19MAR

Knee Pain Despite Total Knee Replacement

Overview:

Any joint in the body may be affected by inflammation along with joints deteriorating with age, leading to pain. According to WHO, it is particularly common in the knee.It could become a serious disability and affect daily activities.

Knee replacement surgery is usually seen as the last resort to relieve pain and stiffness, and restore mobility.

Total Knee Replacement:

Even today, TKR is the common elective procedure of treating severe arthritis of the knee, as there are no known solutions to tackle the root cause of the issue, cartilage damage. The surgery attempts to restore the function of the joint, by means of the replaced or implantedjoint.

Though it has post-surgery challenges, they are often marginalized, sidelined and ignored.

The surgical procedure may not help regain the maximum range of motion, and the inserted replacement may become loose or dislocate along with wearing out after 15 to 20 years1, requiring further surgery. Furthermore, TKR is a highly invasive and expensive procedure.

Knee Pain Post TKR:

Knee is the largest joint in the body made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). Articular cartilage (a smooth substance) covers the ends of the three bones where they touch to enable movement.

The surgeon, during TKR procedure, cuts awaythe damaged bone from the surface of knee joint and replaces itwith a man-made surface of metal and plastic. The replacement is affixed using adhesives or application of mechanical pressure by means such as hammering.

Around 44% of TKR patients2continue to experience pain of any severity 3-4 years after surgery and 15% patients reported severe to extreme persistent pain despite the invasive knee surgery. They also face a lot of restriction in day-to-day life.

The vulnerabilities include having had persistent pain in the past, having psychosocial factors like depression, anxiety, poor mental health, and having other habits such as smoking.

Over one-third of the patients with the most common form of arthritis do not have pain emanating from the joint. The upper low back nerves, the sacroiliac joint, the muscles, and the tendons can all cause pain.

Severe pain despite joint replacement is becoming more common and is often caused by an inaccurate diagnosis of the pain generator before the surgery. Specific etiology must not have been clearly delineated. Knee replacement decision is not to be made with just a cursory exam and an X-ray.

Persistent post-surgical pain (PPSP) is a severe problem with significant social and health care costs, and also causes considerable individual suffering.

Stromal Vascular Fraction (SVF)/ Sonicated Lipoaspirate Filtrate (SLF) – A Procedure Offered By Sahaj Therapy:

SVF/SLF technique uses autologous, adipose derived cells. SVF/SLF cells are a component of the adipose tissue (found under the skin, around internal organs and in bone marrow), that is extracted from the patient’s body using aspiration.

The cells are processed, without the use of enzymes, chemicals, animal products or culturing, and then introduced into the affected joints. The entire process occurs in a single surgical sitting.

The cells are procured from adipose tissue as it is the richest source of Pericytes available within the body.

There are advantages like rapid processing, and clinical application, less chance of contamination and lower costs. Unlike the use of culture expanded cells, there are no risks involved.

The procedure has a strong safety profile with no severe adverse complications linked to the therapy.

References:

  • Buechel FF, et al. "Twenty-year Evaluation of Meniscal bearing and rotating platform knee replacements." Clinical Orthopaedics & Related Research, 388 July 2001:41-50
  • Treede, R. D. et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70, 1630–1635 (2008)