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.
Highlights
Osteoarthritis (OA) in Canada has a marked impact on patient quality of life and comorbid conditions as well as a dramatic economic cost
The effect of opioid medications compared to nonopioid medications showed negligible effect on pain after 12 months of treatment [5]. us, for the savvy clinician, we will review nonsurgical treatments for K-OA such as injections, nerve blocks, and the so-called “regenerative” medicines: corticosteroid (CS) injections, hyaluronic acid (HA) injections, platelet-rich plasma (PRP) injections, prolotherapy, genicular nerve blocks, and stem cell therapy. ese therapies are often viewed as the last stop prior to operative intervention and are of particular
A small study published in 2017 showed no significant changes in WOMAC and Visual Analog Score (VAS) scores between patients treated with either intra- or periarticular prolotherapy [67]. ere are some variabilities in the method of peri-articular administration of the dextrose, but the two key techniques are either Lyftogt’s technique or Hackett’s technique [69]
Summary
Osteoarthritis (OA) in Canada has a marked impact on patient quality of life and comorbid conditions as well as a dramatic economic cost. E cost of this improvement, was steep, and patients receiving TKA had markedly increased risk of adverse events. Up to one third of patients continue to experience chronic knee pain after TKA [29]. Arthroscopy is another common treatment for treating K-OA; it remains controversial with some authors showing it to only provide transient, inconsequential benefit with an unacceptably high risk of adverse events [30]. E authors concluded that the poor quality heterogeneous studies make it difficult to determine if there is an early benefit in pain relief or function with I-CS compared to placebo [37]. With the growing evidence of I-CS having only a mild and transient effect on pain relief, one must question the sustainability of this therapy in modern day evidence-based medicine
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