobjov, and A. Märtson. “Prevalence of anterior knee pain among patients following total knee arthroplasty with nonreplaced patella: a retrospective study of 1778 knees.” Medicina (Kaunas) 50, issue 2, (2014): 82–6. doi: 10.1016/j.medici.2014.06.001.

  • Of the 54% with knee pain at five years, 87% of those develop knee pain only after surgery.
  • 27% of hip-replacement patients still have pain three to four years after surgery.

REFERENCE- Wylde, V., S. Hewlett, I. D. Learmonth, and P. Dieppe, “Persistent pain after joint replacement: Prevalence, sensory, qualities, and postoperative determinants.” Pain152, issue 3, (March 2011): 566–72. doi:10.1016/j.pain.2010.11.023.

  • Pain level following knee replacement averages 5 out of 10, not much different from prior to surgery.

REFERENCE- Kahn, T. L. and R. Schwarzkapf. “Does Total Knee Arthroplasty Affect Physical Activity Levels? Data from the Osteoarthritis Initiative.” The Journal of Arthroplasty 30, issue 9, (September 2015): 1521–5. doi: 10.1016/j.arth.2015.03.016.

  • 47% of knee-replacement patients begin taking pain medications during the year following their surgery.

REFERENCE- Fuzier, R., I. Serres, R. Bourrel, et al. “Analgesic drug consumption increases after knee arthroplasty: a pharmacoepidemiological study investigating postoperative pain.” Pain 155, issue 7, (July 2014): 1339-45. doi: 10.1016/j.pain.2014.04.010

  • Major depression is more common for patients with pain following joint replacement.

REFERENCE- Wylde, V., S. Hewlett, I. D. Learmonth, and P. Dieppe, “Persistent pain after joint replacement: Prevalence, sensory, qualities, and postoperative determinants.” Pain152, issue 3, (March 2011): 566–72. doi:10.1016/j.pain.2010.11.023.

  1. Activity Levels Lower Than Expected
  • Most joint-replacement patients do not return to the levels of activity shown in marketing ads.
  • Many patients are no more active after surgery than they were prior to surgery.

REFERENCE- Harding, P., A. E. Holland, C. Delany, and R. S. Hinman. “Do activity levels increase after total hip and knee arthroplasty?” Clinical Orthopaedics and Related Research 472, issue 5, (May 2014): 1502–11. doi: 10.1007/s11999-013-3427-3.

  • Only 5% or less (1 in 20 people) achieve anything approaching normal activity.
  1. Heart Attack and Stroke
  • Patients age 60 and up are 26 times more likely to experience a heart attack in the two weeks following hip replacement.

REFERENCE- Lalmohamed, A., P. Vestergaard, M. K. de Boer, et al. “Risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement compared with matched controls: a nationwide cohort study.” The American Journal of Gastroenterology 108, issue 8, (August 2013): 1277–85. doi: 10.1038/ajg.2013.108.

  • Patients age 60 and up are 31 times more likely to experience a heart attack in the two weeks following knee replacement.

REFERENCE- Lalmohamed, A., P. Vestergaard, M. K. de Boer, et al. “Risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement compared with matched controls: a nationwide cohort study.” The American Journal of Gastroenterology 108, issue 8, (August 2013): 1277–85. doi: 10.1038/ajg.2013.108.

  • The trauma of joint amputation can cause severe stress, leading to a heart attack.
  • Stroke risk is increased by 400–500%, particularly hemorrhagic stroke as blood thinners, given to reduce the risk of blood clots, cause more severe bleeding.
  1. Blood Clots and Hemorrhages
  • Excising a joint causes severe trauma to blood vessels, likely increasing risk of blood clots.

REFERENCE- Watanabe, H., H. Sekiya, Y. Kariya, et al. “The incidence of venous thromboembolism before and after total knee arthroplasty using 16-row multidetector computed tomography.” The Journal of Arthroplasty 26, issue 8, (December 2011): 1488–93. doi: 10.1016/j.arth.2011.01.001.

  • Blood clots can obstruct heart vessels, causing a heart attack.
  • Blood clots can obstruct arteries that supply blood to the brain, causing a stroke.
  • Blood thinners reduce the risk of blood clots but increase the risk of hemorrhage.
  1. Metal Ions in the Blood
  • Wear particles in knee and hip replacements, particularly metal-on-metal devices, can lead to toxicity from the heavy metals.

