Knee replacements are occurring far too often today and the simple truth is that they may be entirely unnecessary. This is mostly due to the fact that effective nonsurgical options now exist and that in some cases, the knee pain may actually be stemming from another part of the body, such as the spine. Even when using standard criteria for determining candidacy, about one-third of knee replacements are deemed inappropriate when evaluated by independent researchers. When knee pain is legitimately caused by a knee condition, many knee-replacement candidates seek out alternatives to surgery. There are many regenerative-medicine options, such as autologous (coming from one’s own body) stem cell injections, that could potentially relieve pain and increase activity levels without “amputating” the knee, sawing bones, snipping away pieces of meniscus or frayed cartilage, and replacing the knee with a foreign device. If it is determined that your knee pain is due to a spinal condition, there are also nonsurgical options for spinal treatment to consider.
Knee replacement surgery should really be a last resort in only the most extreme cases. For those who are still considering knee replacement despite the risks that it presents, here are six reasons to avoid knee replacement surgery.
1. Chronic Knee Pain
Ultimately, chronic knee pain is the main reason that most people finally decide to have a knee replacement. They simply want relief. Unfortunately, knee replacement surgery may possibly come with even more pain. Studies have shown that many patients still have at least mild pain after their knee replacement. Some even rate their pain as greater than or equal to their pain prior to surgery. Even after two, three, or four years post-surgery, patients have reported that their pain is worsening.
As we mentioned previously, one explanation of chronic knee pain could be that the source of the knee pain is not actually a knee condition. This could be one of the reasons that the pain does not subside after surgery. It stands to reason that if the pain in the knee was caused by spinal nerves, for example, that your pain will not simply go away after a knee replacement. It is essential that the root cause of the pain is discovered and is the focus of treatment. You do not want to have surgery on your knee joint if what you truly are experiencing is a condition in your back.
If you are curious to know whether your back is the cause of your knee pain, there are signs to look for, such as hamstring tightness, bunion formation, and if you are experiencing both back and knee pain. Note that it is not guaranteed that you will experience any of these symptoms if your knee pain stems from the low back. A low back condition can present itself solely as knee pain. On the other hand, if your knee pain is accompanied by back pain, it would absolutely be a sign to avoid knee replacement surgery.
2. Expectation May Not Meet Reality
We have all seen the TV commercials and advertisements of middle-aged and elderly people who are running on a beach or playing sports with their families allegedly after knee replacement surgery. Marketers and advertisers really make it appealing to jump on the bandwagon and give people a false sense of reality. The truth, however, is that only 5% or less (1 in 20 people) actually achieve anything close to normal physical activity following knee replacement surgery.
The disturbing trend of marketing knee replacements to those who are 55 years old or younger has also gotten out of hand in recent years. Younger patients expect much more out of their knee replacements in comparison to older patients. Because of this high expectation, 15% of younger patients actually undergo another surgery to fix their knee replacement just five years after their original surgery.
3. Pseudotumors and Tissue Damage Caused by Metal Ions in the Blood
Wear particles are microscopic pieces of metal, ceramic, or plastic that break off of the joint replacement, irritate the local tissues, and/or enter the bloodstream. These particles, as well as metal ions in the blood, have been the subject of many studies and class-action lawsuits. Additionally, the use of new plastics in artificial joints also poses issues if that plastic breaks off of the joint replacement and irritates local tissues and/or enters the bloodstream. It is also notable that minimally invasive knee replacements involve only partial replacements or resurfacing, however, these smaller devices must all be metal to withstand the stresses of the knee joint. This means more metal wear particles and ions in your bloodstream.
Many studies have demonstrated cause for concern regarding metal ions in the blood after knee replacement surgery:
- In Austria, researchers discovered that the size of the prosthesis is directly correlated with the blood concentration of metal ions. This means that the larger the knee replacement device, the more metal ions found in the bloodstream.
- In Italy, a group of researchers found more metal ions present in knee replacement patients who had a loose prosthesis. This is due to the fact that in some patients, the knee replacement device may not be seated tightly or did not bond correctly to the surrounding bone causing additional wear between the bone and the metal leading to an increased amount of metal particles.
- In Germany, a group found that after a knee prosthesis was implanted, metal ions in the blood increased precipitously.
