Osteoarthritis (OA) is definitely the most common joint pathology, affecting 10% of men and 13% of women above the age of 60.
It can affect any joint, but most commonly the hands, knees, hips and the small joints in the spine. Normal hyaline cartilage is built up of healthy chondrocytes, proteins and extracellular matrix. The hyaline cartilage lubricates the joint and prevents some wear and tear, preventing bone from touching bone. When the cartilage itself wears away , it therefore no longer provides the joint with lubrication and as the degeneration progresses, then more bone touches bone.
Many people are asymptomatic. People who do have symptoms usually suffer from pain and stiffness. With time, range of motion becomes limited and as that particular joint becomes more dysfunctional, then (in the case of OA of the lower limbs) more weight-bearing occurs on the other side, and gradually other joints are more prone to develop OA as well. As I have said a number of times, the sacroiliac joints are affected both by OA of the spine and of the hip joints. Once this triad is affected, all 3 must be addressed. Obesity is a very significant risk factor for developing OA, and also impairs the body’s response to regenerative treatments and response to operative intervention.
Until recently, there has been no definitive treatment for osteoarthritis but only of the symptoms. Operative joint replacement has been the definitive treatment though carries risks and a long rehabilitation program. With some joints, such as hip replacements, there are few risks, and success rates are very good. Knee replacements carry much higher risks of infection and nerve damage. With some joints, there is extremely little experience in joint replacements, such as with the ankle. Shoulder joint replacement is still in its nappy stages.
Happily, however, there has been much in the way of research with regenerative medicine. There are various options including prolotherapy for mild to moderate cases, platelet-rich plasma, PRF- Platelet-Rich Fibrinogen and then bone marrow aspirate, with various combinations of these. These can definitely not only postpone operations, but may provide long term alternatives, especially in joints which are more problematic to replace, and definitely in patients who cannot undergo difficult operative interventions. For further information, please refer to the section on PRP, PRF and stem cells.
In the event that one has severe osteoarthritis that has not responded to these measures, one can use pain modulating procedures directed at the nerves to the joints in order to treat the pain. In the event of patients suffering from neuropathic pain as a complication of an operation, it may be possible to treat the entrapped nerves with hydrodissection.