Comparison Between Knee Injections Versus Knee Replacement

Introduction

Osteoarthritis is a prevalent joint ailment in society, and it most often affects the knee. Over the years, various non-surgical interventions like injections, physical therapy, and surgical procedures such as arthroscopic lavage and total knee arthroplasty (TKA) have been developed for knee osteoarthritis. If the non-surgical treatments have failed, patients are considered for surgery. When only a specific part of the knee is affected, a partial knee replacement might be appropriate. This option is considered for younger patients with limited osteoarthritis damage. However, if the joint damage is extensive, a total knee replacement surgery may be necessary. Both procedures may utilize minimally invasive surgical techniques that involve fewer and smaller incisions compared to traditional open surgery methods.

What Is Osteoarthritis?

Osteoarthritis is an orthopedic condition characterized by the deterioration of the joint’s articular surface. Alongside cartilage degeneration, it comprises other deteriorative changes like weakened ligaments, growth of bony projections within the joint called osteophytes, muscle weakness around the joint, and swelling and inflammation within the joint. Osteoarthritis is a condition that most commonly occurs in weight-bearing joints of the knee.

Patients with knee osteoarthritis usually experience several key symptoms, including stiffness in the joint, ongoing knee pain, a grinding sensation (crepitus) with movement, and decreased joint function. These symptoms will affect the quality of life of patients. Moreover, during a physical examination, the patient may exhibit signs such as restricted range of motion, effusion (joint swelling), and crepitus within the joint. In advanced stages, malalignment may also be present.

How Do Injections Help Manage Knee Osteoarthritis?

• Various types of injections are utilized to treat knee osteoarthritis (KOA). Major injections include cortisone injections, hyaluronic acid (HA) injections, and platelet-rich plasma (PRP) injections.

• Cortisone injections are available in different forms, including Methylprednisolone acetate and Triamcinolone hexacetonide injections.

• Long-term use of corticosteroid injections in knee osteoarthritis is considered safe and effective when no significant knee deformities exist.

• Moreover, repeated corticosteroid injections provide pain relief for knee osteoarthritis patients.

• In addition to cortisone injections, hyaluronic acid injections are administered to patients. These injections have been proven beneficial in reducing pain and enhancing functionality in affected individuals.

• Clinical trials evaluating intra-articular hyaluronan injections over 20 weeks showed that patients experienced pain relief without adverse effects compared to those who received placebo injections.

• Platelet-rich plasma (PRP) injection is another treatment option for knee osteoarthritis (KOA).

• Based on study findings, PRP injections demonstrated improvement in KOOS (Knee Injury and Osteoarthritis Outcome Score) scores over a period of 12 months following the initial cycle of treatment (each cycle comprising three injections).

• PRP is also referred to as autologous conditioned plasma (ACP).

• There is another type of autologous protein solution (APS) known as nSTRIDE that processes a patient's own blood to create APS, which contains higher levels of growth factors and anti-inflammatory cytokines.

• APS has been known to effectively reduce inflammation in chondrocytes, macrophages, and cartilage.

How Does Knee Replacement Help Manage Knee Osteoarthritis?

Knee injection offers temporary relief from pain and inflammation, but its efficacy is short-lived. In contrast, knee replacement surgery can provide a lasting solution with superior clinical outcomes. As osteoarthritis progresses, quality of life and mobility can deteriorate. For such cases, knee arthroplasty, also known as knee replacement surgery or knee resurfacing, is the best choice. During this procedure, the surgeon will remove the damaged bone and cartilage from the affected knee joint, replacing it with an artificial joint designed from advanced materials such as ceramic, metal, or high-quality plastic and polymer components.

Postponing knee replacement surgery is associated with potential risks, including heightened pain, reduced mobility, and joint degeneration. Like any other surgical procedure, there are potential risks, such as cardiac events, nerve damage, blood clots, and infection, although they are rare. Physical therapy and exercise can accelerate the recovery process, helping the patient regain mobility promptly most-surgery. Ultimately, knee replacement surgery will present a viable option for addressing knee arthritis, facilitating a return to an active, pain-free lifestyle.

Knee Injections vs Knee Replacement: Which Is Better?

• Physicians usually struggle with deciding between conservative and surgical treatments for patients with knee osteoarthritis (KOA).

• Non-surgical options like physical therapy, knee injections, and weight management can provide relief and sometimes postpone the need for surgery.

• However, certain studies have proved that patients who undergo total knee arthroplasty (TKA) experience greater relief, better functionality, and improved quality of life compared to those undergoing non-surgical therapy.

• The choice between injection therapy and knee replacement surgery depends on the symptoms and stage of osteoarthritis in each patient.

• Injection therapy is often a preferred option for young people, people wanting to preserve their knee joint, and people with mild or moderate forms of osteoarthritis.

• However, if the joint has significant bone deformity and bone loss, injection therapy may not be a suitable option.

• In such a scenario, knee replacement surgery is usually recommended. It is important to keep a note of these general guidelines.

• Young people would most often seek to preserve their knee joints. So, knee replacement surgery is suitable for people aged 65 and above.

• Generally, surgeons aim to preserve the joint as much as possible.

• To determine the appropriate and most suitable treatment, it is essential to consult a knee specialist who can assess an individual's situation and discuss suitable options.

Conclusion

Deciding between surgical or non-surgical treatment for patients with knee osteoarthritis can be challenging for physicians. Non-surgical treatment options like weight loss, physical therapy, and injections have proven effective for managing mild-to-moderate knee osteoarthritis. However, studies have shown patients who undergo total knee arthroplasty for moderate-to-severe knee osteoarthritis have experienced greater relief, enhanced functionality, and improved quality of life. These patients have also resumed normal activities potentially faster than those who underwent non-surgical approaches.