Chronic knee pain is one of the most common areas of pain that leads to significant limitations in our patient’s lives.
Most people think that knee surgery is the only way to relieve their pain, but patients should be aware that there are many alternatives to knee surgery. These alternative treatment options are proven to prevent or delay knee surgery - a goal of many patients. While knee surgery is commonly performed for structural damage, fractures, and arthritis which has not responded to other treatment options, surgery is not the best option for every patient.
There is a significant cohort of patients who typically benefit from alternatives to knee surgery. These pain relief alternatives are often minimally invasive or non-surgical options for pain relief and prevent patients who would not be ideal surgery candidates from the risks of undergoing surgery and associated recovery time.
The reasons to not opt for surgery can be medically related as well as lifestyle-related. Many patients have multiple chronic medical problems known as comorbidities that can prevent them from safely having anesthesia and surgery. Other patients want to delay surgery as long as possible, given their busy lives. We often see patients who have family events or travel plans to attend before having a surgical procedure. Lastly, there is a group of patients who already have had knee surgery and continue to have pain. These patients often are looking for alternatives to avoid repeat surgery.
All of these reasons are great motivators to explore effective pain relief alternatives to knee surgery.
There are multiple potential reasons patients develop chronic knee pain. The type of injury, duration, and patient goals all play a role in creating a comprehensive treatment plan. Below are approaches and options to consider that can reduce and treat knee pain.
Knee pain can often be significantly improved with a formal physical therapy program. A trained therapist can help develop, teach, and train patients an effective exercise program during these programs. Many knee pain syndromes can dramatically be improved with the proper strengthening of specific muscle groups and improving flexibility. For example, strengthening the quadriceps, a group of muscles in the front of the thigh can help stabilize the knee joint and improve chronic pain and disability.
Home remedies are also something that can be considered to provide pain relief before, during, or after a patient can see a physician. We always recommend these options to our patients but recommend patients be seen for a more thorough evaluation by a medical provider if they do not get relief within 3-5 days of trying these home treatments.
Bracing when appropriate can help improve chronic knee pain. Bracing options are often used to aid with pain from arthritis or patients that have knee instability. Braces can prevent re-injury by preventing hyperextension and falls. An off-loader brace is a type of knee brace used for patients with arthritis to help take pressure off the painful side of the knee and improve the ability to walk.
A knee corticosteroid or Cortisone injection can treat acute and chronic knee pain. Commonly-treated conditions include osteoarthritis, rheumatoid arthritis, and cartilage or meniscus tears. A steroid injection combines an anesthetic (lidocaine or bupivacaine) and a steroid (cortisone, Kenalog, or dexamethasone). The local anesthetic will be responsible for the immediate relief, and the steroid is used to provide more long-term relief. The steroid medication provides a powerful anti-inflammatory effect to decrease pain, swelling, and stiffness.
Visco-supplementation (TRILURON, Synvisc, or Hyalgan) injection is a gel-like fluid called hyaluronic acid. Hyaluronic acid is a substance found in the synovial fluid surrounding the knee joints. It acts as a lubricant and as a shock absorber. These injections are most commonly performed for patients that have osteoarthritis and chronic joint degeneration.
Platelet-rich plasma (PRP) is a regenerative medicine therapy derived from a patient’s own blood to treat tendonitis and arthritis. This therapy first began widespread use in athletes 10-15 years ago. The injection treats a variety of arthritic joint and tendon problems.
A sample of blood is drawn when a patient arrives at the clinic. This sample is centrifuged or spun down so that the different layers are separated out. The platelet layer is identified and isolated. This platelet-rich layer is rich with growth factors that accelerate the body’s own healing process. The PRP is typically injected directly into the knee or area of degeneration near the knee.
A genicular nerve block and radiofrequency ablation is a set of procedures used to diagnose and treat chronic knee pain. These treat the knee pain symptoms from osteoarthritis, failed knee replacement, patients medically unstable for knee replacements, and patients who want to avoid knee replacements. There are three steps to complete the procedure:
Peripheral nerve stimulation or PNS is a rapidly growing effective treatment for nerve pain. This procedure is commonly used in the knee to treat pain after trauma, complex regional pain syndrome (CRPS), neuropathy, or pain after total joint surgery. PNS uses either a temporary or permanent implantable wire to stimulate nerves near the area of injury or pain. These wires use a small amount of electrical energy to block pain and provide relief. The benefit of this therapy is the precision and ability to focus on specific areas that otherwise could not be treated with previously available conventional measures.
PNS does not eliminate the source of pain; it simply interferes with the signal to the brain. Your physician will discuss with you the temporary options vs. permanent options. Both have been shown to provide long-lasting relief. There are many neuropathic pain or nerve pain conditions treated with peripheral stimulation.
A Dorsal Root Ganglion Trial (DRG trial) is a temporary medical device placed under your skin that sends a mild electric current to your spinal nerves to block the feeling of pain. The goal of the stimulator is to help you manage your pain better and potentially decrease the amount of pain medication needed. There are many neuropathic pain or nerve pain conditions treated with dorsal root stimulation. Most commonly, this treatment is used for complex regional pain syndrome or severe nerve pain from previous surgery and/or trauma.
The trial period is a patient’s “test drive” to determine if it will help them long-term. Stimulation does not eliminate the source of pain; it simply interferes with the signal to the brain. A trial is typically 5-8 days long. The goal is a 50-100% reduction in pain. At the end of the trial, the stimulator is removed. We then discuss with our patients if it is something they want to be implanted long-term. Stimulation does not work for everyone, and if so, the implant can be removed and does not damage the spinal cord or nerves.
There are many effective pain relief alternatives to knee surgery, and a growing number of patients are seeking these alternatives. We at Excel Pain and Spine offer a comprehensive list of treatment options for patients with knee pain. If you would like to discuss any of these alternative treatment options, please request an appointment here.