The latest information on joint replacement, repair, and new treatments

When asked to assess the overall state of the field of joint repair and replacement, Dr. Susan GoodmanA rheumatologist, attending physician at New York’s Special Surgery Hospital, believes we are “seeing a future without the need for joint replacement surgery.”

But to get there, “there are some significant hurdles ahead,” she told Healthline.

“In conditions such as rheumatoid arthritis, the problem of joint damage arises from an unidentified inflammation that erodes cartilage. “It’s important to do that,” Goodman said. inflammatory arthritis Those who have abnormalities in the whole joint. ”

For joints such as the knee, which are “extremely vulnerable to mechanical forces due to weight and impact,” obesity “It can also damage artificial joints.”

Dr. Christopher JonesBe a board-certified, fellowship-trained orthopedic surgeon specializing in sports-related knee, shoulder, and elbow musculoskeletal injuries. Either patient’s own cells, allograft tissue, or interpatient transplants has come out with a number of new products that explore “alternative ways to regenerate new cartilage” using

“While this study shows that these new tissue types are indeed durable and provide long-term pain relief to patients, the problem is the progression of joint degeneration in other areas of the knee.” added Mr Jones.

He said it’s not uncommon for the same patient to experience degeneration in other areas two or three years after undergoing cartilage graft surgery to address a portion of the knee and exhibit new symptoms.

“We are now adept at using durable tissue to resurface small and medium-sized lesions and other areas of joint degeneration,” Jones explained.

From his point of view, Dr. Sid PadiaAn expert in vascular and interventional radiology at UCLA Medical Center, he told Healthline that there is generally “no significant impact or change in standard care for patients with joint disease.”

“While there have been no dramatic changes in how we view treatment of people with joint disease, there have been some promising new therapies that have shown potential benefits in treating a variety of joint diseases.” That said, many of these potential new treatments currently under study “have not materialized when it comes to long-term clinical benefits,” he said.

“Many of the new minimally invasive treatments have been shown in studies or have shown short-term benefits because these studies have not evaluated or compared long-term results. [the given procedure] So it’s hard for the medical community to really accept these new treatment options,” Padia added. I think there is a big opportunity to do a periodical treatment.”

According to Jones, the most prominent of the current advances is the use of “biological injectables.” Orthobiologics.

These are injectable substances used by orthopedic surgeons to speed the healing of injuries. It can be used on tendons, ligaments, fractures, etc. and is derived from substances naturally occurring in the body, According to the American Academy of Orthopedic Surgeons.

Jones cited injection therapy, such as using Platelet rich plasma (PRP)Two examples are plasma infused directly into tissue and bone marrow aspirate concentrate using bone marrow cells.

“PRP, bone marrow aspirate concentrate, amniotic fluid suspension allograft injections – all of which are being used to determine how best to utilize them to treat patients suffering from arthritic knee pain. I am researching

Many of these injectable therapies being developed enhance the surgical procedure to advance the healing process and “maintain a more favorable cellular homeostasis to prevent further joint degeneration,” Jones said. ‘, he explained.

He said we can expect more of these types of injections to become available in the next few years to treat symptomatic knee pain. Phase III study He is a principal investigator at UCLA.

“At UCLA, we have this Phase III FDA trial that is looking at one of these products, the trial has finished, and we are now looking at the data and looking at the numbers to see if there are any adverse events for patients. are being processed,” he said.

At UCLA, Padia Working on an alternative to knee replacement surgery This may provide pain relief to individuals who may not be eligible for surgery.

For example, people with high-risk complications or old age may not be eligible for knee surgery. Younger people may also delay surgery as they will eventually need another knee replacement surgery or procedure within the next 20 years.

the procedure is called Knee artery embolizationThis is a minimally invasive procedure in which particles smaller than a grain of sand are injected through a small catheter into an enlarged knee artery. It takes him only two hours to do this and he can go home the same day and return to normal physical activity later in the day.

“We have published results, conducted a randomized trial showing that knee artery embolization of the knee leads to pain relief, and adapted this procedure to patients. tennis elbow“Given the increased use of pickleball, more and more people are starting to have tennis elbow.”

He added that treatment for something like tennis elbow is fairly limited and that surgical correction is “rarely done.” steroid injection It is often the mainstay treatment for this condition and provides short-term benefits.

“Often, people have no choice but to quit physical activity. That’s why we developed this procedure for tennis elbow and it has shown very promising results in people.

a Research in 2022 The journal Advanced Functional Materials highlights a study from Duke University that sheds light on what has been described as the first synthetic gel-based replacement for cartilage.

The researchers behind this gel say it can be pulled and pushed with greater force and weight than naturally occurring cartilage. three times more resistant to heavy wear and tear.

A company called Sparta Biomedical has developed this “hydrogel” product and tested it in sheep, with human clinical trials expected to begin this year. According to the press release.

To give you an overview of how strong this material is, natural cartilage can handle 5,800 to 8,500 pounds of “pull and crush” per inch before reaching its breaking point. Hydrogel is reported to be 26% stronger than natural cartilage in suspension, and he is 66% stronger when compressed.

When asked what’s exciting for him outside of surgery right now, Jones pointed to artificial cartilage that’s just as durable, if not more durable than the real thing.

“Clinical use is a long way off. The problem is trying to figure out how to attach different types of artificial tissue to bone and make them durable over the long term,” Jones explained. bottom. “This could be a potential alternative to traditional joint replacement surgery in the future. The point of all this is to preserve the joint and its natural feel.”

Late 2022, Forsyth Research Research Published in Science Advancespoints out a potential mechanism for generating new chondrocytes.

“The purpose of this research was to elucidate how cartilage regenerates. Dr. Takamitsu mentioned in the release.

This study contributes to a growing body of research suggesting that the future of joint repair to treat arthritis may be at the cellular level.

“I think it has the greatest potential [for the future] It’s the use of stem cells,” Padia said. “The use of stem cells is, first of all, a relatively simple and minimally invasive procedure. Appropriate and precise methods for selection are needed, ideally placebo-controlled studies that are conducted over a period of time sufficient to yield long-term results.