Below is more comprehensive educational information regarding the Non-operative guide for managing osteoarthritis.
Definition: Osteoarthritis is a condition of the bone or joint in which there is loss of cartilage (soft, spongy tissue covering the bone for protection) resulting in the release of inflammatory products causing irritation of the joint lining (synovium) leading to pain and swelling. Additionally, as a result of continued joint impact, there may be an increase in bone formation leading to reduced joint range of motion. Osteoarthritis (OA) is one of the most common forms of arthritis. The joint pain and stiffness caused by OA can make it difficult to work, play sports and perform daily activities.
Weight loss: For every additional 1 pound of weight above ideal body weight (IBW), the knee or hip has 4x’s additional force across the joint. For example, if you are 20 pounds over IBW, there is an additional 80 pounds of force across the joint (20 x 4). If you take an average of 5000 steps per day, then there will be 400,000 pounds of additional force every day on your joint. BOTTOM LINE: for every 1 pound of weight loss, there is a 4-pound reduction in knee-joint load per step. (Messier S, Gutekunst D, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee OA. ARTHRITIS & RHEUMATISM Vol. 52, No. 7, July 2005, pp 2026’2032.)
Motion is Lotion: Exercise is crucial if you have arthritis. Motion in the joint creates increased release of hyaluronic acid which helps to lubricate your joint. Additionally, your muscles act as ‘shock absorbers’ for your joints. Increased Strength=Increased Shock Absorption. Knowing just how much activity to do when you’re hurting can be tricky. After all, research has shown that moderate activity can help prevent the progression of arthritis and improve overall function. But while mild muscle soreness after a workout is normal, sharp pain during or immediately after can signal injury. Two or three weekly 20- to 30-minute, weight-training sessions are sufficient to start reaping noticeable benefits within four to 12 weeks, such as improved energy and muscle tone. Within six months, most people increase their strength 40 percent or more. Give your body at least one recovery day between sessions.
Anti-Inflammatory Diet: Not a diet in the popular sense – it is not intended as a weight-loss program (although people can and do lose weight on it), nor is the Anti-Inflammatory Diet an eating plan to stay on for a limited period of time. Rather, it is way of selecting and preparing anti-inflammatory foods based on scientific knowledge of how they can help your body maintain optimum health. Along with influencing inflammation, this natural anti-inflammatory diet will provide steady energy and ample vitamins, minerals, essential fatty acids dietary fiber, and protective phytonutrients (http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet):
- To get maximum natural protection against age-related diseases (including cardiovascular disease, cancer, and neurodegenerative disease) as well as against environmental toxicity, eat a variety of fruits, vegetables and mushrooms.
- Choose fruits and vegetables from all parts of the color spectrum, especially berries, tomatoes, orange and yellow fruits, and dark leafy greens.
- Choose organic produce whenever possible. Learn which conventionally grown crops are most likely to carry pesticide residues and avoid them.
- Eat cruciferous (cabbage-family) vegetables regularly.
- Include soy foods in your diet.
- Drink tea instead of coffee, especially good quality white, green or oolong tea.
- If you drink alcohol, use red wine preferentially.
- Enjoy plain dark chocolate in moderation (with a minimum cocoa content of 70 percent).
Anti-inflammatory Supplements: Tumeric (contains Curcumin) with BIOPTERINE- Traditionally used in Chinese and Indian Ayurvedic medicine to treat arthritis turmeric/curcumin blocks inflammatory cytokines and enzymes, including NFkB/Cox 1/Cox 2 resulting in reduced Prostaglandins and Leukotrienes. May take without similar adverse effects such as NSAIDS (ibuprofen, Naprosyn, Mobic). A systematic review and meta-analysis was conducted using data reported by RCTs. The primary efficacy measure was pain intensity or functional status. A total of eight RCTs met our inclusion criteria that included 606 randomized patients. Curcuminoids were found to significantly reduce pain (SMD:’-0.57, 95% CI:’-1.11 to’-0.03, P’=’0.04). This pain-relieving effect was found to be independent of administered dose and duration of treatment with curcuminoids, and was free from publication bias. Curcuminoids were safe and well tolerated in all evaluated RCTs (Sahebkar A, Henrotin Y. Analgesic Efficacy and Safety of Curcuminoids in Clinical Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med. 2016 Jun; 17(6): 1192-202). Recommended dose of 400-600mg TID.
