Knee osteoarthritis: useful options before surgery

Knee osteoarthritis (KOA) is an increasing prevalent disease that causes joint pain and disability in adults usually beyond 50 years of age. Obesity and new sport lifestyles have changed age of presentation and currently osteoarthritis symptoms are seen in healthy younger patients (before 50 years).

The goals of therapy for patients with KOA are to control pain and swelling, minimize disability and improve the quality of life. The pharmacological management of KOA includes opioid and non-opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotective agents and some antidepressants, such as duloxetine.

Dolor por artrosis de rodilla

However, there is a number of patients who do not benefit from drug treatments, do not tolerate them, or, in whom these treatments are contraindicated. When available

However, not all patients are good candidates for knee replacement. Young patients before 40 years are not ideal candidates since metal prosthesis have a finite lifespan and, likely, may require a new replacement in a future. There are many patients with high surgical risk that are neither good candidates. In the last few years, there is a new profile of middle-aged patients that have symptomatic KOA only when practicing their favorite sport and for which likewise knee replacement should be the final choice.

Novel intrarticular treatments may potentially be a useful and safe option for those patients that are not good surgical candidates.  Cyclical intrarticular injections of hyaluran (a natural cartilage compound) provide a significant relief without relevant adverse effects (1). Platelet-rich plasma injections are another interesting intrarticular option that have demonstrated sustained reduction of knee pain (beyond 1 year) with remarkably improvement in joint function and minimal or no adverse effects (2). Finally, periodical intrarticular injections of autologous conditioned serum (Orthokine), another blood autologous therapy based on isolation and enrichment of a blood natural anti-inflammatory proteins (IL-1 receptor antagonist) and growth factors, have demonstrated a significant reduction of pain and an increment of mobility and knee function up to 2 years with an excellent safety profile (3). All of these above mentioned treatments control pain and swelling, minimize disability and improve quality of life of KOA sufferers, thus, they should be considered before surgery, mainly, in those bad candidates for knee surgery.