Hyaluronic Acid Or Hyaluronate Injections
Also called viscosupplements, this treatment tries to restore synovial fluid, which is a slippery substance that helps lubricate joints.
A major component of synovial fluid is called hyaluronate. For more than 20 years, doctors have tried to restore mobility and curb pain by injecting hyaluronate directly into the knee joint.
How Is Osteoarthritis Of The Knee Diagnosed
Your healthcare provider will do a physical examination and ask about your medical history. The physical examination might include checks to see:
- If your knee joint area is red or sore.
- If theres a sign you injured your knee.
- How much you can move your knee. This is called your range of motion.
- If your knee feels “loose,” which can mean your joint isnt stable.
- The way you walk, in case you have gait problems that affect your knee. A gait problem is when you dont walk as you would normally.
Get The Right Kind Of Exercise
Moderate physical activity wont increase your risk of osteoarthritis. In fact, by helping you maintain a healthy weight, it can actually reduce the risk. If your knees hurt, however, be smart. Dont start training for a marathon or join a basketball team. Instead, says Khanuja, try lower-impact exercise such as swimming, walking, or using an elliptical machine.
New Pain Treatment For Knee Osteoarthritis Targets Nerves
A relatively new treatment for knee osteoarthritis appears to reduce pain better than traditional corticosteroid injections, according to a study published recently in International Journal of Rheumatic Diseases.
The study, by researchers at Adnan Menderes University in Turkey, compared corticosteroid injections into the joint to a procedure called radiofrequency neurotomy in a group of 73 patients with knee OA. Radiofrequency neurotomy is the use of a heated needle to damage nerves in this case the genicular nerves in order to disrupt pain signals. After receiving treatment, the group that underwent neurotomy reported less pain and greater functional movement than the injection group.
Radiofrequency neurotomy has been used for decades to relieve back and neck pain, but is new to the treatment of knee osteoarthritis. Soo Yeon Kim, MD, an attending physician in the multidisciplinary pain program at Montefiore Health System in New York City, says the location of the back nerves that cause osteoarthritis pain is well documented and the procedure has been shown to be safe and effective. But the position of the nerves in the knee is more variable than in the back, she explains. Additionally, major knee arteries run very near the small nerves that need to be heated, creating a slight risk for arterial damage.
Harvard Health Ad Watch: A New Treatment For Knee Arthritis
The TV ad promises pain relief for knee osteoarthritis, the source of most of the 600,000 knee replacement surgeries performed in the US each year. A man in a bowling alley winces with pain. He nearly falls as he rolls a ball into the gutter.
“Knee acting up again?” asks his buddy, clearly concerned. When pain pills dont seem to help, his buddy suggests a procedure called Coolief for knee osteoarthritis.
“I had it done six months ago,” says the bowling buddy. “And the best part is that it lasts up to one year.”
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Physical Therapy And Exercise
Regular physical activity may be the most important piece of your overall treatment plan. Being active can help you stay mobile, relieve pain, lose weight and reduce your risk of other health problems. Activities such as walking, biking, swimming, yoga and water aerobics are all helpful for your OA symptoms and overall health. If joint pain or stiffness makes activity difficulty, work with a physical therapist to develop an exercise plan and find modifications that work for you.
What Are The Symptoms Of Osteoarthritis In The Knee
Pain is the most common symptom of osteoarthritis in the knee. Your knee might hurt when you move it, or even when you are just sitting still. Other symptoms are:
- Your knee feels stiff, particularly when you first get up or when youve been sitting for a long time.
- Your knee looks swollen or feels puffy.
- You hear a cracking or grinding noise when you move your knee.
- Your knee feels wobbly, as if it could buckle or give out.”
- Your knee might lock up, or feel as if it is stuck.
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How Can I Get Access To This Treatment
ACI is now available on the NHS. This means that more peopleacross the UK can access ACI and its benefits. However, it is only offered to specific patients, usually those with small areas of cartilage damage or early osteoarthritis, as set out by NICE guidelines. You can speak to your GP or consultant to find out more.
Targeting Peripheral Opioid Receptors
Opioids are effective analgesics but their use is limited due to serious adverse side effects like constipation, respiratory depression, tolerance, and dependence. Currently, new opioid receptor agonists with an improved safety profile targeting the µ, , and subtypes are in development. Selectively targeting the peripheral -OR might avoid side effects observed when drugs target the µ-OR. Cara Therapeutics developed the selective -OR agonist CR845 and evaluated its efficacy in knee and hip OA , reporting dose-dependent efficacy in the reduction of pain in hip OA over knee OA38 .
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What Is Osteoarthritis Of The Knee
Osteoarthritis of the knee happens when the cartilage in your knee joint breaks down, enabling the bones to rub together. The friction makes your knees hurt, become stiff and sometimes swell. While osteoarthritis in the knee cant be cured, there are many treatments to slow its progress and ease your symptoms. Surgery is an option for more severe forms of osteoarthritis.
Addressing The Rise Of Knee Osteoarthritis In India
In India, osteoarthritis is the second leading rheumatological problem. Affecting roughly 22 to 39% of the Indian population, OA causes pain, stiffness and restricted movement due to the degeneration of joint cartilage.
