Many of you are searching for knee replacement alternatives. Your knee pain from arthritis is starting to interfere with your quality of life. You have searched Google, you have spoken to friends. You have heard about gel injections, stem cells, platelet rich plasma (PRP) injections as well as various supplements which promise you a painless life despite arthritis in your knee.
Your physician may have recommended a knee replacement — but you’ve heard scary things about them and you are actively seeking an alternative to a knee replacement, and one that has the potential of giving you many years of pain relief.
All the knee replacement alternatives listed above share one thing in common. They do NOT possess the ability to alter the natural history of your arthritis. That means that they will not slow the progression of your arthritis. They might make you feel better temporarily, but that should be your only expectation.
Osteoarthritis, by definition, is a disease which worsens with the passage of time… period.
For many of you, the osteoarthritis is only in one “compartment” or one side of your knee. It may be on the medial or the inner side, or it may be on the lateral of the outer side of your knee. Osteoarthritis usually begins in only one compartment.
As arthritis in that single compartment begins to progress your leg may become bowed — or you may have been born with bowed legs. When the leg bows outward it places a lot of stress on the cartilage on the inside of the knee. That stress will cause an overload of the cartilage and arthritis on that side of the knee will worsen. That will cause further loss of cartilage, and the bowing outward will worsen as well. It becomes a viscous cycle.
Knee Replacement Alternative:
High Tibial Osteotomy
One knee replacement alternative that has stood the test of time and has been improved upon over the last 20 years is a procedure we call a high tibial osteotomy. What that basically means is that we partially cut the tibia near the knee and we move the knee into a normal position. This eliminates the bowing — and this also takes the pressure off, or significantly decreases the pressure on the inner side of the knee where your arthritis is. Less pressure should equal less pain.
As opposed to the alternatives we mentioned previously, a high tibial osteotomy can delay the progression of arthritis. It will not eliminate arthritis, but in the right person, you will have another 7-10 years or more with your knee.
A tibial osteotomy has been a good alternative to a knee replacement for over 20 years. It is more appropriate to consider in young, active patients, and in people with arthritis limited to one side of the knee.
If you have arthritis on one side of the knee and are looking for an alternative to a knee replacement, talk to your doctor about the option of a high tibial osteotomy.
James
Hi Doctor Luks,
Is it possible to have a high tibial osteotomy 1st and after 8_10 years or so have a partial knee replacement? Is there some reason why its not possible to have a partial knee on the same side after a high tibial osteotomy? Does a high tibial osteotomy involve cutting some tendons and ligaments in the knee that compromise a partial knee?
How long does a partial knee last?
Cheers
James
Mary Turner
Hi Dr. Luks,
Thank you very much for your response. It is greatly appreciated. I live in Hudson Falls, NY which is 30 minutes north of Saratoga Springs, NY. If I lived closer I would book an appointment to see you.
My insurance is MVP but I could not find a list of accepted insurances on your site. If you accept MVP and I sent my most recent xray and copy of my menisectomy surgery findings can it be done via the phone or is being seen in the office the only way it works for the insurance?
I am leaning towards the HTO because I want to be realigned to help slow down the arthritis. I was told the arthritis prbly started as the result of an injury and the bowleggedness did not help. My pediatrician years ago never mentioned having it corrected or that it could lead to arthrits. Now, 1/2 my meniscus in the medial area is gone. It could not be repaired. I was not told the osteotomy could cause me to be unhappy with the appearance of my leg. I am definitely for quality of life versus the look.
I see my doctor, next Monday because I need more clarification but I would love a second opinion from you if my insurance is accepted and it can be done over the phone. Or possiby will try to figure out a day to make a trip for an office visit. I want to make sure I am doing the right thing. Pretty sure from researching that my arthritis is too severe for a meniscus transplant and it will not fix the alignment/bowleggedness problem.
Thank You Very Much For Your Response
Sincerely,
Mary Turner
Mary Turner
Hi Dr. Luks,
This is Marty Turner again. I just wanted to clarify that my arthritis is localized to the medial compartment. My lateral compartment and patella are unaffected. If ablation is able to resolve the problem and mask the pain, can an orthotic redistribute the weight as well as an osteotomy? I was told after my menisectomy I would most likely need a partial knee replacement in 5 to 7 years. But because pain since the menisectomy is limiting my activities that an osteotomy is recommended. I know that nothing is guaranteed when it comes to surgery and outcomes or even orthodics. I would value your advice.
Thank You,
Mary Turner
You’ve done your research :-)
An HTO might be an option to review with your surgeon, as would a meniscus transplant. The caveat is that women do not seem to like the appearance of their leg after the osteotomy. If you have one bowed leg and one leg pointing in the other way you will look like you have a windswept deformity. In the right patient, and for the right reasons, I have been pleased with this treatment approach — but it is not for everyone. You’ll need a few opinions on this and you need to find someone who is well versed in meniscus transplantation to see if it is even an option for you.
Mary Turner
Hi Dr. Luks,
My name is Mary Turner and I am 46 years old. In March of 2015, I began having bad pain on the inner side of my right knee. I was treated for an mcl strain and it turned out my intial MRI was mistead. After 4 months of physical therapy and complaining something was still not right a 2nd MRI read correctly that I had a meniscus tear. Menisectomy in Dec. of 2016 revealed a larger than expected tear and stage 2/3 arthritic changes in medial compartment. Since the menisectomy, my knee pain is even worse. I am slightly bowlegged. Off by 8 degrees right leg and 1 degree left. Have always been slightly bowlegged throughout my whole life. I am too young for a partial knee replacement and enjoyed a high level of activity from swimming and running to spin classes. But the pain hurts too much to even lightly jog on. Cortisone shot did not help. Recommendation is a medial opening wedge osteotomy to help delay need for a knee replacement. My physical therapist told me I might want to consider seeing a physiatrist about an orthodic versus surgery. I am so confused. My orthopedic surgeon said orthodics will not correct the problem. What is your opinion? Can an orthodic realign the leg enough to help slow down the progression of arthritis as well as an osteotomy. I am so confused. My activity level has drastically decreased as a result. It hurts and is uncomfortable even just walking around. I still swim and cycle but miss my other activities. I am single and work full time as a nanny. I have already wasted so much money on physical therapy due to being misdiagnosed. I know an osteotomy is going to require more therapy and time off of work. I know you might not be able to respond but if possible I would greatly appreciate it. Can orthotics work as well an an osteotomy? Planning to have ablation done to see if that helps the pain because will not be able to have surgery until the fall at the earliest if decided to go that route.
Sincerely,
Mary Turner
Vilma Oakley
Dear Doctor Luks,
I have this Osteoarthritis of both knees.l am in so much pain,l’ve had the injections. I need some help to weigh up my options, they say l am too young for knee replacement. I am a woman age 59 and very active. Could your procedure be an option for me?
Look forward to your reply.
without seeing you, examining you and your xrays I can’t say… sorry
Oleeta Igar
Hello Dr. Luks,
I have been reading your articles about Osteoarthritis in the knees with great interest. I recently had an MRI of my right knee and it shows Tri-compartmental Osteoarthritis. It uses words like effusion and bone marrow edema (I read about that it one of your articles too -thank you!) and I have a small Baker’s Cyst. My Doctor thinks the only real relief I will get at this point is doing a knee replacement. I have a referral in process to see an Orthopedic Dr. who did Meniscus surgery on the same knee in 2005. Would the high tibial osteotomy.be an option to discuss with him? How much worse is full knee replacement compared to Meniscus surgery and what is the recovery time usually?
Thanks so much for your articles. They speak in plain language and shows a great understanding of what the average patient experiences.
Oleeta