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Would a Knee Replacement Reduce Your Knee Pain?

Thinking of having a knee replacement? The SMART Choice digital decision tool that’s being developed could help you assess your individual risks and benefits.

Knee replacement surgery has been on the rise in Australia, with over 60,000 procedures every year. Most are due to knee pain caused by osteoarthritis, which is increasing, but it’s also in part because we’re living longer.

Your knees are extremely important joints because they allow you to bend to do the most simple – and the most complex – of physical tasks. Plus, they help carry the full weight of your body.

As we age, we want to stay as mobile as possible, to walk comfortably, practise yoga, dance, climb the stairs or get out of bed without knee pain or knee stiffness. The ability to do all of these things with ease depends on the health of your knees.

If osteoarthritis starts to cause chronic knee pain and limited movement, most people seek treatment from rheumatologists and orthopaedic surgeons. But those with osteoarthritis of the knee and knee pain may also benefit from the new SMART Choice decision tool.

If you’re thinking of having a knee replacement, you may be the perfect candidate to participate in the new HCF Research Foundation funded trial of the SMART Choice tool, which will be launching in July 2022. This is the first time HCF members have been invited to participate in this kind of research. (If you’d like to participate you can contact the research study directly using the information at the end of this story).

“A knee replacement substantially improves a person’s quality of life,” says Dr Chris Schilling, Senior Research Fellow at the University of Melbourne and a Principal Investigator for the new SMART Choice digital tool. “In fact, people say it gives them a completely new lease on life, which also boosts their mood. After knee replacement surgery, people can do things they may not have been able to do for years, such as play the sport they love or do everyday activities like getting out of bed without pain – especially from osteoarthritis of the knee.”

What are the causes of knee osteoarthritis?

Osteoarthritis of the knee is caused by the cartilage within the joints breaking down. It usually develops slowly, as mild pain and gets worse over time. Factors that increase the risk of developing osteoarthritis of the knee include age (the risk increases as we age), weight gain, accidents, genetic predisposition and overuse of the joint.

Osteoarthritis of the knee can impact day-to-day life with pain after simple activities like walking, or difficulty sitting and standing and stiffness in the knee, and it can cause other symptoms like swelling, loss of flexibility, bone spurs and acute tenderness or grating pain. It affects the bone, cartilage, ligaments and muscles.

If knee pain persists after targeted exercise and osteoarthritis knee treatment, which can include physio and corticosteroid injections, a knee replacement may be suggested.

“This can be extremely successful surgery that improves your mobility and quality of life,” says Dr Schilling. “Yet research shows that 1 in 5 people only receive minimal improvements from a knee replacement, which means that 11,000 Australians are having surgery that is not benefiting them.”

What should you know before knee replacement?

During knee replacement surgery, your doctor removes the damaged parts of your knee, then fits a prosthetic replacement joint, making sure it’s correctly positioned for stability and alignment. Recovery from this procedure often takes 3-6 months and full knee flexibility may take 12 months to return.

“Understandably, before electing to have a knee replacement, patients ask, ‘Will this surgery help me?’, then they often use Dr Google for answers,” says Dr Schilling.

To remove the guesswork, Dr Schilling and colleagues have spent the last year developing the SMART Choice decision-making digital tool, which will soon be trialled via a smartphone, computer or tablet.

“This quick online assessment involves answering a series of simple questions to provide information such as your age, height, weight and gender and whether you find it difficult bending or walking up or down stairs,” Dr Schilling explains.

The answers are then analysed by the SMART Choice tool, which has a comprehensive database of information that has been collected over 10 years by researchers studying knee replacement patients through the St Vincent’s Melbourne Arthroplasty Outcomes (SMART) Registry, and can help you make an informed decision about knee replacement surgery. On this database are knee surgery patients, who have a range of different ages, physical and medical profiles.

The SMART Choice tool then matches knee surgery candidates with people who have similar physical and medical profiles, and you’re given information about whether you’re likely to find a knee replacement very effective, mildly helpful or of little benefit. The aim is to give insight (informed by patients’ experiences) into whether knee replacement surgery, which is costly and often painful, is likely to make a difference to you.

“We hope the decision-making tool helps people avoid surgery that doesn’t improve their knee pain or movement very much,” says Dr Schilling. “When knee replacements are not very successful, people may feel upset and frustrated after taking time off work, using up sick leave and going through pain while recovering. On the flip side, they feel that those challenges are all worth it if their surgery alleviates their chronic pain and makes movement much easier again.”

A better understanding of knee pain treatment options

The SMART Choice tool was finalised in April 2022 and a pilot study will take place until the end of 2022 to assess how easy it is to use and what impact it has on patients’ choices.

If you use the tool and results show you’re not the best candidate for a knee replacement, you’ll be advised of other evidence-based treatment options that may help reduce your knee pain.

“Knee replacement should only ever be a last resort because, even though new knee joints are made from high-quality materials, they don’t last forever and may need to be replaced 10, 15 or 20 years later,” Dr Schilling explains.

The HCF Research Foundation: Improving member treatment

The development of the SMART Choice tool has been funded by the HCF Research Foundation, which was established 21 years ago to drive research, enquiry and innovation in the delivery of healthcare for the benefit of all Australians.

“We support a wide range of research in many areas, ranging from back pain, mental health, maternity care, and support after a heart attack to preventing adverse drug reactions in the elderly,” says Dr Chris Pettigrew, Head of the HCF Research Foundation.

The Foundation aims to drive positive change so HCF members receive the right care and treatment at the right time, and to improve health outcomes now and in the future.

“There’s a huge trend in telehealth and digital options,” Dr Pettigrew points out. “Whether our members live in rural or regional communities or cities, we want to provide them with even faster, easier access to high-quality, evidence-based, online health information that they can trust.”

If you’re interested in participating in the SMART Choice decision tool study please email the research team at smart-choice@unimelb.edu.au

Words by Stephanie Osfield
First published May 2022

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