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Can You Exercise Your Way Out of Knee Surgery?


No one wants to have a knee replacement. Like any major surgery, the recovery takes time and effort, and it can also be a huge — albeit temporary — disruption in someone’s lifestyle.

Lately, though, more people are trying to fix their pained, cartilage-less knees without a surgical solution. The Washington Post reports that these patients are attempting a wide range of methods, including “acupuncture, external braces, dietary supplements [like] glucosamine and chondroitin sulfate, needle lavage, injections of growth factor [or] stem cells,” and just plain exercise.

Neil Sheth, MD, the chief of Orthopaedic Surgery at Pennsylvania Hospital, understands why someone would want to avoid surgery, but says that efforts to get around a procedure might actually just delay the inevitable. In most cases, knee pain is caused by the breakdown of cartilage in the knee, which cushions the bones in the joint. This breakdown is often caused when the components of the joint — including the bones, cartilage, and ligaments — aren’t lining up the right way. This is called “mechanical mis-alignment.”

“If there’s mechanical mis-alignment in your knee and it stays the same, your cartilage will continually break down, even if you’ve found a way to regenerate it,” Sheth said. “We need to repair the mechanical environment, and that can’t be fixed with exercise. It usually requires surgery.”

Stem cell treatments are increasingly looked to by patients to solve their pain issues, but many of the procedures offered are not FDA approved. Those few specifically use blood-forming cells taken from the patient or a donor, depending on the case. The unapproved treatments often are derived from fat cells. The latter is often extremely expensive.

“I see patients who spend a lot of money out-of-pocket to get stem cell injections, and most of the time, an X-ray of the knee – when it is not bearing any weight – will look like it’s showing that the injections have cured the arthritis,” Sheth said. “But, when the knee compacts, as it does during normal running, walking, or even just standing, the pain the patients feel is usually unchanged.”

Sheth can sympathize with wanting to avoid a major procedure, but he also knows how serious the injury can become without an appropriate intervention.

“Bad knees aren’t a heart attack. They’re not cancer. They’re not something that needs to be addressed immediately because there is imminent danger,” Sheth said. “But, as patients get older and less mobile, the less someone walks because their knee is hurting them, the higher risk they have of developing a blood clot, pneumonia, bed sores, or a urinary tract infection.”

On top of that, elderly patients also have a higher risk of falling if their knees are arthritic and painful, potentially resulting in more serious injuries such as a hip fracture, which can set off a precipitous decline in health.

Part of the reason that knee replacement could become unavoidable — and why preventive exercise may not help — is that patients might have genetic predispositions toward a mechanical defect. For instance, a research team from Belgium found that almost a third of the men and 17 percent of the women in their study population had a skeletal alignment issue that often causes bow-leggedness. That issue, known as varus alignment, was classified as being a misalignment of three degrees or more. Another study showed that a misalignment of only 1.3 degrees could be a contributor to osteoarthritis.

“You look at marathon runners who are running four-minute miles, and they don’t get knee arthritis. But there’s a genetic predisposition to that. You’re only in control of these things to such an extent. My parents are both 80 and have had knee replacements, so I’m probably headed for that,” Sheth said.

For patients who qualify – that is, those who have “wear and tear” arthritis that is confined to a single compartment of the knee and hasn’t spread to either of the other two – a partial knee replacement is sometimes an option. The procedure keeps existing ligaments intact, only takes about 30 to 40 minutes to perform, and usually results in much less pain and swelling, which leads to an easier post-operative rehabilitation.

“I did a partial knee on a patient who is over 90-years-old who lives by himself,” Sheth recalled. “His knee wasn’t great, but he came back after the procedure and said, ‘Doc, 95 percent of my pain is gone.’”

Genetics notwithstanding, Sheth said there are some factors that can potentially stave off a knee replacement. Keeping body weight down eases the impact on the knee. And when exercising, Sheth said avoiding activities that cause pounding or other possible trauma to the knee can better preserve cartilage. Running may be the exercise of choice for some people, but Sheth said periodically mixing in other cardio activities like using a rowing machine, stair stepper, or elliptical machine instead of running daily might help preserve a knee, as well.

What it comes down to is the importance of weighing options. Knee pain can dissuade someone from continuing to live an active, healthy lifestyle later in life, which could lead to further consequences that might jeopardize their independence. It’s best to consult a doctor about debilitating knee pain to determine the best course forward instead of experimenting alone with alternate methods. A knee replacement can cause some (literal and figurative) pain in the present, but it could be key to avoiding far more serious health issues down the road.

“It may seem strange that we’re replacing knees with metal and plastic, but in 2020, this is the best we have,” Sheth said. “And it often allows people to be healthier, longer.”


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