Exploring Total Knee Replacements: Alternatives, Risk Factors, and Non-Surgical Options

Total knee replacement surgery has become standard for individuals with severe knee pain and limited mobility. However, it is crucial to understand that not all knee conditions or injuries necessitate total knee replacement. Non-surgical treatment options are available for knee injuries and conditions, with physical therapy often being one of the first recommended avenues. At EW Motion Therapy, we create individualized treatment plans to help our non-surgical patients reduce pain and improve mobility. Even if you decide our services do not fit your needs, you can still read on as we delve into the conditions that may not need a total replacement, discuss the risk factors associated with the procedure, and non-surgical treatment options such as physical therapy. 

When is a total knee replacement not necessary?

While total knee replacement can significantly improve the quality of life for individuals with debilitating knee conditions or previous injuries, exploring alternatives before considering surgery is essential. Here are a few conditions or injuries that might not require a total knee replacement:

1. Mild to moderate osteoarthritis: In the early stages of osteoarthritis, non-surgical interventions like pain medication, lifestyle modifications, and physical therapy can often provide relief. Total knee replacement is usually reserved for cases where conservative treatments have failed to alleviate symptoms.
2. Ligament tears: If only one of the four major ligaments in the knee (anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, or lateral collateral ligament) is torn, surgical repair or reconstruction may be recommended instead of a total knee replacement.
3. Partial knee replacement: In some instances, only a portion of the knee joint may be damaged, leading to isolated compartmental degeneration. A partial knee replacement, also known as unicompartmental knee arthroplasty, may be a viable option.

Risk factors associated with needing a total knee replacement

Several risk factors can increase the likelihood of someone requiring a knee replacement. While these factors do not guarantee the need for surgery, they indicate a higher risk of developing conditions that may necessitate knee replacement. Some key risk factors include:

1. Age: Advancing age is a significant risk factor for knee problems. As individuals grow older, the natural wear and tear on the knee joints increase, making them more susceptible to conditions like osteoarthritis.
2. Osteoarthritis: Severe osteoarthritis is the most common reason for knee replacement. This degenerative joint disease occurs when the protective cartilage in the knee joint wears down over time. Factors such as age, obesity, previous joint injuries, repetitive knee stress, and genetic predisposition contribute to the development of osteoarthritis.
3. Obesity: Excess body weight places additional stress on the knee joints, leading to accelerated degeneration and an increased risk of knee conditions. Obese individuals are more likely to develop osteoarthritis and may require knee replacement surgery to alleviate pain and improve mobility.
4. Previous knee injuries or trauma: Individuals who have experienced significant knee injuries, such as ligament tears (e.g., anterior cruciate ligament or ACL) or fractures, may be at higher risk of developing knee conditions requiring a knee replacement as they are a risk factor for osteoarthritis, as well. 
5. Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder that causes chronic inflammation and joint damage. It commonly affects the knees, leading to pain, stiffness, and deformity. In severe cases, you may require knee replacement surgery to restore function and relieve pain.
6. Gender: Studies have shown that women are more likely than men to require knee replacement surgery. The reasons behind this disparity are not fully understood. Still, hormonal factors, differences in bone structure, and variations in physical activity levels between genders may contribute to the increased risk in women however this risk factor is lower on the list. 
7. Genetic factors: Genetic predisposition plays a role in developing certain knee conditions, including osteoarthritis. Individuals with a family history of knee problems or joint degeneration may have an increased risk of requiring knee replacement surgery.

It's important to note that while these risk factors increase the likelihood of needing a knee replacement, they do not guarantee it. Many people with these risk factors can effectively manage knee conditions with non-surgical treatments and lifestyle modifications. Regular exercise, weight management, and preventive measures to minimize joint stress can help reduce the risk of developing severe knee problems that may require surgery.

What are my non-surgical treatment options?

Before considering surgery, you and your doctor should explore non-surgical interventions. One such option is physical therapy, which focuses on improving knee function, strengthening the surrounding muscles, and reducing pain. Here are a few critical points about physical therapy:

1. Pain management: Physical therapists employ manual therapy, heat or cold therapy, and transcutaneous electrical nerve stimulation (TENS) to alleviate pain and inflammation.
2. Range of motion exercises: One of the most key areas to maintain, physical therapists guide patients through exercises to increase knee flexibility and restore normal joint movement.
3. Strengthening exercises: Specific exercises are prescribed to strengthen the muscles surrounding the knee joint. Strengthening these muscles can help stabilize the knee and reduce strain on the joint itself.
4. Functional training: Physical therapists work with patients to improve balance, gait, and functional movements to enhance overall mobility and independence.

Apart from physical therapy, several non-surgical treatment options are available for knee conditions or injuries. These alternatives can help manage symptoms, promote healing, and improve knee function. Here are some standard non-surgical treatment options:

1. Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium can help reduce pain and inflammation associated with knee osteoarthritis. Prescription medications, such as corticosteroids or hyaluronic acid injections, may be recommended in some instances to provide relief and improve joint mobility.
2. Assistive devices: Using assistive devices such as knee braces, crutches, canes, or walkers can help relieve pressure on the knee joint and improve stability while walking or performing daily activities. These devices can be especially helpful during recovery following an injury or as a temporary measure for managing chronic knee conditions.
3. Weight management: Maintaining a healthy weight is crucial for knee health, particularly in cases of osteoarthritis. Excess body weight stresses the knee joints, worsening symptoms, and progression. Weight loss through a balanced diet and regular exercise can significantly reduce knee pain and improve overall joint function.
4. Heat and cold therapy: Applying heat or cold to the affected knee can help alleviate pain and reduce inflammation. Heat therapy, such as a warm compress or shower, promotes blood circulation and relaxes muscles. Cold therapy, with ice packs or cold compresses, helps numb the area and reduce swelling.
5. Injections: Besides hyaluronic acid injections mentioned earlier, other injections may be used to manage knee conditions. Platelet-rich plasma (PRP) injections involve using a concentrated solution of the patient's blood platelets, which contain growth factors that may promote healing and reduce inflammation. Stem cell injections use cells from the patient’s body or a donor and are being explored as a potential treatment option for knee injuries and degenerative conditions.
6. Assistive devices and modifications: Modifying the living environment and using assistive devices can help individuals with knee conditions maintain independence and reduce knee strain. These modifications may include installing handrails or grab bars, using elevated toilet seats or shower chairs, and using ergonomic furniture that supports proper posture and reduces knee stress.
7. Complementary and alternative therapies: Some individuals find relief from knee conditions through complementary and alternative therapies. These may include acupuncture, chiropractic care, massage therapy, and herbal supplements. While the effectiveness of these therapies varies, they can provide symptomatic relief and contribute to overall well-being.

It's important to note that the suitability of these non-surgical treatment options depends on the specific knee condition or injury and should be discussed with a healthcare professional. A comprehensive evaluation by a healthcare provider can help determine the most appropriate non-surgical approach to manage knee symptoms and improve quality of life.

Total knee replacement surgery is valuable for individuals with severe knee conditions or injuries that have not responded to non-surgical treatments. However, trying conservative measures such as physical therapy before considering surgery is crucial. Consulting with a qualified healthcare professional, such as an orthopedic surgeon or physical therapist, can help determine the best course of action based on your circumstances. Remember, every treatment decision should be made on a case-by-case basis, weighing the benefits and risks of the procedure and your needs. At EW Motion Therapy, we prioritize open communication with your primary provider to ensure collaboration when deciding the next steps in treatment. If you are curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently-asked physical therapy questions.