Comparing Treatment Options

This guide summarises evidence on the effectiveness and safety of four treatments for osteoarthritis of the knee:

Stem Cell Therapy

Stem cell therapy (adipose derived stromal vascular fraction is the scientific name) from your own fat is allowable under the Excluded Goods Order No. 1 of 2011 by the Australian Therapeutic Goods Administration (TGA) who are Australia’s therapeutic regulatory body. This forms part of the guidelines that doctors follow when treating patients. Since beginning our stem cell treatments in 2009 we have treated hundreds of patients for osteoarthritis, knee and hip pain, and degenerative neurological conditions.

Stem cell therapy is the first treatment for osteoarthritis that positively improves tissue and does not destroy joint tissue. The other three popular treatments listed below have been the only option available until stem cell therapy became available. Stem cell therapy has a safety record demonstrated in both animals and in humans for many years. At this time, if performed carefully and within up-to-date parameters, stem cell therapy appears to be effective.

Adverse Effects

Minor reactions have been observed in some patients including flushing, heart palpitations (for a few minutes after the injection), and slightly raised temperature just after the injection. Possible complications are infection, bruising and transient pain at the site of injection and interactions with medications. One incidence of bleeding led to hospital admission in an elderly patient.

Glucosamine and Chondroitin

The dietary supplements glucosamine and chondroitin have been advocated as treatments for osteoarthritis pain based on the theory that they may increase the rate of new cartilage formation. Glucosamine is a precursor to glycosaminoglycan, which is believed to play a role in the growth of cartilage and its repair. Chondroitin is part of a large proteoglycan molecule that gives cartilage flexibility and is thought to inhibit enzymes that break down cartilage. Both substances are found naturally, and supplements are made from animal tissue. Chondroitin sulfate is purified from animal cartilage, such as cartilage from cows or sharks. Glucosamine comes from the shells of crabs, lobsters and shrimp.

They are both sold over the counter as oral supplements. Supplements are not subject to review or approval by the U.S. Food and Drug Administration and are not standardized. As such, the amount of active ingredients or possible contaminants may vary among products. Glucosamine is available in different forms, most commonly glucosamine sulfate or glucosamine hydrochloride.

Overall treatment benefit not seen

The best evidence on treatment efficacy of glucosamine and chondroitin comes from the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). The GAIT study was a randomized controlled trial comparing groups of people receiving one of five treatments: glucosamine hydrochloride, chondroitin sulfate, the combination of both, celecoxib (an NSAID), or placebo. A total of 1,583 patients with OA of the knee were entered into the study.

In this study, improvement in global pain and joint function was observed in all groups—glucosamine, chondroitin, glucosamine and chondroitin combined, and placebo. However, there was no clinically significant effect on knee symptoms due to glucosamine and/or chondroitin supplementation. The trial also analysed a subgroup of people with moderate to severe OA and found that glucosamine and chondroitin improved pain and joint function better than placebo treatment for this subgroup.

Overall, people with OA of the knee do not have better relief of symptoms when using glucosamine and chondroitin than when receiving a placebo.

Adverse effects

Some people taking glucosamine and chondroitin have experienced minor side effects, including nausea, diarrhoea, and headache. However, there is no difference in the frequency of adverse effects among people using these supplements compared with those receiving placebo.

Viscosupplementation

Synovial fluid serves as a shock absorber to reduce friction from joint motion. Hyaluronic acid is a naturally occurring substance found in synovial fluid. As cartilage wears down in osteoarthritis, the level of hyaluronic acid in the joint also decreases. The intra-articular injection of hyaluronan, known as viscosupplementation, is believed to improve the elastoviscosity of the arthritic joint by increasing the hyaluronic acid concentration. In clinical practice, hyaluronan injections are performed in an effort to reduce pain and improve function.

The clinician enters the joint space with a needle, injecting a small amount of hyaluronan product (2.5–5 cc of solution). The procedure is repeated from three to five times over a period of several weeks.

Treatment benefit not seen

In people with osteoarthritis of the knee, published clinical trials comparing injections of viscosupplements with placebo have yielded inconsistent results. Higher quality and larger trials have generally found lower levels of clinical improvement in pain and function than small and poor quality trials.

Any clinical improvement attributable to viscosupplementation is likely small and not clinically meaningful.

Various hyaluronan products are available for knee joint injection, primarily differing in the molecular weight of the compound. While some trials suggest better clinical response to the highest molecular weight hyaluronan product, other trials have not confirmed this finding. Overall, evidence is insufficient to demonstrate clinical benefit for the higher molecular weight products.

Adverse Effects

Side effects from injection of hyaluronan products usually are minor and short term. Reported rates vary. Minor side effects include pain at the injection site (1–33%), local joint pain and swelling ( < 1–30%), and local skin reactions (3–21%).

More serious side effects can occur. Pseudoseptic reactions, inflammation and swelling of the joint not caused by infection, are uncommon (1–3%) but can be severe and require further medical treatment.

Evidence is insufficient to determine whether the frequency of adverse events is higher with repeat injections.

Arthroscopic Surgery for Osteoarthritis

Arthroscopic surgery allows a surgeon to visualize the interior joint space. The procedure provides access to the joint for lavage, using saline irrigation to remove particulate material, such as cartilage fragments and calcium crystals. Arthroscopy also allows for debridement, whereby surgical instruments are used to smooth any rough articular surfaces. The goals of arthroscopic lavage and debridement are to decrease synovitis and improve joint motion.

Treatment benefit not seen

Arthroscopic lavage, with or without debridement, does not improve pain and function for people with OA of the knee (according to AHRQ below).

Joint Replacement

The below information is taken from an Orthopaedics South Australia guidebook.

Total Knee Replacement guide

This is the last step. Once the joint has gone, only further joint replacements are possible. These options are improving in outcome and recuperation times are reducing. It may well be the only answer especially in severe osteoarthritis but it is still a serious decision to make. We believe that stem cell treatments may delay or prevent the need for a joint replacement.

Helpful Information

The below articles have been gathered to support your understanding of Stem Cell treatment. These articles have been written by some of the foremost practitioners of Stem Cell research and treatment. If you have any questions at all please do not hesitate to contact us.

 

The goals of treatment are to reduce pain and improve joint function. Non-steroidal anti-inflammatory drugs (NSAIDs) and Paracetamol are commonly used as first-line treatment for OA pain, along with exercise and weight loss. The treatments described in this guide are intended to promote healing of damaged cartilage in the knee or to augment the composition of synovial fluid.

The evidence evaluated comes primarily from comparisons of each treatment approach with a placebo. This guide does not address other treatments, such as exercise, physical therapy, pain medications, corticosteroid injections, or knee replacement.

Please note that the results of every procedure will vary from patient to patient. Norwood Day Surgery can neither predict nor guarantee success, please book a consultation to find out if this procedure is right for you.

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