One of the most common reasons patients present to Ortho RI's Biologics Clinic is for knee pain caused by knee osteoarthritis. Osteoarthritis is a normal part of the aging process that results in thinning/loss of joint cartilage. Also known as wear-and-tear arthritis, knee osteoarthritis is a progressive condition that results in irreversible changes to cartilage, meniscus, and bone. It is often associated with inflammation within the knee.
At present time there is no cure for osteoarthritis. The only treatment in medicine currently available that fixes the problem (loss of joint cartilage) is joint replacement surgery. Joint replacement surgery is a safe and effective treatment that involves removing the arthritic joint and replacing it with an artificial joint. There are many conservative options available for treating the symptoms of osteoarthritis, including pain and inflammation, but these options do not stop, slow down, or reverse the osteoarthritic process. These options include weight management, physical activity, use of a knee brace or compression sleeve, medications, corticosteroid injections, hyaluronic acid (gel) injections, and orthobiologics.
Orthobiologics involve the use of human tissue in the treatment of orthopedic conditions. Commonly used biologic treatments include platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and adipose-derived stem cells. These are examples of autologous treatments which are derived from the patient's own tissues and minimally processed prior to being injected into the knee joint. Amnion is an example of an allograft tissue (derived from someone else) that was previously used for the treatment of knee osteoarthritis. Amnion is no longer approved for the treatment of orthopedic conditions in the United States.
While commonly referred to as regenerative treatments, orthobiologics are NOT truly regenerative for osteoarthritis. To date, no biologics treatment option has been shown to regrow joint cartilage or to reverse the arthritic process. This is a common misconception, so let me repeat that again, biologics treatments will not grow new cartilage. Not even stem cells.
At present, platelet-rich plasma (PRP) is the preferred biologic for the treatment of knee osteoarthritis. PRP is currently the best studied orthobiologic in medicine, with more than 22 level 1 studies. The medical literature suggests the PRP is more efficacious for treating the symptoms of knee osteoarthritis than corticosteroid injections or hyaluronic acid injections. In addition, PRP has been shown to work as well as, if not better than, BMAC and adipose. The most beneficial components of the biologics appear to be the growth factors and enzymes present in the plasma, not the stem cells. PRP injections involve drawing a small amount blood and spinning it down in a centrifuge to isolate the liquid (plasma) portion. This liquid gold is rich in platelets, growth factors, and enzymes which help to decrease pain and mitigate inflammation within the knee. Following preparation of PRP, the PRP is injected into the knee joint, similar to other knee injections. The entire process takes less than 30 minutes.
The goals of treatment are to:
- decrease knee pain
- improve knee function
- delay the need for joint replacement surgery
Orthobiologics treatments such as PRP are generally well tolerated and work best in those with mild to moderate osteoarthritis of the knee. Pain relief typically occurs days to weeks following treatment and may provide pain relief lasting as long as 6-12 months. Those with more advanced "bone-on-bone" osteoarthritis are less likely to experience lasting relief of their arthritis symptoms. PRP injections can be repeated at any time if pain recurs.
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