What are the alternatives to orthopaedic joint replacement surgery?
RCA Villages | May 10 2017
Over 1.125 million orthopaedic joint replacement surgeries took place across Australia in a year, according to the latest Annual Report from the National Joint Replacement Registry.
In the short term following recovery, you’ll enjoy less pain and better mobility enhancing your quality of life. However your new prosthetic joint may only see you through a decade before you need a new one. Major surgery always carries risk. Alternatives to joint replacement surgery are available and we’ll explore some of the choices in Australia today.
As with any medical condition or consideration always consult with your medical specialist before making any decision on treatments or solutions.
What is the problem we’re facing into when it comes to knees and hips?
We’re ageing well in Australia. We’re fitter than we’ve ever been before. If you run marathons, trek mountain peaks or participate in long distance cycling races, you may well be competing alongside youthful seventy plus year olds.
Repetitive physical activities such as running add wear and tear to our joints. The more physical you are, the healthier you may be overall but the higher the risk of joint injury. Strength conditioning can definitely help support your joints but some of us have more fickle joints than others.
Osteo-arthritis is a degenerative joint condition that affects more than 1.6 million Australians. It can cause mild to debilitating pain due to joint cartilage wearing down as a result of wear and tear, and age. Osteo-arthritis is managed through exercise, nutrition and pain management through anti-inflammatories. There is a lot of debate about the effectiveness and appropriateness of joint replacement surgery when osteo-arthritis is found to be the cause of joint pain.
As a nation, those 1.125 million joint replacement surgeries that took place in 2015 are on the increase year on year. As we age as a population, so do our collective knees and hips.
According to the Australian Society of Orthopaedic Surgeons one of the most common reasons for hospitalisation was knee disorders. For emergency admissions, one of the top five common reasons for hospitalisation involving surgery was a hip fracture. Their statistics have shown that 55 to 64 years is the most common age for hospital procedures involving musculoskeletal surgery.
The problem with replacing your knee or hip with a prosthetic, either fully or partially, is that you will need to do it all again within 10 years, 15 if you’re lucky. According to asos.org.au a recipient of a joint replacement faces a 5% chance of revision within a decade. As procedures and prosthetics improve, the rate of ‘redo’ or revision surgery has declined since 2004. That’s good news, but not enough.
From my personal experience, I have known people that will choose to persevere with debilitating pain and restricted mobility for longer, knowing that a joint replacement is a temporary solution and that they’re better to hold off. They may ramp up pain medications to cope and wear the associated side effects, and on it goes. That is not living a quality life.
What are the alternative solutions to a hip or knee replacement?
Progressive joint diseases, degeneration and conditions can be debilitating. For that reason, getting rid of your old one and replacing it with a new one makes sense, particularly when you’re experiencing chronic pain daily. A joint replacement means choosing to undergo major surgery with all its risks. Most people that have had joint replacement surgery would deem their new prosthetic hip or knee a blessing.
If your knee or hip joint damage isn’t dire but is starting to call for a solution, here are some joint replacement alternatives to consider exploring with your medical specialist.
Taking pressure off your hips, and particularly your knees, can be achieved by bringing your weight within a healthy range. If you’re currently sitting above a healthy weight range, consider speaking to a health or nutrition specialist. Work with your specialist to agree the changes you need to make to your diet and daily activities to achieve a healthy weight, and reduce pressure on your joints.
Physiotherapy and targeted strength conditioning
A physiotherapy assessment can help determine if your hip or knee discomfort or pain is being brought about by other bio-mechanic, nerve or muscular dysfunction. Even the type of shoes you wear can throw out how everything aligns. Hip or knee pain doesn’t always originate from the hip or knee.
A targeted physiotherapy program can help with mild to moderate knee injury and help you return to full movement. A strength conditioning program to improve muscle strength to help support your joints can be successful in slowing down further degradation. It can also provide support around the joint that will in turn help to better distribute pressure.
An arthroscope is a thin, optic-fibre telescope instrument that a surgeon can use to evaluate, and then treat knee related damage with minimal surgical intervention. Arthroscopy for treatment is only suitable if the damage isn’t extensive. The type of conditions that can be treated via arthroscopy include torn cartilage; removal of bone or cartilage fragments or cysts; ligament reconstruction; washing out infection; and some knee-cap disorders.
While an osteotomy is an alternative to joint replacement it still involves major surgery. Wait for it. ... it is where your leg bones are cut and reset to improve alignment. As you can imagine, recovery is a major event.
Stem cell therapy
Stem cell therapy is where self-regenerating stem cells are implanted to regrow damaged cartilage or joints. Stem cells are grown into a culture from your own adipose (fat) body tissue. The culture is screened and then prepared as a concentrated sample of stem cells ready to be injected directly into the problem joint. Stem cell therapy is thought to help slow down the progression of arthritis. The results appear to vary from patient to patient.
Hip resurfacing surgery
Hip resurfacing surgery is more conservative and less traumatic than a total hip replacement. It is a resurfacing of the femoral head with a smooth metal coating, rather than a prosthetic replacement. The hip socket is removed and replaced with a metal shell. Because it is then a metal on metal articulation it is said to be longer lasting than a hip replacement, with revision surgery less likely. Resurfacing won’t be a suitable solution for everyone and your medical specialist will need to assess your eligibility.
Taking medications such as anti-inflammatories combined with paracetamol may help give pain relief. While medications can help reduce inflammation and pain, over the longer term damage to your liver and kidneys is likely as your body works hard to metabolise the pharmaceuticals.
Australian Orthopaedic Association’s National Joint Replacement Registry Annual Report 2016
Australian Society of Orthopaedic Surgeons > News & Media > Orthopaedic joint replacement surgery rates jump in developed nation as populations age
(image: Tai Chi class at Beleura Village Mornington/RCA Villages)