The Best Alternative to Knee Replacement for Osteoarthritis 

Is there a non-surgical alternative to knee replacement surgery that treats the cause and offers only beneficial side effects? 

The largest study in history on the health effects of being overweight, analyzing data from more than 50 million people from nearly 200 countries, found that excess body weight accounts for the premature deaths of about four million people every year. Most of these deaths are from heart disease, but the researchers “found convincing or probable evidence” linking obesity to 20 different disorders—a veritable alphabet soup of potential health concerns.

In the ABCs of the health consequences of obesity, A is for arthritis. Obesity can make rheumatoid arthritis worse and increase the risk of another inflammatory joint disease—gout, the so-called disease of kings. The most common joint disease in the world, though, is osteoarthritis, and obesity may be its “main modifiable risk factor.” 

Osteoarthritis develops when the cartilage that lines and cushions our joints breaks down faster than our body can build it back up. Our knee is the most commonly affected joint, leading to the assumption that the association with obesity was simply due to the excess wear and tear from the added load on the joints. But non-weight-bearing joints, like our hands and wrists, can also be affected, suggesting the link isn’t “purely mechanical.” Obesity-related dyslipidemia may play a role, with elevations in the amounts of triglycerides, fat, and cholesterol in the blood aggravating inflammation in the joints, just like cholesterol can exacerbate the inflammation in our artery walls.

Osteoarthritis sufferers not only have higher cholesterol levels in the blood, but they also have them within their joints, as you can see below and at 1:52 in my video The Best Knee Replacement Alternative for Osteoarthritis Treatment, in aspirated joint fluid and also found in the cartilage itself.

When cholesterol is dripped onto human cartilage in a petri dish, the inflammatory degeneration worsens, which helps explain why the higher our cholesterol, the worse our disease, as shown below and at 2:05. 

Cholesterol-lowering statin drugs may help prevent and also treat osteoarthritis, as can a cholesterol-lowering diet. In fact, a healthy enough plant-based diet may offer the best of both worlds, dropping cholesterol as much as a starting dose of a statin drug—within a single week—and having only good side effects, such as lowering blood pressure and facilitating weight loss. 

Even losing only about a pound a year for a decade may decrease the odds of developing osteoarthritis by more than 50 percent. Weight reduction may even obviate the need for knee replacement surgery. Osteoarthritis sufferers with obesity who were randomized to lose weight improved their knee function as much as those undergoing surgery—and did so within just eight weeks. The researchers concluded that losing 20 pounds of fat “might be regarded as an alternative to knee replacement.”

Isn’t it easier to get your knees replaced than lose 20 pounds, though? Rarely discussed is the fact that nearly 1 in 200 knee replacement patients lose their lives within 90 days of surgery. Given the extreme popularity of this surgery—about 700,000 are performed each year in the United States—an orthopedics journal editor suggested that “people considering this operation are inadequately attuned to the possibility that it may kill them.” Arguably, that’s the single most salient fact to share with a patient who is considering the operation. Responding to the question of whether patients should be told about the chance the operation may kill them, an orthopedic surgeon said: “To me, the real question is whether this knowledge will help the patient. Will it add to the anxiety of the already anxious patient, perhaps to the point of denying that patient a helpful operation? Or will this knowledge motivate a less-handicapped patient to stick to a diet and physical activity regime? Ultimately, then, the question boils down to the surgeon’s judgment.”

Even among the vast majority who survive the surgery, approximately one in five knee replacement patients describe being unsatisfied with the outcome. Weight loss with a healthy diet, on the other hand, may offer a nonsurgical alternative that treats the cause and has only beneficial side effects.

I continue the alphabet of obesity with the next few videos in the related posts below.

You may be interested in my book on weight loss, How Not to Diet, and its companion, The How Not to Diet Cookbook, which is full of health-promoting, Green-Light recipes. Request them from your local library.

For more on joint health, visit the topic page.