Osteoarthritis of the Knee Overview
Osteoarthritis (OA) is the most common form of arthritis, affecting 32.5 million Americans. This number continues to grow as Baby Boomers age and retire. The condition, which is also known as degenerative joint disease, consists of a progressive deterioration of cartilage in the joint, causing pain, inflammation, swelling, and stiffness. OA commonly affects the knee, especially in older adults who have a 49.6% lifetime chance of being diagnosed with OA by their doctor. The toll of OA greatly impacts our economy through loss of work, costing $100 billion annually according to a 2011 report. Medicare coverage for total knee arthroplasty, alone, came to $9.2 billion annually in 2011. In fact, this is Medicare’s greatest single-procedure expenditure for older adults.
These are already very troubling statistics, but even worse is that conventional care offers little relief short of total knee arthroplasty. Fortunately, in many cases naturopathic medicine combined with platelet-rich plasma offers substantial long-term pain relief without the need for medications or surgery.
- Knee Pain worse with activity
- Swelling / Stiffness
- Dull + Achy pain
- Decreased range of motion
Conventional Approaches to OA Knee Pain
OA patients typically present with chronic knee pain to their primary care or family medicine doctors. The diagnosis is relatively straightforward, and is usually apparent based on case history with imaging used to confirm the condition. X-ray imaging will not show the cartilage breakdown but will show the joint space changes that are the end product of the degeneration. MRI can also be used for a more detailed assessment of the knee, including connective tissue changes and specific areas of cartilage damage.
First line treatments for osteoarthritis of the knee are acetaminophen (Tylenol) and nonsteroidal anti-inflammatories (NSAIDs) such as Ibuprofen. When patients become unresponsive to these therapies, stronger options will be considered. These typically are cortisone injections into the knee or hyaluronic acid injections for lubrication of the knee joint. The final option available after everything else has stopped providing relief is a total or partial knee replacement.
Platelet Rich Plasma for osteoarthritis is a new treatment option that continues to be supported by new orthopedic research for pain relief. The treatment is different than conventional options in the fact that the goal of the treatment is for new cartilage and connective tissue growth instead of symptom management. By regenerating the damaged connective tissue, pain relief is achieved and structural integrity of the joint is preserved.
How PRP Works
The mechanisms of action of PRP have been well documented, including in past issues of NDNR, but I will provide a brief refresher. In OA of the knee, there is chronic wear and tear of the joint, usually from damaged or lax ligaments and tendons. This can facilitate a loose joint that is prone to increased articular action that eventually causes the cartilage to break down. Osteoarthritic knees are also prone to poor vascularity, which reduces circulation into the joint and makes them heal more slowly.
The PRP injection increases the local vascularity and also stimulates a localized healing cascade. This is accomplished through the degranulation of the alpha granules of the platelet cells. The platelets release signaling molecules and growth factors, including: platelet-derived growth factor (PDGF), transforming growth factor (TGF), platelet-derived epidermal growth factor (PDEGF), platelet-derived angiogenesis factor (PDAF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factor (IGF), keratin growth factor (KGF), fibroblast growth factor (FGF), connective tissue growth factor (CTGF), tumor necrosis factor-alpha (TNF?), interleukin 1-beta (ILβ), and IL-8 into the site of injection. The new localized growth factors then initiate a healing cascade through anti-inflammatory agents, stimulating cellular matrices, cellular division, and mesenchymal stem cell recruitment, all of which has a cumulative effect of restoring function and relieving pain.
- Pain Relief
- Strengthens Ligaments, Tendons, Cartilage, and Connective Tissue
- Utilizes your Natural Growth Factors
- Quick Recovery Time
- Non-Surgical / Non-Invasive
PRP OA Knee Pain Relief Summary
PRP or platelet rich plasma has changed the way we approach osteoarthritis pain and provides new hope for patients suffering from chronic joint pain. The treatment is evidence based and highly effective for knee pain. Patients now have a non-surgical option available that helps them avoid surgery while restoring their quality of life. This enables people to return to exercise, hobbies and spending active time with friends, family and loved ones.