Injury and trauma -> Wear and tear -> Possible Initial surgical intervention -> Osteoarthritic changes -> Joint replacement???James Slater
This is the all too familiar picture of the fate of some of our weight bearing joints as we age, but this may well be about to change. The overall level of function for joint prosthesis (particularly the knee) is far
below that afforded by our own tissue. For the many millions of people worldwide who have had, or are considering, joint replacement, the alternatives are extremely limited. We are told to either cope with the pain and dysfunction or, if we meet the requisite criteria, have the joint replaced.
I recently heard the term “internal amputation of the joint”, it is very apt. If you have had the chance to be in theatre to witness this type of surgery or if you have seen one on YouTube, you will realise what a brutal business it is. To have to go through this type of ordeal and come out the other side with a joint which, although normally not as painful as pre-surgery, affords you so little in the way of improved function seems a big price to pay. In addition, as our life expectancy continues to improve, the incidences for revision surgery will also increase. Currently a total knee replacement should last around 20 years before problems such as joint loosening leads to a revision procedure being undertaken (half knees or hemi-arthroplasty are lasting around 10 years)1,2. Also these revision procedures tend to be more complicated than the primary replacement which in turn may adversely affect their longevity. This has perhaps lead to the health authorities, and the Dr’s employed by them, making decisions regarding the appropriateness of surgery based not solely on the patient’s needs, but also on having to balance the financial implications for the possible need to repeat this surgery as the patient ages and the implant degrades.
In the last 15 years in the UK alone we have seen almost 2 million hip and knee replacements, and the numbers continue to increase. The types of prosthesis are changing, with different materials being employed, however the basic problems will not alter. We are replacing mother-nature’s work with a crude approximation of what used to be there and the recipient has to undergo significant invasive surgery to achieve this.
There have been many advances in recent years with the use of stem cells to treat various conditions such as blood diseases, cancers and skin grafts. Using autologous material (that derived from the patient’s own body) in the treatment of disease or injury makes perfect sense. However, this type of OrthoBiologics is a very young branch of medical science but new advances are being made all the time. In the field of orthopaedic medicine platelet rich plasma (PRP) injections have been around for almost 20 years but have been used much more widely in the last 10 years. Initially they were used to promote cell regeneration in soft tissue issues such as muscles, tendons and ligaments, it has only been in the last 5 years that it has been used on joint surfaces. 3,4.
Very recently clinical trials have been performed using PRP injected onto areas of joint damage and re-evaluated at intervals up to and including 1 year later using both MRI imaging and function-based questionnaires 5. A systemic review of 10 level 1 randomised control trials carried out in 2016 indicated significantly better pain relief and improved function 12 months after injection compared with injecting hyaluronic acid. While knee cartilage did not seem to regenerate for patients, the fact that the arthritis did not worsen may be significant. Any treatments which can improve tissue homeostasis is potentially very important as evidence suggests that an average of 4 to 6% of cartilage disappears each year in arthritic joints.6,7
In this field of joint preservation, Acten® seems the perfect partner. Augmenting the autologous treatments with a totally natural collagen peptide for articular cartilage nutrition should provide not only a slowing down of the degenerative changes which are already progressing, but may actually help promote the development of new tissue at the joint interface.7.
Anecdotal evidence from those individuals taking Acten® since its release in March 2016 has been overwhelmingly positive, with reports of decreased aching and increased joint range of movement consistently noted. The expectation of increased physical capacity in our later years does not appear to be matched by the efficacy of current management methods in degenerative joint conditions. Looking to develop the body’s own tissues and augment this with natural supplements may provide a viable alternative to what is currently offered.
Buechel FF, et al. “Twenty-year Evaluation of Meniscal bearing and rotating platform knee replacements.” Clinical Orthopaedics & Related Research, 388 July 2001:41-50.
Total Knee Replacement” Agency for Healthcare Research and Quality Publication No. 04-E006-2.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013 Feb;41(2):356-64. doi: 10.1177/0363546512471299. Epub 2013 Jan 8. PubMed PMID: 23299850.
Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. 2013 May;23(3):238-9. doi: 10.1097/JSM.0b013e31827c3846. PubMed PMID: 23238250.
Eckstein F, Cicuttini F, Raynauld JP, et al. Magnetic resonance imaging (MRI) of articular cartilage in knee osteoarthritis (OA): morphological assessment. Osteoarthr Cartilage. 2006;14:46–75.
Hunt TJ, Editorial Commentary: The time has come to try Intra-articular Platelet-Rich Plasma Injections for your patients with Symptomatic Knee Osteoarthritis. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 33, No 3 (March) 2017: pp671-672
Raynauld JP, Martel-Pelletier J, Berthiaume MJ, et al. Long term eval- uation of disease progression through the quantitative magnetic reso- nance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes. Arthitis Res Ther. 2006;8:21.
Randomized Observational Multicenter Study to Assess the Efficacy and Safety 0f the Association of Fortigel (10 Gr) and Fucoidan (100 Mg) in Patients with Gonarthrosis Martin-Martin LS1*, Pierluigi B2, La Medica C3, Melis G4, Nuvoli G5, Piccinni V6, Pietrapertosa M7, Vincenti B8, Vinicola V9