Being forced to wait for knee replacement. Treatment options to help avoid the knee surgery

Ross Hauser, MD, Caring Medical Florida
David N. Woznica, MD, Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Danielle R. Steilen-Matias, MMS, PA-C, Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

Being forced to wait for knee replacement. Treatment options to help avoid the knee surgery

This article gives options for patients in pain who have been told that their knee replacement cannot be performed for them at this time.

You probably do not need to be told what researchers have confirmed: Patients who are waiting months until their doctor can be available for the surgery, suffer from severe and accelerated knee instability, difficulty walking, and pain. Perhaps like yourself, most of these patients rely on painkillers and cortisone to get them through until surgery. Perhaps like yourself, these people as they become more disabled, take excessive medication to possibly include anti-depressants to help deal with the depression and isolation that comes with battling chronic pain.

However, this does not have to be the fate of all patients who were told they they need to wait to get a knee/joint replacement. In many cases, the ideal intervention is actually not surgery but regenerative options that can repair the joint non-surgically.

Waiting for knee replacement – the burden excessive wait times had on patients

In one study, doctors from Laval University in Quebec wrote in the medical journal Rheumatology (1) about 153 patients who had been given a date far in advance for their total knee replacement. What the doctors wanted to study were the patient’s changes in pain, function, and quality of life and the possible burden excessive wait times had on these patients.

Here is what they published:

Overall, subjects suffered a significant deterioration of their condition while waiting, in terms of knee pain, contralateral knee pain, functional limitations, and quality of life.

The problem is compounded because one of the factors that will give a patient pain after knee replacement, is the poor management of their pain before the surgery.

Patient education – the longer you wait for knee replacement the less likely you will want it.

Researchers from four universities including the University of Ottawa, the University of Montreal, the University of Toronto, and the University of Chicago, published research in the medical journal Osteoarthritis and Cartilage. In this study, the researchers say more patients, when given educational aids and time to think about the benefits and side effects and complications of knee replacement, opted out of getting the knee replacement (compared to a control group). 

The evidence for Prolotherapy Injections for knee osteoarthritis

The knee is the most common joint treated with Prolotherapy at Caring Medical. We use a comprehensive Prolotherapy injection approach that stimulates the natural repair of connective tissue. This is a today treatment for knee osteoarthritis and a possible alternative to knee replacement surgery.

In this video, Ross Hauser, MD explains a Prolotherapy knee treatment as performed at our Caring Medical clinics. This is not typical of the way treatment may be performed in other doctor’s offices.

Video learning and demonstrated points:

  • Prolotherapy is an injection technique that stimulates growth factor cells that work to repair damaged joints.
  • Prolotherapy can be very helpful in patients with knee instability or hypermobility caused by damaged knee ligaments and tendons. Knee instability is a cause of knee osteoarthritis and degenerative wear and tear.
  • In this video, Ross Hauser, MD is seen demonstrating intra-articular (inside the knee) as well as injections surrounding the outside of the knee.
  • In addition to knee osteoarthritis, Prolotherapy injections can help patients with problems that will eventually lead to degenerative knee disease.
    • Patellofemoral pain syndrome and patellofemoral tracking problems.
    • Weakened and damaged ligaments and tendons and their attachments to the bones and muscles that make the knee work.
  • In the video you see that Dr. Hauser is injecting into the
    • The Knee’s medial joint line here where the medial collateral ligament is.
    • The pes anserine tendon
    • The medial patellar retinaculum tendon
    • The distal quadriceps attachments
    • The lateral joint line where the lateral collateral ligament is located.
    • The attachment of the iliotibial band
    • The capsular knee ligament attachments


In this video Ross Hauser, MD demonstrates an ultrasound examination of a patient’s knee with COMPLETE LOSS OF ARTICULAR CARTILAGE

  • At 1:14 the patient’s knee instability caused COMPLETE LOSS OF ARTICULAR CARTILAGE
  • In this patient we would recommend Prolotherapy to the ligaments and stem cell treatment into the joint. Prolotherapy to address the knee instability and stem cell treatments to address the cartilage issue.
  • We rarely offer stem cell treatments. In this case, the complete loss of cartilage in the knee calls for it.

Research: Prolotherapy treatments for patients with knee osteoarthritis showed significant improvement in scores for pain, function, and range of motion

Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you is presented here and intermingled with out own 27+ years of empirical observation of patient benefit.

