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Osteoarthritis and Knee Replacement
Osteoarthritis is the most common form of arthritis. It is a progressive disease of the whole joint which eventually leads to breakdown of cartilage, bone and a loss of healthy joint fluid. Check out our blog on What is Osteoarthritis to learn more about the condition. Osteoarthritis (OA) is a common condition in adults. In the US, the incidence of OA is projected to increase to 3.5 million per year by 2030. In the knee, osteoarthritis is apparent in up to 50% in people over the age of 75; one third suffer from symptoms caused by knee osteoarthritis.
Knee replacement is the only curative procedure for osteoarthritis.  In fact, 94-97% of knee replacements take place due to osteoarthritis, with the most common being end-stage osteoarthritis.  Knee replacement cures arthritis because it removes the portion of the knee joint that is affected by the condition. Of all the people over the age of 55, only 1.5% of them have radiographic evidence of severe knee OA that is painful. Mild to moderate knee OA impacts 10% of the population over the age of 55.  While this research suggests that most people with severe OA may not experience pain symptoms, end-stage OA commonly requires knee replacement to relieve pain and improve knee function. Knee replacement provides positive outcomes for people in terms of improving knee function, relieving pain, avoiding a repeat implant, and reducing costs associated with continuing treatment of OA. However it may not be the best treatment option for everyone.
Knee Replacement Outcomes on Arthritis
Knee replacement has been shown to have positive outcomes on improving knee function, relieving pain, and avoiding reoperation. In a research study published by Carr and colleagues, total knee replacement is considered amongst the most effective of all surgical treatments in improving the quality of life. Research shows that 88% of people report improved quality of life and satisfaction after knee replacement surgery.
Likewise, according to the Arthritis Association, the success of managing pain with a total knee replacement in younger patients is about 90% to 95%.  By reducing the pain caused by arthritis, knee replacement can enable you to continue engaging in the physical activities you love.
Knee replacement is also a cost-effective solution for osteoarthritis. According to Liddle and colleagues, for people with disabling knee OA, having total knee replacement can help reduce continuing health-care costs by $278 per year for each individual. On the other hand, avoiding a knee replacement and instead treating OA non-surgically actually increases a person’s healthcare cost by $1978 per year.
Negative Outcomes of Knee replacement on Arthritis
Total knee replacement (TKR) is considered the gold standard treatment for OA but it may not be the best treatment for all patients. A significant portion of people report dissatisfaction with their knee replacement surgery. For example, 15% to 20% of patients are dissatisfied with their knee replacement. Additionally, as many as 20% of patients might continue to endure knee pain or have problems after TKR. Likewise, the quality of life reported after surgery either remains the same or gets worse in around 9 to 12% of patients following knee replacement.  So while knee replacement removes the damage caused by osteoarthritis, it may not completely relieve the pain associated with the condition for everyone. The replacement does not make arthritis go away completely. Improving quality of life and reducing pain after surgery is also strongly related to engaging in an effective exercise program and maintaining a healthy weight.
Another challenge facing people undergoing knee replacement is that the replacement has a limited lifetime, meaning that people undergoing the procedure may need a revision surgery that can result in worse outcomes than the initial surgery. According to a research study conducted by Deere and colleagues, while 82% of total knee replacements can last over 25 years, many people will need a revision knee replacement in their lifetime. Around 5% of people over the age of 70 will undergo revision surgery, and this number increases to 35% for younger males in particular.  Revision surgery also comes at a larger financial expense to the individual and the health care system and can lead to worse knee function and pain than primary knee replacements.
Alternative Treatments for Arthritis
Although knee replacement is the only curative treatment for OA, it is mainly suggested for end-stage OA. Taking into consideration the risk of knee replacement dissatisfaction, surgery revision, and complications of knee replacement, several alternative treatments are indicated for OA which has not yet reached the end-stage. Research shows that a regular exercise program, physical therapy, losing weight or maintaining a healthy body weight, and walking aids such as a cane can provide support for people with osteoarthritis. Curovate is an evidence-based app that can help you start your rehabilitation process, providing you with a physical therapy plans, daily video exercises, ways to measure and monitor your progress, and much more! Download the Curovate App by clicking on the links below.
Likewise, to help relieve pain and allow for adequate knee function in day to day life, non-surgical therapies can be implemented alone or in combination with pharmacological therapies such as simple analgesics and non-steroidal anti-inflammatory drugs. Please speak to your medical doctor to ask about medication that may be appropriate for your knee osteoarthritis pain.
Knee replacement is the only curative procedure for osteoarthritis. However, it is mainly suggested for end-stage OA. While knee replacement provides positive outcomes for people in terms of improving knee function, relieving pain, avoiding re-surgery, and reducing costs associated with continuing treatment of OA, it may not be the best treatment option for everyone. An effective exercise program plays an important role in improving the quality of life with surgically or non-surgically treated arthritis. Curovate provides you with an evidence-based app that can help you with daily rehabilitation exercises and recovery with or without knee replacement. You can also use the app to measure your knee range of motion. Download the Curovates App by clicking on the links below.
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- Is it safe for me to exercise if I have knee osteoarthritis or hip osteoarthritis? But I have pain due to my osteoarthritis. Why should I exercise?
- How long will my knee replacement last? And is there anything I can do to make my knee replacement last longer?
1. Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ. Knee replacement. The Lancet. 2012 Apr 7;379(9823):1331-40.
2. Deere K, Whitehouse MR, Kunutsor SK, et al. How long do revised and multiply revised knee replacements last? An analysis of the National Joint Registry. Lancet Rheumatol. 2021;3(6):e438-e446.
3. Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998 Nov;(356):93-110.
4. Liddle AD, Pegg EC, Pandit H. Knee replacement for osteoarthritis. Maturitas. 2013 Jun;75(2):131-6.Epub 2013 Apr 9. PMID: 23582106.
5. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Annals of the rheumatic diseases. 2001 Feb 1;60(2):91-7.
6. Arthritis Foundation. Total knee replacement surgery considerations. (n.d.) Retrieved November 3, 2022