Having a partial or total knee replacement (also called unicompartmental or total knee arthroplasty) is a serious undertaking that will have a permanent impact on your life – both immediately following the surgery and for years to come. If persistent meniscus knee pain is leading you to consider knee replacement surgery, now is the time to consider all options.
A new treatment option for meniscus knee pain is available in select European markets. The NUsurface Implant is the first “artificial meniscus,” and it is made of medical-grade plastic and inserted into the knee through a small incision. The NUsurface® Implant is not meant to completely eliminate the need for knee replacement later in life, but to offer an alternative to treat knee pain and keep patients active until much more invasive knee surgery is indicated. By giving patients an additional step on the path toward knee replacement, the NUsurface implant can potentially reduce the need for more invasive, revision knee replacement surgery, in which the old knee replacement implant is removed and replaced with a larger one.
But which procedure is right for you? As you navigate this life-changing decision, here are three things to consider when contemplating NUsurface surgery vs. Partial or Total Knee Replacement:
1. Knee replacement surgery is typically not recommended for patients younger than 50, while Meniscus replacement surgery with the NUsurface® implant may be an option for patients as young as 30
A patient’s pain and activity/disability level are two indications for surgery; most patients who undergo a partial or total knee replacement are age 50-80. Why? Knee replacements are not as durable as your knee and eventually wear out. On average, a knee replacement implant may be anticipated to last about 15-20 years, so if you have the procedure in your 40s, you will most likely need to have a second, and possibly third surgery, called a revision knee replacement, later in life.
A revision knee replacement is generally more challenging and higher risk than the first surgery. The goal remains the same to relieve pain and improve function. However, revision knee replacement surgery is a more lengthy, more complex procedure that requires extensive planning, specialized implants and tools, extended operating times, and mastery of complicated surgical techniques to achieve a good clinical result. Coupled with the fact that you will be older and may be less resilient when the revision surgery is required, is why knee replacement is generally not recommended for younger patients.
The NUsurface® Meniscus Implant is designed to reduce pain and allow patients to return to activities of daily living without the need for knee replacement. By delaying the need for knee replacement surgery until later, patients and doctors have more options for managing debilitating knee pain in middle-age patients.
2. Meniscus replacement with the NUsurface implant does not remove bone or cartilage Knee replacements do
Inserted through a small incision, approximately 4 to 8 centimeters in length, the NUsurface® Meniscus Implant does not require fixation, screws, or glue. As such, the procedure to insert the device does not require the removal of any the load bearing bone from your knee. Because the NUsurface implant is not attached to your knee, and does not require significant removal of bone, it may be easily removed and exchanged for another NUsurface implant, or if desired the implant may be permanently removed without affecting future treatment options, including knee replacement.
In contrast, knee replacement surgery involves significant changes to your knee joint that cannot be reversed, and the fixation of metal/plastic components into your knee.
More specifically, during a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The top of the tibia is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may be added under the kneecap (patella) surface. The artificial components of a total knee replacement are referred to as the prosthesis. As with all surgical procedures, your surgeon will explain what treatment options are best for you, and not everyone who undergoes knee replacement receives all of these components.
3. Your doctor may tell you that you are not a good candidate for meniscus replacement, or knee replacement surgery
Even if your knee pain is significant, most doctors will recommend non-surgical treatment options before surgery is offered. Non-surgical treatments have the potential to help reduce pain and improve function, but they may not be able to slow the progression of any degenerative changes inside your knee. Most non-surgical treatment programs combine lifestyle modifications, weight loss, oral and/or injection medications, bracing, and physical therapy.
Lifestyle Modifications for Knee Pain
Your doctor may recommend rest or a change in activities to avoid provoking osteoarthritis pain. This advice may include modifications in work or sports activities. It may mean switching from high-impact activities, such as aerobics, running, jumping, or competitive sports, to low-impact exercises, such as stretching, walking, swimming, or cycling.
Weight Loss Program for Knee Pain affects weight-bearing joints, such as the knee. Estimated that for each kilogram you weigh, your knees feel the force of 1.36 kg of pressure when you take a step. As a result, your doctor may recommend a weight loss program. Losing just 4.54 kg will result in 13.6 kg less pressure per knee, per step.
Medications for Knee Pain
Pain-relieving drugs, like acetaminophen (also known as paracetamol), can help reduce pain. Non-steroidal anti-inflammatory drugs, such as ibuprofen, can help reduce pain and inflammation. Opioid drugs may also be prescribed to address pain, but carry risks related to addiction. Doctors sometimes recommend potent anti-inflammatory agents called corticosteroids that are injected directly into the knee joint to provide temporary relief of pain and swelling. Hyaluronic acid injections in the knee are also sometimes recommended by your doctor to aid with lubrication of the knee joint to provide short-term pain relief. While oral and injection medications may temporarily reduce pain, they will not heal a damaged meniscus nor any underlying condition.
Physical Therapy for Knee Pain
A balanced fitness program and physical therapy may improve joint flexibility, increase range of motion, reduce pain, and strengthen the muscles that support your knee. Supportive devices, such as braces, splints, elastic bandages, crutches, or a walker, may be recommended by your doctor. Ice or heat may be applied to the affected joint for short periods several times a day. Your therapist or doctor may also use a treatment called neuromuscular electrical stimulation (NMES) to help improve the strength of your leg.
Your doctor may give you additional or alternate information regarding meniscus knee pain and knee replacement surgery, depending on your particular situation. If you have questions about which treatment might be best, schedule an appointment with your doctor to discuss what’s right for you.