Tag Archives: knee arthritis

Radio Frequency Ablation vs. Hyaluronic Acid

Radio frequency ablation compared with a single injection of hyaluronic acid for chronic knee pain. Reported in the Journal of Bone and Joint Surgery September 2020

There are many potential approaches to alleviating the pain associated with osteoarthritis. The most common approach is suppressing the inflammatory response to cartilage breakdown. This would include icing, oral anti-inflammatory medication, Injectable anti-inflammatory medication like steroids.

Activity modification, weight loss, and physical therapy can also mitigate some of the symptoms of arthritis.

Injection of platelet rich plasma which provides growth factors for cartilage regeneration has been shown to be effective in early arthritis theoretically improving or repairing the cartilage through the delivery of growth factors.

There are also injectable medications that rehydrate the remaining cartilage in an arthritic joint, and lubricate the joint, by incorporating into the articular cartilage. Examples of this would be Synvisc or Euflexxa. (  hyaluronic acid ).

Another approach is simply to try to suppress the pain and stay active despite the arthritis. Examples of this would be Tylenol, Narcotics, or nerve ablation. Nerve ablation is an attempt at decreasing the nerve stimulation Signal coming from the arthritic joint to the brain. Prior studies of radio frequency ablation have demonstrated 6 to 12 months of relieving knee arthritis pain.

The final option is joint replacement which is removing the worn out cartilage and bone spurs, thus eliminating the source of ongoing inflammation and pain in the knee or hip. Joint replacement is a resurfacing of the joint with metal and plastic creating a new weight bearing surface. This new metal cap over the end of the bones ( Joint replacement ) shields the underlying nerves in the bone from stimulation and therefore relieves the pain associated with arthritic wear. This is a permanent solution but a very difficult surgical recovery, Associated with it.

In this randomized perspective trial of 260 subjects. The patients were either given intra-articular injection with hyaluronic acid or underwent nerve ablation. They were comparable and randomly assigned to the treatment option. They were followed at one months three months and six months after the procedure. Consistently the group with radio frequency ablation did better in terms of pain and function. At six months follow up the group with radio frequency ablation still had 48% improvement while the hyaluronic acid group had 22% improvement. The results also demonstrated a much more significant improvement in pain and function in patients with early-stage arthritis versus in stage bone on bone arthritis.

In conclusion radio frequency ablation of the sensory nerves around the knee is a viable alternative with better functional outcome compared to hyaluronic acid injection.


The Link Between Distance Running and Arthritis

marathonAlthough distance running is often associated with numerous health benefits, the impact on hip and knee joint health has been inconclusive up to this point. Long-distance running has been linked with an increased prevalence of arthritis in some studies, but others have shown an inverse association or no association at all.

In a recent study published by Journal of Bone & Joint Surgery, authors Ponzio et al. investigate hip and knee health in active marathon runners, including the prevalence of pain, arthritis and arthroplasty (joint replacement) and associated risk factors.

To conduct their research, Ponzio et al. distributed a hip and knee health survey internationally to marathon runners from 18-79 years old, divided into subgroups by age, sex BMI and physical activity level. The survey questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, risk factors and current running status. The results were then compared with National Center for Health Statistics’ information for a matched group of the US population who were not marathon runners.

What the authors of the study found is that while age, family history and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, there was no correlation with running history. In the researcher’s cohort study, the arthritis rate of active marathoners was below that of the general US population.

While the authors conclude that longitudinal follow-up is needed to determine the effects of marathon running on developing future knee and hip arthritis, it’s a hopeful and encouraging finding for long-distance runners.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in joint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

PRP Injections May Be the Answer to Osteoarthritis

PRP-and-the-kneeAlthough osteoarthritis is one of the most common chronic joint conditions, few nonsurgical options have shown long-term benefits. Impacting almost 27 million Americans, the disease causes pain, swelling, and mobility issues as the cartilage between joints wears down. Joint replacement surgery can provide relief once the disease has significantly progressed, but nonsurgical alternatives have only had short-term benefits. Now, a new study published in The Journal of Arthroscopic and Related Surgery suggests that Platelet-Rich Plasma (PRP) injections could combat pain and improve joint functioning in the knee.

