Knee Replacements
Recently I discovered a report published by Move ― the national consumer-based organisation for muscle, bone and joint health ― estimating that as many as one in four knee or hip replacements are not required for people with osteoarthritis.
In 2016, almost 100,000 Australians received joint replacements to treat osteoarthritis of the hip or knee at an estimated cost of more than $2 billion. This means that thousands of Australians underwent unnecessary operations at enormous expense.
The chief executive of Move, Rob Anderson claimed that “People with osteoarthritis often lack clear, evidence-based information and have to find their own way through a health service system which currently lacks integration,”
Dr Linda Swan, chief medical officer at Medibank suggested “There is a growing number of people having joint replacement surgery in Australia and that number is growing faster than many other places in the world,”
She stated “When you look at the evidence, it suggests there are people who are having surgery that might not need it. This report is a call to action around the fact that there is a need for greater awareness among Australians that surgery is not the only, or necessarily best, treatment for osteoarthritis.”
Peter Choong, director of orthopaedic surgery at Melbourne’s St Vincent’s Hospital, which co-funded the report, said: “People need to understand there can be much better ways to treat osteoarthritis, and surgery should be a last resort
Alarmingly in Victoria there was a 175 per cent increase in hip replacements and a 285 per cent increase in knee replacements between 1994 and 2014.
Why the Higher Numbers?
These numbers are staggering, and they have to make you wonder: Why is this such a growing problem? Degeneration of the knees is not a new phenomenon to our society? I think the rate has been accelerated by the obesity epidemic in this country, recent advancements in surgery and for years now our children (the fastest growing demographic for ACL injuries and later chronic knee arthritis) and young adults have had an increase in screen time and less time active playing.
Many of our knee problems are a result of chronic degeneration. I have seen this with patients as well as family members―years of subtle biomechanical dysfunction leading to gradual degradation of the joint, followed by stiffness, swelling, and eventually debilitating pain. A lot of people responded favourably to the new hardware. My own father is a prime example. But that does not make me a big advocate of knee replacement surgery. I am more of an advocate of common sense and conservative management, even going so far as to say that I am a “preventionist.” I am genuinely happy that there exists a technology for replacing damaged and degenerated joints―but I think there is so much more we can do before an operation is required.
Preventing Asymmetrical Stress Problems.
To understand the basic principles of prevention, think back to when you were 6 years old, and remember the old “Dem Bones” song. The ankle bone is connected to the knee bone! It’s simple and a little silly, but truer words have never been spoken. The foot and ankle influence movement and function throughout the entire skeletal structure. If there are subtle differences in function and flexibility from one foot to the other, those differences are translated superiorly through the knees into the hips, pelvis, and spine.
The most common influential factor of the feet is bilateral, asymmetrical excessive pronation. The dropping of the navicular bone in the foot and internal rotation of the foot/ankle complex slightly twists the knee―because the ankle bone is connected to the knee bone!
The slight internal rotation of the tibia means that the tibia and femur bones of the knee now have a new abnormal relationship and loading. In jargon increased Q angle. An increased Q angle has been associated with increased incidence of all knee injuries/strains including ACL injuries, and strains that occur in sport.
However let’s assume you don’t do anything very athletic that predisposes you to the running and jumping forces associated with a typical ACL tear or traumatic knee injury. What happens then? The difference is speed of injury. You end up with the slow accumulation of micro trauma as opposed to the sudden onset of macro trauma. Asymmetrical stress to the all the structures of the knee eventually lead to damage and arthritis. Arthritis is a function of abnormal loading not purely a function of age! Otherwise everyone the same age would have the same degeneration and each of the knees in your own body would degenerate at the same rate. Incidentally it is one of the main reasons prospective soldier with flat feet were denied enlistment, the micro trauma would result in them “breaking down”
So many people (in my experience >70%) have “flat feet” which then contributes to degenerative changes in the knees, hips, pelvis, and spine.
For me, the most basic form of prevention comes from custom-made functional orthotics to create the biomechanical symmetry in the feet that are transferred up the Kinetic Chain. Creating a symmetrical foundation at the feet with functional orthotics allows the joints above the feet to function more symmetrically. This reduces the effect of unequal forces and angulations on the cartilaginous structures and enhances the neuromuscular response to proprioceptive input.
When the harmful bio mechanical stresses are managed efficiently, the result is a reduction in micro trauma. This means that there is less inflammation, scar tissue, and joint space degradation.
Once the foundation is right, foot adjustments to ensure proper joint movement and strengthening exercises can achieve amazing results even in severely degenerated joints. Joints are supposed to move!! Motion really is lotion! I think it is my obligation to point out wellness strategies and alternatives. I know that I can’t be the only one out there who doesn’t want to participate in the latest joint replacement technology.
So how effective really is conservative care?
Some people suffer knee pain so acutely, they’re ready to jump on the surgical table for a total knee replacement. While this option can work, conservative care may be just as effective at relief–plus less costly, less dangerous, and requiring little to no “down time.”
That’s what a recent study covered in Reuters Health found: that “while 85 percent of patients who underwent surgery showed clinically-significant improvement after one year, so did 67 percent assigned to a combination of supervised exercise, use of insoles, pain medication, education and dietary advice.” In our clinic we get wonderful results and I have "saved" a number of grateful patients from surgery
Risks of knee surgery
You need to understand and respect that knee replacement is not without complication. Dr. Andrew Pollak, chairman of orthopaedics at the University Of Maryland School Of Medicine in Baltimore stated. “Knee replacement is a big surgical procedure and there are risks associated with it.” One percent of patients die within 90 days of their procedure, and about 1 in 5 have residual pain at least six months after the fact. In my clinical experience many are also disappointed with the lack of movement they are left with.
Many knee problems are relatively easy to fix conservatively.
This is true but of course it depends on the nature of the problem. Best of all is prevention. If you would like an expert assessment, diagnoses and effective treatment and management strategies. Give us a call at Goolwa Chiropractic. We will do our best to help.