Chicago patients pursue alternatives to knee replacement surgery

Dr. Victoria A. Brander evaluates patient Dagmar Weinberg, who combats arthritis with physical therapy and medication. (Photo courtesy of Roy Freeman)

Dr. Victoria A. Brander evaluates patient Dagmar Weinberg, who combats arthritis with physical therapy and medication. (Photo courtesy of Roy Freeman)

Excruciating knee pain first drove Roelette Smith to seek orthopedic specialists at highly rated Northwestern Orthopaedic Institute in Chicago about 12 years ago. “It was unreal,” says Smith, a Chicago resident and candidate for knee replacement surgery due to advanced, degenerative arthritis.

Instead, she reduced stiffness and alleviated pain through physical therapy and $950 yearly injections that lubricate and cushion knee joints. “I’m able to get around better and do more,” Smith says.

Chicagoans undergo knee replacement surgery, which involves replacing damaged joints with artificial components, at lower rates than residents in most metro areas, according to Medicare data analyzed by the Dartmouth Atlas of Health Care. The reasons aren’t exactly clear, but experts speculate factors might include higher spending on preventive care, access to minor knee procedures and an increase in programs offering non-surgical options first.

The cost of knee replacement procedures may give some pause, too. Healthcare Blue Book estimates the fair market price for total knee replacement in Chicago at $20,185, based on what providers usually accept from insurers as payment in full. So many instead choose less expensive alternatives to improve function and reduce pain.

Providers at Northwestern ask most patients to participate in a nonsurgical treatment program before they’re considered for joint replacement surgery, says highly rated Dr. Victoria A. Brander, who specializes in rehab and physical medicine. Patients in the program try exercise, various medicines, injections, weight loss and physical therapy. Many ultimately decide to forgo surgery, including some with end-stage osteoarthritis.

Angie’s List members explore other options, too. David Goodman of Lisle, who has osteoarthritis in both knees, saw several orthopedic doctors before going to chiropractor Richard Whitney at highly rated Whitney Chiropractic in Lisle for joint manipulations designed to improve function and reduce pain. “I went from planning for knee replacement surgery to being virtually pain free,” Goodman says.

Brian Marion, a highly rated chiropractor in Chicago who’s provided pre- and post-operative care for many knee replacement patients, says adjustments and exercise may reduce pain, improve range of motion and allow some to safely delay surgery. But treatment options depend largely on the condition of a patient’s knee. “We can’t replace cartilage,” says Marion, who typically charges $100 for an initialvisit. Insurance coverage varies.

If a joint retains range of motion, it’s usually OK to delay surgery, says Dr. James Bresch, a highly rated surgeon at Park Ridge-based Orthopaedic Surgery Specialists. But he says patients should explore options with providers, not wait until pain is unbearable or the chance to do a limited procedure like partial knee replacement passes.

Providers say sometimes surgery is the only viable option. Chicago member Dorothy Brockington Bins says injections only temporarily alleviated arthritis pain in her left knee. In 2009, she underwent successful joint replacement surgery that provided a lasting fix. She’s considering having her surgeon, highly rated Dr. Joseph Thometz of Palos Heights, perform the procedure on her right knee. But she continues to pursue alternatives. “Right now, the injections seem to work,” she says

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