Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies

Abstract

Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.

The Role of Cashew (Anacardium occidentale L.) Nuts on an Experimental Model of Painful Degenerative Joint Disease

“…Chronic pain related with osteoarthritis is a major concern for which there are few viable treatments. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes and an increased caregiver burden [32]. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits [33].…”

Patient-Reported Outcomes After Platelet-Rich Plasma, Bone Marrow Aspirate, and Adipose-Derived Mesenchymal Stem Cell Injections for Symptomatic Knee Osteoarthritis

“…Indeed, quality trials are still necessary to support cell-based therapies for chronic knee OA. [21][22][23][24] This study has important limitations. Patients were not randomized into treatment groups; in fact, treatment was chosen according to severity although all were symptomatic and with similar scores, and the outcomes were not compared with a placebo or alternatives.…”

Therapies for osteoarthritis today and tomorrow: Review

“…After diagnosis of OA, a patient could be treated with non-pharmacologic therapy, simple analgesics or over the counter NSAID's, Rx NSAID's, and/or intra-articular (IA) corticosteroids all prior to surgical intervention. Even more interesting is a comparison between AAOS, ACR, OARSI 7 for US patient and what treatments are recommended vs. inconclusive evidence vs. not recommended. American Academy of Orthopaedic surgeons (AAOS) recommends only topical NSAID's, oral NSAIDs and Tramadol.…”

“…Even IA injection of hyaluronic acid (HA) is not recommended together with Chondroitin and Glucosamine supplements. 7 Also, there are calls for use of IA corticosteroids to be reconsidered. 7 The Cochrane report by Juni at all.…”

“…7 Also, there are calls for use of IA corticosteroids to be reconsidered. 7 The Cochrane report by Juni at all. 8 generates some controversy about the use of this most common treatment for OA even with limited evidence of efficacy.…”