Total Knee Replacement (TKR) is routinely performed to alleviate pain associated with Osteoarthritis of the knee. The number of such replacements will continue to increase as I indicated in last week’s Blog. Part of the explanation is increasing obesity and in part because of increasing longevity. What is not explained so easily is the trend for ever-younger patients to undergo a TKR. I thought it appropriate to provide an informed consent exercise for those considering a joint replacement while still active.
Return to activity following Total Knee Replacement vs. Knee Stem Cell Treatment.
Total Knee Arthroplasty reliably reduces pain and improves health-related quality of life in 90% of patients. Yet, functional performance in patients one year after Total Knee Replacement remains lower than for healthy adults or those receiving stem cell interventions, with reports of 18% slower walking speed, 51% slower stair climbing speed, and deficits of nearly 40% in quadriceps strength. These figures are cited both from my research presented at the TOBI International Regenerative Medicine Symposium held in Los Angeles this past June and from scientific publications. One year after TKR, patients reported having greater difficulty with kneeling, squatting, moving to the side, turning, cutting, carrying loads, stretching, performing lower extremity strengthening exercises, playing tennis, gardening, and participating in sexual activities, when compared to healthy adults or those who underwent a stem cell intervention as contrasted to a Total Knee Replacement.
Restated, compared to healthy adults or recipients of stem cell intervention for osteoarthritis of the knee, patients receiving Total Knee Replacements perform significantly worse at all times for all measures of a functional nature. One-month post-operative, knee replacement recipients experience significant losses when compared to the preoperative assessment while stem cell recipients are well on their way to maximum medical improvement. At six months, a total knee recipient will recover to preoperative levels on all measures, except knee flexion range of motion, but still exhibited the same extent of limitation they did prior to replacement surgery. Let me illustrate. I was biking and fishing last week for four days in Southwest Wisconsin. I am partners in a small farm and took my truck in for service. Jerry, my 52year old mechanic in the nearby town is six months post knee replacement. “Jerry, how is you knee doing?” “It’s almost to the condition it was at just prior to the surgery.”
In conclusion, the persistent impairments and functional limitations after Total Knee Replacement suggest that those with arthritis who seek an active, mature, athletic life style might do better to consider an Orthopedic Cellular Stem Cell intervention. While the Total Knee Replacement recipient seems to return to preoperative functional capacity at six months and never is really active again, the stem cell recipient may return to sports at six to 12 weeks and will continue to improve for 18 months