Knee Cartilage Damage? Alternatives to Knee Replacement

The knees bear a tremendous amount of abuse in a lifetime, resulting in knee cartilage damage. Luckily, there are many viable alternatives to knee replacement.

Treatment in our office can be very, very effective at relieving knee pain. However, even we understand that there are limits to pain relief that can be obtained. While the numbers are low, we have had patients who did not respond proceed to knee or hip replacements.

Personally, I want to save everybody from surgery and keep them as functional as they want to be. In a perfect world this would be an obtainable goal.

Luckily, there are additional options that are available to arthritis sufferers that were not available even 10 years ago.

Before we get into those other options, we need to cover some important points first.

  1. Just because you have arthritis does NOT mean it is causing your pain. Countless times we have had patients with “arthritis pain” get total relief in just a few visits.  We did nothing to the arthritis, but the arthritis was not causing the pain.
  2. Treatment around the knee HAS to consist of solid soft tissue techniques such as Graston, fascial manipulation or ART. Anything less is not the best. That means that mobilization, manipulation, exercises, ultrasound, laser and interferential therapies are just likely not going to cut it.
  3. You HAVE to get off your butt and use the darn joint. It is abundantly clear that exercise and strengthening the knee joint will improve arthritis pain and function.
  4. The use of any type of anti-inflammatory may likely keep you from getting the best improvement possible because it blocks the healing process.
  5. Weight loss will always help. Drag out the old physics book and do some math on how much extra force the knee has to deal with at 10 extra pounds. Jack that number up to 50 and the forces start to have more zeros on the end. The weight’s go to go.

Ok…now that that’s out of the way we can address the findings of this particular article.

I remember the first time I had a discussion with a patient about injections of hyaluronic acid into the knee (Sandy–if you’re reading this I’m talking about you…). It was probably about 12-13 years ago, so this is not a new technology.

Basically, the procedure involves injecting hyaluronic acid, or some version of it, into the joint. Hyaluronic acid injections contain the building blocks of cartilage, so it makes at least some sense that this might be a good idea.

The results over the years seems to have been okay. Not stellar, but okay. With one exception (a patient who developed an infection in the joint after the injection–but this was a technique problem and not a problem with the treatment), I have not seen any downsides to this. Some seem to respond, some don’t.

In this particular study, researchers compared the effectiveness of two types of substance used in the injections. Hyalgan has been one of the main products available almost since the beginning and is considered a low molecular weight product. The results on pain reduction were compared to an intermediate weight product.

The pain reduction was better with the intermediate weight product. While the difference was not great, it was enough to suggest that this product was a better option for pain control and certainly adds to the total picture of what this type of approach can add to treatment of knee arthritis.

Have you tried these injections before? If so, how did they work for you?

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.