Achy joint treat­ments that could BEES’ be the KNEES

Scottish Daily Mail - - Good Health - By VIC­TO­RIA LAM­BERT

For mil­lions of peo­ple in this coun­try, knee pain is part and par­cel of their daily lives. Around one in five peo­ple aged over 45 has os­teoarthri­tis, where the car­ti­lage that cush­ions the bone in our knees wears thin. It’s a grow­ing prob­lem, says or­thopaedic sur­geon Mark Wilkin­son, who is also a pro­fes­sor of or­thopaedics at the Univer­sity of Sh­effield.

‘The in­ci­dence is in­creas­ing be­cause of our age­ing pop­u­la­tion, and be­cause rates of obe­sity, a ma­jor risk fac­tor for knee os­teoarthri­tis, are ris­ing,’ he says.

There is no cure and treat­ments fo­cus on re­liev­ing pain un­til the joint de­te­ri­o­rates so much that a re­place­ment is nec­es­sary. Yet, in­creas­ingly, such treat­ments are be­ing called into ques­tion.

A re­cent study dis­cov­ered that cor­ti­sone in­jec­tions — one of the most com­mon treat­ments to ease pain and re­duce swelling in os­teoarthri­tis — could do more harm than good.

Sci­en­tists from Boston Univer­sity found that the steroids in th­ese jabs could speed up the joint’s dis­in­te­gra­tion — has­ten­ing the need for a knee re­place­ment. one the­ory is that the steroids may be toxic to car­ti­lage in some cases.

‘We’ve been telling pa­tients that even if th­ese in­jec­tions don’t relieve your pain, they won’t hurt you,’ the study leader, Dr Ali Guer­mazi, a pro­fes­sor of ra­di­ol­ogy, wrote in the jour­nal ra­di­ol­ogy. ‘We are now see­ing that th­ese in­jec­tions can be harm­ful to the joints.’

Mean­while, although pre­scrip­tion­strength non-steroidal anti-in­flam­ma­tory drugs (NSAIDs), such as di­clofenac and ibupro­fen, can re­duce pain, they can bring side-ef­fects, too, such as stom­ach ir­ri­ta­tion. And a re­view in The Lancet in 2016, which an­a­lysed re­sults from 74 tri­als, found that parac­eta­mol had at best a 4 per cent chance of im­prov­ing os­teoarthri­tis pain.

So where does that leave the mil­lions of peo­ple in the UK with painful knees?

WheN teacher An­gela raynes, 65, found her­self plagued by de­bil­i­tat­ing knee pain, she chose a new ap­proach. She’d had in­ter­mit­tent knee pain since she was 16, and two years ago the pain in both knees be­gan to make it hard to walk and drive long dis­tances.

Scans re­vealed se­vere os­teoarthri­tis, but An­gela, from North Thoresby in Lin­colnshire, turned down a steroid jab and dou­ble knee re­place­ment.

‘I knew the re­cov­ery pe­riod would be hard as I live on my own,’ she says.

After re­search­ing on­line, she chose a new treat­ment where fat cells are ex­tracted from the tummy and then in­jected into the knee — it’s thought they help en­cour­age the tis­sue to re­pair it­self.

An­gela had the pro­ce­dure in 2018 — it took a day and her knees are now pain-free. ‘I have my life back. I can work, drive long dis­tances and walk on the beach again.’

other new treat­ments are start­ing to re­place older pro­ce­dures. here we ex­plore which cut­tingedge tech­niques may ben­e­fit you.


OLD STYLE: More than 70,000 peo­ple in the UK have at least one cor­ti­sone (steroid) in­jec­tion each year as a short-term fix to re­duce the swelling of os­teoarthri­tis.

Such jabs have a 70 per cent suc­cess rate, says Chin­may Gupte, a con­sul­tant or­thopaedic sur­geon at The Welling­ton hospi­tal in Lon­don and Im­pe­rial Col­lege health­care NhS Trust, and the ef­fect can last for three months.

how­ever, they can also re­duce the ac­tiv­ity of the im­mune sys­tem, which, says Mr Gupte, ‘may even ac­cel­er­ate the arthritic process and in­crease risk of in­fec­tion when you do have an op­er­a­tion’.

