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New Treatments For Osteoarthritis of the Knee

New treatments for osteoarthritis of the knee

In this article you will find out everything you need to know about the most effective new treatments for osteoarthritis of the knee to help prevent you from having surgery.

Aging is a sad reality for the majority of us. Nobody wants to grow older because youth feels like a fresh breath of air and nobody wants to give up on such an amazing part of their lives where they are free to do whatever they want. However, aging comes with its sets of challenges and drawbacks for everyone and sadly, they seem to compromise on our quality of life too!

As a person starts to age, their age is not the only factor that starts increasing. In fact, there are several other internal and external changes as well that start accumulating and making you who you are – an elderly person with time.

Wrinkles, fine lines, less elastic skin, weakened bones, joint pain – all seem to bring the souvenirs that increasing age brings for everyone. Osteoarthritis is also one of the most common and prevalent age-related conditions that many people encounter over time.

Although this is a condition that could be managed and treated appropriately, unfortunately many people do not realize this unless it is too late to stop the disease progression or the already-spreading damage. Even then, many steps could be taken to stop the damage and this is indeed helpful for all the affected people.

What Is Osteoarthritis of the Knee? 

To explore the advanced and new treatment methods that are now being used for reversing osteoarthritis, it is very important that we know and understand what this disease is and how it develops.

Osteoarthritis (also known as OA for short) is a degenerative, age-related condition. It is one of the most common forms of arthritis in the world as well. In this disease, there is mainly age-related wear and tear of a joint and its surrounding cartilage. [1]

Depending on which type of osteoarthritis it is and how much damage it has caused to a person, it may either present as an asymptomatic condition or a full-blown symptomatic condition that makes mobility and daily-life functioning compromised and difficult for the affected person. [2]

New osteoarthritis treatment into the knee

What Causes Osteoarthritis?

Since it is mainly an age-related disorder, therefore it will be reasonable to say that osteoarthritis is indeed an age-related disorder.

However, apart from this main factor, there are several other risk factors as well that make a person susceptible towards developing osteoarthritis, and some of them include:

  • Female Gender:

Women are automatically more prone to develop osteoarthritis because of several reasons. Firstly, their joints are seen to be more mobile and lax than men, which predisposes them to get subjected to wear and tear earlier than men. [3]

Secondly, as a female reaches menopausal age, her estrogen levels start to decrease. Increased estrogen levels enhance bone growth but with menopause, these estrogen receptors are unable to detect anymore incoming estrogen and so, the bone is no longer under its protective impact.  [4]

  • Obesity: 

People with an increased body weight and mass are also more susceptible to develop osteoarthritis, mainly osteoarthritis of the knee.

The reason for this is obvious – with an increased body weight, more and more weight is put on the knee joints, making them compromised and thus, leading to bone and cartilage degeneration before anything else. [5]

  • Sports’ Background/Injuries: 

Athletes and sportsmen, who are more prone than anyone else to suffer from injuries, sprains, and muscle tears, are often seen to develop osteoarthritis at a certain age.

Their joints, muscles, and tendons, all have been put to their maximal usage since a very long time and so, it is almost expected for their joints to give away all the strength that they had been holding in once these sportsmen stop playing or give up on maintaining their fitness status. [6]

Unlike other forms of arthritis, namely Rheumatoid Arthritis, Septic Arthritis, and Reactive Arthritis, usually osteoarthritis is not associated with any other symptoms apart from the affected bones and joints-related ones. This makes it easier to get diagnosed and treated.

Old Treatment Options For Osteoarthritis

It would not exactly be correct to refer to all these conventional methods as ‘old’ ones mainly because they are still employed for the treatment of many patients even today. It is just that now, there are more advanced and targeted interventions and treatment methods that help achieve the desired results in no time.

Several clinical studies have revealed successful results and are thus hoped to replace the older methods of treating osteoarthritis. However, some old ways of treating osteoarthritis include:

Lifestyle Modifications

Even today, the foremost priority is to bring changes into the lifestyle of the osteoarthritis patients. This dudes increased activity, weight loss, and muscle work to power up the body and make it lose any excess weight that might be indirectly contributing towards making human joints of the person obese and thus, resulting in the cumulative joint damage. [7]

Pain Relief Medications

Typically, the joint pain of osteoarthritis presents in such a way that the joints feel stiff and immobile when the person wakes up in the morning. Then, as the day passes by, the joint pain only increases and makes it difficult for the person to move along.

