Last updated: 11/24/2009

Nonsurgical alternatives

MEDICATION. The most common conservative alternatives to knee replacement surgery are analgesics, or painkilling medications. Most patients who try medication for knee pain...

begin with an over-the-counter NSAID such as ibuprofen (Advil). If the pain cannot be controlled by nonprescription analgesics, the doctor may give the patient cortisone injections, which relieve the pain of arthritis by reducing inflammation. Unfortunately, the relief provided by cortisone tends to diminish with each injection; moreover, the drug can produce serious side effects.

If the knee pain is caused by rheumatoid arthritis, a group of medications known as disease-modifying antirheumatic drugs, or DMARDs, may help to slow or stop the progress of the disease. They work by suppressing or interfering with the immune system. DMARDs include such drugs as penicillamine, methotrexate, oral or injectable gold, hydroxychloroquine, leflunomide, and sulfasalazine. DMARDs are not suitable for all patients with RA, however, as they sometimes have serious side effects. In addition, some of them are slow-acting and may take several months to work before the patient feels some relief.

LIFESTYLE CHANGES. A second alternative to knee surgery is lifestyle changes. Losing weight helps to reduce stress on the knee joint. Giving up specific sports or other activities that damage the knee, such as jogging, tennis, high-impact aerobics, or stair-climbing exercise machines, may control the pain enough to make surgery unnecessary. Wearing properly fitted shoes and avoiding high heels and other extreme styles can also help to control pain and minimize further damage to the knee.

BRACES AND ORTHOTICS. Some patients with unstable knees are helped by functional braces or knee supports that are designed to keep the kneecap from slipping out of place. Orthotics, which are inserts placed inside shoes, are often helpful to patients whose knee problems are related to their gait. Orthotics are designed either to correct the position of the foot in order to keep it from turning too far outward or inward, or to correct problems in the arch of the foot. Some orthotics are made of soft material that cushions the foot and are particularly helpful for patients with osteoarthritis or diabetes.

Complementary and alternative (CAM) approaches

Complementary and alternative therapies are not substitutes for arthroscopy or joint replacement surgery, but some have been shown to relieve physical pain before or after surgery, or to help patients cope more effectively with the emotional and psychological stress of a major operation. Acupuncture, chiropractic, hypnosis, and mindfulness meditation have been used successfully to relieve the pain of osteoarthritis as well as postoperative discomfort. According to Dr. Marc Darrow, author of The Knee Sourcebook, a plant extract called RA-1, which is used in Ayurvedic medicine to treat arthritis, relieved pain and leg swelling in patients participating in a randomized trial. Alternative approaches that have helped patients maintain a positive mental attitude include meditation, biofeedback, and various relaxation techniques.

Alternative surgical procedures

Arthroscopy is the most common surgical alternative to knee replacement. It should be understood, however, as a way to postpone TKR rather than avoid it completely. The arthroscopic procedure most often used to treat knee pain from osteoarthritis is debridement, in which the surgeon cuts or scrapes away damaged structures or tissues until healthy tissue is reached. Most patients who have had arthroscopic débridement have been able to postpone TKR for three to five years.

Cartilage transplantation is a procedure in which small bone plugs with cartilage are removed from a part of the patient's knee where the cartilage is still healthy and transplanted to the area in which cartilage has been damaged. Another form of cartilage transplantation involves two operations, one to remove cartilage cells from the patient's knee for culture in a laboratory, and a second operation to place the new cells within the damaged part of the knee. The cultured cells are covered with a thin layer of tissue to hold them in place. After surgery, the cartilage cells multiply to form new cartilage inside the knee. Unfortunately, as of 2003 neither form of cartilage transplantation is usually beneficial to patients with osteoarthritis; transplantation has been most successful in treating patients whose knee cartilage was damaged by sudden trauma rather than by gradual degeneration.