It’s estimated that nearly 800,000 knee replacements are currently performed in the United States each year. Due to the combination of ageing and poor lifestyle choices, researchers expect the number of annual total or partial knee arthroplasty procedures to triple by 2040.  While many patients report significant improvements in pain and function following a knee replacement, such a procedure does carry some risks that can lead patients to exhaust non-surgical options before considering surgery. These risks can include infection, blood clots, anesthesia complications, prolonged recovery (including persistent pain and swelling, limited regain of mobility, nerve damage, and additional surgeries to repair or replace the artificial joint). What, if anything, can be done to delay or possibly prevent a knee replacement?

First, let’s take a look at what ultimately leads a patient to consider a knee replacement. Luckily, a 2024 study looked at what finally led patients to consider total knee replacement surgery and found the top two reasons are “when the existence of pain impedes the capacity to participate in daily life activities” and “fears and uncertainties regarding the progression of the disease.” Thus, patients who can manage their pain enough to perform their usual activities and feel like they have a handle on the condition are less likely to consider surgery.

There are MANY conditions that can lead up to needing a knee replacement, of which the most common is osteoarthritis. Osteoarthritis is a condition in which the smooth surfaces of the joint (called hyaline cartilage) erode, leading to eventual bone-on-bone contact, which can be painful and disabling. While genetics can play a role, osteoarthritis is typically the result of wear and tear on the joint, either from overuse and/or poor biomechanics.

When a patient seeks chiropractic care to help manage osteoarthritis of the knee, the examination will consider the patient as a whole because issues in other parts of the kinetic chain can lead to increased forces on the knee. For example, if the ankle is overly pronated (rolling inward), it can place added stress on the knee joint. Any issues potentially contributing to the patient’s knee pain will be addressed with a multimodal approach including manual therapies, like manipulation and mobilization; balance and resistance exercise training; prescription foot orthotics; physical therapy modalities such as electrical stim, ultrasound, pulsed electromagnetic field, and laser; as well as diet and weight management strategies to reduce inflammation. Patients may also be encouraged to perform weight bearing exercises as the cartilage in the knee joint requires compressive forces to absorb nutrients and stay healthy.