Last updated: 11/24/2009

Nonsurgical alternatives

LIFESTYLE CHANGES. The American Association of Orthopaedic Surgeons (AAOS) has published a fact sheet about the effects of aging on the knee joint aimed at the baby boomer generation....

Many adults in their 40s and 50s have been influenced by the contemporary emphasis on youthfulness to keep up athletic activities and forms of exercise that are hard on the knee joint. Some of them try to return to a high level of activity even after TKR. As a result, some surgeons are suggesting that adults in this age bracket scale back their athletic workouts or substitute low-impact forms of exercise. Good choices include water aerobics, tai chi, yoga, swimming, cycling, and walking.

COMPLEMENTARY AND ALTERNATIVE (CAM) APPROACHES. Complementary and alternative therapies are not substitutes for knee revision 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 postoperative discomfort following revision surgery. 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 revision surgery. It is a procedure in which a surgeon makes three or four small incisions in the knee in order to insert a device that allows him or her to see the inside of the joint, insert miniaturized instruments to remove or repair damaged tissue, and drain fluid from the joint. Arthroscopy has been used successfully to treat stiffness in the knee following TKR and improve range of motion in the joint. It is not successful in treating infected prostheses unless it is used very early.

Other surgical alternatives to knee revision surgery include manipulation of the joint while the patient is under general anesthesia, and arthrodesis of the knee. Arthrodesis is a procedure in which the joint is fixed in place with a long surgical nail until the growth of new bone tissue fuses the knee. It is generally considered a less preferable alternative to knee revision surgery, but is sometimes used in the treatment of elderly patients with infected prostheses or weakened bone structure.