Finding Relief from Chronic Knee Pain: Options Beyond Surgery

Suffering from knee pain. Please advise on effective remedies?

Hello, Dr.
Shi.
I have been suffering from degenerative arthritis for about ten years.
I have been receiving hyaluronic acid injections for approximately five years, but I feel there has been little improvement and no significant therapeutic effect.
I often experience pain throughout the day and sometimes take painkillers, but I am concerned about kidney damage.
I live with constant knee pain, which makes my life very unpleasant.

If I consider surgery, I would like to know: 1) Will I be able to restore the normal function and appearance of my legs (as my knees are swollen and appear bent)? 2) After the surgery, will I be able to squat and kneel normally? If the surgery is successful, how long does rehabilitation typically take for recovery?
I have heard that minimally invasive surgery is less painful.
If minimally invasive options are not available, does that mean the pain will be unbearable and the procedure cannot be performed? I also heard that minimally invasive surgery is not covered by insurance; could you please inform me about the costs involved?
I hope to receive prompt responses to these questions.
Thank you!
P.S.
I do not wish to undergo surgery, but I have been troubled by knee pain.
I have seen doctors for ten years with no progress.
The biannual hyaluronic acid injections feel like a routine procedure with no therapeutic effect, which seems like a waste of medical resources.
Is there truly no better medical technology available in this high-tech era? I hope you can clarify these concerns for me.
Thank you very much!
- Lai Weng, May 28, 2021

Lai Weng, 70~79 year old female. Ask Date: 2021/05/28

Dr. Shi Guozheng reply Orthopedics

1.
Normal function can be restored; during the surgery, the deformed joint will be corrected to a straight position.

2.
If the knee joint is currently difficult to bend, then after surgery, in order to be able to squat, it is essential to commit to rehabilitation.

3.
Performing knee replacement surgery using minimally invasive techniques tends to be less painful.
Typically, pain management will be implemented post-surgery, which helps to reduce discomfort.
However, if the minimally invasive approach only involves arthroscopic debridement, it will be ineffective.

4.
Total knee replacement surgery is covered by health insurance, but if a higher-quality ultra-high molecular weight polyethylene insert is desired, additional out-of-pocket expenses will be required.

5.
A 76-year-old patient is still considered relatively young.
In my experience, the average age of patients undergoing surgery is over 70, and some healthy elderly individuals, even in their eighties, can still undergo surgery.

Reply Date: 2021/05/28

More Info

Chronic knee pain, particularly due to osteoarthritis, can be a debilitating condition that significantly impacts quality of life. It’s understandable that after ten years of managing this condition with treatments like hyaluronic acid injections, you are seeking more effective options. Here, I will address your concerns regarding surgical options, recovery, and alternative treatments.

1. Restoration of Function and Appearance: Surgical interventions for osteoarthritis, such as arthroscopy, osteotomy, or total knee replacement, can potentially restore function and improve the appearance of the knee. However, the extent of recovery can vary based on the severity of the arthritis, the specific procedure performed, and individual factors such as age, overall health, and adherence to rehabilitation protocols. In cases of advanced osteoarthritis, total knee replacement is often recommended, which can lead to significant pain relief and improved mobility. However, it may not completely restore the knee to its original appearance, especially if there has been significant deformity due to the disease.

2. Post-Surgery Mobility: After surgery, many patients are able to resume normal activities, including squatting and kneeling, although this can depend on the type of surgery performed. For instance, total knee replacement patients typically begin physical therapy shortly after surgery to regain range of motion and strength. Full recovery can take several months, with many patients achieving significant improvements within 3 to 6 months post-operation, but complete recovery may take up to a year.

3. Minimally Invasive Surgery: Minimally invasive techniques, such as arthroscopic surgery, can reduce recovery time and postoperative pain compared to traditional open surgeries. However, not all patients are candidates for these procedures, and the effectiveness can vary. It’s important to discuss with your orthopedic surgeon whether you qualify for minimally invasive options and what the expected outcomes are.

4. Cost and Insurance Coverage: The cost of minimally invasive surgeries can vary widely depending on the facility and the specific procedure. In many cases, insurance may not cover certain advanced techniques, particularly if they are considered experimental or if there are established alternatives. It’s advisable to consult with your insurance provider and the surgical facility to understand the financial implications.

5. Alternative Treatments: Before considering surgery, you might explore other non-surgical options. Physical therapy can strengthen the muscles around the knee, improving stability and reducing pain. Weight management is also crucial, as excess weight can exacerbate knee pain. Additionally, some patients find relief through alternative therapies such as acupuncture, massage, or the use of braces.
6. Emerging Technologies: In the realm of knee pain management, there are ongoing advancements, including regenerative medicine techniques like platelet-rich plasma (PRP) therapy and stem cell therapy. These treatments aim to promote healing and reduce inflammation but are still under investigation regarding their long-term efficacy.

In conclusion, while surgery can offer significant relief and restoration of function for chronic knee pain, it is essential to weigh the benefits against the risks and consider all available options. Consulting with a specialized orthopedic surgeon who understands your specific condition and treatment history will provide you with the best guidance tailored to your needs. It’s also important to remain proactive in managing your condition through lifestyle modifications and exploring all available treatment avenues.

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