For these osteoarthritis patients, it is important to prescribe some osteoarthritis drugs that target pain relief promptly. Usually, non-steroidal anti-inflammatory drugs (NSAIDs) such as Acetaminophen, Ibuprofen, and Naproxen seem to do the job really well. For resistant cases, opioids may be used to relieve pain, as well. [8]

However, it is due to the side effects and dependence on drugs for some people that make them avoid using these medicines for a long time.

Capsaicin Cream

Although it may sound like a questionable choice for the people who have never heard about this treatment option, yes, capsaicin – a component extracted from chili peppers – has indeed been used for the treatment of osteoarthritis!

It was found that capsaicin can desensitize or reduce the amount of substance P in your nerves. Substance P is a pain neurotransmitter and it enhances the amount of level of pain that you usually experience. Thus, by reducing the amounts of Substance P,  capsaicin acts as an inhibitor of pain.

Capsaicin also reduces the inflammation reducing pain and swelling that people with osteoarthritis experience. [9]

Although not that commonly used in orthopedic practice nowadays, Capsaicin is usually available in the form of gel, creams, and plasters.

Joint Replacement Surgery

For refractory cases and also for those people who are unable to find relief with the usual medications, physical therapy and other treatment plans, the final resort of treatment lies in performing joint replacement surgeries for the affected joints.

In the world today, knee replacement surgery and hip replacement surgeries have been performed on the affected joints of osteoarthritic patients for a long time. It is also employed in the field of rheumatology where patients have to suffer from chronic pain due to autoimmune processes. [10]

However, some patients are also injected with intra-articular injections of corticosteroids to achieve pain reduction and relief from inflammation. Some people also prefer taking Vitamin D and Calcium supplements to cope with the excess loss of bone-related damage.

New Treatment Options For Osteoarthritis of the Knee

Thanks to the efficiency of several clinical trials and experiments that researchers have done over the years, there now exist several breakthrough ways for treating osteoarthritis that one could only dream about before.

Some popularly used newer methods used for the treatment of osteoarthritis are discussed as follows:

Autologous Chondrocytes Implantation (ACI)

Chondrocytes are cartilage-forming cells. In this method, usually full-thickness joint damage, all the way down to the bone, is treated. This method is so effective that it has now been approved by the Food and Drug Administration (FDA) to be used on patients with cartilage defects, mostly in the lower femur area of knees (knee joints). [11]

In this method, a very small piece of the patient’s articular cartilage is harvested. This piece of the cartilage is then sent to a laboratory where it is analyzed, the chondrocytes are extracted and then treated enzymatically to improve their condition and make them appear healthy, in case they were degenerating due to wear and tear. This whole process takes about 6-8 weeks to be completed.

Once these new chondrocytes are ready to be implanted, an open surgical procedure takes place where a small patch is sewn over the defected articular cartilage of the patient. It is this patch where the ‘changes’ chondrocytes are injected. These chondrocytes then start behaving as their healthy selves and start producing normal, healthy cartilage to cover up for the damage done in this area.

Although this procedure only has a longer duration of action, other than that, it is just a minor procedure and the first extraction step is usually done as an outpatient technique.

So far, placebo studies and experiments have proven that this method has been 85% successful. It has even allowed full mobility to be restored in several people after a year. [12]

According to the National Institute of Health and Care Excellence (NICE), ACI will prove to be one of the best treatment options for osteoarthritis in young people and in delaying the onset of the disease in those who have just started showing the early signs of cartilage damage.

Hyaluronic Acid/Hyaluronate Injections as a new treatment for osteoarthritis of the knee

Sometimes, osteoarthritis also becomes predisposed to develop due to the reduction in the amount of friction between the joints. This occurs when the spaces between the joints decrease and the synovial fluid lining the joint spaces begins to dry. This leads to the development of the knee joint pain – the most commonly affected area and can even lead to the development of joint disease if left untreated.

However, when hyaluronic acid or hyaluronate was used to stimulate the formation of this dried up fluid once again in the form of injecting it into the articular spaces, it was seen that many people benefited from this mode of treatment as well, as it stimulated the production of growth factors and antibodies that work to produce new, cartilage cells and maintain its strength. [13]

 

Mesenchymal Stem Cells & Bone Marrow Aspirate

Mesenchymal stem cells are produced by the bone marrow. The unique property of these stem cells is that they can take up the shape, function, and form of any type of cell when they are manipulated to do so.

