…”effect of repeat injections of hyaluronic acid unclear. May not halt progression of OA nor delay knee replacement”…

Written by admin on December 29, 2012 – 11:02 am -

“Osteoarthritis (OA) is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth, which ultimately lead to pain and joint stiffness. Most commonly affected joints are the knees, hips, and joints in the hands and spine. OA of the weight bearing joints (e.g. knee and hip) typically have the most clinical significance. The causes of OA are presumed to be related to mechanical and molecular events in the joint (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm).

OA usually begins after the age of 40. OA affects 13.9% of adults aged 25 and older and 33.6% of those aged 65 and over (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm). Among those affected, approximately one quarter of them are severely disabled. [3] Osteoarthritis is the leading cause of mobility disabilities such as difficulty walking or climbing up stairs. OA of the knee is one of five leading causes of disability among non-institutionalized adults. [4]

Knee OA is the most prevalent, followed by hip OA. Both knee and hip OA result in joint pain and stiffness which can ultimately interfere with function and restrict activities of daily living [5].

There is no cure for OA. In addition, there are currently no known therapies that can prevent progression of OA. Treatment of OA typically focuses on minimizing pain and swelling, reducing disability and improving quality of life.
Treatment typically starts with non-pharmacologic therapy approaches including exercise programs, weight loss, patient education and shoe insoles. [6] Non-pharmacologic approaches are typically tried before medications are started.

Pharmacologic treatment is typically the next step and focuses on relief of pain. Pharmacologic therapy typically includes acetominophen, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase (COX-2) inhibitors and opiates. Each of these medications can be beneficial in some patients and each is associated with characteristic side effects. Given that the patient population is typically an older one, often with other comorbid conditions, the side effects associated with long term use of some of the OA medications can be particularly problematic.

Intra-articular glucocorticoid injections are another potential component of OA treatment….”

For the entire article please click below.

Hyaluronic Acid for Treatment of Osteoarthritis of the Knee…

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PRP May Be Superior Knee OA Treatment When Compared With Visco Supplementation

Written by admin on December 6, 2012 – 8:18 pm -

Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.

Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M.

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Orthokine Therapy: Modern Day Fountain of Youth?

Written by admin on October 1, 2012 – 9:52 am -

Orthokine therapy is a new sports medicine treatment recently receiving widespread interest and acclaim. It was developed primarily for the treatment of osteoarthritis (OA) by German doctors, Dr. Peter Wheling and Julio Reinecke, PhD., of Dusseldorf, Germany. Little is known about this experimental technique, and there is scant data to support its efficacy, but anecdotal reports have been, high-profile and promising. Much like the mythical fountain of youth, the technique, its clinical mechanism, and its results are shrouded in mystery. Similar to Platelet Rich Plasma Therapy (PRP therapy), whose mechanism and effect has been discussed at great length, and is now widely-recognized in the public consciousness as the standard musculoskeletal rejuvenation therapy, Orthokine therapy is also an autologous treatment provided as an injection of the patient’s own blood. There are no foreign materials or substances used, so risk of adverse side effects is minimal, and the injections are well-tolerated.

In theory, proteins commonly found in patient’s blood –such as Interleukin – 1- Receptor – Antagonist (IL -1Ra) – possess inherent anti-inflammatory and analgesic properties that serve to protect and to preserve the cartilage in an arthritic joint against degradation by osteoarthritis.

During the Orthokine procedure, blood is obtained from the patient using a syringe containing beads that will enhance and/or release the production of these cartilage-protective proteins. The blood is stored at body temperature for up to 9hours, during which time, the concentration of the joint preserving proteins, have increased up to 100 times greater than normal. After the incubation period, the sample is centrifuged to isolate the enriched serum of proteins from the other elements of blood. It is then divided into numerous vials that may be used immediately or frozen for future treatments. The serum is then injected into the affected joint to decrease pain, increase range of motion, and decelerate the progression of degenerative joint disease, and (hopefully) improve the joints longevity. The practitioners report almost immediate improvement and symptom resolution for 2-4 years.

Orthokine therapy is being used throughout Europe but is not yet FDA approved for use in the United States. Professional athletes such as Kobe Bryant and Alex Rodriguez are among those who have traveled to Europe to receive the Orthokine therapy with the hopes of alleviating pain, enhancing their performance and extending their athletic careers.

It is unclear whether Othokine is the long-sought OA treatment (minimally invasive, long-lasting, relatively inexpensive to provide), the next innovation, or just the latest “snake oil” cure-all. It is certain, however, that despite the lack of clinical data, many more modern day Conquistadors will travel to Europe to imbibe this latter day fountain of youth, following the examples of the superstar “Ponce de Leon” that preceded them.–at least until it is “discovered” again somewhere else.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

Wehling, P. D. P. (2012). Molecular orthopaedics. Retrieved from http://www.wehling-hartmann.de/en/wir-ueber-uns/
Wheling, P. D. P. (2007). Osteoarthritis: The individual osteoarthritis therapy. Retrieved from http://alfa-arthro.com/dokumenti/BookletOA_Pat_05062007.pdf

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