In the past, nonsurgical treatments have included using anti-inflammatory drugs and corticosteroid and hyaluronic acid (HA) injections. While they ease discomfort, research hasn’t found that the conditions are improved over a longer length of time, necessitating total knee replacement surgery. PRP, however, might offer a new solution.

PRP is blood plasma infused with platelets and contains several different growth factors. It’s been used to help alleviate pain from damaged muscles, ligaments, tendons, and joints by healing damaged cells and promote formation of cartilage repair tissue. Until now, no tests about its efficacy have been conclusive, partly due to small sample sizes. To make a more definitive claim, researchers from The First Affiliated Hospital of Chongqing Medical University conducted 10 randomized controlled trails with 1,069 patients.

562 patients received PRP injections to their knees, 429 received HA injections, and 78 received saline injections. Studies had three month, six month, and 12 month follow-ups. Although at six months, relevant studies showed no difference in pain or function scores, at one year, the researchers found that PRP was significantly more effective than HA at relieving pain and improving function.

Researchers were concerned that the proinflammatory substances PRP releases could be detrimental to tissues. However, no tissue damage was reported at either the six or 12 month follow-up and there were no differences in adverse effects between PRP and HA. More research will be needed before this can be confirmed.

Overall, these results show that PRP could be a viable nonsurgical option for patients with knee OA, helping regenerate tissue and stimulate HA production over a longer period of time.

Is knee pain impacting your quality of life? Dr. Stickney, a Kirkland orthopedic surgeon specializing in procedures including total knee replacement, can help you determine what surgical or non-surgical options are best for you. Contact his office today to learn more.

Running Might Be Good for Your Knees After All

running-and-kneesOne of the most common myths around running is the toll it can take on your knees as you get older. Both runner and non-runners generally promote the claim that  exercise causes the cartilage around your joints to deteriorate, leading to arthritis and possibly necessitating treatment by an orthopedic surgeon. However, recent research has shown that it can actually be beneficial for your body and joints, warding off arthritis in the future. Researchers from Brigham Young University have found that running changes the joint’s biochemical environment so it functions better, longer.

 Various studies have followed runners throughout lengthy periods of time to determine that they are less likely to develop osteoarthritis than their non-runner peers, but until now, why this is has only been conjecture. Sports medicine experts speculated this was due to a lower body mass putting less strain on the knees, but little work had been done to isolate the impacts of running on joint health.

The team at BYU studied fifteen male and female volunteers, all of whom were runners, under 30, and had no history of arthritis. The researchers collected a small amount of blood and synovial fluid, a fluid that lubricates joints, from each volunteer — the healthier the joint, the lower the amount of synovial fluid present. They also looked at specific substances within the knee, including cartilage oligomeric matrix protein (COMP), usually a marker of arthritis and present in higher levels in unhealthy knees, and other inflammatory molecules.

The volunteers ran for 30 minutes and sat for the same period, each session occurring on separate days. When the volunteers ran, higher COMP levels were observed in the blood than the synovial fluid, indicating that exercise pushed the substance into their blood and out of the joint. However, when sitting for only 30 minutes, the amount of COMP and inflammatory molecules was raised.

This suggests that even half an hour of exercise alters the knee, lowering inflammation and substances that indicate arthritis. However, sitting for that same amount of time also changes the knee, and not for the better. It could make the joints biochemically more vulnerable to diseases in the future.

The researchers, who published their findings in the European Journal of Applied Physiology, hope to study older or injured runners to see if their knees have fundamental differences from young, healthy joints, and how running might impact them.

Is joint pain impacting your ability to exercise? Interested in learning more about total knee replacement or non-surgical alternatives? Contact Dr. Stickney, a Kirkland orthopedic surgeon, today.

