[The purpose of this website is to provide up-to-date information about advances in prevention of and early intervention in arthritis of the knee, thereby creating an informed public requiring fewer Total Knee Replacements.]

This Web site has been compiled by Dr. Edward MacMahon, who is a semi-retired Board Certified Orthopedic surgeon and member of the Orthopedic Research Society.

Behind the scenes, a high-stakes competition is taking place over the future treatment of the growing number of patients with osteoarthritis (OA) of the knee.

On one side of the controversy are those medical professionals whose goal is to prevent the later need for a Total Knee Replacement. Pitted against them are the manufacturers of knee replacements and the surgeons who specialize in implanting them.

The stakes are enormous. The recent $310 million settlement between the artificial knee and hip joint makers and the government to settle illegal kickbacks to surgeons illustrated the value of the stakes. ref 

Since those most personally affected by the competition are people with arthritis of the knee, it is they who urgently need to be informed of new advances in order to determine the most appropriate treatment.

The purpose of this website is to provide up-to-date information about advances in prevention of and early intervention in arthritis of the knee, thereby creating an informed public requiring fewer Total Knee Replacements.

The three most common types of arthritis of the knee are:

1. Alignment disorders of the leg. These lead to overloading in one area and the subsequent and rapid wearing out of that area—for example, bow legs (Fig. 1).
   
   

   Fig. 1. Both knees need total knee replacement. This could have been prevented.

   
   
2. Sports-related injuries. These damage some of the joint surfaces and ligaments that control surface movements. Repeated abnormal motions, and the body’s attempt to heal the recurring injuries, produce the typical “wear and repair” arthritis of the whole knee typically found in former athletes (Fig. X below).
       
   
   
3. Inflammatory arthritis of knee resulting from chemical metabolic disorders. Even though not caused by misalignment or injury, such inflammation leads to extensive destruction of the joint. The most common example is rheumatoid arthritis, but there are many other cases in which the specific cause is unknown. 

Contrary to popular belief, none of these three types is the inevitable result of old age. What all have in common, however, is that they have an onset—and, without early intervention, are likely to progress over time to a point where joint replacement is required.

The number of Total Knee Replacements being performed annually in the U.S. is rapidly becoming a financially unsustainable burden on the health care system. Worldwide, the frequency of this procedure is skyrocketing—despite the fact that it is irreversible and that, over time, many replacements loosen or wear out. When this happens a second, more complicated procedure called a revision is required.  Indeed, the number of Total Knee Replacement revisions has become so great that a new sub-specialty in orthopedic surgery has emerged.

The medical wave of the future, however, is the prevention or early diagnosis of a disease, followed by some form of early intervention. This is made possible by the new science of dividing disease processes into a series of steps that, when laid out, map the pathway of the disease from beginning to end. The advantage of this method is that, once the steps are identified, treatment can focus on blocking the disease at its early stages. Today, for example, blockers such as sunscreens to prevent skin cancer and beta blockers for heart disorders have become part of the everyday medical lexicon. Those activists who campaigned so successfully against smoking can be expected to become involved in the prevention of end-stage arthritis of the knee.

We now know the first steps in the pathways of many forms of arthritis of the knee. Currently, early treatment for alignment disorders of the knee shows the most promise for preventing the need for later Total Knee Replacement. Chemical blockers for early rheumatoid arthritis also should soon be available.

As a result, waiting for osteoarthritis of the knee to advance to the stage of requiring joint replacement need not be a patient’s only medical option. If you have been diagnosed with osteoarthritis of the knee and told you may need a Total Knee Replacement, click on Prevention vs. Replacement for more details—and to find the knowledge you need to make an informed medical decision.

NOTE: THIS WEB SITE IS FOR INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY.

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