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Treatment for Osteoarthritis

Treatment for Osteoarthritis

Osteoarthritis is one of the most common causes of pain in joints (1).   Often known as OA, the condition becomes more common as we age, and some joke that OA stands for Old Age. Although many people think OA is degeneration of the bone caused by reduced bone density, OA is characterized by cartilage degeneration. Cartilage is a smooth, spongy tissue that covers the end of bones to reduce joint friction and act as a shock absorber to permit smooth and functional joint movement. Cartilage degenerates for many reasons, including the wear and tear associated with aging, previous history of injuries and long-term obesity are the major risk factors. Recently OA has been identified as an inflammatory condition that can accelerate early degeneration, and debate is ongoing in this area (2).   Overweight people have a higher incidence of arthritis in their fingers, the hypothesis being that excess body fat may increase the inflammation that causes cartilage to degenerate (3). Many people feel running will increase OA, but research shows otherwise (4)., and running may even have a protective effect on the cartilage (5). Even long-term involvement in pivoting sports does not seem to cause cartilage degeneration unless the person has sustained a specific injury.

OA commonly causes painful and swollen joints, which reduces their ability to function at normal levels. Unfortunately, there is no easy way to re-grow or regenerate cartilage, and every treatment option has advantages and disadvantages. We’ve listed the main treatment options below, briefly describing the pros and cons.

Treatment Description Pros Cons
Surgery  –

OATS

They are transplanting cartilage from a non-weight bearing area of the bone into the degenerated cartilage(6). OATS (Osteochondral Autograft Transplant System) has been increasing in popularity. It can provide new cartilage into a focused point of cartilage loss.

Results are encouraging, particularly in younger populations

Post-operative recovery is slow and can be painful. Muscle wastage is often severe. Not practical for large areas of cartilage damage.
Surgery – Microfracture A procedure where small holes are drilled into the bone, so that blood and bone marrow cover the cartilage and form a type of cartilage replacement Can cover a wide area Recovery can be slow, up to one year. Muscle wastage requires post-op training. Results can be variable (7)
Platelet Rich Plasma Injection Withdrawing blood and spinning it into a centrifuge to separate the platelets (the body’s healing and clotting substance), then injecting back into a joint.

 

Relative simple procedure, low risk Expensive; research has not supported its effectiveness and is generally not recommended for OA (8)

 

Stem Cell Injection

 

Harvested Stem cells are prepared and injected into the joint.

 

Some research shows improvements (9) Expensive, and not legal in many places. The mechanism by which it works is not well understood
Physiotherapy / Exercise based therapy Strengthening and improving flexibility and function through exercise and modality

 

Good evidence to support its efficacy in lower limbs (10) Requires active participation (not passive)
Surgery – Joint Replacement Removing and replacing both sides of the joint. Very common and safe, results are generally good—relatively quick recovery. Invasive, may not achieve full function and may need to be redone or revised in 10-15 years (earlier in knees than hips).

Whichever pathway you choose for osteoarthritis, a patient should carefully consider all of the above possibilities, and the injured person should share the decision-making with family members, colleagues and a range of health professionals.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920533/
  2. https://pubmed.ncbi.nlm.nih.gov/23194896/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978723/
  4. https://www.ingentaconnect.com/content/wk/smart/2022/00000030/00000002/art00005
  5. https://www.degruyter.com/document/doi/10.7556/jom_2006_06.0004/html
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847821/
  7. https://www.ncbi.nlm.nih.gov/books/NBK77891/
  8. https://jamanetwork.com/journals/jama/fullarticle/2786501
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529316/
  10. https://www.tandfonline.com/doi/abs/10.1179/108331904225005052

 



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