Why Has Arthroscopy Failed to Improve Knee Arthritis?

If you have osteoarthritis, arthroscopic surgery with debridement to “clean up” your arthritic knee is no more beneficial than having Advil or Tylenol and physical therapy. This is according to a new study in the New England Journal of Medicine, which is the second prominent study to come to this conclusion, but orthopaedic surgeons have continued performing the surgery in an attempt to improve the wellbeing of patients with osteoarthritis.

According to the study’s authors ‘We conducted a single-centre, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic débridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone.’

The researchers noted, ‘The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).’ The researchers added that ‘Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.’

The same findings were reported in 2002 in a large study done by the Department of Veterans Affairs, but in spite of this, it is doubtful that orthopaedic surgeons will decrease the number of procedures that they perform. This is because patients whose wellness is affected by arthritic pain will almost always fit in to one of the clinical indications for arthroscopic knee surgery, which include suspected ligament tear, damaged meniscus cartilage, evidence of bone fragments from a fracture, joint pain from an injury, unexplainable joint pain, lesions or other problems detected by x-rays, joint disease and a need for joint surgery.

If you are such a patient, you may also have unrealistic expectations of what surgery can do for you. Arthroscopic surgery is often very helpful in athletes with injuries, and so patients with abnormalities on MRI scans believe they, too, can be relieved of chronic pain with surgery. Yet, the research clearly shows that the meniscus tears and other joint abnormalities that patients with arthritis suffer with have nothing to do with their pain and they do not respond to surgery. Therefore, studies like this highlight the need for physicians to limit unnecessary and costly surgery when it does little to help.

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Why Has Arthroscopy Failed to Improve Knee Arthritis?

Categories: knee osteoarthritis, Research, surgery

Is Ayurveda As Good As Drugs For Knee Osteoarthritis?

We often think that drugs and chemicals are the only treatment that should be considered for serious health problems, like those caused by knee osteoarthritis. We have relied on traditional scientifically-led medicines for a long time and they are those that are prescribed by doctors and medical professionals. But increasingly we are looking for alternative ways to deal with debilitating conditions. One of the most promising of these is Ayurveda, a traditional Indian approach.

Now an Ayurvedic preparation has passed a test as an alternative to high-end drugs for the treatment of knee osteoarthritis. Perhaps even better news for supporters of Ayurveda is that it has shown few adverse effects, according to the study, which involved government-supported clinical trials across the country. The trials were held in 2006-07 and the findings have been published now in the British journal Rheumatology.

The drugs that are commonly used to treat osteoarthritis in the knees are the high-end glucosamine sulphate and celecoxib. According to a number of experts, patients may deteriorate to end-stage arthritis and often require joint replacement surgery, which is very costly and not available for everyone. Osteoarthritis can also be treated with analgesics, which provide symptomatic, long-term pain relief but also expose patients to potentially serious toxins.

For the first time ever this study saw scientists making a head-to-head comparison for traditional medicine and the Ayurveda method. They chose Ayurvedic formulations based on texts and expert opinion. They found that two shunthi-guduchi formulations, called SGC and SGCG, were equivalent to taking oral glucosamine sulphate and celecoxib in reducing knee pain and improving knee function in patients. This is very important as it shows that we no longer have to rely on medical science for treatments.

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Is Ayurveda As Good As Drugs For Knee Osteoarthritis?

Categories: Ayurveda, knee osteoarthritis, treatment

How Could Plasma Treatment Improve Your Knee Osteoarthritis?

There are several treatments of osteoarthritis (OA), but scientists may have discovered another one with promising results. A study by researchers from the Hospital for Special Surgery has shown that platelet-rich plasma (PRP) could improve the wellbeing of patients with knee OA by treating pain, improving function, and, in up to 73% of patients, delaying the progress of the otherwise progressive disease.

The study, which was published in the Clinical Journal of Sports Medicine, used PRP injections produced from the patient’s own blood to deliver a high concentration of potentially healing-enhancing growth factors to the patient’s cartilage. Brian Halpern, MD, chief of the Primary Care Sports Medicine Service at the Hospital for Special Surgery, New York City, and lead author of the study, explained, ‘You take a person’s blood, you spin it down, you concentrate the platelets, and you inject a person’s knee with their own platelets in a concentrated form. This then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritis symptoms and decrease inflammation.’

According to Hollis Potter, MD, chief of the Division of Magnetic Resonance Imaging at the Hospital for Special Surgery, and another author of the study, the researchers used many methods to evaluate OA improvement, including MRI assessment, to ensure the validity of the results. ‘The problem with a lot of the PRP studies is that most people have just used subjective outcome instruments, such as pain and function scores,’ she said. ‘When you add MRI assessment, it shows you the status of the disease at that time, regardless of whether the patient is symptomatic or asymptomatic or they have good or poor function in the knee.’

Halpern explained, ‘The knee can be divided into three compartments, the medial compartment, the lateral compartment and the patellofemoral compartment. If we look at these compartments individually, which we did, in at least 73% of these cases, there was no progression of arthritis per compartment at one year. That is very significant, because longitudinal studies suggest a four to six percent progression of arthritis at one year.’

He added that the study is a small case series and PRP needs to be compared to traditional treatments in a larger, randomised, control trial. However, he concluded, ‘We are entering into an era of biologic treatment, which is incredibly ideal, where you can use your own cells to try to help repair your other cells, rather than using a substance that is artificial. The downside is next to zero and the upside is huge.’

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How Could Plasma Treatment Improve Your Knee Osteoarthritis?

Categories: knee osteoarthritis, plasma treatment, Research