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Cameron Dixon
Malcolm Campbell
Uwrit 1103
April 12, 2016
Knee Replacement Is it Worth the Trouble?
As Americas population ages (particularly the Baby Boomers), there is more of a
need for joint replacement surgeries than ever before. Older adults are not willing to
become couch potatoes and they want their joints to let them enjoy the activities they are
used to doing. According to a 2006 study presented at the American Academy of
Orthopaedic Surgeons, hip replacements are expected to increase 174% in the next 30
years and knee replacements will rise more than 600%. (Journal of Bone & Joint
Surgery) Humans are not meant to live as long as we are living now. Therefore, our joints
certainly wont last that long and it is inevitable that many of us will end up having some
sort of joint replacement surgery. However, now adults as young as their 40s and 50s are
having the surgery in order to deal with arthritis or wear and tear on their joints. Often
obesity is a cause of severe joint damage and as we all know, America has a problem with
obesity. We are basically a physically active society and this particular kind of surgery
allows people to live a mostly pain free life and gives them back the ability to be
physically active again.
According to the National Institutes of Health, joint replacement surgery is
defined as removing a damaged joint (where two or more bones come together - for
example, the knee or hip) and putting in a new one. Sometimes, the orthopedic surgeon
will replace or fix only the damaged parts and not have to remove the whole joint. Joint
replacement surgery can make the difference between living in constant pain or being

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able to go back to the activities they once enjoyed. There are many risks and long term
problems that can result from this, or any surgery and obviously they need to evaluated
before the decision is made to proceed. There are many different types of joint
replacement surgeries that doctors are doing now including the use of artificial bones or
even using parts from animals as well. The surgery continues to evolve and improve and
better outcomes can be expected than in the past. Doctors and researchers are studying
which techniques are the most effective and long lasting. According to Dennis
Armstrong, due to the new advancements in joint replacement surgery, 90-95% of the
time it has been successful and lasting. There are different kinds of joint replacement
offered, but the most common joint replacement surgeries are hip, knee, and shoulder. I
will be focusing on knee replacement surgery in this paper.
At the age of thirteen I had double knee surgery. I was lucky enough to have
outpatient laparoscopic surgery but my recovery literally took the entire summer before
my freshman year of high school. There were grueling physical therapies sessions several
times a week, anti-inflammatory drugs, knee braces and crutches that aided me in my
recovery. I had relief from the pain I had been in, but not complete relief. I remember my
doctor telling me that I will likely be a candidate for knee replacement at some point in
my life, probably in my 40s. I am glad to know there is something to help me when I get
older, should I need it. However, are there other less invasive treatments being
researched? Are the techniques improving to the point where patients will only need one
joint replacement in their lifespan? Is the recovery process less demanding?
Physicians tend to recommend knee replacement surgery more now because of the
advances in technology and computer-aided surgery. Robotic surgery is becoming more

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commonplace. Artificial joints are built better now than they were even five years ago.
The surgery has been around for decades and doctors are very comfortable with it.
Patients are desperate for pain relief and are concerned over the safety of the pain
medications they may have been taking for extended periods of time. "People don't want
to take medications," said Paul Lachiewicz, MD, professor of orthopedics at the
University of North Carolina at Chapel Hill. "They want it fixed." Nowadays, you see
advertisements on television for artificial joints which further increases the awareness of
the procedure. Surgeons are recommending this procedure at earlier stages to try and save
the patient from months or years of debilitating pain. They are confident with the devices
now on the market and know they will last longer and allow patients to return to active
lifestyles much sooner.
There are downsides to all these advances. Cost is a major concern. Even though
this surgery is quite expensive, most insurance plans including Medicare pay for it.
However estimates show that joint replacements cost hospitals over $9 billion in 2004.
Other concerns are will there be enough qualified surgeons to meet the demand in the
future. According to Dr. Stephen Hurst, an orthopedic surgeon in San Mateo, CA, the
number of orthopedic surgeons is not growing at the rate that the need for joint
replacement is increasing. Anyone who has tried to make an appointment with an
orthopedic surgeon recently knows that it can take weeks to be seen even for something
urgent. The growing number of younger people (people in their 40s and 50s) having this
procedure also increases the likelihood that they will probably outlive their artificial knee
and have to have it replaced with another one at some point. With every surgery comes
more cost and more risk for the patient. The American Academy of Orthopedic Surgeons

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is aware of these concerns and are doing things to ensure there will be minimal
complications in the future such as establishing a registry to identify which implants last
longer and anything that can be done to lengthen their life even more. They are working
with vendors of the artificial joints to gather this information. Other countries such as
Great Britain and Canada already have these registries.
So who is a candidate for knee replacement surgery? Obviously this is something
the patient and their surgeon must decide together. The typical patient profile is someone
between the ages of 55 and 74 who has obviously been suffering knee pain for a while.
However, as I have mentioned, people in their 40s are having the replacement surgery
also. All other causes of knee pain have been ruled out such as severe sprains or infection.
They most likely have had all the xrays, MRIs, and other tests. They have also tried
physical therapy and pain medication or anti-inflammatory drugs. Many have tried
alternative medicine anything to relieve the pain including weight loss. This procedure
should be the last resort as it is the most invasive and carries the highest risk, but it also
carries a very high success rate.
I have three people very close to me who have had knee replacement surgery in
the last two years. Each case is different but all outcomes have been positive. My
mothers cousin suffered severe knee pain for years after a bad automobile accident while
she was in her 20s left her with virtually no cartilage in her knee. She had tried
everything until the surgeon said knee replacement was the only option left. She was in
her late 40s. They left her go in pain for so long, hoping she would be old enough that she
would not outlive her knee replacement. Surgery was successful but recovery was long

