What happens to the joint in osteoarthritis?

Osteoarthritis is the commonest form of arthritis. And knee joint is mostly affected. It is a degenerative disease in which “wear-and-tear” happens. People of age more than 50 years are impacted due to this, but it has been seen in younger people also.

With the degenerative changes in the cartilage, the protective space between the bones is reduced and it hampers the smooth movement of the bones. Gradually the whole cartilage gets damaged and the bones rub against each other thus causing severe pain and also forms bone spurs.

This disease develops gradually and with degeneration, the pain worsens.

How to diagnose osteoarthritis?

  • X-ray (radiograph):The assessment of damage to the cartilage is done by taking an X-ray of the knee in the standing position.
  • Computed tomography scan (CT or CAT scan): This radiological modality gives a better perception of the damage than X-ray alone.
  • Magnetic resonance imaging (MRI): Skeletal structures, blood vessels, and tissues can be visualized properly with this technique.
  • Arthroscopy: This minimal access procedure allows us to view the inside of the joint and perform certain corrective procedures, but it requires to be done under anesthesia.

What is joint preservation?

  • It is a novel treatment modality that emphasizes pain relief using biological mechanisms.

What are the types?

  • Nonsurgical treatment
  • Treatment with Autologous Adipose-Derived Stromal Vascular Fraction
    • Adipose-derived Stromal Vascular Fraction (Ad-SVF) contains a heterogeneous mix of adipose stromal cells,( progenitor cells, pericytes, T-regulatory cells, endothelial progenitor cells, anti-inflammatory M2 macrophages, extracellular matrix, and many other cells types.)

      These cells are injected into the articular space of the joint, where they attach themselves to the damaged sites, and due to its unique ability, they form/repair the site they attach. Thus, they help in the formation of the cartilage and repair of the other tissues inside the joint.

        The process is done in these basic steps –
      • Lipoaspiration of adipose tissue,
      • Ultrasonic cavitation, centrifugation,
      • And filtration which takes around 40 minutes.
        The stromal vascular fraction is very safe in comparison to other treatment modalities
      • Firstly, it is autologous, it means, the cells obtained are of the patient’s own.
      • Secondly, the processing and administration of the injection are done in the same single surgical sitting
      • There are no age limitations for this treatment
      • Preferred in the early grade of osteoarthritis
      • BMI of the patient is not a limiting factor
      • Done under local anesthesia
      • Patients can start walking from the same day
  • The stromal vascular fraction is given in the intra-articular space or injected into the intraarticular space. (i.e. within the articular space of the joint).
  • The adipose tissue obtained is not cultured using any enzymes or chemical or animal product.
  • The patient can feel the effect (reduction in pain) within the first week of the treatment and by 3-4 weeks, the patient can get back to their normal activities.
  • There is no need for bed rest or any other external support.
  • There is clinical evidence that reported the growth of cartilage inside the knee joint over time. Thus, it provides long-term benefits and in many cases, there is no requirement for any further intervention.
  • Though, this therapy is not recommended
    • If the patient is pregnant,
    • Having any blood disorders
    • Too lean to obtain sufficient adipose tissue
    • Having any ongoing infection
    • Having gout or pseudogout
    • Having any chronic terminal disease like cancer
  • But if there is severe deterioration of knee cartilage (late-stage osteoarthritis), the only option available is to go for surgical intervention.
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