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Is There an Alternative to Joint Replacement?

By Debra K. Brinker, RN

Joint replacement surgeries are increasing rapidly. In the last ten years, knee replacements have more than doubled and hip replacements more than tripled.1 The most common cause of chronic knee and hip pain leading to joint replacement is osteoarthritis. Other causes of knee and hip pain include bursitis, tendonitis, sports injuries, chondromalacia patella, ligament injury, meniscal injury, femoroacetabular impingement, and labral tears, all of which often lead to surgical intervention. Many patients do not want to have surgery, but are not informed about the non-surgical reparative options that are available. Looking into regenerative options now can save the need for surgery later.

Destructive Joint Motion:
The Cause of Osteoarthritis
The goal of many therapeutic, non-surgical modalities such as weight loss, exercise, physiotherapy, and bracing is to decrease pain and improve function. In many cases, they are helpful for a short period of time, but unable to provide long-term pain resolution because they do not repair joint instability. This is because increased mechanical stress caused by injury to the ligaments, meniscus, labrum, etc. alters joint function and allows for destructive joint motion. (See figure 1.)

figure 1

The consequences of destructive joint motion are a higher susceptibility to another injury and the development of osteoarthritis.  The road to osteoarthritis, and the ensuing joint replacement, can only be remedied when the problem of joint instability is addressed.

Ibuprofen and cortisone destroy cartilage
NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroid injections are generally used for fast-acting pain relief, but they inhibit the properties of healing, and accelerate cartilage degeneration and joint destruction. (See figure 2.)

figure 2
figure 2

Interestingly, NSAIDs and corticosteroids accelerate the very disease for which they are most often used. Shortly after doctors started injecting cortisone and other steroids into joints back in the 1950s, reports of terrible joint diseases began to surface.

Despite the well-documented dangers, they are still popular for people looking for immediate, short-term pain relief. However, their use should be cautioned in those who have joint injuries and osteoarthritis.

Is arthroscopy helpful?
Arthroscopic surgery may relieve symptoms temporarily, but long-term will further destabilize the joint and boost degeneration. It is a direct assault to the joint tissue which can lead to future surgeries.

Athletes have a low rate of returning to their sport full-time and a high rate of new injury post-surgery. Surgery makes joint instability worse, not better. (See figure 3.)

figure 3

Many surgeries such as labral repair and ACL reconstruction provide remarkable short-term pain relief. However, the replacement material will not function long-term like the original.

Patients must understand that with each NSAID prescription, corticosteroid injection, or surgical procedure that shaves or cuts tissue, the risk of developing long-term arthritis and the eventual joint replacement is greatly increased.

Regenerative Treatments are the Future of Pain Care
The key to successfully restoring joint integrity for the long-term is to stimulate the area to heal. Prolotherapy (Regenerative injection therapy) works with, rather than interferes with, the healing process of the body. It stimulates the normal inflammatory-reparative mechanisms for musculoskeletal pain and injury: laying down new collagen, strengthening the tendons and ligaments, repairing the meniscus of the knee and hip labrum, and boosting cartilage growth. (See figure 4.)

figure 4
figure 4

Therefore, it can decrease the chance of developing long-term arthritis because it addresses the root cause of arthritis: joint instability. Prolotherapy offers hope to those trying to avoid joint replacement. While surgery is necessary in a small percentage of patients, specifically for full thickness tears, non-surgical regenerative therapies should be a first-line, conservative treatment tried prior to surgery.

Is Prolotherapy the same as viscosupplementation?
No. Viscosupplementation (hyaluronic acid injections) is used in hopes of providing some short-term pain relief and to delay an anticipated knee replacement. It gives a temporary lubricating cushion in the joint.

However, it does not correct the underlying joint instability, so the destructive joint motion continues. This is what Prolotherapy corrects and what makes it unique as a pain treatment.

What about pain after surgery?
Regenerative options are effective even after surgery if a patient still complains of unresolved pain. Residual pain is common if the surgery did not correct the actual cause of pain. (See figure 5.) For those who have failed surgery, or have an advanced condition, Biocellular Prolotherapy, or Stem Cell Therapy, may be the treatment of choice. This utilizes the patient’s own cells by concentrating and injecting them directly into the damaged tissue to accelerate repair. These regenerative treatments offer promising alternatives to joint replacement and the opportunity for healing, as well as the return to function and athletics, for those suffering from chronic joint pain.

1  Kim, S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997–2004. Arthritis & Rheumatism,2008: 59: 481–488. doi:10.1002/art.23525

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