Causes of Degeneration of the Knee and Surrounding Structures

The knee is the largest joint in the body, connecting the thigh and leg bones. Our knees are extremely vulnerable to injury and damage because we use them with nearly every leg movement we make. Sprains, tears, and bruising of the knees can occur because of daily wear and tear on the joint, as well as a host of other reasons. No matter the cause or causes, however, it is because our knees take such a beating that we ought to care for them in the best possible ways.

Mechanical Issues
Knee injuries occur in even the most cautious individuals because, frankly, injuries happen to all of us. Mechanical issues such as the presence of broken pieces of cartilage or bone that become wedged within the knee joint; foot and hip pain that compromises your posture, alignment, gait and knee function; as well as the dislocation of the patella—commonly referred to as the kneecap—are all examples of how improper movement can wreak havoc on your knees.
Medical Conditions
Medical conditions such as osteoarthritis and rheumatoid arthritis of the knees are also to blame for chronic and prolonged pain that can cause the knee to deteriorate. With osteoarthritis (OA), cartilage degenerates due to aging, use, and bone-on-bone friction in the absence of any remaining cartilage. Rheumatoid arthritis (RA) involves inflammation of the synovial membrane that surrounds the knee joint. With RA, cartilage disintegrates as inflammation increases, pain persists, and mobility is diminished.
Physical Injuries
Other contributing factors to knee pain that lead many to consider surgery include injuries, such as tears in the anterior cruciate ligament or ACL. ACL ruptures are rather common in both professional and amateur athletes, as this ligament connecting the thigh bone to the shin bears the brunt of quick movements and sudden changes in position on the court or the field.
Fractures of the knee, whether the result of direct contact or idiopathic in nature, can also create a perfect storm for degeneration of the joint. Meniscus tears which are the result of damage to the knees’ “shock absorbers,” bursitis, a condition in which the small sacs, or bursae, around the knee become inflamed, and tendinitis, which involves inflammation of the tendons that join bone to muscle, can all cause continuous, protracted pain that requires medical intervention.
Risk Factors
There are several key factors that are within our control in preventing knee damage and deterioration of the joint and surrounding cartilage. Obesity, often quoted as a precursor to a variety of ailments, creates excess pressure and strain on the knees and as such, increases the risk of developing osteoarthritis and destroying cartilage. Limited flexibility and poor muscle strength also contribute to knee pain, as flaccid or weak muscles are unable to absorb the stress of your movements, which in turn forces your knees to do the job. Lastly, there appears to be a significant correlation between consumption of alcohol and beer, and an increase in osteoarthritis. OA greatly increases the chances of developing more knee pain, making alcohol a probable contributor to the degeneration of the knee.
The Dangers and Risks of a Total Knee Replacement

While a total knee replacement (TKR) is often suggested as treatment for impaired knee function, no matter the cause, it is important to note that there are a host of dangerous risks and complications that can result from a total arthroplasty, or TKR.

For one, the risks of contracting infections as the result of general surgery and in response to metal implants that may be placed within the knee cavity to repair and reset the damage, are extremely high. If left untreated or poorly managed, infections can spread throughout the body and cause catastrophic, septic conditions.
Blood clots are another risk factor of a TKR and one of the most frequently reported complications of a total arthroplasty. Clots can form in the legs, break off, and travel to the lungs, heart, or brain, causing asphyxiation, bleeding, and even death. Additional risks of a total knee replacement include chronic pain, nerve damage, limited range of motion and mobility, as well as a decrease in independent functioning.
Alternatives to a Total Knee Replacement
HemiCap and Osteotomy
Despite the inherent risks involved in a TKR, there may be times when you and your doctor determine that surgical intervention is indeed necessary. Depending on the conditions you are dealing with, you may want to inquire about your candidacy for smaller scale procedures, such as the HemiCap Wave or osteotomy. The HemiCap Wave has preliminarily demonstrated success with the use of an implant meant to restore the articulation between the patella and femur. An osteotomy on the other hand, allows the surgeon to cut or remove part of the bones surrounding the knee, so as to encourage better bone alignment.

Stem Cell Therapy

With the advent of stem cell therapy, there are even more alternatives and options to total knee replacements and surgical, restorative care. According to the
Journal of Arthritis Research and Therapy, the transplantation of mesenchymal stem cells (MSC) into the damaged areas of the knee and its surrounding structures, appears to successfully generate cartilage—like tissue that assimilates into the natural tissue present. MSC transplantation requires fewer surgical procedures than other treatments, is less invasive, and can be used as an effective approach even in the presence of extensive joint or cartilage damage. It is hoped that stem cell treatment will one day be the standard by which other restorative procedures are measured.
Choosing the Treatment That is Best For You

While total knee arthroplasty is a procedure laden with risks, pitfalls, and significant long term orthopedic limitations, it may be warranted in extreme medical situations. Prevention of the conditions that lead to knee and cartilage degeneration is always the best way to go, but if you are beyond that point, it is important for you to know that there are alternatives procedures and therapies you can pursue.

Dr. Shahen Kurestian, DC is a Doctor of Chiropractic who can help you determine your best arthropathic and orthopedic treatment options. Dr. Kurestian’s offices are located in Glendale, California. There, he and his Body Systems Wellness team aim to serve the public, provide the best healthcare possible, and conduct themselves with steadfast conviction and determination to their clients’ safety and welfare.
Contact Body Systems Wellness for a free consultation. Let us help you find the best alternatives to a total knee replacement and the minimally invasive care you deserve.
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