Knee Pain Resolution

New Help for Bone Damage in Knee Arthritis!

Have you been told that surgery is the only option to treat your knee arthritis? Now there may be another answer!

We all know that the loss of cartilage is the primary issue in arthritis. This cartilage loss leads to pain and loss of function, and quite often medications and injections will not relieve the pain and disability. The next option presented may be surgery.

As recently as only many months ago, once a patient had developed bony changes beneath their knee cartilage loss, there was no option but to proceed with surgery.  That surgery was often a total knee replacement, with long recovery times and often poor outcomes. Now Arthrex may be giving us a better alternative with the intra osseous bioplasty.

Surgeons have known for some time that arthritis could lead to swelling in the bones adjacent to the joint. This is known as subchondral edema, and is associated with a great deal of pain. Researchers believe that cartilage loss leads to damage in the underlying bone, which then leads to an influx of blood with limited venous drainage. This can increase pressure in the bone, cause further bone damage and lead to pain. Remember occasions when you may have slammed your finger in a door. The tip would swell, and the finger would hurt like crazy, even when it was barely touched. This is the type pain subchondral edema can create. For years it was thought that once this occurred,  the only option for pain relief was to do surgery. Now we think there may be another option.

Intra Osseous Bio-plasty and cellular therapy

Earlier this year, Kasik published a study on the treatment of such knee bone lesions.  His conclusion was:

“Biologic treatment of Bone Marrow Edema of the knee using BMAC (bone marrow) and iDBM (bone graft)  is an effective adjunct to arthroscopy that provides short-term pain relief for BMLs associated with degenerative conditions of the knee.”

As you will note in the title, this article presupposes that these procedures will be adjuncts to knee arthroscopy.  The journal article references “short term relief” only because the study is new, and patients have yet to be followed long term. The hope is that the next paper will reference “long term relief”. But the bigger question is about  knee arthroscopy.  Is a surgical procedure really required for this new approach?

The article above, clearly suggests patients can get improved function and less pain through the use of a demineralized bone product, mixed with cellular therapy (your own stem cells that are taken from your hip). All patients in the study had arthroscopy, thus it is difficult to determine if the actual arthroscopic procedure played any role other than as a delivery agent of the major products. In light of studies showing no improvement in patients with degenerative arthritis treated with arthroscopy alone, the question becomes “can we provide these products without surgery and anesthesia?”   We believe these products can be safely and comfortably provided without surgery.

Knee arthritis can be disabling.  It can cause severe pain and limit activities and many people go on to have total knee replacement, with high numbers of patients having chronic pain even after surgery.  Research has shown that there is reason to believe cellular therapy can work for patients with knee arthritis.  In our clinic, we have found good success treating knee arthritis and we already address these subchondral problems by placing cells in this injured region. Nonetheless when failures patients do fail to get the degree of relief we had hoped for, one is often left to wonder if the subchondral bone changes are the reason. Now Arthrex may have helped us find a better solution to treat this problem.

It is important to understand that the actual procedure itself, is essentially the same as what we do now. The only difference is the addition of a demineralized bone product that may act as a scaffold, and give the new cells guidance as they work to become osteoblasts (bone precursors) and go on to create new, healthy bone.

Don’t wait for treatment

If you have knee arthritis don’t wait too long to seek treatment. Regenerative therapy is a very reasonable option, but using our own cells to heal is a balance between repair and regeneration. Once tissues are damaged beyond a certain point, there is only so much that can be done, and we are left with a “repair” process that may not be as successful as the regeneration we had hoped to obtain.  With this new option we hope to improve patient outcomes even further.

At Southcoast we are here to help.  We promise to have board certified physicians evaluate your issues, and help you find your best option to return to an active, healthy lifestyle. We won’t mislead you. We won’t sell you a product that has no chance of success.  Come see us soon and let us tell you if you might be a candidate.