One of the most common forms of OA occurs in the knee. Knee osteoarthritis is linked to heavy physical labor, which is widespread across Indias rural communities. A 2016 study also found that the prevalence of OA was more common in Indias lower socioeconomic classes, leaving many of the affected people without the necessary resources to treat the condition.
As of now, there is no cure for knee osteoarthritis. Doctors typically promote non-pharmaceutical measures, like losing weight or trying certain exercises. There are some medical treatments that can alleviate pain, like hyaluronate injections, physical therapy and even surgery. But these treatments can be expensive and difficult to access, and people living in Indias rural villages may struggle to get to the right clinics.
Rising Risk Factors Among Women and the Elderly
Seeking a Solution
Although there is currently no cure for knee OA, a group of researchers in India has made a medical breakthrough. In September 2022, the Drug Controller General of India approved Stempeutics StemOne, a new stem cell therapy for knee OA. StemOne will become Indias first commercially-available allogeneic cell therapy treatment for knee OA.
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Are The Ads Accurate
Based on the 30-second TV commercial described above and a six-page online brochure, some of the claims seem exaggerated, misleading, or incomplete. For example:
Finally, learning that Coolief was “cleared” by the FDA might lead you to assume the FDA evaluated the evidence and concluded this procedure is safe and effective. In fact, Coolief did not require specific FDA approval because the FDA concluded it was similar enough to other “legally marketed” devices.
Knee Replacement Alternatives To Consider
Crunching sounds as you climb stairs, chronic aching and swelling: Knee osteoarthritis is a real pain. If youre suffering with it, you may be considering surgery.
Getting a knee replacement is one approach, but you may not need surgery, at least not right away. And some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young for a knee replacement the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery.
There are several things you can try first, on your own or with a professionals help, that can help with knee pain and even delay the need for replacement.
Arthritis doesnt go away, but there are things you can do to lessen the pain and stay more active.
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How Do I Take Care Of Myself With Knee Osteoarthritis
It can be frustrating to cope with osteoarthritis of the knee symptoms that keep you from working or enjoying daily activities. Fortunately, there are several things you can do for your symptoms:
- Applying ice or heat reduces your knee pain, stiffness and swelling.
- Losing weight or maintaining a healthy weight takes stress off your knees.
- Enjoying activities such as swimming, biking or walking keeps your knee joint flexible.
- Using a knee brace or adding shock-absorbing inserts in your shoes can reduce pressure on your knees.
- Participating in self-management programs can help you feel more in control of your health.
Editorial Note On The Review Process
F1000 Faculty Reviews are commissioned from members of the prestigiousF1000 Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions .
The referees who approved this article are:
- Frank Zaucke, Orthopaedic University Hospital Friedrichsheim gGmbh, Frankfurt, GermanyNo competing interests were disclosed.
- Andrew Pitsillides, Skeletal Biology Group, Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, NW1 0TU, UKNo competing interests were disclosed.
- Changhai Ding, Menzies Research Institute, University of Tasmania, Hobart, Tasmania, 7000, AustraliaNo competing interests were disclosed.
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Laser Therapeutic Ultrasound And Electrical Stimulation
The OARSI guidelines strongly recommended against the use of laser therapy for knee OA, citing an implausible biological mechanism and no efficacy, with a very low overall quality of evidence.8 The potential mechanisms of pain relief by laser therapy are due to the stimulus of tissue metabolism and modulation of the inflammatory process. However, literature shows contrasting evidence regarding the use of laser therapies, more specifically low-level laser therapy , in treating individuals with knee OA. A meta-analysis evaluating the effectiveness of LLLT on symptoms and function in patients with knee OA, showed no therapeutic benefit of LLLT compared with placebo for patients.58 A more recent meta-analysis showed that LLLT seems to reduce pain and disability in individuals with knee OA when compared to placebo in randomized controlled trials.59
Studies regarding therapeutic ultrasound, although reporting beneficial effects of the therapy for knee OA, show methodological limitations that hinder the evidence synthesis, such as the inclusion of mixed interventions.60, 61, 62, 63, 64 Thus, there is low quality of evidence to support the use of therapeutic ultrasound for individuals with knee OA.8 However, the ACR guidelines conditionally recommends its use , meaning that therapists need to give a complete and clear explanation of benefits, harms, and burdens of the treatment when presenting it as an option to a patient.13
Therapies Targeting Senescence And Aging
Age is a key risk factor for the development of OA, and age-related changes within the joint might represent targets for therapy. Aging and OA are closely related but still occur independently of one another. Some hallmarks of aging can influence the development of OA, such as genomic instability, telomere attrition, epigenetic alterations, loss of proteolytic homeostasis, dysregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication137,138. So far, no human clinical trials have been designed to specifically target aging-related processes, but pre-clinical studies targeting some of the age-related factors generated promising data which may lead to novel therapeutic strategies. In the meantime, there are several senolytics known, which have the potential to qualify as therapeutic agents to treat OA.
