Living with Chronic Knee Pain

Are there options other than knee replacement?

Treatment for chronic knee pain due to arthritis/degenerative joint disease often starts with conservative management including anti-inflammatory medication, lifestyle modification including weight loss, joint bracing, and physical therapy. As the condition progresses, treatment escalates to interventional therapies ranging from knee injections with steroids or joint lubricants to genicular nerve blocks and eventually to surgery. When all else fails, knee replacement surgery may be the last option.

The incidence of joint replacement procedures is high, with over 1 million total hip and total knee replacement procedures performed each year in the United States.  The 2010 prevalence of total knee replacement in the total U.S. population was 1.5%. Prevalence was higher among women than among men and increased with age. The prevalence of total knee replacement at fifty years of age was 0.68% and increased to 2.9% at sixty years, 7.3% at seventy years, 10.4% at eighty years (1).

These estimates corresponded to 4.7 million individuals (3 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. 

Complications related to total knee replacement, although uncommon, range from minor problems to devastating, life-threatening events. Knee replacement surgery can result in physical complications ranging from pain and swelling to implant rejection, infection and bone fractures. Pain may be the most common complication following knee replacement surgery. 

Reports estimate that around 20 percent of total knee replacement patients are dissatisfied with their outcome. Similarly, in a systematic review of high-quality prospective studies of patients with osteoarthritis undergoing total knee replacement, the proportion of people with an unfavourable long-term pain outcome in studies ranged from 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in about 20% of patients after knee replacement (2). 

 

​This clinical trial aims to study an alternative therapy using an established form of neuro-electrical stimulation for arthritic knee pain. It is based on the experience of clinicians utilizing dorsal root ganglion stimulation for the treatment of other forms of knee pain and is designed to give patients an option other than surgery or knee replacement.

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