Total Knee Prosthetic sales rose almost 7% in the fourth quarter of 2013. When Wall Street analysts sought to find out why and asked physicians-73% of those surveyed reported that patient behavior had changed during the quarter; 35% attributed the changes in behavior to the Pull –Forward theory resulting from concerns about Obamacare. While it is very difficult to differentiate between aging demographics, seasonal variations, and an increase of those covered by insurance, or patient angst about health care changes; my question is what is the hurry? Before surgery, there are a large number of possibilities for Non-Arthroplasy treatment of Osteoarthritis of the Knee. I have reviewed those options and they are archived in my Blogs. Remember, once you have a total knee, the only salvage for dissatisfaction is a very life altering revision procedure. Last week, I focused on the reasons for early failure of a knee replacement (early is defined as two years). What has not been addressed is the life altering impact of revision knee prosthesis. While a surgeon might change the X-Ray at the time of the revision knee surgery; what are the chances of returning to the quality of life enjoyed with arthritis prior to the initial procedure two years earlier? “ Doctor, Can I have my arthritis back and the life I enjoyed prior to the knee replacement?” The latter is not an infrequent question that I have heard over my professional career.
Aging has normal physiologic effects and they affect sports for mature athletes. That aging also affects the activities of daily living of non-athletes. Basic Science principles now allow us to address age-related changes in bone, meniscus, articular cartilage, and the muscle tendon complex without surgery. What is the appropriate non-operative management of stages 2 and 3 arthritis owing to traumatic, degenerative and arthritic conditions? There is little question concerning a joint replacement for stage four debilitating arthritis when there is limited motion, instability and deformity. As well, there is an Appropriate Use Criteria to analyze the impact of arthroplasty and cartilage restoration/stem cell intervention. When there is no alternative, have a joint replacement; but failure results in a revision surgery at two years. There is an alternative for most; it is called Bone marrow Aspirate Concentrate/ Stem Cell intervention. The failure of such might lead to a primary joint replacement. To date, not one of my several hundred knee stem cell recipients have gone on to a knee replacement.