I just returned from our annual meeting of Orthopedic Surgeons in Orlando, and have been trying to pull together the most up to date evidence on the uses of these exciting new technologies for treating arthritic joints, and ultimately regenerating worn out cartilage that has broken down and allow some regeneration. The ideal “recipe” is still years away, but we are developing a greater understanding of the reasons joints deteriorate, and are trying to develop treatments to slow this process.
One thing that is clear, there is no technology out there that “cures” arthritis. What we do know, that in a damaged joint (from previous injury, meniscus tears, genetics, weight issues) the balance between the enzymes and chemicals in the joint get out of balance, and the cells that breakdown cells (catabolic) are working harder than the cells that maintain a healthy joint.
Many of our treatments are aimed at changing regaining that balance. HA (hyaluronic acid) is a gel made from rooster com and can also be made synthetically. Some of the brand names include Synvisc, Eufflexa, Orthovisc, or Suppartz. The HA is given weekly from 1-5 injections depending on the brand. These have been very popular, and recently the American Academy of Orthopedic Surgeons practice guidelines have indicated they are not recommended anymore, as long term studies do not show an effectiveness over corticosteroids (cortisone injections). We still do provide these for patients as it is covered by insurance and up to 70% of patients to get relief. Steroid injections do have their risks, including infection. In a patient that is looking for pain relief, and who is not ready for a knee replacement, this is a common alternative. I imagine it will not be long before insurance companies no longer cover them.
We have been using Platelet rich Plasma (PRP) for the past 5 years in treating patients with mild-moderate arthritis. Double blind studies have shown better pain relief than HA or steroids at 6 months. PRP seems to work in part, by reducing the inflammatory cells that breakdown cartilage. PRP is not covered by insurance, but it is a straightforward procedure. We take blood in the office, centrifuge the cells and concentrate and separate the platelets (which are full of growth factors), and inject them into the joint that is affected. The results are seen over weeks, not days and can last over 6 months. My personal feeling is that this is a much better option than HA or steroids. The risks of all injections includes infection or post injection swelling or pain that can last several days. These risks are very small, however.
I have recently been trained to harvest stems cells and use these to target damaged joints or tissues. This is one of the most exciting new technologies out there, and we believe that by targeting stem cells to damaged joints, that stimulate new growth of cartilage and slowing the joint breakdown will allow us to develop that “recipe” of various growth factors to heal a damaged joint.
My next blog will be on the specifics of stem cells, and how bone marrow stem cells differ from those derived from fat, and the pros and cons of both.
Lesley J Anderson, MD