By Ross Walker

Around 10% of men and 18% of women suffer significant clinical arthritis to some degree. There is no doubt that in 2015 the definitive treatment is a total knee replacement but on average these only last around 15 years.

It is, therefore, collective wisdom that people should wait until at least age 65 before considering a total knee replacement.

Recent large trials have suggested that arthroscopy itself is of no value in the treatment of osteoarthritis of the knee although it may be good for other conditions such as a torn meniscus. So, are there any other alternatives for the future?

Firstly with improved computer technology and better joint materials there is little doubt that total knee replacement will get much better longevity, possibly up to 25 years or beyond.

2.  Stem Cell Therapy. As a sufferer of traumatic right knee arthritis from far too much sport until my early fifties I have suffered chronic pain in the knee since and around five years ago had stem cell therapy. This actually made my knee worse but there are strong anecdotes that people have had significant improvements with stem cell treatments and as the science improves it may certainly become the primary therapy for osteoarthritis.

A recent study on rats with cartilage damage showed when given human embryonic stem cells that certain groups of cells known as chondro-progenitors develop into chondrocytes, which basically are the cells of cartilage. In four weeks the cartilage was partly repaired and in 12 weeks the cartilage was back to normal.

3.  Platelet Rich Plasma Therapy (PRP).  A few years ago after my failed stem cell therapy I underwent a course of PRP. This basically involves taking 60mls of blood in the morning, spinning down the platelets and injecting 6mls of platelets back into the joint in the afternoon. I had six consecutive weeks of treatment and have a few years on still gained moderate improvement from this therapy.

4.  Injection of Some Form of Lubricant Fluid Directly into the Joint. The lubricant, typically hyaluronic acid is given via one injection directly into the joint. In Australia this is typically Synvisc (Hylan-F20) and typically gives around six months of relief (plus or minus a steroid injection). Recent work from the US University Johns Hopkins showed that hyaluronic acid alone lacks protein that binds the hyaluronic acid to affected surfaces. When the research has added HA binding peptides (HAB peps) the combination lasted for twelve times longer compared with the hyaluronic acid alone. This is not available clinically as yet and has only been tested in animals and the laboratory.

5.  A Different gel contains Stromal Drive Factor 1 (SDF1) and acts like a homing beacon drawing out normal precursor cells from surrounding tissues (i.e. stem cells) and converts them into normal cartilage cells to repair the joint. Growth factors are also added to the gel. The new cartilage integrates seamlessly with the damaged tissues leading to normal levels of what is known as proteoglycans which are the proteins that make the tissue tough and resilient with good structural properties and also looks like normal cartilage. 

6.  White cells called Neutrophils release small components called microvesicles which can deliver anti-inflammatory compounds directly into the cartilage and it is proposed that long acting anti-inflammatories maybe directly injected to damaged cartilage via these microvesicles.

7.  Lifestyle factors for osteoarthritis. It is counter intuitive but a new study suggests that habitual running actually protects against osteoarthritis. A study from the US involving 2683 participants, average age 65, 56% women and average BMI 28.6 showed that those who participated in regular running had less deterioration in symptomatic osteoarthritis and x-ray confirmed osteoarthritis.

8.  Yoga and Tai Chi can help prevent osteoarthritis. A study of 75 adults with known knee osteoarthritis were randomly assigned to 60minutes twice a week of Hatha yoga for eight weeks along with home practice compared with the control group and this showed a 20% improvement in pain, energy and mood along with physical function. This was still present nine months later after the trial finished.

9.  Weight loss can preserve knee cartilage in obese and overweight people. A study of 500 obese/overweight people had MRI’s at baseline and four years later and found that those who lost greater than 10% of their body weight had a slower degeneration of their knee cartilage.

10.  Natural therapies. There are some very well studied natural that may also be of benefit here. The top two are the Polypill from drred.com.au, one capsule twice a day. This has very strong anti-inflammatory properties and comes from French Oak Polyphenols. Wagners New Zealand green lipped mussels 850mgs one capsule twice a day also has some strong evidence for joint osteoarthritis.

 All the glucosamine products have some reasonable evidence and a new product coming out soon, Glucosalive, may even be better. High doses of Omega 3 in either fish or krill oil are also good anti-inflammatories. Rosehip Vital five capsules a day has some good evidence for osteoarthritis and finally Theracumin one capsule daily.

The most important aspect of osteoarthritis is you should not suffer in silence and also you should try to avoid taking chronic pharmaceutical pain killers such as non-steroid anti-inflammatory drugs and in particular the prescription narcotics. These bring with them a whole differerent set of problems.