Another op­tion is lu­bri­ca­tion gel jabs. hyaluronic acid, for ex­am­ple, is thought to mimic the joint’s nat­u­ral lu­bri­cants, but Mr Gupte says they don’t work for ev­ery­one. NEW AP­PROACHES: In­jec­tions of platelet-rich plasma (PrP) — the pa­tient’s blood is spun to separate out cells called platelets — is an ‘in­ter­est­ing’ new op­tion, says Nima hei­dari, a con­sul­tant or­thopaedic sur­geon at The re­gen­er­a­tive Clinic in Lon­don.

Platelets con­tain growth fac­tors thought to stim­u­late car­ti­lage re­pair. The Na­tional In­sti­tute for health and Care ex­cel­lence (NICe) says that, while safe, PrP ther­apy has lim­ited ef­fi­cacy.

An­gela had the 45-minute Li­pogems pro­ce­dure, which in­volves har­vest­ing up to 350ml of fat cells from the tummy via sy­ringe. This is then cleaned and in­jected into the af­fected knee.

‘There they re­lease com­pounds that seem to stop cell death and en­cour­age pro­lif­er­a­tion of the lo­cal tis­sues to re­pair them­selves,’ says Mr hei­dari. ‘They also seem to have a pain-killing ef­fect.’

The pro­ce­dure is only avail­able pri­vately and costs £6,400. The re­sults last two to three years.

A re­view this year con­cluded the ther­apy ‘will have an im­por­tant role in the con­ser­va­tive treat­ment of os­teoarthri­tis’, re­ported the jour­nal Knee Surgery, Sports Trau­ma­tol­ogy, Arthroscop­y.

how­ever, Pro­fes­sor Wilkin­son says: ‘There is no good clin­i­cal trial ev­i­dence that in­jec­tion of stem or fat cells has any im­pact on symp­toms or dis­ease in arthri­tis.’


OLD STYLE: ‘Arthro­scopies, a form of surgery to re­pair dam­aged car­ti­lage, were read­ily per­formed 20 years ago, but are quite in­ef­fec­tive,’ says Mr Gupte. ‘Th­ese oper­a­tions are not rec­om­mended in most pa­tients, un­less there is a loose piece of bone or gris­tle.’

NICe says the pro­ce­dure should only be given to peo­ple with a clear his­tory of the knee lock­ing. NEW AP­PROACHES: os­teotomies, where the bone is cut so it can be moved to the cor­rect po­si­tion, are a good choice, par­tic­u­larly where there is some nat­u­ral mis­align­ment, says Mr hei­dari.

‘It al­lows us to change the shape of the tibia bone — the larger shin bone in the lower leg — then fix it in a new po­si­tion, where the limb is straight, us­ing metal plates and screws. It’s not a cure, but de­creases pain and can keep the knee go­ing for longer be­fore more in­ter­ven­tion is needed.’

Tib­ial os­teotomies are avail­able on the NhS and pri­vately, cost­ing around £8,000.


OLD STYLE: Nearly 100,000 knee re­place­ments are car­ried out each year on the NhS. ‘This is a great op­er­a­tion,’ says Pro­fes­sor Adrian Wil­son, a Lon­don-based knee and sports in­jury specialist. ‘In the over-65s, suc­cess rates are high and the new joint can last 25 years.

‘In younger pa­tients, the fail­ure rate be­comes more of a prob­lem and in the un­der-55s, one-third of all pa­tients has to have a re­place­ment within seven years.’

This is due partly to th­ese pa­tients be­ing more ac­tive so putting ex­tra pres­sure on the new joint, says Mr hei­dari. NEW AP­PROACHES: There are three com­part­ments to the knee: the kneecap, the inside (me­dial) com­part­ment and the out­side (lat­eral) com­part­ment — in­creas­ingly, pa­tients are be­ing of­fered re­place­ment of only one or two of th­ese, in­stead of a full ar­ti­fi­cial joint.

‘re­place­ment of one com­part­ment is well-es­tab­lished,’ says Mr Gupte. ‘Tri­als are un­der way for the re­place­ment of two com­part­ments, but this is still de­bated.’

Those un­der 50 who need a new joint may be of­fered a knee al­lo­graft — where do­nated car­ti­lage and bone re­places the pa­tient’s own, although this is still in de­vel­op­ment, says Mr Gupte.


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