The Link Between Gum Disease and RA

 gum-disease-RAWhen your dentist reminds you to floss, they may be improving your orthopedic well being, along with your oral health. New research published in Science Translational Medicine discovered that the bacteria behind gum disease could also be the catalyst behind rheumatoid arthritis (RA). Although about 1.3 to 1.5 million Americans suffer from RA, an autoimmune condition which causes inflammation, swelling, pain, and stiffness in the joints and can necessitate joint replacement surgery, the root cause is unknown.

The relationship between gum disease and RA has been explored in the past. In 2008, a German study that appeared in the Journal of Periodontology found that people with RA are eight times more likely to develop gum disease than people without RA. In 2012, researchers discovered a correlation between tooth loss and joint inflammation — the greater the tooth loss, the greater the joint inflammation. Various other studies looked at different types of bacteria, such as that responsible for periodontal disease, to try and find a connection, though this research probes further at what specific strain of bacteria could link the two issues.

An international group of researchers collected blood samples from 100 people with gum disease and 100 people with healthy gums to study the bacteria at play. They also gathered blood and joint fluid samples from over 200 people who met RA’s disease criteria, and fluid from between the gum and teeth from nine people with periodontitis and eight people without. By testing and comparing the samples, the researchers noted that those with gum disease had higher levels of citrullinated proteins in their gum fluid than normal. While citrullination is a natural protein regulatory process, the scientists discovered that a strain of bacteria called Aggregatibacter actinomycetemcomitans was responsible as it produces a toxin that splits open certain cells, releasing citrullinated proteins.

The immune system in patients with RA reacts to this by creating antibodies specifically designed to combat the toxin, suggesting that the bacteria could trigger the autoimmunity of RA. While more research is needed to find a definitive correlation, researchers from Case Western University noticed that patients with RA saw a decrease in pain and other arthritis symptoms when they treated their gum disease.

This still doesn’t provide an exact answer of what can cause RA, nor does it prove gum disease is the main culprit since the presence of one doesn’t necessarily guarantee the other. As the disease’s onset can take decades, it’s possible there are other inflammatory processes at play and poor brushing habits can’t be blamed entirely. However, these findings provide new understanding of how the disease works and interacts with other bodily systems.

If you’re suffering from joint pain, knee arthritis or hip arthritis contact Dr. Stickney, a Kirkland orthopedic surgeon who specializes in procedures including total knee replacement and knee arthroscopy surgeries.

Innovative Developments in Treating Knee Osteoarthritis

stickney-300Knee osteoarthritis is a progressive degenerative condition. Up until recently, all treatments have been directed at ameliorating its symptoms, with no hope of stopping disease progression. However, recent trials using Platelet-Rich Plasma (PRP) to treat the disease, rather than just the symptoms, have had encouraging results. 

PRP is concentrated plasma from your own blood that has been separated to include platelets, small blood cells that are loaded with growth factors responsible for healing cells and that help form clots so your body can repair any damage.  Many of these growth factors have been shown to promote cartilage regeneration. Although PRP has been used since 1987 to help with cell regeneration, using it to stimulate cartilage renewal is fairly new. The treatment entails drawing blood and injecting the PRP into the knee.  

Two recent scientific papers reported decreased pain and improved function after PRP injections. In 2011, the Journal of Arthroscopy reported on the comparative results of injecting knees with PRP versus viscosupplementation with hyaluronic acid (HA), a procedure that injects a lubricating fluid into the joint. At the six-month follow-up, the PRP group had less pain. A second study in the American Journal of Sports Medicine in 2016 reported on the comparative results of injecting PRP versus saline, which was used as a control. The results of this study showed dramatic improvement at six months in both pain and function for the PRP group. There is much more to learn about PRP injections, and a lot of research is ongoing in this field. 

This data is very encouraging. PRP is readily available, easily processed, safe, and one of the only proven regenerative treatments for early arthritis of the knee.

If you’re suffering from arthritis or are interested in learning more about PRP knee injections as a treatment option, contact Dr. Stickney, a Kirkland orthopedic surgeon