Management of Osteoarthritis
Primary Medical Therapy
Advanced Medical Therapy
What is Involved ?
Primary Medical Therapy
• Non Steroidal Anti-inflammatories
*It is important to consult with your doctor prior to using anti-inflammatories in the treatment of your
• Glucosamine is an amino-acid that forms the common `back bone’ of cartilage matrix.
• Evidence suggests that glucosamine supplements may offer both pain relief and reduce the
progression of arthritis
• At least 1500mg/day of Glucosamine Sulphate (NOT Glucosamine Hydrochloride)
• Chondroitin ? Shark Fin ??
• Many glucosamine preparation have additional additives. Some evidence suggests additional
benefits with Glucosamine + Chondroitin Sulphate preparations.
• Allergy/anaphylaxis - Glucosamine is derived from shell fish.
• Research :
• McAlindon, et al. Glucosamine and Chondroitin for Treatment of Osteoarthritis - Review Article,
JAMA 2000, 283(11):1469-1475
• Clegg, et al. Glucosamine, Chondroitin Sulphate, and the Two in Combination for Painful Knee
Osteoarthritis, N Engl J Med 2006, 354:795-808
• Regular and appropriate exercise can be effective in reducing pain and disability associated with arthritis
• A structured program created and supervised by a professional rehabilitation Exercise Physiologist or
Physiotherapist is recommended.
• Exercise Principles (FITT)
Frequency : At least 3 session per week for > 8weeks
Intensity : Moderate Intensity
Type of exercise : Aerobic, resistance and load bearing
Time : At least 30minute sessions
• Research :
Petrella, et al. Is exercise effective treatment for osteoarthritis of the knee?, BJSM 2000, 34:326-331
Podiatry assessment and relevant biomechanical adjustment can often help to unload areas of arthritis and therefore reduce pain and improve function.
• Increased weight is a risk factor for the development of osteoarthritis in weight bearing ie. (hip and knee)
and also non weight bearing joints (ie. hand).
• Loss of 5kg has been shown to be effective in reducing the risk of knee arthritis by a factor of up to 50%.
• It is important to have a structured weight loss program developed by a qualified Nutritionalist or Dietician.
• Research :
Felson, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham
Study. Arthritis Rheum 1997, 40:728-733
The most common disease affecting the knee is osteoarthritis. The cartilage in the knee gradually wears away, causing pain and swelling. Knee problems are very common, and they occur in people of all ages. Knee problems can interfere with many things, from participation in sports to simply getting up from a chair and walking. This can have a big impact on your life.
Injuries to ligaments and tendons also cause knee problems. A common injury is to the anterior cruciate ligament (ACL). You usually injure your ACL by a sudden twisting motion. ACL and other knee injuries are common sports injuries. Treatment of knee problems depends on the cause.
Traditional options for patients suffering from the knee or hip injury, arthritis or pain include arthroscopic joint surgery, total knee or hip joint replacement. Besides the cost and the risks of those orthopedic surgeries, several months of rehabilitation is usually needed after the surgeries.
For many patients these intense orthopedic surgeries may not be an option due to their younger age especially considering the fact that we are living longer and more active lifestyle and the Joint Replacement may not last for more than 10 to 15 years. Also, the injuries may not be serious enough to require any surgery.
As an alternative to the knee and hip (and other joints) surgery or replacement, alleviate joint pain, arthritis and other medical conditions that caused it with a simple office injection procedure. We encourage the patients to walk the same day and most experience almost no downtime after our procedures whatsoever.
And if you are considering a knee, hip or other joint replacement, you might want to learn about how the adult stem cells and PRP procedures stack up against these risky Orthopedic surgeries.
Traditionally – a Total joint replacement of the hip or knee is often considered to be a accepted approach to treatment for patients suffering from significant arthritis or injury in their knee and hip joints. Over the years, due to aging baby-boomers and active lifestyle causing more sports injuries, these procedures have become more common. It has now become something that almost seems inevitable for us as we age.
But what about an alternative that could be just as successful as joint replacement and may be a better option for many of the patients before even considering joint replacement. And, all of this with significantly lower risk and cost.
When comparing two options - a treatment that involves simply an injection of your own natural cells in an outpatient setting may be significantly more attractive option for many patients than undergoing risky orthopedic surgery and replacing your entire joint with artificial material.
We play a key role in this cutting-edge stem cell medical field. While many types of stem cells are currently used in orthopedic healing, the most common are mesenchymal stem cells and hematopoietic stem cells to help regenerate tissue and rebuild cartilage, muscles, tendons and ligaments.
Because it is now possible to induce pluripotency in cells that have not come from embryos, the controversial use of embryonic stem cells has fallen on the way side and in the favor of the accessible cells found within the patient’s own body.
