| About 20% of the 900,000 arthroscopic knee | | | | So... orthopedic surgeons win no matter what. |
| surgeries performed annually in North America are | | | | Surgeons perform surgery. |
| done as treatment for osteoarthritis (Time, 2008). A | | | | If they can't 'scope a patient, they can replace the |
| knee arthroscopy is a procedure where a small | | | | knee. |
| telescope is inserted into a joint and debris is | | | | So what are the options for a patient if they don't |
| removed. The vast majority are done by orthopedic | | | | want a knee replacement? |
| surgeons. | | | | The big question is this: can cartilage- the gristle that |
| It turns out that knee arthroscopy may be no more | | | | caps the ends of long bones, and which wears away |
| effective over two years than non-surgical treatment | | | | during the process of arthritis, re-grow? Some |
| using physical therapy and medications, according to a | | | | physicians like K. Dean Reeves, a physical medicine |
| recent study published in the New England Journal of | | | | and rehabilitation specialist, in Kansas City, Kansas are |
| Medicine (Kirkley A, et al. A Randomized Trial of | | | | studying the effects of prolotherapy in inducing |
| Arthroscopic Surgery for Osteoarthritis of the Knee. | | | | cartilage growth. |
| NEJM. 2008; 359:1097-1107). | | | | Prolotherapy is a procedure where cartilage is |
| The researchers examined 178 patients who had an | | | | purposefully injured to stimulate the formation of |
| average age of 60. All patients received standard | | | | chondroblasts, early cartilage cells that have the ability |
| non-surgical treatment, including physical therapy, | | | | to regenerate. He has just completed a double-blind |
| anti-inflammatory drugs or analgesics such as | | | | study on knee arthritis using prolotherapy techniques. |
| acetaminophen and ibuprofen, glucosamine | | | | In the knee arthritis study, after one year, there was |
| supplements, and injections to lubricate the joint. | | | | a 44 percent improvement in pain, 63 percent |
| Eighty-six of the patients also underwent | | | | improvement in swelling, and a 14-degree |
| arthroscopic surgery. Patients were evaluated over | | | | improvement in flexibility. There was an 85 percent |
| two years using a scoring system that measured | | | | reduction in knee buckling episodes. Improvement in |
| pain, stiffness and physical function. After three | | | | joint space was also noted. |
| months, the surgery group initially showed more | | | | Other physicians are studying the effects of growth |
| improvement, but two years after the procedure, | | | | hormone. |
| there was no significant difference between the | | | | Finally, the most promising approach appears to be |
| groups. | | | | the use of a combination of cartilage irritation and |
| The results paralleled the findings of a 2002 | | | | stem cells. |
| Department of Veteran Affairs study conducted at | | | | Dr. Nathan Wei, a rheumatologist in Frederick, |
| the Houston VA (Moseley JB, et al. A Controlled Trial | | | | Maryland, states, "We are studying the effect of a |
| of Arthroscopic Surgery for Osteoarthritis of the | | | | prolotherapy-like procedure in combination with |
| Knee. NEJM. 2002; 347: 81-88). | | | | autologous stem cells and growth factors for |
| In response to the most recent study, E. Anthony | | | | osteoarthritis of the knee. Autologous stem cells are |
| Rankin, MD, president of the American Academy of | | | | stem cells obtained directly from the bone marrow of |
| Orthopedic Surgeons, said, "As a tool for treating | | | | the patient. These stem cells are then concentrated |
| arthritis alone, it probably isn't a good tool". | | | | using a special technique. Once they are reintroduced |
| In an accompanying editorial, Robert Marx, an | | | | into the knee capsule along with other growth |
| orthopedic surgeon at the Cornell University Medical | | | | factors using ultrasound guidance, they have the |
| College of Cornell University, wrote that the study | | | | capacity to differentiate into cartilage cells. Growth |
| provides "strong support" for the conclusion that | | | | factors are used to send the healing phase into 'warp |
| "arthroscopic surgery is not effective therapy for | | | | speed.' |
| advanced osteoarthritis of the knee." Marx added | | | | The early results are very encouraging and parallel |
| that the procedure could offer benefits for patients | | | | the findings of others. In the final analysis, if we can |
| experiencing additional knee problems. | | | | demonstrate significant improvements in clinical |
| Both orthopedic surgeons added that "knee | | | | measures along with cartilage regeneration, we can |
| replacement surgery is an option for those with | | | | reduce the tremendous number of knee surgeries |
| serious arthritis." | | | | performed every year." |
| Approximately 555,000 total knee replacement | | | | He goes on to say, "Obviously, if a patient has |
| procedures, also called total knee arthroplasty (TKA), | | | | severe arthritis -"bone on bone" with no cartilage left, |
| are performed each year (Saletan W. Washington | | | | then this procedure is not going to help him. That |
| Post September 14, 2008). | | | | patient then will need a knee replacement. We would |
| Primary total knee replacement is most commonly | | | | like to get to the patient before that stage. |
| performed for osteoarthritis (OA). | | | | |