We Replace Far Too Many Joints: New Study May Help End That Practice

By Chris Centeno, MD /

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If you read this blog, you know that I’m not a fan of joint replacements. That doesn’t mean I haven’t told people who really need them to get them, but a chunk of my career has been devoted to making sure many patients can avoid them. However, new research may make my job even easier and also provide some help to surgeons who tend to replace far too many joints.

When to Replace Joints:  New Light on a Dark Subject

Total joint replacement continues to be on the rise, despite being expensive and fraught with risks of complications. It’s often not successful in relieving the pain of those who suffer from osteoarthritis—the most common reason to have the surgery in the first place.

To make matters worse, it is believed by academics that more than one in three knee replacements are not needed! But how do you know if you need a new hip or knee? When a surgeon recommends joint replacement, it’s difficult for a hurting patient to argue.

Results of a study posted in DG News last month tells us there may be a better way to decide on the need for joint replacement surgery. Researchers looked at what role collagens (proteins found in connective tissue) in the various components of joints play in determining the risk for joint replacement in patients. They discovered that biomarkers of extracellular matrix turnover can possibly predict a high risk of joint failure and the need for TJR.

What the Heck Is ECM?

Extracellular Matrix (ECM) is the mortar that holds together your cellular bricks. For example, your cartilage cells live in a specific mix of proteins that provide cushion and nutrients for those cells. Hence, if your ECM is healthy, those cells are too. However, if the ECM begins to break down, like bricks losing mortar, the whole structure is likely to fall apart.

ECM Breakdown May Be the Key to Predicting When Joint Replacement Is Needed

The researchers looked at data from two previously completed clinical trials that had involved oral supplements. For their study, they included post-joint replacement subjects (8 post-hips and 19 post-knees) with baseline CTX-I and CTX-II (biomarkers of cartilage breakdown and disease progression) levels available to analyze.

The team compared the risk of joint replacement (hip or knee) in patients with high vs. low CTX-I and CTX-II values, controlling for other factors like sex, age, and body mass index. Results of the study showed that a higher urine CTX-II was linked to a greater than 3 times risk of total joint replacement of the hip or knee. And, an elevated CTX-I was associated with an almost 9 times greater risk of knee replacement.

What Can You Do?

Preventing breakdown of your ECM is step 1. How do you do that? First, we know that common American problems associated with obesity like metabolic syndrome, make this breakdown worse. That means cleaning up your diet and getting more exercise. However, you can also help yourself by making sure you don’t become a surgical victim. Meaning, using orthobiologics to reduce help keep the wear and tear at bay. You can learn more about how all of that works by reading my book below:

The upshot? You should be focused on making sure your joints aren’t breaking down or trying to reduce that breakdown as you age. Why? We replace far too many joints because it seems easier, but realize that this procedure is the surgical amputation of the joint and insertion of a prosthesis!

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2 thoughts on “We Replace Far Too Many Joints: New Study May Help End That Practice

  1. Jim Rodden

    Is there a no replacement alternative if you’re already bone on bone in both knees?

    1. Regenexx Team

      Hi Jim,
      We treat bone on bone knees, and knee replacement Candidates regularly. To see if you particular situation would be a Candidate, please use the the “Are You a Regenexx Candidate” to submit the Candidate form here: https://regenexx.com/conditions-treated/knee/ Please see: https://regenexx.com/blog/knee-arthritis-stem-cell-treatment/ and https://regenexx.com/blog/ironman-stem-cell-procedure/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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