The Case Against Joint Surgery

As our population gets older, the number of joint surgeries performed in the United States, including  joint replacements, is increasing at an alarming rate…but is it really necessary?

Currently, the United States performs joint replacement surgeries at a much higher rate than most other developed countries. Among the most popular – Knee replacement and knee repair. There are approximately 600,000 knee joint replacement  surgeries and over 1,000,000 knee arthroscopic surgeries performed in the United States every year. That number increased by 50% in just a decade1, which begs the question… Are our joints getting weaker – or are we too quick to accept surgery as the answer?

Consider the following:

  • Even with millions of surgeries performed each year, there is very limited information regarding long-term outcomes, such as disability and residual pain. 1
  • A recent study looking at long-term results offered some disappointing data2 that would seem to indicate surgery is not the best choice for everyone. 2
  • Younger, more active adults are getting knee replacements and other joint surgeries, only to find ongoing pain and an inability to return to an active lifestyle. Many of these patients could have benefitted from an effective non-surgical approach.
  • Yet another study of more than 200 patients with knee or hip replacement, found that only 50% of those patients reported significant improvement after joint replacement surgery.4

Aren’t Surgeries Supposed to Fix Joint Pain?

Many people are surprised to learn that there is significant controversy over the effectiveness of various joint surgeries – even those not involving joint replacement.

  • knee-scar-200Knee debridement surgeries have been shown to offer no better pain relief or performance than placebo.
  • Knee surgeries to repair meniscal tears are not particularly effective either, and do not slow down the progression of ostaoarthritis.7
  • A recent study showed that as many middle age and elderly patients  without knee pain had meniscus tears versus those who didn’t have tears.8 That calls into question the meniscus as the source of the pain and the rationale for operating meniscal tears in the first place.

Arthroscopic surgery for knee osteoarthritis provides no additional benefit to physical therapy.5,6  That is not surprising since the knee cartilage is a living tissue that produces needed protective and lubricant substances for the joint. Once this key tissue is removed from the joint, it leaves the joint vulnerable to further damage and degeneration, often requiring further surgery and even more removal of key tissue.

Other types of joint surgeries that are commonly performed have not shown to be useful, and there is significant controversy over their effectiveness.  Knee debridement surgeries have been shown to be no better than placebo. Arthroscopic surgery for knee osteoarthritis provides no additional benefit to physical therapy.

  • Knee debridement surgeries have been shown to offer no better pain relief or performance than placebo.5,6
  • Knee surgeries to repair meniscal tears are not particularly effective either, and do not slow down the progression of ostaoarthritis.7
  • A recent study showed that as many middle age and elderly patients  without knee pain had meniscus tears versus those who didn’t have tears.8
  • Arthroscopic surgery for knee osteoarthritis provides no additional benefit to physical therapy.5,6  That is not surprising since the knee cartilage is a living tissue that produces needed protective and lubricant substances for the joint. Once this key tissue is removed from the joint, it leaves the joint vulnerable to further damage and degeneration, often requiring further surgery and even more removal of key tissue.
  • That calls into question the meniscus as the source of the pain and the rationale for operating meniscal tears in the first place.That calls into question the meniscus as the source of the pain and the rationale for operating meniscal tears in the first place.  A newer procedure, micro fracture, is now gaining popularity. This procedure often requires the patient to spend 4-8 weeks on crutches and pain medication.

Then you have to consider that any joint surgery involves significant risk.

Any time a surgeon cuts into the body, there are dozens of things that can go wrong compared with very few things that should automatically go right. Potential risks include:

  • blood clots
  • pulmonary embolism
  • unknown reactions to anesthesia
  • infections
  • nerve damage
  • persistent pain
  • failure of prosthesis (in joint replacement cases)

In the US alone, there are over 12,000 catastrophic deep joint infections after total joint replacement surgery per year. Catastrophic in this case means total death of tissue surrounding the joint, or the joint itself, which can lead to severe bone surgeries, and repeat replacement procedures. On top of this, joint replacement surgeries have been found to significantly increase the risk of heart attacks9, stroke10, and bleeding ulcers.

Even when joint replacement surgeries are successful, they require long, painful recovery periods and the use of mobility aids such as canes, crutches, or walkers.  Another overlooked effect of joint surgery is a permanent decrease in range of motion, strength, and activity level.

So What’s the Alternative?

Regenerative treatment is a new state-of-the-art conservative option with the potential  of using the body’s own healing powers to restore function and decrease pain in patients with chronic joint pain. Our regenerative treatment, RegenaJoint, is safe, requires no hospital stay, involves minimal recovery time, and is a lot less expensive than surgery. And because it doesn’t damage joints or tissue, Regenerative treatment can be attempted prior to more invasive methods, and may even make the body stronger and better able to handle a joint replacement or other surgery in the event joint damage worsens or becomes more severe over time.

RegenaJoint addresses all the most common sources of chronic joint pain: the loss of cartilage in the joint space, the laxity and weakness of surrounding tendons and  ligaments. It is applied directly to the joint through injection, with a minimally invasive technique that doesn’t require post-operative care or recovery. In many cases, our patients find themselves returning to activity within a week or two of treatment. All of this while avoiding the risks and complications of possible joint surgery.

Schedule a free consultation today to learn how regenerative treatment can help you manage your chronic joint pain.

 

REFERENCES

1) Kim S, et al. Increase in outpatient knee arthroscopy in the United States: A comparison of national surveys of ambulatory surgery, 1996 and 2006. JBone Joint Surg Am, 2011;93:994-1000.

2) Carr A, et al. Knee Replacement, Lancet, 2012. Doi: 10.1016/SO140-6736(11)60752-6.

3) Wylde V, et al. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain, 2010; 152(3):566-572.

4) Hawker GA, et al. Which patients are most likely to benefit from total joint arthroplasty? Arthritis Rheum, 2013; 65(5): 1243-1252.

5) Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med, 2008; 359:1097-1107.

6) American Academy of Orthopedic Surgeons (AAOS) Annual Meeting: Abstract SE67. Presented March 19, 2013.

7) Pearse EO, et al. Partial meniscectomy in the presence of sever osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy, 2003; 19(9):963-968.

8) Englund M, et al.Incidental findings on knee MRI in middle aged and elderly persons. N Engl J Med, 2008; 359(11):1108-1115.

9) Lalmohamed A, et al. Timing of acute myocardial infarction in patients undergoing total hip or knee replacement: A nationwide cohort study. Arch Int Med, 2012; 172(16):1229-1235.

10) Lalmohamed A, et al. Timing of stroke in patients undergoing total hip replacement and matched controls: A nationwide cohort study. Stroke 2012; 43(12):3225-3229.

 

Disclaimer:

Individual conditions, treatment and recovery times may vary. Each patient’s experience with regenerative medicine is different. Some patients may require multiple treatments.

The content of this website is for informational purposes only. This website does not offer or provide medical advice of any kind. Nothing contained on this website is intended or shall be construed to constitute professional advice for any purpose including medical diagnosis or treatment.

Some patients with chronic back pain do require surgery. If directed to pursue surgery by your physician, prompt action is advised, as waiting may reduce the efficacy of surgical treatment.

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