Therefore, when these mesenchymal stem cells are injected into the articular cartilage, it is seen that they take up the shape of chondrocytes and start producing new cartilage along with reducing the inflammation that is present as a result of the joint pain and existing cartilage damage. [14]

Similarly, using bone marrow aspirate in place of mesenchymal stem cells also has a similar, or maybe even a better impact. Bone marrow aspirate is easier to obtain and it works in a similar way just like the mesenchymal stem cells.

A randomized trial published in the BMC Musculoskeletal Disorders showed that this mode of treatment has optimal results and needs more elaboration to be introduced as a trusted mode of treatment. [15]

Prolotherapy:

Many of the structures have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

The bottom line for new treatments for osteoarthritis of the knee

All the new treatment plans show that osteoarthritis can be managed perfectly and optimally if it is diagnosed in its earlier stages. Osteoarthritis may sound like a degenerative condition that makes the affected joints only grow worse with time, this is not actually true. It is a very curable condition.

Although the earlier it gets diagnosed, the better it is, osteoarthritis still seems to be a condition that is still seen to benefit from the advanced mode of interventions and treatments that will soon achieve their proven status and would be introduced to the world.

 

References

    1. Sen R, Hurley JA. Osteoarthritis. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/
    2. Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone research, 5, 16044. https://doi.org/10.1038/boneres.2016.44
    3. Tschon, M., Contartese, D., Pagani, S., Borsari, V., & Fini, M. (2021). Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data. Journal of clinical medicine, 10(14), 3178. https://doi.org/10.3390/jcm10143178
    4. Hussain, S. M., Cicuttini, F. M., Alyousef, B., & Wang, Y. (2018). Female hormonal factors and osteoarthritis of the knee, hip and hand: a narrative review. Climacteric, 21(2), 132-139.
    5. King, L. K., March, L., & Anandacoomarasamy, A. (2013). Obesity & osteoarthritis. The Indian journal of medical research, 138(2), 185–193.
    6. Bestwick-Stevenson, T., Ifesemen, O. S., Pearson, R. G., & Edwards, K. L. (2021). Association of Sports Participation With Osteoarthritis: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine, 9(6), 23259671211004554.
    7. Garver, M. J., Focht, B. C., & Taylor, S. J. (2015). Integrating lifestyle approaches into osteoarthritis care. Journal of multidisciplinary healthcare, 8, 409–418. https://doi.org/10.2147/JMDH.S71273
    8. Crofford L. J. (2013). Use of NSAIDs in treating patients with arthritis. Arthritis research & therapy, 15 Suppl 3(Suppl 3), S2. https://doi.org/10.1186/ar4174
    9. Guedes, V., Castro, J. P., & Brito, I. (2018). Topical capsaicin for pain in osteoarthritis: A literature review. Reumatología Clínica (English Edition), 14(1), 40-45.
    10. Singh, J. A., Tugwell, P., Zanoli, G., & Wells, G. A. (2019). Total joint replacement surgery for knee osteoarthritis and other non‐traumatic diseases: a network meta‐analysis. The Cochrane Database of Systematic Reviews, 2019(9), CD011765. https://doi.org/10.1002/14651858.CD011765.pub2
    11. Mistry H, Connock M, Pink J, et al. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2017 Feb. (Health Technology Assessment, No. 21.6.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK424075/ doi: 10.3310/hta21060
    12. Minas, T., Ogura, T., & Bryant, T. (2016). Autologous Chondrocyte Implantation. JBJS essential surgical techniques, 6(2), e24. https://doi.org/10.2106/JBJS.ST.16.00018
    13. De Lucia, O., Murgo, A., Pregnolato, F., Pontikaki, I., De Souza, M., Sinelli, A., Cimaz, R., & Caporali, R. (2020). Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis. Advances in therapy, 37(4), 1347–1359. https://doi.org/10.1007/s12325-020-01256-7
    14. Zhu, C., Wu, W., & Qu, X. (2021). Mesenchymal stem cells in osteoarthritis therapy: a review. American journal of translational research, 13(2), 448–461.
    15. Kim, G. B., Seo, M. S., Park, W. T., & Lee, G. W. (2020). Bone Marrow Aspirate Concentrate: Its Uses in Osteoarthritis. International journal of molecular sciences, 21(9), 3224. https://doi.org/10.3390/ijms21093224

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