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and painful. She worked very hard in rehab and has finally gotten back to normal within
the last six months. Now she says the surgery was worth it. A few months after the
procedure she had her doubts because she was still having pain and rehab was intense.
My great aunt just had knee replacement six weeks ago. She is in her late 70s and
is very overweight. She had tried everything to relieve the pain but nothing was working.
The surgeon was hesitant with her, given her weight problem but he did the surgery. She
already claims to be pain free but is having a hard time with the rehab. The extra weight
she is carrying is probably putting more stress on the knee replacement. It will be
interesting to see how she is feeling in a few more months.
A close family friend had knee replacement exactly one year ago. He was in his
mid 50s at the time and had been an avid tennis player up until about five years ago when
his knee started bothering him. He also did everything he could to avoid the surgery
including taking steroid injections directly into the knee. Surgery was successful for him
although he claims to still not be back to normal. He is still doing rehab on his own.
These three cases are just a few examples of the hundreds of thousands of knee
replacement surgeries that take place each year. As I stated before, this number is
expected to grow enormously in the next 20 years.
According to the National Institutes of Health website, there are several different
types of knee replacement surgeries. In a total knee replacement, the entire knee joint is
replaced. In a partial knee replacement, just the damaged part of the knee is replaced. The
down side of this surgery is that after one part of the knee is replaced, arthritis may

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develop in another healthy part of the knee. If that happens additional surgery would be
required. Surgeons can attach joint components to bone by cementing them to existing
bone. Replacement parts can be made with a porous surface and the patients own bone
can grow into the surface of the joint to secure them. There is also something called MIS
or Minimally Invasive Surgery where there is a smaller cut needed to do the surgery,
therefore speeding up the healing process.
One interesting fact I discovered is the number of total knee replacements is
greater in women than in men, and has been this way for the past fifteen years. According
to sciencedaily.com one possible reason is that women are more prone to osteoarthritis
than men for a number of reasons including hormones, genetics and obesity. After the
surgery, women tend to heal better and faster than men.
What are some of the alternatives being studied for knee replacement surgery?
Injections of Hyaluronic Acid directly into the knee joint are being used. This is a
substance found in healthy knees. Damaged or arthritic knees stop producing much of the
acid for reasons doctors do not understand. These injections are usually well tolerated and
can give relief for up to 12 months, but they do not work for everyone. Another
technology that is being tried is PRP or Platlet Rich Plasma which is basically your own
blood injected into your knee. PRP and stem cell injections may be the best alternative to
knee replacement but there is still much research to be done. Most of these treatments are
considered experimental and are therefore not covered by insurance. That being said, an
injection can cost up to $5000 per knee.

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It is exciting that these non-invasive therapies are being developed and are finding
some success. ABC News published an article in 2013 that said there were virtually no
cons to the procedure of injecting stem cells as an alternative to knee replacement other
than the cost. Success was being seen with no complications or side effects. (Neporent).
I hope that by the time my generation will need knee replacement surgery that
these therapies and many other new ones are readily available, approved by the FDA and
are affordable to the masses. I hope their success rates are high and insurance pays. After
all, its almost of sure thing that I will be a patient!

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Works Cited
Armstrong, Dennis. "Learning Article." Learning Article. Web. 05 Apr. 2016.
Carr, Andrew J. "Knee Replacement." N.p., n.d. Web. 8 Apr. 2016.
Davies, B. L., Y. Baena, F M Rodriguez, A. R W Barrett, M. P S F Gomes, S. J. Harris,
M.
Diseases Orthopaedic Institute. 52.2 (1993): 65. Web. 5 Apr. 2016.
Grelsamer, Ronald P. "Total Knee Replacement." Bulletin of the Hospital for Joint
"Hip, Knee Replacement Surgery Rates Skyrocket over 7 Years." - Amednews.com. N.p.,
n.d. Web. 12 Apr. 2016
"Knee Replacement." NIHSeniorHealth:. N.p., n.d. Web. 10 Apr. 2016.
Rushin, Steve. "Hip Replacement." Sports Illustrated 96.6 (2002): n. pag. Web. 6 Apr.
2016.
ScienceDaily. ScienceDaily, n.d. Web. 12 Apr. 2016.
"Total Knee Replacement." Total Knee Replacement. N.p., n.d. Web. 12 Apr. 2016.
"Total Knee Replacement-OrthoInfo - AAOS." Total Knee Replacement-OrthoInfo AAOS. N.p., n.d. Web. 12 Apr. 2016.

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