TREATMENT OF KNEE ARTHRITIS
Knee osteoarthritis is associated with articular cartilage degeneration, joint space narrowing, and subchondral pathology. About 10% of men over 60 years of age have symptomatic knee arthritis. The incidence is slightly higher in women. Treatment, to mention a few modalities, can include exercises, muscle strengthening, Transcutaneous Electrical Nerve Stimulation, weight loss, bracing, medication, joint injection therapy with ozone, cortisone, PRP, or Hyaluronic acid. Non-Steroidal Anti-Inflammatory medication can be helpful.
INTRAARTICULAR (JOINT) PRP, HA, OR BOTH FOR KNEE ARTHRITIS
We commonly use PRP (platelet-rich plasma) in the treatment of KOA (Knee Osteoarthritis). PRP consists of plasma from the patient’s blood plus platelets rich in anti-inflammatory and growth factors. We customize the PRP for patients. For instance, in osteoarthritis, we have found low white count PRP to be beneficial. The literature supports using this type of PRP.
Hyaluronic acid (HA) is also helpful for the treatment of KOA. Many studies state that PRP is more beneficial and is longer lasting than HA.
Intraarticular PRP and HA administered together are more beneficial than PRP alone or HA alone. Several studies report this. This combination is one of our more popular treatment options. We can offer both PRP and HA at a cost often less than the regular price of PRP alone.
The duration of PRP and HA treatment is often nine months to 18 months. It is not unusual to repeat this treatment.
BONE MARROW INJECTIONS FOR KNEE ARTHRITIS
There is another exciting treatment option that we offer!
Before discussing this option, it is essential to describe the reason for Knee Osteoarthritis pain. The pain can be from inside the joint structures (intra-articular) or from outside the actual joint space (usually from the supporting bone). Painful intra-articular structures can consist of meniscal tissue, synovial lining tissue, or bare bone. The pain of an arthritic knee can also come from the supporting bone. The supporting bone can develop areas of lessened bone density.
These are called “bone marrow lesions” or “BML’s.” Studies show that treating the joint with PRP, HA, or stem cells is effective, but the treatment only lasts for up to 18 months. In addition, this treatment doesn’t necessarily stop the progression of arthritis or always decrease the chance of having a future total joint replacement. On the other hand, studies show that treating the supporting bone in knee arthritis reduces symptoms and lessens the chance of needing a total joint replacement.
Important Studies
It is important to discuss two significant peer-reviewed studies that examine the treatment of knee arthritis with stem cells. A connection to the full script of both articles is linked below.
The first study by Hernigou, Delambre, Quiennec, and Poignard (2020) c examined stem cell placement in the supporting bone of the joint versus a total joint replacement in the same patient.
This study included 140 adults aged 65 to 90 who had bilateral knee medial compartment arthritis. They had similar pain in both knees and all patients elected to undergo a different treatment on each knee-arthroplasty (total knee) on one side, and bone marrow stem cells into the bone on the other.
Both of these procedures were performed during the same surgery under general anesthesia. At a mean 15 year follow up, only 18% of the 140 bone marrow patients underwent total knee arthroplasty. This means 82% of the 140 patients did not need a subsequent total knee replacement. Interestingly, the revision knee arthroplasty (a second and more difficult operation) rate done in the knee arthroplasty side was about 16%. So, the failure rate of the stem cell knee was about the same as the need for a second more difficult operation on the original knee arthroplasty side. Put in laymen’s terms, when two patients had treatments of one knee with an arthroplasty (total knee) and the other knee with into the bone stem cells, the success rate was statistically the same fifteen years after the procedures.
The second article examined knee arthritis differences between a joint-only injection with stem cells versus a bone injection with stem cells. This study was completed by Hernigou, Bouthors, Bastard, Flouzat Lachaniette, Rouard, and Dubory (2020)2.
In this study, there were 60 knees with bilateral knee arthritis followed for 15 years. 20% of the stem cell bone treatment went on to a total joint arthroplasty. However, 70% of the joint-only treatment went on to knee arthroplasty. This joint-only group initially did well, but the results didn’t last.
The above studies illustrate that joint-only treatment with stem cells is temporarily adequate but not consistently long-lasting. That is why repeated intraarticular PRP, HA, or both injections are occasionally necessary. On the other hand, bone marrow-derived stem cells injected into the supporting bone in knee osteoarthritis are very effective and give a longer-lasting result.
At Sierra Stem Cell institute, we inject both the joint space and also the supporting bone in patients with knee osteoarthritis. We have been happy with the results most of the patients we have done.
The injections that were done by Dr. Hernigou and his team used general anesthesia. We have developed local block anesthesia for pelvic aspiration and knee bone injections. In addition, we use oral analgesic medication plus nitrous oxide. Most patients tolerate the procedure extremely well.
The two studies by Dr. Hernigou are listed below. We want to mention that Dr. Hernigou is considered by many to be the father of stem cell injections in knee arthritis. About three years ago, Dr McClish had the privilege of spending a one-on-one hour with this kind gentleman. Dr Hernigou was found to be engaging, intelligent, knowledgeable, articulate, and honest.
We will be glad to discuss with you any questions you might have.
The articles listed here can be downloaded free of charge. They are worth reading. We also have copies in our office.
1Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen-year follow-up.
Philippe Hernigou1,2 & Jérôme Delambre2 & Steffen Quiennec2 & Alexandre Poignard2
Received: 10 January 2020 /Accepted: 6 April 2020. International Orthopaedics
https://doi.org/10.1007/s00264-020-04571-4
2Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study.
Philippe Hernigou1 & Charlie Bouthors2 & Claire Bastard1 &
Charles Henri Flouzat Lachaniette1 & Helene Rouard3 & Arnaud Dubory1
Received: 12 April 2020 /Accepted: 26 June 2020
# SICOT aisbl 2020. International Orthopaedics
https://doi.org/10.1007/s00264-020-04687-7
Thank you,
Laurence McClish, MD