Osteoarthritis (OA) is the most common form of arthritis affecting almost 30 million Americans. While traditionally viewed as a disease of older adults, it is quite clear that younger people can also develop significant disease. This is a probably due to a combination of factors including genetics, previous trauma, as well as earlier detection.
While the standard types of conservative treatments may help, some patients do not respond to topical or oral anti-inflammatory drugs, steroid injections, lubricant injections, bracing, and physical therapy.
Weight reduction, activity modification, low impact aerobic exercise, and quadriceps strengthening exercises are also conservative measures that need to be tried.
So what happens if they fail?
Knee arthoscopy has been used by enthusiastic orthopedists for decades. A study in 2008 cast doubt on the efficacy of this procedure for OA. Since that time other studies have also shown that knee arthroscopy is relatively unsuccessful for this condition. Conditions that appear to particularly point towards a poor prognosis with arthroscopy are OA present for more than 2 years, obesity, the presence of large bony spurs, significant joint space narrowing, smoking, and cartilage defects exposing underlying bone.
If alignment of the knee is abnormal, then a procedure called osteotomy is often suggested. With this procedure, the surgeon removes a wedge of bone from the either the femur (upper leg bone) or tibia (the lower leg bone) to help the joint line up better. This is a temporary solution but sometimes successful.
Biological procedures that have been used in younger patients include osteochondral grafting where a bone and cartilage plug is taken from a non-weight-bearing area and plugged into the weight-bearing lesion. Autologous chondrocyte (a patient's own cartilage cells) implantation, and meniscus transplantation, have also been tried. A newer technique where allograft cartilage (donor cartilage) is minced and mixed with a fibrin glue and pasted into the lesion has also been used. All patients have been young with discrete cartilage defects. None have been older with the typical larger defects seen with long-standing osteoarthritis.
Another popular procedure orthopedists use is unicompartmental arthroplasty. This is a procedure where only the narrowed part of the knee is replaced. There is more rapid recovery as well as less blood loss, and fewer complications. The success of this procedure is highly dependent on the experience of the surgeon.
The procedure that appears to be most promising though for younger patients with OA of the knee is guided autologous stem cell layering.
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