Arthritis Treatment: Knee Osteoarthritis - What Are the Alternatives to Knee Replacement?

Arthritis is a term derived from the Greek: "arthron" meaning joint and "itis" meaning inflammation. It is used to refer to more than 100 different diseases.

The most common form of arthritis is osteoarthritis (OA) which affects more than 20 million Americans. Osteoarthritis is a condition that impacts hyaline articular cartilage, the tough gristle that caps the ends of long bones.

Hyaline cartilage is a complex material consisting of a combination of proteoglycans (complexes of proteins and sugars) and chondrocytes. Chondrocytes are located within the matrix... picture a gelatin mold with grapes. The gelatin is the matrix and the grapes are the chondrocytes. Chondrocytes are cartilage cells that manufacture matrix under normal healthy circumstances. They are responsible for nourishing the matrix as well.

However, when OA develops, a distinct change in the joint environment occurs. Chondrocytes begin to elaborate destructive enzymes causing cracks in the cartilage. These are called "fissures" and "fibrillations."

One of the most common areas affected by osteoarthritis is the knee. This is not a surprise since OA preferentially attacks weight-bearing joints.

The treatment of OA of the knee is primarily symptomatic. Weight loss, exercise, physical therapy, assistive devices (such as canes, braces, and walkers), analgesics (pain-relieving medicines), non-steroidal anti-inflammatory drugs (NSAIDS) which also reduce inflammation and pain, as well as thermal modalities such as heat and ice can all be employed.

However, once those resources are exhausted and the patient has undergone injections with glucocorticoids ("cortisone") and viscosupplements (hyaluronic acid..." rooster comb shots"), there is a large void that is present because until recently the only remaining option was knee replacement surgery.

Despite the improvement in technology, knee replacement surgery is still surgery with all the attendant risks of a major invasive procedure in a hospital setting. And the specter of having to have a revision procedure (a replacement of the replacement) done maybe three times in one's lifetime is an unhappy picture.

Recent work using autologous stem cells, sometimes referred to as mesenchymal stem cells looks very promising. (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)

While not effective for everyone, there is abundant evidence in animal models as well as anecdotal data in humans that certain procedures that incorporate mesenchymal stem cells using a framework of fat and stimulated by autologous growth factors may indeed slow down the rate of cartilage loss and may even improve cartilage thickness. This procedure is also undergoing an evolution of sorts just as all other medical procedures do. If the early work is validated, then this approach will certainly bridge the gap between current symptomatic options and surgery.

And just like recent data showing that orthopedic procedures are declining in patients with rheumatoid arthritis, maybe someday the same will be true for, patients with OA of the knee.