Joint replacement surgeries are a $20 billion per year
industry in the United States. Without question, they have improved the lives
of millions of people. But they aren’t for everyone.
Replacing worn-out bone and cartilage from your knee, hip,
or shoulder with metal and plastic is a major operation. It almost always
requires a hospital stay and months of rehab for you to regain motion,
strength, and the ability to do daily activities. And for very active people,
these surgeries often mean being less active than you would like to be.
The good news is that we are entering a period in healthcare and in orthopedic surgery when it’s becoming possible to treat osteoarthritis without surgery. Some of these treatments relieve the pain and swelling that make it hard to run, play sports and do other activities you love to do. But there are some newer treatments that offer the potential to reverse the wear-and-tear on the joint and actually rebuild damaged cartilage.
The following is a list of some of the newer, more exciting
treatments available to treat bone and joint pain and help with the symptoms of
osteoarthritis. Several of these treatments are currently being investigated as
tools to help rebuild damaged bone and cartilage in your joints. I’ll go into
each of these treatments in more detail in future articles and videos, but here
is a quick summary.
Peptides are short chains of amino acids, or small proteins,
that we naturally make in our bodies. Peptides are involved in almost every
bodily action. They are master controllers of many functions in the body,
including hormone production, cell signaling, and cell-to-cell communication.
There are a number of peptides that have shown good results
in relieving pain from osteoarthritis and musculoskeletal injuries and healing
damaged tissue. Some of the most popular peptides for bone and joint purposes
are BPC-157, Thymosin Beta 4 (TB 500), and AOD 9604. Depending on the peptide,
they can be administered orally, by a subcutaneous injection, or by applying a
topical cream. And unlike steroid hormones, which stay in the body a long time,
peptides have a very short half-life, so they have been shown to be extremely
Platelet-rich plasma, or PRP, is a treatment that has been around for over a decade, although it is still considered experimental by insurance companies. PRP is a treatment in which we draw a small amount of blood, similar to when you’re getting lab work. Then we spin the syringe of blood in a centrifuge to remove the red blood cells. What remains is the plasma, filled with platelets that contain growth factors and other nutrients that nourish the damaged tissue.
PRP has been shown to be helpful for a number of
musculoskeletal conditions, including muscle and tendon injuries. It is
especially interesting as a treatment for osteoarthritis, as it has shown
better results than cortisone and hyaluronic acid injections for
early-to-moderate osteoarthritis symptoms.
Exosomes are the most recent advancement in the treatment of
osteoarthritis. While stem cells have been used in orthopedic surgery and
regenerative medicine clinics for many years, exosomes have potential to
surpass them for aging joints. With stem cells, a surgeon usually harvests them
from the pelvis or other parts of the body, often by a surgical procedure. But
the number of stem cells in these preparations is limited.
Exosomes are thought to be important mediators of cell communication that participate in numerous physiological processes. Think of exosomes as the key aspect of stem cells, working to heal damaged cartilage in osteoarthritis without the patient undergoing a procedure to harvest stem cells. Exosomes have been shown in early research to protect the arthritic joint by promoting cartilage repair, inhibiting inflammation of the joint lining, and aiding in subchondral bone remodeling.
Pentosan polysulfate is what’s known as a Disease Modifying
Osteoarthritis Drug (DMOAD). It has been used for years for horses and dogs. It
is currently FDA approved for interstitial cystitis of the bladder, so it can
be repurposed as an osteoarthritis treatment.
Pentosan is an exciting new treatment, because studies show
that it can help heal the subchondral (under the cartilage) bone lesions in
osteoarthritis and decrease pain. It is typically self-administered in an
Staying active is crucial!
Finally, please remember the goal is to stay active. Don’t
let anyone – a physician, orthopedic surgeon, or anyone else – tell you that
you must stop exercising. You might have to modify what you do, but exercise
and using your muscles and moving your joints is beneficial for osteoarthritis.
If you have osteoarthritis or joint pain that keeps you from
being as active as you would like, call (843) 577-8484 to schedule an
appointment with me in Charleston, South Carolina or Charlotte, North Carolina.
You can discuss all your options, including some treatments you will never hear
about from your primary-care doctor or hospital-based orthopedic surgeon!