Knee Replacement Failures in the News
Most patients believe that a knee replacement is like replacing a worn out or broken part in your car. However, these past few years news stories have begun to appear that show the reality of what’s really happening in patients. Let’s dig in.
Danette’s Story
This appeared in the Washington Post about a woman with knee arthritis (8):
“When a doctor said that knee replacement would reduce her arthritis pain by 75 percent, Lake was overjoyed.
“I thought the knee replacement was going to be a cure,” said Lake, now 52 and living in rural Iowa. “I got all excited, thinking, ‘Finally, the pain is going to end and I will have some quality of life.’”
But one year after surgery on her right knee, Lake said she’s still suffering.
“I’m in constant pain, 24/7,” said Lake, who is too disabled to work. “There are times when I can’t even sleep.”
This is a story I’ve heard many, many times in the clinic. Someone who believed that knee replacement would make all of their problems disappear, but who actually ended up worse off. So let’s dig into the research data on this topic as it’s been reported. How often does this happen? Is this the exception or the rule?
Knee Replacement Surgery by the Numbers
The surgery rates doubled from 1999 to 2008 and that rate is still exploding with 3.5 million procedures a year expected by 2030. Most of those people believe that getting their knee replaced is just like changing a worn-out part in their car, but nothing could be further from the truth, Let’s dig in.
Up to 1/3 of Knee Replacement Patients Suffer from Chronic Pain
A large systemic review of many studies reviewed the results of 14 studies that reported pain after knee replacement surgery. That study demonstrated that between 10% to 34% of patients reported chronic pain despite getting their knee replaced (1).
1 in 5 People are Dissatisfied with their Surgical Results
Another large study looked at 1217 consecutive patients who had knee replacements between 2006 and 2008 and who filled out validated quality of life and functional questionnaires. The result? 1 in 5 people were dissatisfied with their knee replacement results (2).
Knee Replacement is Not Cost-Effective
A recent study that looked at existing government collected data in knee replacement patients found that the way the procedure is being practiced right now, it’s not cost-effective (3). The problem is that when the procedure is used in younger people, it results in higher rates of patients who are dissatisfied with the results. When used in older patients with lower expectations, the procedure works better. Hence, the move towards replacing younger knees has made the procedure not cost-effective.
Other Options
As we talk about often on this blog, there are other well-researched options outside of knee replacement for most patients. For example, we only have a single randomized controlled trial on knee replacement. That study showed that it wasn’t all that effective, for example, you had to replace 5-6 knees to get one person to report that they had more than 15% functional improvement or more (4). However, we now have three RCTs on using precise injections of your own bone marrow stem cells to help your arthritic knees (5-7). These now show that there is a 1 in 5 failure rate at 15 years causing those patients to convert to knee replacement. However, these procedures don’t involve amputating your knee and inserting a prosthesis and all of the increased risk that comes with that invasiveness.
If you’re interested in learning more about the RCT that showed that knee replacement had poor results, see my video below:
The upshot? Knee replacement is not all it’s cracked up to be. While there are some patients that do need this surgery, most can prevent it. So look at all of your options!
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References
(1) Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012 Feb 22;2(1):e000435. doi: 10.1136/bmjopen-2011-000435. PMID: 22357571; PMCID: PMC3289991.
(2) Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010 Sep;92(9):1253-8. doi: 10.1302/0301-620X.92B9.24394. PMID: 20798443.
(3) Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ. 2017 Mar 28;356:j1131. doi: 10.1136/bmj.j1131. PMID: 28351833; PMCID: PMC6284324.
(4) Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015 Oct 22;373(17):1597-606. doi: 10.1056/NEJMoa1505467
(5) Centeno C, Sheinkop M, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018 Dec 13;16(1):355. doi: 10.1186/s12967-018-1736-8. PMID: 30545387; PMCID: PMC6293635.
(6) Hernigou P, Bouthors C, Bastard C, Flouzat Lachaniette CH, Rouard H, Dubory A. Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study. Int Orthop. 2020 Jul 2. doi: 10.1007/s00264-020-04687-7. Epub ahead of print. PMID: 32617651.
(7) Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2020 Apr 23. doi: 10.1007/s00264-020-04571-4. Epub ahead of print. PMID: 32322943.
(8) The Washington Post. https://www.washingtonpost.com/national/health-science/treatment-or-torment-some-knee-replacements-fail-to-solve-chronic-pain/2018/12/21/76d5aa42-ffe6-11e8-862a-b6a6f3ce8199_story.html Accessed 2/14/21
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