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THE KNEE INSTITUTE: SPECIALISING IN TREATING THE OSTEOARTHRITIC KNEE

 

SUMMARY – THE FACTS

  • Average life expectancy is about 85 years and increasing.
  • There is no cure for your knee osteoarthritis, and it will worsen.
  • Eventually you will need a Total Knee Replacement (TKR) with a metal and plastic prosthesis.
  • TKR is often effective when assessed by surgical technique measures (Xray appearance, implant survival, surgeon assessment), however 10-34% of patients experience long term pain and immobility. (1)
  • Ehe prosthesis will eventually wear out. It may last a maximum of 20 years before needing a revision (replacement of the initial (primary) knee replacement prosthesis).
  • TKR revisions are difficult to perform and wear out faster than the initial TKR. Each revision provides less improvement in pain relief, energy levels, sleep quality and physical mobility than the preceding arthroplasty. (2)
  • Hence it is best to avoid the need for primary and revision TKRs. This requires minimising the rate of progression of knee osteoarthritis before you reach the point of needing a TKR.
  • The best way to do this, is to optimise your body composition (minimise fat content) and maximise leg strength and knee stability, to control the forces on the knee joint and to optimise joint health. (3)
  • This is best achieved via a calorie-restricted, anti-inflammatory diet and a structured, continuous physiotherapy program using proven mechanical and electrical aids.
  • 80% of people who present for elective joint replacement have not had any, or adequate, conservative management (weight loss, exercise, etc). (4, 5)
  • 70% of people who present for elective joint replacement are overweight or obese. (6, 7)

The Knee Institute’s Knee Osteoarthritis program:

  • Optimises knee health to minimise knee osteoarthritis progression and defer the initial TKR (and hence revisions).
  • Improves body and knee health, so that should you need a TKR, you are in better health for the best outcome from this major surgical procedure.

The Knee Institute’s Knee Osteoarthritis program components have proven clinical results in their ability to decrease pain, increase function and defer TKR (8, 9, 10, 11, 12). The program enables you to reduce your knee pain, preserve your mobility and independence, and minimise the number of knee operations you will require.

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DETAILS

Osteoarthritis of the knee is a common problem in Australia and around the world. There are many causes of osteoarthritis and there is no cure once the disease has started. However the rate of disease progression can be slowed by many factors. The more factors that are addressed, then the slower the rate of disease progression. In addition, with correct treatment, the symptoms of pain, stiffness, swelling and weakness can be minimised.

The best treatment for osteoarthritis of the knee is to decrease mechanical and chemical wear of the knee cartilage and surrounding tissues. This is achieved by strengthening the muscles around the knee, losing any extra body fat, and minimising inflammation in the knee joint and the body. This will slow down the progression of the osteoarthritis.

Severe osteoarthritis that impairs function and causes uncontrollable pain, can only be treated with a total knee replacement or arthroplasty.

TKRs are successful at increasing surgical technique assessment measures. However, once you have rehabilitated from this major surgery:

  • 10-34% of patients will still have pain and immobility.
  • 10% of patients will need a replacement (called a revision) within 10 years.
  • The remaining 90% of replacements will loosen or wear out after 10-20 years, also requiring a revision.
  • Each revision provides less improvement in pain relief, energy levels, sleep quality, physical mobility than the preceding arthroplasty. (2)

Due to the immediate surgical, and long-term residual pain and immobility risks of a primary TKR, and the relatively low success rate of a revision TKR, it is best to delay the need for the first TKR as late as possible. This means you should delay the progression of knee osteoarthritis as much as possible, so that your first TKR and subsequent revisions are deferred and ideally prevented.

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(1) Beswick AD, Wylde V, et al. “What proportion of  patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients”. BMJ Open 2012;2:e000435 doi:10.1136/bmjopen-2011-000435
(2) Deehan DJ, Murray JD. “Quality of life after knee revision arthroplasty”. Acta Orthopaedica 2006;77 (5):761-766.
(3) Roddy E, Zhang W. et al. “Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review.” Annals of the Rheumatic Diseases 2005 Apr;64(4):544-548.
(4) Jordan KM, Sawyer S, et al. “The use of conventional and complementary treatments for knee osteoarthritis in the community.” Rheumatology 2004;Vol. 43:381-384
(5) J Rheumatology 2007;Vol. 34:2291-300
(6) Archives of Internal Medicine 2004;Vol 164:807
(7) Messier SP, Gutekunst DJ, et al. “Weight Loss reduces Knee Joint Loads in Overweight and Obese Older Adults with Knee Osteoarthritis.” Arthritis & Rheumatism 2005;Vol 52:2026-2032
(8) Felson DT, Zhang Y et al. “Weight loss reduces the risk of symptomatic knee osteoarthritis in women: The Framingham Study”. Ann Int Med 1992;116:535-539.
(9) Messier SP, Loeser RF et al. “Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet and Activity Promotion Trial.” Arthritis Rheum 2004;50:1501-1510.
(10) Roddy E, Zhang W. et al. “Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee – the MOVE consensus.” Rheumatology 2005 Jan;44(1):67-73.
(11) Zizic TM, Hoffman KC, et al. “Treatment of Osteoarthritis of the Knee with Pulsed Electrical Stimulation”. Journal of Rheumatology 1995;Vol 22 Issue 9:1757-1761.
(12) Mont M, Hungerford D, et al. “Pulsed Electrical Stimulation to Defer TKA in Patients with Knee Osteoarthritis.” Orthopedics October 2006