Patients coping with arthritis, sports injuries, tendon strains, sprained ligaments, muscle injuries and more, will be comforted to know that surgery is not the only option of treatment available to them. Faster healing as well as improved functionality both are possible with innovative, cutting- edge adult stem cell and PRP procedures.
MEDICAL LITERATURE - PRP AND STEM CELLS IN KNEE INJURIES
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2. Current clinical therapies for cartilage repair, their limitation and the role of stem cells. Dhinsa BS, Adesida AB. Curr Stem Cell Res Ther. 2012 Mar;7(2):143-8. 2.
3. Mesenchymal stem cell-based treatment for cartilage defects in osteoarthritis. Qi Y, Feng G, Yan W. Mol Biol Rep. 2012 May;39(5):5683-9.
4. Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis. Koh YG, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi Y. J. Arthroscopy. 2013 Jan 29.
5. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Arch Iran Med. 2012 Jul;15(7):422-8.
6. Developments in stem cells: implications for future joint replacements. Proc Maclaine SE, McNamara LE, Bennett AJ, Dalby MJ, Meek RM. Inst Mech Eng H. 2013 Mar;227(3):275-83.
7. Current surgical options for articular cartilage repair. Peretti GM, Pozzi A, Ballis R, Deponti D, Pellacci F. Acta Neurochir Suppl. 2011;108:213-9.
8. Mesenchymal stem cell-based treatment for cartilage defects in osteoarthritis Qi Y, Feng G, Yan W. Mol Biol Rep. 2012 May;39(5):5683-9.
9. Prospects of stem cell therapy in osteoarthritis. Roberts, Genever, McCaskie & De Bari; Regen. Med. (2011) 6(3), 351–366).
10. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis. Rutjes AWS, Jüni P, MD; da Costa BR, et al. Ann Intern Med. 2012 Jun 11.
11. Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-analysis. Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Arch Phys Med Rehabil. 2013 Nov 27.
12. A Randomized Clinical Trial Evaluating Plasma Rich in Growth Factors (PRGF-Endoret) Versus Hyaluronic Acid in the Short-Term Treatment of Symptomatic Knee Osteoarthritis. Sánchez M, Fiz N, Azofra J, et al. Arthroscopy. 2012 Aug;28(8):1070-8.
13. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M. Arthroscopy. 2011 Nov;27(11):1490-501.
14. Treatment of Knee Osteoarthritis with Autologous Mesenchymal Stem Cells: A Pilot Study. Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J. Transplantation. 2013 May 15.
15. Current clinical therapies for cartilage repair, their limitation and the role of stem cells. Dhinsa BS, Adesida AB. Curr Stem Cell Res Ther. 2012 Mar;7(2):143-8.
16. Mesenchymal stem cell-based treatment for cartilage defects in osteoarthritis. Qi Y, Feng G, Yan W. Mol Biol Rep. 2012 May;39(5):5683-9.
17. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9.
18. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Spaková T, Rosocha J, Lacko M, et al. Am J Phys Med Rehabil. 2012 May;91(5):411-7
19. Therapeutic effectiveness of intra-knee-articular injection of platelet-rich plasma on knee articular cartilage degeneration]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1192-6.
20. Growth factors in the treatment of early osteoarthritis. Civinini R, Nistri L, Martini C, Redl B, Ristori G, Innocenti M. Clin Cases Miner Bone Metab. 2013 Jan;10(1):26-9.
21. Treatment of knee chondropathy with platelet rich plasma.Preliminary results at 6 months of follow-up with only one injection. Torrero JI, Aroles F, Ferrer D. J Biol Regul Homeost Agents. 2012 Apr-Jun;26(2 Suppl 1):71S-78S.
22. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: A proof-of-concept clinical trial. Jo CH, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS. Stem Cells. 2014 Jan 21.
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25. Autologous bone marrow concentrate: review and application of a novel intra-articular orthobiologic for cartilage disease.Sampson S1, Botto-van Bemden A, Aufiero D. Phys Sportsmed. 2013 Sep;41(3):7-18.
26. Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee, Jae-Do Kim, Gun Woo Lee, Gu Hee Jung, Cheung Kue Kim, Taehun Kim, Jin Hyung Park, Seong Sook Cha, Young-Bin You, European Journal of Orthopaedic Surgery & TraumatologyJanuary 2014
27. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series.Hauser RA1, Orlofsky A. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72.
28. Treatment of chronic patellar tendinopathy with autologous bone marrow stem cells: a 5-year-followup. Pascual-Garrido C, et al. Stem Cells Int. 2012; Epub 2011 Dec 18.
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48. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Emadedin M1, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Arch Iran Med. 2012 Jul;15(7):422-8.
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