Q. I have had pain in my knee for more than two years and it continues to get worse. I went to the doctor and I was told I had arthritis and would soon need a knee replacement. I tried anti-inflammatory medications, which helped a little but bothered my stomach. Physical therapy did not help. I had a cortisone shot in my knee, which only helped for a few weeks and the pain came back. I do not want surgery and wonder if there any alternative treatments?
A. The usual indication for knee-replacement surgery is when you cannot live with the pain. Although the X-rays or MRI scan are helpful, I tell patients your knee will tell you when it is time for the surgery. Your physician has tried the usual non-surgical treatments, which unfortunately have not worked for you. Other options include viscosupplementation injections such as Synvisc, which is a hyaluronic acid injected into the knee joint. This acts as a lubricant, which can help decrease pain in 75 percent of people with arthritis for six months to a year. This is FDA approved and covered by most insurance companies.
An unloader brace can be specially fit if your arthritis if it’s mostly on one side of the knee and can help reduce pain. Other treatments that are somewhat experimental and thus not covered by insurance include PRP, stem cells and amniofix.
PRP is plasma harvested from your own blood that has been spun in a centrifuge and injected into your knee. Early studies suggest that this can decrease pain and inflammation in about 50 percent of patient with arthritis. It costs about $1,000. Stem cells can be obtained from your fat, bone marrow or embyonic tissue and injected into your joint. This is very expensive ($3,000-$8,000) and has not yet been shown to regrow cartilage. It can give pain relief in some patients.
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Once a method can be developed to secure the stem cells to the arthritic areas of the knee and trigger the cells to form cartilage then this will potentially revolutionize arthritis treatment. Amniofix is an amniotic compound injected into the knee just being studied for arthitis treament.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net