REFERENCE- Catelas, I., M. A. Wimmer, and S. Utzschneider. “Polyethylene and metal wear particles: characteristics and biological effects.” Seminars in Immunopathology 33, issue 3, (May 2011): 257-71. doi: 10.1007/s00281-011-0242-3.

  • Wear particles are microscopic pieces of metal, ceramic, or plastic that break off of the prosthesis and irritate tissues and enter the bloodstream.
  • Patients who receive knee replacements have higher levels of various metals, such as chromium and cobalt, in their blood.
  • The larger the prosthesis, the more metal ions found in the blood.

REFERENCE- Friesenbichler, J., W. Maurer-Ertl, P. Sadoghi, et al. “Serum metal ion levels after rotating-hinge knee arthroplasty: comparison between a standard device and a megaprosthesis.” International Orthopaedics 36, issue 3, (March 2012): 539-44. doi: 10.1007/s00264-011-1317-4.

  • Several hip-replacement device manufacturers have undergone major recalls in recent years due to findings of increased blood metal ions and shards of metal in patients.
  • Titanium wear particles from metal and polyethylene prostheses have been shown to create chromosomal instability, reproductive failure, and gene damage in the cells for many generations.
  • One-third of minimally invasive hip replacement patients develop pseudotumors, caused by black soot-like metal particles worn from the prosthesis.

REFERENCE- Smeekes, C., B. Ongkiehong, B. van der Wal, et. al. “Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain.” International Orthopaedics 39, issue 4, (April 2015): 631-8. doi: 10.1007/s00264-014-2605-6.

REFERENCE- Bosker, B. H., H. B. Ettema, M. van Rossum, et al. “Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips.” Archives of Orthopaedic and Trauma Surgery 135, issue 3, (March 2015): 417–25. doi: 10.1007/s00402-015-2165-2.

  1. Allergies to Prosthetic Joint
  • Components of knee replacement devices can cause allergies.

REFERENCE- Van Der Straeten, C. and K. A. De Smet. “Current expert views on metal-on-metal hip resurfacing arthroplasty. Consensus of the 6th advanced Hip resurfacing course, Ghent, Belgium, May 2014.” Hip International 26, issue 1, (February 8, 2016): 1-7. doi: 10.5301/hipint.5000288.

  • People with sensitivities to metals, so as those in certain jewelries, will likely have sensitivities to the metals in a joint prosthesis.

REFERENCE- Van Der Straeten, C. and K. A. De Smet. “Current expert views on metal-on-metal hip resurfacing arthroplasty. Consensus of the 6th advanced Hip resurfacing course, Ghent, Belgium, May 2014.” Hip International 26, issue 1, (February 8, 2016): 1-7. doi: 10.5301/hipint.5000288.

  • Having any allergy, such as to pollen or cat dander, is tied to having more pain and inflammation after a knee replacement as the hyperactive immune system perceives the device as foreign.

REFERENCE- Hinarejos, P., T. Ferrer, R. Torres-Claramunt, et al. “Patient-reported allergies cause inferior outcomes after total knee arthroplasty.” Knee Surgery, Sports Traumatology, Arthroscopy, (November 3, 2015): 1–5. http://www.ncbi.nlm.nih.gov/pubmed/26531183.

  • A small study concluded that two-thirds of knee- and hip-replacement patients had allergies to the metals in their joint prosthesis.
  1. Bleeding Stomach Ulcers
  • Sixfold increase in stomach bleeding following a hip replacement, and the risk lasts for up to 12 weeks following surgery.

REFERENCE- Lalmohamed, A., P. Vestergaard, M. K. de Boer, et al. “Risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement compared with matched controls: a nationwide cohort study.” The American Journal of Gastroenterology 108, issue 8, (August 2013): 1277–85. doi: 10.1038/ajg.2013.108.

  • Two- to three-times increase in stomach bleeding following a knee replacement, and the risk lasts for up to 6 weeks following surgery.

REFERENCE- Lalmohamed, A., P. Vestergaard, M. K. de Boer, et al. “Risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement compared with matched controls: a nationwide cohort study.” The American Journal of Gastroenterology 108, issue 8, (August 2013): 1277–85. doi: 10.1038/ajg.2013.108.

  1. Hip Fractures Following Knee Replacement
  • A large-scale Swedish study showed a 4% increase in hip fracture risk during the 10 years following knee replacement.

REFERENCE- International Osteoporosis Foundation. "Hip fracture risk rises in the 10 years after total knee replacement." ScienceDaily. http://www.sciencedaily.com/releases/2016/04/160416153140.htm.

