Osteoarthritis (OA) is one of the most common degenerative diseases of the adult population today. The knee joint is the most frequently affected, with studies estimating 30% of all adults having radiological signs of OA, with 8.9% showing clinical symptoms such as pain or stiffness. Other common joints affected are hips, spine and hands, which can present clinical symptoms such as swelling, mechanical locking, and weakness.OA is conventionally seen as progressive wear and tear of the articular cartilage, but mechanical force and histologic studies have demonstrated that OA is a complex inflammatory disease of the entire joint, which includes the cartilage, synovial lining, synovial fluid the perticular ligaments and the subchondral bone.
Nonsurgical management is the recommended first approach to early OA.The various conservative treatment options usually address one of the disease phases, either by modifying the disease course or by reducing symptoms. Arguably the most effective management of symptooms, which is something you can do in your own home, is dietary weight management combined with low impact excercises such as biking , swimming,and stretching. The helps by alleviating weightbearing stress, increasing range of motion, reducing soft tissue inflammation, improving circulation, and giving stability by strengthening the muscles around the knee joint. Evidence has shown that knee from body weight are significantly increased going up and down staris. For example, if you weight 200lbs, the scientific evidence shows that losing 15-20lbs could make a significant difference in your symptoms.
Studies have suggested that the immune system activation is one of the main drivers of the advancement of OA. Nonsteroidal anti-inflammatory drugs(NSAIDs)helps by both controlling inflammation and the resulting pain. Newer topical NSAID formulations provide similar responses with less systemic exposure,absorbed into the underlying joint structures,inhibiting the enzymes that leads to inflammation. Intra-articular corticosteroids also work as a potent anti-inflammatory and are considered to be a cost-effective non-invasive treatment. Corticosteroid injections are often combined with local anesthetics, helping with near immediate relief of symptoms, allowing a break in the pain cycle.
Hyaluronic acid (HA) injection is a gel like product that provides joint lubrication and shock absorbency. HA provides the viscoelastic component of the synovial fluid and also a component of the extracellular matrix of the cartilage. In people with OA, HA concentrations can decrease by up to 50%, so these injections can provide improvement in knee pain function that can last around 6 months.
Platelet rich plasma(prp)injection is a modern option that's derived from blood centrifuged to concentrate the growth factors stored in the platelets, which have a regulatory role in tissue inflammation, cell migration and proliferation. PRP can be prepared in the office and injected into the joint the same day, often having beneficial effect lasting from 6 to 12months.
Mesenchyml Stem cells(MSCs)rely on a multitude of signaling proteins including growth factors, cytokines and molecules called exosomes. MSCs can provide regenerative effects via tissue repair and their immunomodulatory and anti-inflmmatory actions. The goal of this therapy is for the local delivery of MSCs to encourage a healthier environment, at AOKC several treatment protocols are available to best utilize this advanced product.
All of these nonsurgical treatments can provide positive outcomes for patients with OA without the need of a knee replacement. At AOKC, treatments are tailored to the individual, sometimes combining therapeutic strategies with the goal of reducing pain, improving mobility and quality of life.