Is there any other treatment for knee arthritis prior to knee replacement? Part II

In Part I, we discussed, NSAIDs, short acting, and long acting steroids. Are there other oral supplements that are helpful? Unfortunately, there is minimal data that glucosamine and chondroitin sulfate are of any benefit in cartilage metabolism when taken orally. Multiple other supplements are available online and in pharmacies, but published peer reviewed studies have given little credence to their effectiveness.

Platelet rich plasma (PRP) Google hits exceeded 20 million in 2018. A recent systematic review of PRP in knee OA noted that although the data was inconclusive, it may be effective. In a review of 6 prospective randomized studies, it was concluded that PRP may have beneficial effects for patients with mild to moderate OA. Other authors have concluded in prospective, randomized studies that PRP and high–molecular-weight hyaluronic acid yielded similar results and resulted in moderate improvement in patients’ symptoms from knee OA.

A “stem cell” is an undifferentiated cell which is capable of forming more cells of the same type and from which other kinds of cells arise by “differentiation”. Thus, when removing these cells from bone marrow or fat and concentrating the cells, they can be injected into the knee joint with the hope that they will form new cartilage adjacent to existing cartilage on a joint surface. Mesenchymal stem cells have been isolated from bone marrow, adipose tissue, synovium, blood, and amniotic fluid. In a review of 7 randomized controlled trials using stem cell treatment for patients with knee OA, the overall results led to the conclusion that mesenchymal stem cell injections could potentially be efficacious for decreasing pain and may improve physical function. Mesenchymal stem cells appear to be most helpful in younger patients with mild to moderate knee OA and chronic patellar tendinosis. The radio and TV adds that state that “95% of patients with stem cell injections into their knee will experience dramatic results” are simply untrue and NOT substantiated by any clinical published studies.

Hyaluronic acid injections are used to improve the thickness or viscosity of synovial fluid (joint fluid) in the knee. It acts not only as a lubricant but there is some evidence that it improves the chemistry of the existing cartilage cells in the knee and prevents degeneration of the knee cartilage. It is manufactured from chicken rooster comb and there are 2 available preparations that are considered “high molecular weight” which means that the “residence time” or time that the material remains in the joint is increased compared to other injectable medicines. In a recent article which reviewed all the different hyaluronic acid preparations, only those with a high molecular weight or “cross linked” seemed to have the best results. This injectable material can be given every 6 months and is covered by most insurance companies. (Dr. Bert’s conclusions regarding injectable treatments for knee OA and his 3rd blog on this subject will be posted tomorrow)