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Caring Medical &
Rehabilitation Services

Chicagoland office
715 Lake Street, Suite 600
Oak Park, IL 60301

Southwest Florida office
9738 Commerce
Center Court
Fort Myers, FL 33908

708.393.8266 Phone
855.779.1950 Fax

Knee replacement failures


Ross Hauser, MD

Ross Hauser, MD talks about concerns over knee replacement complications.

Recently doctors tried to come up with a formula that would better allow them to predict who would have knee replacement and subsequent revision knee replacement surgery failure.

Who was most at risk?

        • Patients who had tibial tuberosity osteotomy (bone realignment surgery)
        • Patients with kidney faliure
        • Patients with rheumatic diseases
        • Patients who had Posterior-stabilized constrained total knee arthroplasty for complex primary cases
        • Patients who had to have the revision surgery within 5 years of the first surgery
        • Patients with septic loosening.1

Sadly, many patients experience pain after total knee replacement. The saddest part is that many are told this surgery is their only option due to the severe knee osteoarthritis, so when a total knee arthroplasty fails, hope is lost too. For women and older patients, the chances of a successful knee replacement are lower than that of men and younger patients.

In a study out of London, researchers sought to uncover various predictors of a successful (or unsuccessful) outcome in a total knee replacement2. Looking at 1,991 total knee replacement patients over a three-year period, they discovered various predictors of poor outcomes. Among the findings were that females and older people had worse functional outcomes following the replacement surgery. While women should take this information into account, any Prolotherapist would argue that all knee osteoarthritis patients should seek a second opinion from a Prolotherapist to see if they can avoid surgery and its potential adverse outcomes.

At Caring Medical and Rehabilitation Services, (CMRS), we specialize in pain cures, not pain management. As such we always research, write our own research, and explore new methodologies to curing Knee Pain. Coming up on our twentieth year in practice, we can still safely say that surgery for many defects of the knee is not the first option we would choose. Why? Because we have found and shown in research that Prolotherapy is effective for curing knee pain.

Does Knee Replacement Work? To be fair, we wanted to report on some positive outcomes and knee surgery success rates

“Arthroscopic joint debridement is a potential and sufficient treatment for knee osteoarthritis in a middle-term time interval. This procedure results in an excellent or good outcome in approximately 60 % of patients in approximately 5 years.”3 Joint debridement is a sort of “power-washing” of the joint to wash away loose tissue and other loose bodies in the joint. Sixty percent patient satisfaction is good. Unless you are in the other 40%.

Bone surgery for the knee
As the knee degenerates, it changes in shape. A popular treatment involves restoring the shape by bone surgery to alleviate pressure and pain. Osteotomy is a surgery that the researchers say, “should always be performed if possible.” When a surgeon recommends an osteotomy for the knee the goal is that they can change the shape or slope or angle of the bone to realign the knee to relieve pressure on the pain causing part of the knee by distributing your weight to a sturdier part of your knee. The hope of course is to extend the life of your real knee and delay knee replacement surgery. Surgery to avoid surgery!

Concerns are:
1) You are removing anatomy, as we like to say, if you didn’t need it, it wouldn’t be there in the first place.
2) Extended recovery time and immobility.
3) If the Osteotomy does not work, a knee replacement is next and unfortunately, total knee replacement is a much more complicated surgery with some bone missing or altered. This complication is why knee replacement is usually called for from the start.

So why always perform this surgery if possible? Because there is a chance by altering the knee that knee cartilage can regenerate! In fact it has been reported in 60% of cases following high tibial osteotomy that there has been some degree of cartilage regeneration.  (See cartilage repair).

Prolotherapy for knee pain

Comprehensive Prolotherapy injections, whether dextrose, Platelet Rich Plasma Therapy,  Stem Cell Injection Therapy  for Knee Osteoarthritis, or other growth factors is a less complicated, less risky, and less invasive procedure. As we have reported in previous articles, we have documented articular cartilage regeneration in the Journal of Prolotherapy. Here is our summation:

“Prolotherapy improved the pain and function in five knees with osteoarthritis. All five degenerated knees showed evidence of articular cartilage regeneration in their standard weight-bearing X-rays after Prolotherapy. It is suggested that before and after X-ray studies can be used to document the response of degenerated joints to Prolotherapy.”5

Prolotherapy is the only treatment found to stimulate cartilage repair and regeneration, as is shown by the X-rays. Furthermore, Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent!

 1. Luque R, Rizo B, Urda A, Garcia-Crespo R, Moro E, Marco F, López-Duran L. Predictive factors for failure after total knee replacement revision. Int Orthop. 2014 Jan 9.
2. Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE, Dieppe PA. Predictors of outcomes of total knee replacement surgery.Int Orthop. 2014 Feb;38(2):429-35. doi: 10.1007/s00264-013-2268-8. Epub 2014 Jan 9.
3. Spahn G, Hofmann GO, Klinger HM. The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012 Aug 15.
4. Spahn G, Klinger HM, Harth P, Hofmann GO. [Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study]. Z Orthop Unfall. 2012 Jun;150(3):272-9. Epub 2012 Jun 22.
5. Hauser RA, Cukla JJ. Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees After Prolotherapy. Journal of Prolotherapy. 2009;1:22-28.

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