  • In research from June 2017, doctors publishing in the British Medical Bulletin (2reviewed and evaluated Prolotherapy findings and determined Prolotherapy treatments for patients with knee osteoarthritis showed significant improvement in scores for pain, function, and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%).

  • Researchers found that  Prolotherapy treatments in female patients with knee osteoarthritis resulted in significant improvement in pain, function, and range-of-motion scores.(3)
    • In this study they took 24 female patients with an average age of 58 (the youngest being 46 the oldest 70) and gave them three monthly Prolotherapy injections.
    • At the end of week 24 of the study, knee range of motion increased, pain severity in rest and activity decreased. Improvements of all parameters were considerable until week 8, and were maintained throughout the study period.

  • In June 2017 research, (4) doctors from the University of Wisconsin School of Medicine and Public Health write: Systematic review, including meta-analysis, and randomized controlled trials suggest that Prolotherapy may be associated with symptom improvement in mild to moderate symptomatic knee osteoarthritis and Prolotherapy was effective in overuse tendinopathy.

  • Doctors from the University of Wisconsin (5) continued on their research into Prolotherapy. They found Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants and continued as such at follow up an average of 2.5 years after initial treatment, this study from 2015.
    • This followed up on an earlier study which appeared in the Archives of physical medicine and rehabilitation (6and suggested “Prolotherapy resulted in safe, substantial improvement in knee osteoarthritis-specific Quality of Life compared with control over 52 weeks. Among prolotherapy participants, but not controls, magnetic resonance imaging-assessed intra-articular cartilage volume change (intra-articular cartilage volume stability) predicted pain severity score change, suggesting that prolotherapy may have a pain-specific disease-modifying effect.”

  • In Caring Medical research appearing in the Journal of Prolotherapy,  Dr. Hauser was able to document articular cartilage regeneration.(7)
  • In April 2016, A multinational team representing university researchers in Argentina and Dr. Dean Reeves from the University of Kansas Medical Center, Dr. J Johnson Michigan State University and Dr Rabago from the University of Wisconsin, School of Medicine and Public Health researchers confirmed that Prolotherapy could regrow articular cartilage in the knee in a study of patients with an average age of 71 seventy-one.(8

  • A study, published in the journal Scientific reports (9) found that three to five sessions of Prolotherapy knee injections have a statistically significant and clinically relevant effect in the improvement of WOMAC composite score, (a scoring system of pain, function, and stiffness) at 12 to 16 weeks compared to formal at-home exercise. The benefits of the treatment were sustained up to 1 year.
  • In another study led by University of Wisconsin School of Medicine and Public Health researchers, patients reported substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living.(10)

If you have a question about knee replacement options we can help you

References:

1. Desmeules F. The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery. Rheumatology (2010) 49 (5): 945-954. [Google Scholar]
2 Hassan F, Trebinjac S, Murrell WD, Maffulli N. The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review. Br Med Bull. 2017 Mar 4:1-18. [Google Scholar]
3 Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015 Apr;7(2):35-44. [Google Scholar]
4  Rabago D, Nourani B. Prolotherapy for Osteoarthritis and Tendinopathy: a Descriptive Review. 2017 Jun;19(6):34. doi: 10.1007/s11926-017-0659-3.  [Google Scholar]
5 Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complementary therapies in medicine. 2015 Jun 1;23(3):388-95. [Google Scholar]
6 Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L. Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Archives of physical medicine and rehabilitation. 2013 Nov 30;94(11):2075-82.  [Google Scholar]
7 Hauser R. The regeneration of articular cartilage with prolotherapy. Journal of Prolotherapy. 2009;1(1):39-44.  [Google Scholar]
8 Topol GA, Podesta LA, Reeves KD, Giraldo MM, Johnson LL, Grasso R, Jamín A, Clark T, Rabago D. Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis. PM R. 2016 Apr 4. pii:S1934-1482(16)30054-5.  [Google Scholar]
9 Sit RW, Chung VCh, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis. Sci Rep. 2016 May 5;6:25247  [Google Scholar]
10 Rabago D, van Leuven L, Benes L, Fortney L, Slattengren A, Grettie J, Mundt M. Qualitative Assessment of Patients Receiving Prolotherapy for Knee Osteoarthritis in a Multimethod Study. Journal of alternative and complementary medicine (New York, NY). 2016 Dec;22(12):983.  [Google Scholar]

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