Knee replacement given to patients with low back and hip pain
In the case of chronic joint pain, a thorough examination is imperative in identifying the correct diagnosis. That sounds like common sense, but the sad truth is that the source of pain is often missed. Let’s take a look at some recent research.
One study sought to understand why up to 20 percent of patients who undergo total knee replacement still have persistent pain and why secondary surgery rates are on the rise1. Forty-five patients were studied. What the researchers found was somewhat shocking. The pain was not originating in the knee – here is what they said:
“Patients may still be undergoing knee (replacement) arthroplasty for degenerative lumbar spine and hip osteoarthritis. . . We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.”
In other words, patients received a knee replacement when the cause of pain came from the hip and spine.1
Masked Hip Pain
Distribution of pain originating in the hip was:
- 89 % to the groin
- 38 % to the buttock
- 33 % to the anterior thigh
- 29 % to the knee
- 27 % to the greater trochanter
- 17 % to the low back
- 8 % to the lower leg
Twenty-nine percent to the knee? No wonder so many total knee replacement patients still had knee pain!
Conservative Treatment vs. Surgery
Often, a patient who is seeking a Prolotherapy consultation will have had a surgery recommendation elsewhere. Reasons for surgery are many, but they may have nothing to do with the actual problem causing the pain as cited above. Also, undergoing conservative treatments before surgery is truly common sense.A physical examination and a listening ear are the best ways to diagnose pain. Unfortunately, rarely will a physician describe a ligament or tendon injury as a cause of chronic pain when in fact ligament and tendon weakness are the source of most musculoskeletal injuries. In our opinion, when it comes to chronic pain, physicians with a listening ear and a strong thumb to palpitate the suspect areas make the most accurate diagnoses. In cases where ligament damage and instability are found, Prolotherapy is a conservative and effective treatment in treating injured ligaments and tendons causing chronic pain, arthritis and sports injuries.
1. Al-Hadithy N, Rozati H, Sewell MD, Dodds AL, Brooks P, Chatoo M. Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies? Int Orthop. 2012 Jan 11. [Epub ahead of print]
2. Nakamura J, Oinuma K, Ohtori S, et al. Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip. Mod Rheumatol. 2012 Apr 11. [Epub ahead of print]