Highlights
- Explore advanced therapies that can transform your experience with severe knee pain.
- Stay informed on emerging treatments that promise hope for joint health restoration.
Summary and Pathophysiology
Severe bone-on-bone knee pain, mainly caused by osteoarthritis (OA), results from cartilage loss leading to direct bone contact, inflammation, pain, and reduced mobility. Diagnosis involves clinical evaluation and imaging like X-rays and MRI to assess cartilage damage. Non-surgical treatments such as lifestyle changes, physical therapy, bracing, and injections aim to relieve symptoms and delay surgery. Surgical options include total or partial knee replacement, while emerging regenerative therapies like platelet-rich plasma (PRP) and stem cell treatments show promise but remain under investigation.
Diagnosis
Diagnosis starts with medical history and physical examination focusing on pain, range of motion, and ligament status. Imaging, primarily X-rays, confirms cartilage loss and joint damage using grading scales. MRI may be used to assess soft tissues. Patient-reported outcome measures like WOMAC and KOOS help evaluate pain and function.
Non-Surgical Treatments
Conservative management includes weight loss to reduce joint stress, low-impact exercises, and physical therapy to improve strength and flexibility. Knee braces and assistive devices help stabilize and offload the joint. Injection therapies, such as corticosteroids and hyaluronic acid, may reduce pain and inflammation, though long-term efficacy varies. Additional options include transcutaneous electrical nerve stimulation (TENS) and medications like duloxetine to manage pain.
Surgical Treatments
Surgery is considered when non-surgical methods fail. Total knee replacement replaces damaged joint surfaces and corrects deformity, requiring months for recovery and carrying risks like infection. Partial knee replacement targets a single compartment, allowing quicker recovery with fewer complications. Emerging options include autologous chondrocyte implantation (ACI) to regenerate cartilage and minimally invasive procedures like genicular nerve ablation for pain relief in non-surgical candidates.
Emerging and Experimental Therapies
Regenerative treatments such as PRP and stem cell injections aim to reduce inflammation and promote cartilage repair but are largely experimental and not yet FDA-approved for OA. Advanced techniques like matrix-induced autologous chondrocyte implantation (MACI) and 3D-printed cartilage scaffolds are under investigation. Viscosupplementation and corticosteroid injections remain common but have variable long-term benefits.
Rehabilitation and Outcomes
Rehabilitation after surgery focuses on restoring motion and strength, with physical therapy critical for both surgical and non-surgical cases. Outcomes depend on disease severity and treatment type. Non-surgical therapies have improved pain and function, with some evidence favoring stem cell and PRP injections. Interventional procedures like genicular artery embolization also show promising pain reduction.
Research and Future Directions
Research centers on optimizing regenerative treatments and integrating multimodal approaches tailored to disease stage. Although promising, many novel therapies remain investigational pending further clinical trials. Future efforts aim to refine protocols, enhance patient-specific treatment, and delay or prevent joint replacement through improved pain control and cartilage preservation.
The content is provided by Sierra Knightley, Scopewires
