What knee replacement alternatives may fit before surgery

What to do at home first

Keep moving, but stay within what the joint handles without a sharp rise in soreness. Short walks, light strength work, and level ground may help you stay active.

If swelling or soreness keeps rising, shorten the activity and allow more rest. Don't force the joint through a movement that makes it steadily worse.

A cane or well-fitted brace may reduce strain and steady your balance. Ask your doctor which medicine is safer with the rest of your health.

What to ask about office treatment

QC Kinetix offers regenerative treatments, meaning office procedures that place prepared material from your own blood or bone marrow into the joint. A provider first reviews your health and examines the sore knee or hip.

Tenderness, swelling, and lost movement may point to care at the clinic. The exam may instead lead to physical therapy, another doctor, or a talk with a surgeon.

Ask about risks, how long relief might last, and the price of later visits. An office procedure can't promise that you will avoid replacement.

When to discuss replacement

Talk seriously about replacement when severe soreness and lost movement continue after a fair try of non-surgical care. That care may include exercise, easier activity, a brace, or medicine your doctor considers safe.

For some people, replacement improves movement more than continued non-surgical care, but surgery carries greater risks. Your doctor can explain what the X-ray shows and what replacement may change.

Waiting may be reasonable while you can manage daily tasks and want more time. If several choices haven't helped, ask whether repeating them has a clear purpose.

Sources

1. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA, and education plus structured land-based exercise as core for hip and polyarticular OA. Topical NSAIDs are strongly recommended for knee OA (Level 1A). Intra-articular corticosteroids and hyaluronic acid are Level 1B/2 for knee OA depending on comorbidity and are NOT recommended for hip or polyarticular OA. Oral NSAIDs are not recommended for people with cardiovascular comorbidity or frailty, and oral and transdermal opioids are strongly not recommended (Level 5).

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

2. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing for tibiofemoral knee OA, topical NSAIDs for knee OA, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA. Radiofrequency ablation for knee OA, acupuncture, thermal modalities, acetaminophen, duloxetine and tramadol are only CONDITIONAL recommendations.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

3. FDA states directly that regenerative medicine therapies - including stem cells, stromal vascular fraction, umbilical cord blood, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes - have NOT been approved for the treatment of any orthopedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain. FDA further states that being charged for these products, or being offered them outside an FDA-overseen clinical trial, means a patient is likely being deceived and offered a product illegally, and that a product's presence on clinicaltrials.gov or a firm's FDA registration does not mean the product is legally marketed. Reported harms include blindness, tumor formation, neurological events and life-threatening bacterial infections.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA.gov, 2021.

4. The Cochrane review of land-based therapeutic exercise for HIP osteoarthritis included 10 randomised trials, seven of which the authors judged to have a low risk of bias, though results remain vulnerable to performance and detection bias because participants could not be blinded and all primary outcomes were self-reported. The evidence base for hip is substantially thinner than for knee.

   Fransen M, McConnell S, Hernandez-Molina G, et al. — Exercise for osteoarthritis of the hip.. Cochrane Database of Systematic Reviews, 2014. DOI: 10.1002/14651858.CD007912.pub2.

5. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

6. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.