Stem Cell Signaling OA Knee Pain Overview
Osteoarthritis (OA) is the most common form of arthritis, affecting 32.5 million Americans. This number continues to grow rapidly 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 45% lifetime risk of experiencing symptomatic OA pain. 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 $3.5 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 for patients, in many cases functional medicine combined with stem cell therapy offers substantial long-term pain relief without the need for medications or surgery.
- Knee Pain worse with activity
- Swelling / Stiffness / Inflammation
- Instability / Loss of Balance
- Dull + Achy pain
- Decreased range of motion
Causes / Risk Factors
- Chronic wear and tear
- Poor blood flow
- Nutritional deficiencies
- Prior knee injury
- Prior knee surgery
- Genetics / Epigenetics
People with osteoarthritis typically present with chronic knee pain to outpatient clinics such as their primary care, family medicine doctors, or nurse practitioners. The diagnosis is usually very apparent, and can be made on case history along 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, Naproxen, and Aleve. 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.
Regenerative Knee Pain Relief
Stem Cell Signaling allografts with PRP treatments work in completely different ways than conventional options such as cortisone and hyaluronic acid injections. The goal with conventional standard of care treatments, is disease management and short term pain relief. This is achieved very effectively with cortisone and hyaluronic acid, but new research has now demonstrated that cortisone erodes cartilage in the long term. Hyaluronic acid is not as destructive to the joint, but does nothing to stop the disease from continued progression. So what does all of this mean? In the short term patients will get pain relief but it destroys their joints further in the long term. This then leads down the path of complete joint replacement. Basically, the typical OA knee pain patient will go from Ibuprofen, to cortisone injections, to hyaluronic acid injections, and then invariably knee replacement. As you can imagine, this in not an appealing path for many patients, not to mention the years of chronic pain on top of everything else.
Regenerative allograft pain treatments fill that huge gap in standard of care and give patients a new therapeutic option to consider before knee replacement surgery. Instead, of trying to manage the osteoarthritis, regenerative injections aim to reverse and restore the integrity of the joint. This is done by strengthening cartilage inside the damage arthritic joint, and by strengthening the tendons and ligaments that support the knee joint. Through normal wear and tear of aging, the joints ligaments and tendons become stretched out and essentially weak. This then creates more mobility in the joint and more bone on bone and cartilage on cartilage interaction and grinding. Over time, this grinding weakens the the joint and pain gradually begins increasing. By treating the whole joint, including the supporting ligaments and tendons, we are able to minimize and prevent the grinding down of the joint while simultaneously improving blood flow into the space and modulating local inflammation in the joint. This comprehensive approach to joint restoration provides long term pain relief and improves structural integrity of the knee.
Benefits of Regenerative Injections
- Pain Relief
- Faster Recovery Time than Surgery
- Non-Surgical / Non-Invasive
- Strengthens and Enhances Connective Tissue
Stem Cell Signaling OA Knee Pain: Case example
William is a 66 year old man who presented to our clinic with knee pain of 9 years duration. For the first 5 years of his knee pain, William managed the condition with Ibuprofen and was able to complete his day to day activities. After approximately five years, the pain became more severe and Ibuprofen was no longer minimizing his pain. At this point in time, William presented to his primary care family medicine doctor. His doctor ordered an x-ray and diagnosed him with osteoarthritis (OA). William then received a cortisone injection into his right knee, as it was the more painful side.
The cortisone injection provided good pain relief for the next 3 months without the need to use Ibuprofen during this time. After 3 months, Williams pain slowly began increasing once more. His doctor had him resume Ibuprofen daily in order to prolong the time between the cortisone injections. William then received another cortisone shot in both his right knee and left knee 6 months after the first shot. This time, the cortisone only provided relief for 1 month after the injections and William’s pain returned. His doctor then decided to change William’s treatment plan, and administered hyaluronic acid injections into both knee of his knees.
William received pain relief from the hyaluronic acid injections for the next 6 months and was satisfied with this treatment. He then received the same injections again 6 months later and continued this protocol for the next 2 years with good relief. After this time, William began noticing that the hyaluronic acid treatments were not lasting 6 months as they were previously. His doctor now ordered an MRI of both his knees, which revealed osteoarthritis in both of his knees with the knee medial compartment being the most severe. His left and right MCL were also sprained. At this point, his doctor referred William to an orthopedic surgeon for a knee replacement evaluation.
William was not open to surgery at this point in his life and began to explore non-surgical options. He ended up finding our clinic and we reviewed his treatment options. William decided that he wanted to try PRP with a regenerative allograft and we moved forward. William’s right knee pain was a constant 6/10 pain on the visual analog scale, with 8/10 pain at its worst. We treated William’s right knee first with an allograft in platelet rich plasma solution. The treatment included intra-articular injections as well treatment on the MCL, LCL, pes anserinus, and distal quadriceps tendon attachment. We completed 2 PRP follow up treatments as well at 1 month and 2 months after the signaling allograft treatment. 3 months after the initial injection treatment we re-evaluated Williams case. His pain at this time was 0/10 on average in his right knee and 1/10 after a 3 mile walk. He was very satisfied with the outcome and we agreed no further injection treatment was needed at the time but we did work on establishing maintenance exercises and stretching that he could do at home for further prevention and longevity of the joint.
Stem Cell Signaling OA Knee Pain Summary
Osteoarthritis is an extremely common condition impacting millions of Americans. The condition can cause pain in various joints, with the knee joint being the most common. Patients typically experience chronic dull and achy knee pain for many years as the condition slowly progresses. Standard medical care focuses on managing the disease progression through anti inflammatory medications, steroid injections, hyaluronic acid injections, and ultimately complete knee replacement surgery. Patients are often left to decide between living in chronic pain or undergoing a major surgery. This unfortunately, is not an attractive position to be in and leaves patients searching for alternatives. This is where regenerative medicine therapies such as alternatives to stem cell therapy, ECM, and PRP come in. This approach has revolutionized orthopedic medicine and has provided hope and most importantly results for thousands upon thousands of patients. Regenerative injections focus on healing and improving the damaged cartilage in the joint and strengthening the tendons and ligaments of the knee joint. This delivers long lasting pain relief as the joint returns to a healthy and functional state. Patients are able to return to living the life they intended, pain free and strong in many cases.