CAS - Knee Replacement

Before deciding on knee surgery, Dr. Bowers may try several knee surgery alternatives to relieve the pain and inflammation in your knee.

Lifestyle modification
The first alternative to knee surgery is lifestyle modification. This may include weight loss, avoiding activities such as running and twisting which can aggravate the knee injury, modifying exercise to no- and low-impact, and other changes in your daily routine to reduce stress on your knee.

Exercise and physical therapy
Exercise and physical therapy may be prescribed to improve the strength and flexibility of your hip and other lower extremity muscles. Your exercise program may include riding a stationary bike, light weight training and flexibility exercises. An aquatic therapy program is especially effective for the treatment of arthritis since it allows mild resistance while removing weight bearing stresses.

Anti-inflammatory medications
Arthritis pain is caused by inflammation in the knee as the bones rub against each other due to eroded cartilage. Reducing the inflammation of the tissue in the knee can provide temporary relief from pain and delay knee surgery.

Anti-inflammatory medications may be prescribed to decrease swelling in the joint. These medications may be used to reduce inflammation, reducing pain temporarily. A corticosteroid injection may also be used to reduce pain; in this procedure a powerful anti-inflammatory agent is injected directly into the joint.

Glucosamine/Chondroitin
A dietary supplement called glucosamine/chondroitin may improve the joint's mobility and decrease pain from arthritis of the knee. Glucosamine and chondroitin sulfate can slow the deterioration of cartilage in the joint, reducing the pain of bone on bone. Both are naturally occurring molecules in the body. Glucosamine is thought to promote the growth of new cartilage and repair of damaged cartilage, while chondroitin is believed to promote water retention, improving the elasticity of cartilage, and also to inhibit cartilage-destroying enzymes.

Joint Fluid Therapy
While medications and supplements can be helpful in reducing inflammation and pain and help you delay or avoid knee surgery, there are trade-offs. Drug therapies may have side effects, and there is a limit to how much pain reduction can occur.

In a procedure called joint fluid therapy, a series of injections is made directly into the knee joints. This therapy is designed to reduce pain by improving lubrication in the knee, replacing the synovial fluid that lubricates the knee. Hyaluronate is used for the treatment of osteoarthritis knee pain in patients who have failed to get adequate relief from simple painkillers or from exercise and physical therapy.

A solution made of highly purified, sodium hyaluronate (trade name SUPARTZ*) is used in this procedure. SUPARTZ is made from a natural chemical found in the body and is found in particularly high amounts in joint tissues and in the fluid (synovial fluid) that fills the joints.

The body's own hyaluronan acts like a lubricant and shock absorber in synovial fluid of a healthy joint. Osteoarthritis reduces your synovial fluid's ability to protect and lubricate your joint.

A physician administers an injection of SUPARTZ solution into your knee once a week for 5 weeks (a total of 5 injections). This helps to re-lubricate your knee and reduce the pain of osteoarthritis, possibly delaying or helping you avoid knee surgery.

Bracing
A brace may be used to provide external stability to the knee joint. Braces are devices made of plastic, metal, leather and/or foam and are designed to stabilize a joint, reduce pain and inflammation and strengthen the muscles of the knee. By putting pressure on the sides of the joint, the brace causes the joint to realign, which in turn decreases the contact between the two rough bone surfaces and reduces the pain while increasing mobility.

As you can see, there are several non-surgical options for treating osteoarthritis. These methods can delay knee surgery by providing short-term relief. However, any drug therapy program is likely to have side effects which should be taken into consideration. Non-surgical procedures may also have limited results compared to the long-term results of knee surgery.

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3/24/2007

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