  1. Knee and Hip Misalignment Following Hip Replacement
  • Alignment of the hip and knee alters following hip replacement, affecting walking, function, the back and ankle, and possibly increasing the risk of arthritis.

REFERENCE- Akiyama, K., K Nakata, M. Kitada, M. Yamamura, et al. “Changes in axial alignment of th ipsilateral hip and knee after total hip arthroplasty.” The Bone and Joint Journal 98-B, issue 3, (March 2016): 349–58. doi: 10.1302/0301-620X.98B3.35468.

  1. Complications in Smokers
  • Smokers have a 53% greater chance of infection.
  • Smokers have a 161% greater chance of stroke.
  • Smokers have a 63% greater chance of death at one year postop.
  • Smokers have a 34% greater chance of pneumonia.

REFERENCE- Singh, J. A., T. K. Houston, B. A. Ponce, et al. “Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans.” Arthritis Care & Research 63, issue 10, (October 2011): 1365–74. doi: 10.1002/acr.20555.

The Source of Preoperative Joint Pain Isn’t Always the Joint

  1. One-third of knee replacements are unnecessary or medically inappropriate as the knee joint isn’t the true source of the pain.
  2. Decisions are often made to replace a joint based on cursory exams and X-rays, both poor indicators for the true source of the pain.
  3. 77% of knee-replacement patients describe their pain as numbness, meaning it’s coming from a pinched nerve, likely in their low back, and not the knee joint.
  4. Loose tendons or ligaments can be a source of joint pain.
  5. Disc and nerve issues in the back can be a source of joint pain.
  6. Patients with referred pain (pain coming from somewhere else) won’t benefit from joint replacement since the joint is not the true source of the pain.

The Cost for Joint Replacement Is Astronomical

  1. Average cost for a total knee replacement (plus additional services such as anesthesia, pathology, etc.) in the United States in the year 2015 was over $55,000.

REFERENCE- CostHelper. “How Much Does a Knee Replacement Cost?” http://health.costhelper.com/knee-replacement.html.

  1. Average cost (mean adjusted per state) for knee replacement exceeds average annual income in many states, including California, Tennessee, New Jersey, and Texas.
  2. 7 in 10 Americans don’t have enough saved to cover the cost of knee replacement in retirement.
  3. Out-of-pocket costs for a knee replacement for those covered by insurance would drain the life savings of 60% of Americans.
  4. Average cost for a hip replacement in the Unites States in the year 2015 was nearly $40,000.

REFERENCE- CostHelper. “How Much Does a Knee Replacement Cost?” http://health.costhelper.com/knee-replacement.html.

Additional Facts About Hip and Knee Replacements

  1. Over 700,000 knee replacements and over 300,000 hip replacements are performed each year in the United States, and these numbers continue to climb.

REFERENCE- Centers for Disease Control and Prevention (CDC). Total numbers knee and hip replacements in the United States. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm.

  1. 6 in 10 knee-replacement surgeries have no clear medical indication.

REFERENCE- Riddle, D. L., W. A. Jiranek, and C. W. Hayes. “Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study.” Arthritis & Rheumatology 66, issue 8, (August 2014): 2134–43. doi: 10.1002/art.38685.

  1. Overweight or obese patients have poorer outcomes and more complications.
  2. 25% of patients who have a single joint replacement will have another joint replacement within two years.
  3. Knee replacement in younger patients (under 60) is becoming a trend.
  4. In younger, more active patients, 15% of knee replacements need revisions after just five years.

REFERENCE- Neal, Todd. “Study: Outcome Poor with Hip Resurfacing.” MedPage Today, (October 1, 2012). ttp://www.medpagetoday.com/Orthopedics/Orthopedics/35059.

  1. Patients age 80 and over are 13 times more likely to perish from complications of a hip replacement.

*Regenexx-SD Is an Alternative to Hip and Knee Replacement

  1. Regenexx treats hip and knee problems using the patient’s own stem cells or blood platelets.
  2. 57% of knee patients report greater than 50% relief 3 months following the procedure.
  3. 76% of knee patients report greater than 50% relief 48 months following the procedure.
  4. 36% of hip patients report greater than 50% relief 3 months following the procedure.
  5. 46% of hip patients report greater than 50% relief 48 months following the procedure.

*This section uses the fall 2015 advanced registry Regenexx data, which is collected as patients are treated and is not the same as a controlled trial.