New research out last week shows that because we’re replacing knees in more middle aged patients, the number of revision surgeries needed in the future will be epic. A staggering 1.5 million US adults are likely to need a revision knee replacement surgery before age 70, which is a dramatic jump in these surgeries. The issue is that while a first knee replacement surgery is a big procedure, they tend to be shorter 60-90 minute procedures with less blood loss, anesthesia time, and risk. A revision surgery on the other hand is a very big surgery, usually lasting 3-4 hours with much more risk to the patient. The revision procedure is just technically more difficult, as the old prosthesis has to be removed and a new one inserted. In addition, since tissues have grown into the old knee replacement prosthesis, extracting it safely from those tissues can be a challenge. So what can you do to avoid being one of those patients who needs a revision surgery? Look for knee replacement alternatives. These include:
–Avoid knee meniscus surgeries that remove meniscus tissue after a tear. These knee surgeries are known to advance the development of knee arthritis as there is less cushioning with less meniscus. If your knee is locking due to a torn meniscus, get a doctor to inject SynVisc (or another brand of hyaluronic acid) to dislodge the piece. If it still locks, consider biologic treatments for the tear like PRP or knee stem cell injections. If you still need surgery, have the surgeon remove the smallest possible amount of meniscus.
-Try SynVisc or another brand of hyaluronic acid injection. Make sure the surgeon or physician does this knee injection under imaging guidance and not blind. This WD-40 lubricant injection may help buy you a few more years, especially if you start early when your arthritis is less severe.
–Avoid steroid shots into the knee. Recent research shows that these shots can kill off large numbers of cartilage cells. You need all the cartilage cells you can get.
-If you have mild arthritis that doesn’t respond to SynVisc or hyaluronic acid injections, consider platelet rich plasma injections, which have been shown to work better.
-If you have more significant knee arthritis, consider stem cell injections.
-Have someone look at why your knee has arthritis, as there are usually biomechanical and or other causes.
The upshot? Think twice about getting a knee replacement if you’re under 65 or you may be in the crowd of 1.5 million patients who will need much a riskier knee revision surgery.