How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts

Abstract

Abstract:The objectives of osteoarthritis (OA) management are to reduce pain and inflammation, slow cartilage degradation, improve function and reduce disability. Current strategies for managing knee OA include nonpharmacological interventions, oral pharmacological treatments, localized intra-articular injections, and surgery. It has become evident that the inflammatory response is a key contributor to the development and progression of knee OA. Signaling pathways involving growth factors and cytokines are being investigated for the development of new therapies that target the underlying biological processes causing the disease. This concept of 'molecular orthopedics' enables more patient-centered diagnostic and treatment strategies. In contrast to other conservative therapies, which ultimately only address OA symptoms, intra-articular injections, in particular autologous conditioned serum (ACS), provide benefits that have the potential to outweigh those of established pharmacological treatments and surgery. Surgery has historically been considered the final solution for treatment of knee OA, both by treating physicians and by patients; however, there are increasing concerns regarding the lack of randomized clinical trials providing evidence to support this opinion. Intra-articular injection of ACS has demonstrated efficacy as a treatment for knee OA in a number of studies, with a very low rate of adverse events and side effects, compared with surgery. Treatment with ACS utilizes the release of anti-inflammatory cytokines and regenerative growth factors to support the natural healing processes in the knee, and has the potential to provide a valuable alternative to surgical intervention.

Influence of Periostin on Synoviocytes in Knee Osteoarthritis

“…The prevalence of OA is rising due to increased life expectancy and risk factors such as obesity (1). It is evident that the inflammatory response is a key contributor to the development and progression of knee OA (3). OA is characterized by articular cartilage damage, low-grade synovial inflammation and hypertrophic bone changes, which lead to functional deterioration (1).…”

Autologous cell-free serum preparations in the management of knee osteoarthritis: what is the current clinical evidence?

“…The predominant cytokine in ACS is IL-1Ra with an average concentration of 2015 compared to 236 picograms per milliliter (pg/ml) in a basal blood sample [41]. Additional components of ACS described include platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), insulin-like growth factor (IGF), and fibroblast growth factor (FGF) amongst others [41,44,45]. Hix et al [20] reported the average concentration of IL-1Ra in APS to be 63,740 pg/ml whereas Woodell-May et al [46] noted it to be 30,853 pg/ml.…”

“…The aforementioned growth factors, which include TGF-β, PDGF, VEGF and IGF, have been shown to stimulate chondrocyte proliferation and augment articular cartilage metabolism [44,52]. Whilst it is perceived that both ACS and APS potentially mitigate the inflammatory cascade, the detailed pathways or mechanisms through which they perform these actions have not been fully described [40,45,47,53].…”

Not All Stem Cells Are Equally Great: Donor Single-Nucleotide Polymorphisms (SNP) May Matter More Than Previously Thought

“…Even small articular cartilage injury is difficult to repair by itself and may cause joint degeneration, so the restore of chondrocytes from their progenitor cells is the key to the treatment of osteoarthritis. 36 In fact, MSC transplantation has been emerging as one of the most promising methods for treating OA and has been demonstrated in several animal models. [37][38][39] In addition, registered in website Clinicaltrials.gov is more than 50 proof-of-concept clinical trials.…”