Knee pain to knee replacement – problems in postmenopausal womenJanuary 6, 2016 January 6, 2016
Knee pain in the active woman.
Common, treatable and often overlooked or mismanaged
Doctors have published research in the prestigious Journal of orthopaedic research suggesting something of the obvious. For post menopausal women to have a success knee replacement they most have strong bones.1
The problem is many pre-surgical treatments to help women strengthen their bone and alleviate their knee pain cause weakened bones.
Despite the variety of effective treatments, and physicians who specialize in treating pain, women often suffer unnecessarily and may treat their pain with medications that may be ineffective and possibly harmful, according to a review of research related to women and pain by the American Society of Anesthesiologists.
ASA conducted the literature review and issued the Women’s Pain Update to help raise awareness of the many options available to women for controlling both acute and chronic pain, and how a pain medicine specialist can help them choose the right treatment.
Among other things, the studies showed that remedies such as music, yoga and rose oil are proven effective for several types of pain, that opioids are often used inappropriately.1
The problem is identifying patients who have strong enough bones. This is discussed in troubling research from NYU Langone Medical Center, Hospital for Joint Diseases. They looked at patients suffering from posttraumatic osteoarthritis and suggested that this is a special group of patients that require a different set of rules because of high revision surgical rates and surgery failures.
Posttraumatic osteoarthritis is caused by injury or trauma. For a older woman athlete for instance this injury could be an ACL tear, meniscal tear, or any injury treated or untreated. Having a knee arthroscopy certainly qualifies for as posttraumatic injury. For non-athletes, a broken bone sustained in a fall or car accident could cause posttraumatic osteoarthritis.
What these injuries and treatments have in common is progression to osteoarthritis and microfractures of the bone.
Here is the what the NYU researchers published:
- Total knee arthroplasty (replacement) is often the best answer for end-stage, posttraumatic osteoarthritis after bone fractures about the knee.
- Although Total knee arthroplasty in this setting is often considered more technically demanding, outcomes are typically worse for patients.
- Posttraumatic knee replacement patients were on average younger and healthier than the primary knee replacement population.
- The posttraumatic knee replacement group had higher rates of superficial surgical site infections and bleeding requiring transfusion.
- History of posttraumatic knee osteoarthritis was found to be an independent risk factor for prolonged operative time, increased length of hospital stay, and 30-day hospital readmission.2
Doctors in Sweden have published results of a fracture risk study that show that individuals with total knee replacement had a low risk for hip and vertebral fracture in the decade before surgery.
However, after total knee replacement, the risk for hip fracture increased by 4% and the risk for vertebral fracture increased by 19% percent.
This is not backwards statistics – before knee replacement lower risk of hip and vertebral fracture. After knee replacement greater risk. How does this happen? Patients overestimate their abilities following the replacement surgery and put themselves at risk for fractures at other joints.3
This may be a case of patients expecting too much from a knee replacement and not paying enough to their hips and spine – this is covered in our article Do patients expect too much from their joint replacement?
Often we will see a patient who had a knee replacement procedure and continue to have pain following the surgery. Studies suggest that this may be caused by the high number of possible post-surgery knee replacement complications.
Knee Replacement Complications
Researchers writing in the medical journal Clinical Orthopaedics and Related Research noted that “Despite the importance of complications in evaluating patient outcomes after total knee replacement (TKA), definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.” So that there was a need to develop a standardized list and definitions of complications and adverse events associated with TKA.
At the Magaziner Center, we specialize in treating chronic pain, sometimes they are women who have been suffering a long-time with joint pain.
We recently reported on research that shows 63% of women age 50 and older reported persistent, incident, or intermittent knee pain during a 12-year study period.
Mostly these women suffered from obesity, osteoarthritis, and previous knee injury. Ironically, many women opt for knee replacement surgery with the belief that they will be able to lose weight. This idea has been disproved in much of the medical literature.
The researchers found that:
- 44% of women had some sort of knee pain in a one month period
- 23% of the women studied had “pain on most days in a one month period
- Of those experiencing some sort of pain versus “pain on most days,” 9% and 2% had persistent pain; 24% and 16% had incident pain; and 29% and 18% had intermittent pain, respectively.
Researchers determined that a higher BMI (obesity) predicted persistent and incident pain patterns, while osteoarthritis was a predictor of persistent pain. Those reporting knee injury were likely to have persistent or intermittent pain patterns.2
Most of the patients we see in our office are patients that have already been to many different doctors with varying degrees of success or failure in their knee pain treatments. While we are in New Jersey, we see patients from all over the world looking for the “answer” to their knee osteoarthritis.
In Prolotherapy, we use a dextrose based solution, and for many, this offers the desired results of ligament, tendon and cartilage rebuild to satbilize the knee. Sometimes we offer the patient Prolotherapy in the form of Platelet Rich Plasma Therapy. Here we draw the patients blood, spin it, until we can harvest the blood platelets, which are rich in healing cells. Sometimes we offer Stem Cell Therapy to the patient. Stem cells have the capability to mimic the building blocks of proteins to heal the knees.
Recently research showed that women in the “Middle-aged and Mature Women” group showed significant improvement to their knee pain using dextrose Prolotherapy 3
1 Huang CC, Jiang CC, Hsieh CH, Tsai CJ, Chiang H. Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res. 2016 Feb;34(2):240-8. doi: 10.1002/jor.23003. Epub 2015 Aug 11.
2 Kester BS, Minhas SV, Vigdorchik JM, Schwarzkopf R. Total Knee Arthroplasty for Posttraumatic Osteoarthritis: Is it Time for a New Classification? J Arthroplasty. 2016 Aug;31(8):1649-1653.e1. doi: 10.1016/j.arth.2016.02.001. Epub 2016 Feb 13.
2. A. Soni, A. Kiran, D. Hart, K.M. Leyland, L. Goulston, C. Cooper, M.K. Javaid, T.D. Spector, N.K. Arden. Reported knee pain prevalence in a community-based cohort over 12 years. Arthritis & Rheumatism, 2011; DOI: 10.1002/art.33434
3. Rabago D, Zgierska A, Fortney L. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up.J Altern Complement Med. 2012 Apr;18(4):408-14.
Post being updated 12-27-2016