Are patients getting knee replacement for back and hip pain?

Failed Total Knee Replacement
Are patients getting knee replacement for back and hip pain?

Researchers in the United Kingdom examined why up to 20% complain of persisting pain and subsequently there was a rise in secondary surgery to the primary knee replacement.

Here is what they said: “Forty-five consecutive patients referred to our department with painful total knee replacement were reviewed with our standard protocol, including history and examination, inflammatory markers and radiological studies including radiographs of the hip and knee and computed tomography scan of the knee joint. Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease which resolved after injections of the relevant joints. Nine patients had unexplained pain. Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.” (1)

Proper diagnosis, this is why in our practice we use our hands to examine the patient, taking a careful examination and patient history.

It may also be damagied ligaments
Researchers have long noted that weakened ligaments play a key role in the need for a second or “revision” surgery on the knee.

In one landmark study in 2007, Researchers writing in the medical journal Der Orthopäde examined how loose ligaments played a role in the need for follow up (revision) knee surgery.(2)

The researchers examined 135 knee revisions and noted that

-In 32.6 % of all cases, ligament instability was the primary reason for revision.
-In another 21.6%, ligament instability was identified as a secondary reason for revision.

They concluded: Ligament instability is a common reason for revision total knee arthroplasty (TKA).

In other medical literature researchers noted that “Anterior cruciate ligament reconstruction failed to restore normal rotational knee kinematics during dynamic, functional loading and some degradation of graft function occurred over time. These abnormal motions may contribute to long-term joint degeneration associated with ACL injury and reconstruction.”(3)

Surgery is complex, a second one frequently even moreso. Before the surgical option is considered as the “only course,” patients need to explore Prolotherapy and Platelet Rich Plasma therapy. Our patients have found that these treatments provide excellent results on the previously surgically repaired knee and helped them avoid a revision surgery. Prolotherapy and Platelet Rich Plasma Therapy trengthen and repair the ligaments that remain weak, loose, or damaged following surgery without surgical intervention.

1. Al-Hadithy N, Rozati H, Sewell MD, Dodds AL, Brooks P, Chatoo M. Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies? Int Orthop. 2012 Jan 11. [Epub ahead of print]

2. Graichen H, Strauch M, Katzhammer T, Zichner L, von Eisenhart-Rothe R. [Ligament instability in total knee arthroplasty - causal analysis.] Orthopade. 2007 Jun 21;

3. Tashman S, Kolowich P, Collon D, Anderson K, Anderst W.Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res. 2007 Jan;454:66-73.