Most of the patients view surgery as like getting a part fixed in their car. A part wears out, so you replace it or “fix it” with a new one.

I prefer to look at it like Doctor Centeno describes it: “Surgery is damage to accomplish a goal,” and that goal is not always accomplished. Let’s take this surgical damage concept to the knee. Here attached are some pictures of the damage caused during a knee replacement procedure. Piece of cake!! Muscles split or cut, tendons cut, nerves pulled, bones cut, ligaments and tendons stretched. Minor stuff!  What follows are things to consider before proceding with a knee replacement:

1.Pain after knee replacement surgery.

Persistent post surgical pain is a prevalent but under acknowledged condition after total knee replacement. Three to four years after knee replacement surgery 44% of patient still experience significant pain. In fact 15% report severe-extreme persistent pain.

(Ref:https://www.ncbi.nlm.nih.gov/pubmed/21239114) 

2. Need for knee replacement surgery.

Knee replacement surgery is many times unnecessary. In a new study released in the Arthritis and Rheumatology Journal the finding are alarming since it found that only 44% of the total knee replacements done in the US where judged as appropriate. In 27.1% of the knee replacement done in the US the evidence was inconclusive. And what is worse, in 34.3% the surgery was judged as totally inappropriate.

(Ref: http://onlinelibrary.wiley.com/d…/10.1002/art.38685/abstract

3.- Recovery from knee replacement surgery.

Recovery can take over six months and at times it can take up to a year. 
So as to not discourage patients from having knee replacement surgery, patients are told that they will be well and running around in no time. They use terms like “a few weeks”. “Few”! That is a big word. Ask your surgeon to define the word “few”. According to Dr. Brian Hatten MD who wrote “Road to Recovery” What to expect after knee replacement surgery it is not that simple. It for sure does not sound like a piece of cake to me. Just read the guide. Here is the link to it. 
(Ref: https://www.mykneeguide.com/post-op/road-to-recovery). 

4.- Cost of knee replacement surgery.

It can get way up there. Add them up yourself. Six to twelve weeks before you can return to work. If you have a deductible in your insurance policy it can go anywhere from a couple hundred dollars to three or five thousands dollars. Add to that any copays for doctors visits before the surgery, plus medications cost, plus physical therapy deductibles that your insurance policy may have, and any transportation cost you may have for a while since you won’t be driving for four to six weeks. All of these can add up to a good pile of money. In addition if your insurance policy covers only 80% of the surgery and hospital stay, you would be in for a big surprise since the average cost of knee replacement surgery is forty nine thousands five hundred dollars. So your 20% would be $ 9900. Not a piece of cake by any means. Check the following link for more details about cost.
(Ref: https://www.healthline.com/…/total-kne…/understanding-costs…) 

5.- Complications and risks of knee surgery.

The older you are and the worse your health is the greater the risk. Complications include:  
a) A prosthesis component can become loose or dislocate if it does not seal to the bone well or is misaligned. b) Legs may be slightly different lengths after surgery. In some cases a shoe insert can remedy this problem. c) The new knee may be stiff. Most people who have undergone knee replacement surgery can bend their knees at least 115 degrees. However, some people develop scar tissue that hinders flexibility. This limited flexibility is more common in people who had limited flexibility before surgery. d)An allergic reaction to the bone cement can occur. In these cases the bone cement and prosthesis must be removed. e) Damage can occur to the knee’s patella (knee cap) and/or the soft tissue (muscles, ligaments and tendons) that support the joint between the patella and the femur. f) In rare cases there is damage to surrounding arteries, veins and/or nerves. g) Deep venous thrombosis (DVT) is widely recognized as a major risk in patient that undergo total hip or total knee replacement surgery. Even when proper prevention measures are taken, it is estimated that 3% of patients will develop DVT and 1.5 % will develop pulmonary embolus, the most common cause of death following joint replacement. h) 200% to 300% increased risk of bleeding stomach ulcer i) you are 30 time more likely to have a heart attacks in the first two weeks. And here are the references:

(Refs:https://www.arthritis-health.com/…/total-knee-replacement-r…
http://scarysymptoms.com/…/can-knee-replacement-lead-heart…/
https://www.telegraph.co.uk/…/Heart-attacks-more-common-aft…
https://www.nature.com/articles/ajg2013108

https://www.stoptheclot.org/orthopedic-surgery-fact-sheet.htm  

What other alternatives is there What other alternatives is there then that offers any significant chances of you avoiding surgery?

There are a variety of regenerative medicine techniques that are available today and that are becoming very popular alternatives to surgery! Many patients avoid surgery all together or at least postpone surgery for several years with simple Regenerative Medicine Procedures such as Prolotherapy, PRP and Stem Cell Therapy. These are done at the doctors office in a little over an hour under local anesthesia and at a much lower cost to you. You walk in and out! Find out more about these techniques before you plunge into a major surgical procedure specially when the damage done at times is irreversible. Talk first to friends who have had a knee replacement and see what they tell you. And remember, surgery should always be your last choice. You can always have it done later if all else fails!! 

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