Management of Osteoarthritis

• Up to two thirds of people suffering from osteoarthritis are of working age.
• Osteoarthritis is a progressive condition.
• Traditional treatments are only directed toward pain relief/analgesia.
• We believe in the active management of arthritis.
• Whilst pain relief remains a primary objective, we use a multidisciplinary approach that aims to actively prevent reduce progression of arthritis.

Treatment Plan/Options

Primary Medical Therapy

• Analgesia - Simple Analgesics and/or non-steroidal anti-inflammatories
• Supplements - Glucosamine Sulphate
• Exercise - Exercise Physiology/Physiotherapy
• Biomechanical Assessment - Podiatry
• Weight Loss - Nutritionist/Dietician

Advanced Medical Therapy

• Hyaluronic Acid (HA)
• Platelet Concentrate (PC)
• Low Dose Stem Cells (includes HC + PC)
• High Dose Stem Cells (includes HC+ PC)

What is Involved ?

• Prior to any treatment you will receive a thorough `arthritis health care’ consultation with one of our sports medicine physicians. Current pain management therapies will be optimised.
• If relevant, further nutritional and exercise consultations will be arranged.
• Your suitability for for other `advanced medical therapy’ options will be assessed.
• Formal imaging (XRays or MRI) will be arranged if required.
• Your response to treatment will be regularly followed up to maximise potential improvement. 

Primary Medical Therapy 

Analgesia

• Paracetamol

• Non Steroidal Anti-inflammatories

*It is important to consult with your doctor prior to using anti-inflammatories in the treatment of your

arthritis.

Supplements

• Glucosamine

• Glucosamine is an amino-acid that forms the common `back bone’ of cartilage matrix.

• Evidence suggests that glucosamine supplements may offer both pain relief and reduce the

progression of arthritis

• Dose

• At least 1500mg/day of Glucosamine Sulphate (NOT Glucosamine Hydrochloride)

• Chondroitin ? Shark Fin ??

• Many glucosamine preparation have additional additives. Some evidence suggests additional

benefits with Glucosamine + Chondroitin Sulphate preparations.

• Risks

• Allergy/anaphylaxis - Glucosamine is derived from shell fish.

• Research :

• McAlindon, et al. Glucosamine and Chondroitin for Treatment of Osteoarthritis - Review Article,

JAMA 2000, 283(11):1469-1475

• Clegg, et al. Glucosamine, Chondroitin Sulphate, and the Two in Combination for Painful Knee

Osteoarthritis, N Engl J Med 2006, 354:795-808

Exercise

• Regular and appropriate exercise can be effective in reducing pain and disability associated with arthritis

• A structured program created and supervised by a professional rehabilitation Exercise Physiologist or

Physiotherapist is recommended.

• Exercise Principles (FITT)

Frequency : At least 3 session per week for > 8weeks

Intensity : Moderate Intensity

Type of exercise : Aerobic, resistance and load bearing

Time : At least 30minute sessions

• Research :

Petrella, et al. Is exercise effective treatment for osteoarthritis of the knee?, BJSM 2000, 34:326-331

Biomechanical Assessment

Podiatry assessment and relevant biomechanical adjustment can often help to unload areas of arthritis and therefore reduce pain and improve function.

Weight Loss

• Increased weight is a risk factor for the development of osteoarthritis in weight bearing ie. (hip and knee)

and also non weight bearing joints (ie. hand).

• Loss of 5kg has been shown to be effective in reducing the risk of knee arthritis by a factor of up to 50%.

• It is important to have a structured weight loss program developed by a qualified Nutritionalist or Dietician.

• Research :

Felson, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham

Study. Arthritis Rheum 1997, 40:728-733

The most common disease affecting the knee is osteoarthritis. The cartilage in the knee gradually wears away, causing pain and swelling. Knee problems are very common, and they occur in people of all ages. Knee problems can interfere with many things, from participation in sports to simply getting up from a chair and walking. This can have a big impact on your life.

Injuries to ligaments and tendons also cause knee problems. A common injury is to the anterior cruciate ligament (ACL). You usually injure your ACL by a sudden twisting motion. ACL and other knee injuries are common sports injuries. Treatment of knee problems depends on the cause.

Traditional options for patients suffering from the knee or hip injury, arthritis or pain include arthroscopic joint surgery, total knee or hip joint replacement. Besides the cost and the risks of those orthopedic surgeries, several months of rehabilitation is usually needed after the surgeries.

For many patients these intense orthopedic surgeries may not be an option due to their younger age especially considering the fact that we are living longer and more active lifestyle and the Joint Replacement may not last for more than 10 to 15 years. Also, the injuries may not be serious enough to require any surgery.

As an alternative to the knee and hip (and other joints) surgery or replacement, alleviate joint pain, arthritis and other medical conditions that caused it with a simple office injection procedure. We encourage the patients to walk the same day and most experience almost no downtime after our procedures whatsoever.

And if you are considering a knee, hip or other joint replacement, you might want to learn about how the adult stem cells and PRP procedures stack up against these risky Orthopedic surgeries.

Traditionally – a Total joint replacement of the hip or knee is often considered to be a accepted approach to treatment for patients suffering from significant arthritis or injury in their knee and hip joints. Over the years, due to aging baby-boomers and active lifestyle causing more sports injuries, these procedures have become more common. It has now become something that almost seems inevitable for us as we age.

But what about an alternative that could be just as successful as joint replacement and may be a better option for many of the patients before even considering joint replacement. And, all of this with significantly lower risk and cost.

When comparing two options - a treatment that involves simply an injection of your own natural cells in an outpatient setting may be significantly more attractive option for many patients than undergoing risky orthopedic surgery and replacing your entire joint with artificial material.

We play a key role in this cutting-edge stem cell medical field. While many types of stem cells are currently used in orthopedic healing, the most common are mesenchymal stem cells and hematopoietic stem cells to help regenerate tissue and rebuild cartilage, muscles, tendons and ligaments.

Because it is now possible to induce pluripotency in cells that have not come from embryos, the controversial use of embryonic stem cells has fallen on the way side and in the favor of the accessible cells found within the patient’s own body.

Patients coping with arthritis, sports injuries, tendon strains, sprained ligaments, muscle injuries and more, will be comforted to know that surgery is not the only option of treatment available to them. Faster healing as well as improved functionality both are possible with innovative, cutting- edge adult stem cell and PRP procedures.

MEDICAL LITERATURE - PRP AND STEM CELLS IN KNEE INJURIES

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2. Current clinical therapies for cartilage repair, their limitation and the role of stem cells. Dhinsa BS, Adesida AB. Curr Stem Cell Res Ther. 2012 Mar;7(2):143-8. 2.

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10. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis. Rutjes AWS, Jüni P, MD; da Costa BR, et al. Ann Intern Med. 2012 Jun 11.

11. Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-analysis. Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Arch Phys Med Rehabil. 2013 Nov 27.

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