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Help For Arthritic Knees
Osteoarthritis is the most common cause of pain and disability in knees. In the knee joint, smooth articulate cartilage, called surface cartilage, covers the ends of the femur and tibia . Between the two bones sits a second type of cartilage, called menisci, which acts as a shock absorber. Joint fluid also lubricates the knee joint.
Osteoarthritis starts as the lack or loss of surface cartilage, progressively involving the surrounding bone, tissues and synovial fluid. In OA, your knee cartilage may thin in spots or disappear completely, resulting in areas of exposed bone.
X-rays, MRI and knee arthroscopy can help you and your doctor to determine the right treatment plan, which may include these noninvasive options.
Summary And Future Outlook
Recognition of OA is a complex disease with multifactorial nature, and the whole joints are involved in the degenerative process is crucial for cartilage repair. Therefore, it is necessary to increase our knowledge in basic sciences to comprehensively understand the mechanism of different joint components in OA pathology. Until now, in the clinics, conservative management, including physical measures and pharmacological therapy are still the first choices offered for OA patients. Joint arthroplasties or total replacement surgeries are served as the ultimate therapeutic option to rehabilitate the joint function of patients who withstand severe OA. However, these approaches are not able to induce healing processes or halt the degenerative processes in the joints. Demand for cartilage regeneration remains a big challenge both for clinicians and researchers.
FIGURE 2. Future trends of tissue engineering in treating OA. Proper cell selection, appropriate bioactive stimulus, and perfect design of scaffolds are central to tissue engineering. Novel scientific technologies, including CRISPR gene editing, 3D bioprinting, and AI should be used to facilitate the development of tissue engineering in treating OA.
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Treatments Targeting Inflammatory Mediators And Pathways
It is now commonly accepted that OA has an inflammatory component that might be more dominant in specific patient subgroups and joint tissues. The release of various pro-inflammatory mediators like prostaglandins, cytokines, and chemokines has been demonstrated in numerous pre-clinical OA animal models and in patients74. Synovitis is a common feature of inflammatory OA, and technical progress in imaging technologies like ultrasound and MRI revealed synovitis in a large number of patients at different disease stages75,76. A plethora of triggers including aberrant mechanical forces, metabolic syndrome, increased age, and fragments of cartilage extracellular matrix or crystals might induce the release of these mediators from various responsive joint tissue cell types. A large number of recent review articles address cells and components of the innate immune system as the main drivers of OA inflammatory processes77,78. Non-steroidal anti-inflammatory drugs and glucocorticoids are commonly used to treat OA but are not optimal owing to moderate effectiveness and serious side-effects in long-term use79,80.
Making Knees New Again
How are your knees? If youre like many people age 50 and older, theyve been aching. If youre 65 or older, you may have some degree of osteoarthritis, in which the cartilage that cushions the ends of the bones in the joints begins to degenerate or wear away.
Symptoms can range from stiffness to severe pain and limited mobility. So its probably not surprising that surgeons perform more than 700,000 knee-replacement surgeries in the United States each year.
Total knee replacement is very effective, but implants dont last forever. Although they can last 20 years, one study found that about 14.9 percent of men and 17.4 percent of women who receive a total knee replacement will need another. The earlier you get your implant, the more likely youll be back in surgery at some point.
Thats why knee replacement should only be considered after youve tried everything else, says Harpal S. Khanuja, M.D., chief of hip and knee replacement surgery with the Department of Orthopaedic Surgery at Johns Hopkins. That includes following your doctors recommendations for losing weight, physical therapy, pain management, and modifying your activities.
I tell people its time for a replacement when they cant live the life they want to live it is not a good solution for an occasional pain, Khanuja says.
To keep knee replacement as a last resort, keep your knees healthy with these smart steps.
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New Hydrogel Injection For Knee Osteoarthritis Offers Patients A Return To Mobility Without Surgery
SAFE AND SUSTAINED PAIN RELIEF WITH A SINGLE INJECTION
A new hydrogel injection for knee osteoarthritis that harnesses non-biodegradable hydrogel technology Arthrosamid® was officially launched to the UK market at the British Orthopaedic Association Annual Congress, 21st- 24th September 2021.
Pioneered by Contura International Ltd, , Arthrosamid® offers an alternative to current therapies and fulfils an unmet clinical need for an effective, long acting, safe and minimally invasive treatment to alleviate pain associated with knee osteoarthritis .
The treatment has the potential to change the present care pathway for managing OA, which affects approximately 8.5 million people in the UK . Around 1 in every 5 people aged over 45 in England is affected by knee osteoarthritis and current treatments are not long lasting or involve invasive knee replacement surgery. Despite a large suffering population, there has been very little innovation in the range of OA treatments on offer to meaningfully help patients until now.
Consisting of 2.5% cross-linked polyacrylamide and 97.5% non-pyrogenic water, a 6ml dose of Arthrosamid® is injected into the joint space to cushion the knee and relieve pain in one single treatment. Patients can expect to see improved mobility and pain relief within days where the effect is long lasting.
A number of clinical studies have been completed into Arthrosamid® with further trials ongoing:
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09:34 Nov 01 2022