Osteoarthritis (OA) is the most common form of arthritis. In a healthy joint, there is a cushion of articular cartilage and fluid between the two joint bones, allowing for the bones to move frictionlessly against each other. Degenerative wear and tear of joints allows cracks and fisures to develop within the cartilage, and thereby causes friction and erosion. This friction causes inflammation, pain, and stiffness that worsens throughout your life. OA can occur in any joint, but it is most common in the knees.
Causes of Osteoarthritis
OA stems from a lack of lubricant within the joint. Less lubricant causes friction, the friction causes deterioration of cartilage. Those who don't make enough lubricant in their joints tend to be over age 55, female, overweight, or have injured that joint in the past.
Symptoms of Osteoarthritis
People who suffer from osteoarthritis often have stiffness, crackling, swelling, or tenderness in their joints that cause pain during movement or weight-bearing activities.
On your first visit to The Active Joint Institute, we will obtain a medical history, take x-rays, analyze the way you walk, and perform a focused physical examination of your knees. With this information, one of our providers will discuss with you the findings, what it means for you, treatment options, and the outlook. Together, we will discuss treatment options and formulate a treatment plan suited to your specific needs.
Most treatment for OA is focused on relieving pain rather than on treating the actual problem of arthitis. At ActiJoint, we strive to offer the best and most reliable treatments for osteoarthritis to not only treat pain but also prevent or postpone the need for surgical intervention. We can help reduce friction and the wear of cartilage in the joint with hyaluronic acid injections, physical therapy, platelet rich plasma (PRP), and mesenchymal cells. These treatments seek to slow, stop, or even reverse the progression of OA. Each of these treatments have been proven to increase lubrication, protection, and cushioning within the joint. Using biologics (PRP and mesenchymal cells) adds further benefit to our expectations including the production of new cartilage that fills in the cracks and fissures and smooths out the joint surface. With continued treatment, pain relief is incredibly likely to follow. Treatment targeted at only pain relief will mask the joint pain, but it won’t treat it. Without treatment to reduce friction, the cartilage will continue to wear quickly, and surgery may become the only option.
All injections at ActiJoint are performed under ultrasound guidance. Blind (or unguided) injections are the norm at most orthopedic clinics, however, this method of injection has only a 75% accuracy rate. We go above and beyond the standard of care by providing this enhanced service. At ActiJoint, we used ultrasound-guided injections to provide 100% accuracy in ensuring that the medication makes it precisely within the joint capsule. It's been proven that ultrasound guidance improves effectiveness of treatment, because treatment is most helpful when the medication is injected directly into the joint. This is one of the many aspects that sets The Active Joint Institute apart as a leading injection facility.
Treatment options for OA include but are not limited to the following:
Hyaluronic Acid Injections: Hyaluronic acid (HA) is a natural fluid in all connective tissue and joints that lubricates the joint and provides protection and cushioning to the articular cartilage. Those who suffer from osteoarthritis have less lubricant in their joints than others, and the lubricant that is present is less effective than normal. Osteoarthritis can be treated by injection lab-made hyaluronic acid into your joints. By injecting your joint with HA, you are provided with the much needed lubricant that renews and restores your joint fluid back to normal. This protection not only relieves pain, it can slow the progression of arthritis by removing friction in the joint. Normally the improvement in joint health and pain relief lasts about six months.
Platelet-Rich Plasma (PRP) is a serum rich with your body's own growth factors that stimulates a regenerative healing response within the joint. Derived from your own blood, there is no chance of having an allergic reaction to PRP. We collect a small sample of your blood into a special vacutainer (a tube for collection blood) and is then spin it in a centrifuge for 10 minutes. This centrifugation process separates whole blood into its components including red blood cells, white blood cells, and plasma. Within the plasma layer are highly concentrated platelets, the cells that promote blood clotting, which contain a specialized chemicals called growth factors. The basic idea behind PRP injections is to deliver high concentrations of growth factors to an area of injury with the hope of stimulating a healing response and reducing inflammation in the tissue.
Learn more about Platelet Rich Plasma (PRP)
Steroid Injections (Cortisone): To avoid the long term complications of oral steroid use, many doctors will inject a long-lasting steroid into a joint to help with inflammation and pain. Although usually very effective at treating pain the first time, cortisone has the tendency to not control pain as well with repeated use. Cortisone also does not stop the progression of OA but rather temporarily treats only pain. Cortisone can also cause further deterioration of the joint with repeated use, so it is generally recommended to limit cortisone injections to 3-4 times a year on an as-needed basis. Contact us or talk with one of our providers at your appointment if you have any questions or concerns about cortisone injections.
Physical Therapy: Physical therapy can help improve muscle strength to create better shock absorption during high impact activities. It can also improve range of motion and balance - both of which stimulate the natural production of HA within the joint. Subsequently, physical therapy provides another means to protect, lubricate, and cushion your joints. Therapists also can educate you in proper biomechanics since improper movement may accelerate the wear and tear of joints and worsens OA.
Home Exercises: You should follow the mantra, "Motion is lotion." Because activity can naturally produce the HA lubricant in your joints, the more activity you do, the better. However, overdoing it can worsen your arthritis symptoms. Let pain be your guide in deciding which activities are helpful and which are harmful. While home exercises are incredibly helpful in stimulating lubrication in the joints, it is not meant to take the place of physical therapy.
Braces: Special unloading braces can take the weight off your joints to assist in pain relief from weight-bearing activities. They can also correct for misalignment.
Over-the-Counter Medications: Non-prescription pain relievers can help with OA symptoms. Most doctors recommend acetaminophen (Tylenol), because it has fewer side effects than other drugs. Because OA is an inflammatory condition, one of our providers may recommend non-steroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen. Many of those who suffer from OA have found relief with supplements like glucosamine, fish oil, Tumeric, chondroitin, and S-adenosylmethionine. Although studies have not proven their benefit, they are considered safe. We also carry over-the-counter medications such as CBD oil, balm, and lotions as an alternative means of pain relief. CBD medications are legal and not associated with the same psychotropic side effects as marijuana.
Prescription Medications: In the event that over the counter medications don't adequetly control your pain, one of our providers may recommend prescription strength medications. Although these are more effective, you will need to be closely monitored for adverse effects due to a higher dosage.
Surgery: Surgery is a completely viable option for many of those who suffer from osteoarthritis; however, the outcome can often be disappointing for many patients who go into it expecting to feel 20-years old again. Many people undergo an arthroscopic surgery (scope) to have their knee cleaned up, but this procedure often does not diminish pain or help the course of arthritis, and so is no longer recommended in patients with moderate to severe osteoarthritis (a level 3 or 4 on the Kellgren-Lawrence scale). Knee replacements are typically for patients with an average of 8 out of 10 on the pain scale, and can take up to one year of recovery.
Once the arthritis has become bone-on-bone, it is labeled severe (Kellgren score of 4), and you are eligible for a knee replacement. The current recommendation for severe osteoarthritis is knee replacement surgery, but this is not the only option available! It is our hope to prevent the need for a knee replacement by not only treating your pain but slowing the progression of OA. At The Active Joint Institute, one of our providers will discuss treatment options with you, so you can make an informed decision about your care.
Alternative Therapies: Acupuncture is a treatment based on Chinese medicine. How it works is not entirely clear, yet some studies have found that acupuncture may provide short-term pain relief for people with OA. Chiropractic care can provide pain relief in patients who suffer from arthritis, particularly if the spine is involved. Cartilage transplant and micro-fracture surgery show some promising initial results, but are still under scrutiny and are not widely available. Unfortunately, we do not offer any of these services at ActiJoint.