And your surgeon says you need surgery… maybe not… next
Meniscal Tears May Not Need Surgery
Jack Cush reporting in RheumNow cited a study published in the British Medical Journal examines whether knee surgery or conservative medical management benefits those with degenerative meniscal tears. Patients with knee pain from a degenerative meniscal tear were randomized to either arthroscopic surgery (followed by daily exercises at home) or physical therapy (neuromuscular and strength exercises) two to three times a week for 12 weeks.
Over the next 2 years both groups improved. Muscle strength had improved more, on average, in the physical therapy group at the three-month checkup, but at the final two-year checkup, there was essentially no difference between the surgery and therapy groups, including in pain, ability to function in sports and recreation activities, and quality of life. The researchers noted that 19 percent of the therapy group opted to have surgery at some point but had achieved “no additional benefit” by the end of the study.
Conservative exercise therapy was equal to arthroscopic intervention overall, but also showed positive effects over surgery short-term muscle strength. Clinicians should consider conservative management and physical therapy in middle-aged patients with degenerative meniscal tears.
Comment: Degenerative meniscus tears are secondary to the arthritis. Surgery is not generally warranted.
Hope for young people with bad osteoarthritis of the hips… next
Stem Cells Could Replace Hip Replacements
Christopher Wanjek writing for Live science reported scientists have coaxed stem cells to grow new cartilage on a scaffold shaped like the ball of a hip joint. This is a major step toward being able one day to use a patient’s own cells to repair a damaged joint, thus avoiding the need for extensive joint-replacement surgery.
In addition, the scientists used gene therapy to grant this new cartilage the ability to release anti-inflammatory molecules when needed. If done in patients, this technique could help prevent a return of arthritis, if that was what damaged the joint in the first place.
The new technique may be ready to test in humans within three to five years and may ultimately work with other joints, such as knees, said Farshid Guilak, a professor of orthopedic surgery at Washington University School of Medicine in St. Louis, who co-led the project.
Comment: We stopped doing stem cell procedures for hips at our center because we weren’t getting the results we wanted. While this approach looks like it might work I’m reserving judgement. The hip has a unique mechanical structure that makes any type of stem cell procedure problematic..
Sara Freeman writing in Rheumatology news reported on a study that showed that persistent knee pain is in important predictor of structural joint damage and could potentially be used to predict knee osteoarthritis earlier according to Dutch research reported at the World Congress on Osteoarthritis. The analysis found that women participating in the Rotterdam study who had knee pain on most days of the preceding month were more than 4 times more likely to develop knee osteoarthritis within 5 years on MRI than were those without frequent knee pain.
New Treatment Shows Promise for Crippling Knee Arthritis
Alan Mozes writing for Healthday reported on a small study that demonstrated that just one injection of stem cells can reduce pain and inflammation.
The idea is experimental: Extract stem cells from a patient’s own body fat — cells known for their ability to differentiate and perform any number of regenerative functions — and inject them directly into the damaged knee joint.
To explore the potential of stem cell therapy, the study authors focused on 18 French and German men and women, aged 50 to 75, all of whom had struggled with severe knee osteoarthritis for at least a year before joining the study.
Between April 2012 and December 2013, all of the patients first underwent liposuction to extract fat-derived samples of a specific type of stem cell. The researchers noted that these particular stem cells have been shown to have immune-boosting and anti-scarring properties, as well as the ability to protect against cell “stress” and death.
A third of the patients received a single “low-dose” injection of their own stem cells directly into their knee. Another third received a “medium-dose” injection, involving a little more than four times the amount of stem cells, while the remaining group received a “high-dose” injection packed with roughly five times as many stem cells as the medium-dose group.
After six months, the study team found that all three groups showed improvements in terms of pain, function and mobility.
However, only those in the low-dose group were determined to have “statistically significant” improvements in terms of both knee pain and function recovery.
Comment: this data is in keeping with other studies.
Embryonic stem cells come from human embryos and these cells have the capacity to differentiate into most any cell type in the body. However, because human embryos need to be destroyed to create these cells, there have been obvious ethical concerns. The government ban on new stem cells lines in the early 2000s led to more study of adults stem cells (MSCs). These are cells taken from adults and so they have none of the ethical concerns that limit ESC research. Over the last 7 years the amount of work published annually on MSCs has exceeded that of ESCs, and in 2011 more research was published on MSCs than ESCs. In addition, from 2011-2013, while ESC research has plateaued, MSC research continues to grow.
Comment: MSCs have been demonstrated to work, particularly for osteoarthritis. Whether other stem cell lines such as induced pluripotential stem cells, allogeneic donor cells, or umbilical cord cells will also be used extensively is conjectural.