- Other German researchers discovered higher serum levels of chromium and cobalt in knee replacement patients when compared to patients without knee replacements.
Why do these discoveries matter? These wear particles and metal ions can cause harmful metal toxicity within your body as well as create pseudotumors and tissue damage at the genetic level. Additionally, according to the FDA, other adverse reactions may include skin rashes, cardiomyopathy, neurological changes including sensory changes (auditory, or visual impairments), psychological status change (including depression or cognitive impairment), kidney function impairment, and thyroid dysfunction.
- Even when cross-linked Polyethylene is used instead of metal, a study showed that it caused the knee tissues to produce a much nastier stew of cartilage inflammation and break down chemicals.
4. Device Failure Caused By Allergies
In the past few years, multiple studies have discussed that the components of knee replacement prostheses can cause allergies. Two groups of people are at a significantly higher risk of potential rejection or loosening of their device and/or toxicity from wear particles.
- Those with any type of allergy. Even patients with allergies that are as simple as pollen or dander should avoid knee replacement surgery. People who are considered “allergic” have hyperactive immune systems and secrete antibodies inappropriately to rid their bodies of the thing that they have mistaken as harmful. If that one thing is a knee replacement device, this drastically affects the outcome of a surgery.
- Those with metal sensitivities. Patients who have more specific allergies to metal will likely have issues with the metals that are used in joint replacement prostheses.
Unfortunately, those who consider themselves to be an “allergic person” may experience more pain after a knee replacement because of an allergy related to the replacement device and the chronic inflammation that it causes. Those people who suffer from four or more different allergies may suffer from pain that is more prevalent. The cement used to bond the device to the bone can also cause an allergic reaction. In these cases, the device is more likely to fail, need to be replaced sooner, or causes chronic pain.
5. Increased Risk of Heart Attack, Stroke, and Bleeding Stomach Ulcers
Knee replacement patients aged 60 and up are 31 times more likely to experience a heart attack in the two weeks following surgery. When you amputate a joint from a patient, there is severe trauma to the blood vessels and bone marrow space. This leads to extreme stress on the body and a higher risk of blood clots that could potentially cause an embolism in the heart, lungs, or brain. Clots are fairly common. According to one study, blood clots in the legs that produced symptoms were found in 34% of patients.
Men are at an even greater risk of having a heart attack after knee replacement surgery. One research study discovered that the risk of heart attack in men who have had a knee replacement increases by 79% in the years that follow the procedure. Additionally, the stress of undergoing the joint removal alone may be enough to trigger a stroke or a heart attack. Bleeding stomach ulcers can also occur following knee replacement. Study results show a three-times increase in stomach bleeding for up to six weeks post-surgery.
6. Increased Risk of Hip Fracture
A surprising addition to knee replacement surgery risks is the rise of hip fractures following surgery. A Swedish study observed the medical records of the “entire Swedish population born between 1902 and 1952.” The risk for hip fracture for those who received knee replacements before surgery was relatively low. In total, 3,221 patients suffered a hip fracture within 10 years following knee replacement surgery. This accounted for a 4% increase in the risk of hip fracture after knee replacement. In addition, we are also seeing bone density loss in hips. There could be a correlation between the two.
Knee Replacement vs. Stem Cell Therapy -- Regenexx
Alternatives to Knee Replacement Surgery
Although many patients have tried steroid injections or gel shots to increase the lubrication of their knee joints, this is not the best approach. Steroid shots actually kill off stem cells, cartilage cells, and increase cartilage breakdown. Even the commonly used local anesthetics used in the knees can be toxic to stem and cartilage cells. Those who suffer from mild arthritis may benefit from precise injections of highly concentrated platelet-rich plasma (PRP). These natural growth factors from your own platelets can support healthy cartilage. The Regenexx protocols allow for the ability to produce better and more individualized platelet products that the typical PRP centrifuge. If you suffer from moderate or severe arthritis, precise guided injections of your own stem cells may be a better choice to provide relief.
Since there are alternative options and a great number of risks associated with knee replacement surgery, you may want to just say no while you explore your options. Our Regenexx Procedure Candidate Form is a great place to start understanding if regenerative orthopedic medicine is right for you.