If you have knee replacement surgery?

Today, a growing number of experts are asking if all these operations are really necessary, especially those performed at an earlier age. Do all potential patients who offer minor remedies have a fair trial? How many knee replacements result from unrealistic patient expectations or the subtle influence of monetary gains among the surgeons who practice them?

A recent study by Daniel L. Riddle, a physiotherapist at Virginia Commonwealth University, and two medical colleagues, for example, examined information from 205 patients who underwent total knee arthroplasty. Less than half – 44% – met the criteria of "adequacy" and 34.3% were considered "inappropriate", the rest being classified as "inconclusive".

Although patients with less severe pain and loss of function may still benefit from replacement surgery, the researchers suggested that their gains would probably be lower. "This study shows that the cost associated with these small changes is very high," said Dr. Riddle. "People who suffer very badly from pain and functional loss have much more to gain."

In a multicentre study of 4,498 people with arthritic knees and a second study of 2,907 people with arthritis last year, the quality of life of patients after knee replacement surgery was improved. Dr. Bart Ferket, of Mount Sinai School of Medicine, Icahn, New York, and his coauthors, said that those with the worst functional status initially had everything to gain from surgery and made the operation more effective. economically justifiable.

"The key question is to select the patients most likely to benefit from the surgery," Dr. Ferket said in an interview. "For the moment, it's not optimal. Up to 20% of patients are not satisfied with the outcome of the surgery. "

Dr. Steven Teutsch of U.C.L.A. According to the Center for the Advancement of Health, it is important that "patients understand the pros and cons of knee replacement surgery because recovery is not a picnic. A significant number of these procedures can be avoided or delayed. "However, he added during an interview," it is an elective procedure that can be extremely useful for the right person at the right time. "

A detailed discussion with the doctor should precede a decision on surgery, "and the decision should be shared," said Dr. Teutsch.

So what should you try before deciding to go under the knife? The most important is weight loss (if necessary) to reduce stress on the arthritic knees and exercises or physical therapy to strengthen the muscles that support these vulnerable joints and improve the range of motion. One or more injections of a hyaluronic acid gel directly into the knee joint to lubricate it can relieve pain in some patients up to six months. Injections of corticosteroids, which reduce inflammation, may provide more immediate relief, although these injections can not be repeated too often, with the risk of further damage to the joint.