Hyaluronic acid (HA) or Viscosupplementation is a product that is manufactured from a natural source of HA. HA is a natural substance that is found in the human body as well as in animals and bacteria. In the human knee, HA is a thick, slippery fluid that helps cushion, lubricate, and protect the bones and joint tissue. In patients with OA of the knee or hip, the HA gets thinner over time and becomes less able to provide protection. Hyaluronic Acid is used to relieve OA knee pain in people who do not get enough relief from simple pain medications such as acetaminophen, ibuprofen, or naproxen or from exercise and physical therapy. These injections can be performed every 6 months. It can take up to 8 weeks for pain relief after the 3rd injection. In some cases, these injections do not provide pain relief. The overall success rate is higher if the osteoarthritis is less advanced/severe and used in combination with other treatment modalities as described below.
Alternative Treatment Options: Platelet-rich plasma (PRP) therapy: Sometimes called PRP therapy or autologous conditioned plasma (ACP) therapy, attempts to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles, or even bone. Although not considered standard practice, a growing number of people are turning to PRP injections to treat an expanding list of orthopedic conditions, including osteoarthritis. It is most commonly used for knee or hip osteoarthritis, but may be used on other joints or tendons as well. Platelet-rich plasma is derived from a sample of the patient’s own blood. The therapeutic injections contain plasma with a higher concentration of platelets than is found in normal blood. What is plasma? Plasma refers to the liquid component of blood; it is the medium for red and white blood cells and other material traveling in the blood stream. Plasma is mostly water but also includes proteins, nutrients, glucose, and antibodies, among other components. What are platelets? Like red and white blood cells, platelets are a normal component of blood. Platelets alone do not have any restorative or healing properties; rather, they secrete substances called growth factors and other proteins that regulate cell division, stimulate tissue regeneration, and promote healing. Platelets also help the blood to clot; a person with defective platelets or too few platelets will bleed excessively from a cut. A 2016 study comparing PRP to visco-supplementation demonstrated improved pain score and function at the 12-month follow-up in the PRP group. Other WOMAC and SF-36 parameters improved only in the PRP group. (Raeissadat SA1, Rayegani SM2, Hassanabadi H3, Fathi M4, Ghorbani E5, Babaee M5, Azma K6. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015 Jan 7;8:1-8. doi: 10.4137/CMAMD.S17894. eCollection 2015).
Genicular nerve radiofrequency ablation (GNRFA) is a 2-step procedure. First, patients are given a diagnostic block under fluoroscopy or ultrasound guidance. Specifically, 1 mL of lidocaine is injected using a 20-gauge, 3.5-in spinal needle around the superior lateral, superior medial, and inferior medial genicular nerve branches. If the patient reports a ≥50% reduction in baseline pain for a minimum of 24 hours following the injection, then the patient is a candidate for genicular ablation. The osseous landmarks for the diagnostic block are exactly the same as for the ablation procedure. Both procedures are well tolerated in the office setting under local skin anesthesia. GNRFA has been shown to consistently provide short-term (3 to 6-month), and sometimes longer, pain relief in patients.
SPRINT Peripheral Nerve Stimulator (PNS) is a 60-day treatment that has been proven to provide significant and sustained relief from chronic pain. It works by specifically stimulating targeted peripheral nerve fibers within the area where the pain is located, and it has been studied extensively to provide relief for low back pain, shoulder pain, post-amputation pain and chronic post-operative pain. SPRINT PNS sends mild electrical pulses directly to the nerves which can reduce pain signals. You control the level of stimulation with a hand-held remote to your pain relief comfort level.
Osteotomy may be considered as an alternative to total knee arthroplasty, but an understanding of the indications, contraindications, and limitations is essential. Typically, patients are younger than 65, have good range of motion (more than 120 degrees and less than 5 degrees flexion contracture), have arthrosis isolated to one compartment only, have no ligamentous instability, and lack inflammatory condition of the joint.