Best treatment osteoarthritis of the knee
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Osteoarthritis is the most common type of arthritis affecting approximately 28 million Americans. It is a disease that causes premature degradation (wearing away) of hyaline cartilage, the type of cartilage that caps the ends of long bones within a joint. Osteoarthritis occurs as a result of a number of metabolic disturbances that result in cells called chondrocytes, producing a multiplicity of destructive enzymes that degrade cartilage.
At the same time, cytokines, inflammatory proteins are produced by the synovium (lining of the joint) that foster inflammation.
There is some evidence that underlying bone also participates in the process.
The end result is eventual loss of cartilage with exposure of underlying bone and chronic inflammatory changes in the synovium.
Osteoarthritis (OA) is primarily a disease of weight-bearing areas including the neck, low back, hips, and knees.
The treatment of osteoarthritis has largely been symptomatic with total joint replacement reserved for those patients who fail more conservative measures, including analgesic medication, non-steroidal-anti-inflammatory drugs (NSAIDS), physical therapy, exercise, and injections of either glucocorticoid or hyaluronic acid.
Both orthopedists as well as rheumatologists have searched for alternative solutions, particularly with the knee.
Currently, there are four major methods of managing full thickness cartilage defects in the knee.
The first is what is called microfracture. With this technique, multiple holes are drilled into the bone where cartilage is missing or damaged. The theory is that mesenchymal stem cells escape from the bone marrow into the knee joint and grow cartilage. The results of this type opf procedure are mixed and the recovery is lengthy.
The second type of procedure is mosaicplasty. Holes are again drilled but then autologous cartilage plugs (cartilage plugs obtained from non-weight-bearing areas of the patient's knee) are plugged into the holes.
The third is autologous chondrocyte implantation. Here, a cartilage plug is removed from a non-weight-bearing area of the knee. It is then processed so that the cartilage cells are cultured so they multiply. A short time later these cells are placed back into the knee at the site of the weight-bearing lesion and a thin film is tacked down to keep all the cells in place. The recovery period with this procedure is also a long one.
With the three above techniques, there are no good randomized controlled studies to show that they are truly effective. Also, these procedures have been used primarily for smaller cartilage defects and the larger defects seen with OA.
The final procedure is autologous mesenchymal stem cell layering. With this procedure, a patient’s own stem cells obtained from bone marrow and fat are prepared and placed into the area of osteoarthritis using both ultrasound as well as arthroscopic guidance. The results are still too early to make significant claims but preliminary data looks promising.
For more information, readers are referred to an article my colleagues and I authored:
(Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48)
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