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Knee replacement versus signaling cell treatment for osteoarthritis India
Knee replacement versus signaling cell treatment for osteoarthritis
Discussion- Osteoarthritis of the knee is a very common condition in India. It causes pain, deformity and affects mobility. Both knees are commonly affected. Surgical treatment, usually a total knee replacement, offers permanent cure. Other surgical treatments include a high tibial osteotomy and partial knee replacement. A new modality of treatment is now available with the help of medicinal signaling cells. This is an interventional treatment without the scalpel.
Total knee replacement is a routine surgical procedure done under anesthesia that involves hospitalization. The surgeon amputates the worn out portion of the joint and cements in a prosthesis. After discharge the patient undergoes physiotherapy for about three months in order to squat on the floor and regain full function. Total knee replacement is a tested operation and it has a 95% success rate. It provides pain relief, corrects deformity and provides a good quality of life. It is invaluable in young patients who have got very severe post traumatic arthritis stemming from a road traffic accident. In medically fit patients, and willing to undergo this surgery, it is the operation of choice due to its sanction by usage and high success rate.
Although it is a common-place operation, some patients are skeptical or fear a major surgery. Others have comorbidities like heart, lung, kidney disease or neurological complications, diabetes which increases their risk for this surgery. Very elderly patients often are afraid of surgery. Often times the patient is very young to undergo a knee replacement. The longevity of a standard knee implant is about 10 to 15 years. Durable implants that last 30 to 35 years are also available. Young patients undergoing a knee replacement are likely to need one or two revisions in their lifespan.
Biological treatments are an emerging treatment for orthopedic conditions. They involve no metal prosthesis. They are performed with the help of a needle, need no anesthesia and hospitalization.
They utilize platelet rich plasma (PRP) and undifferentiated cells known as medicinal signaling cells (MSC's). PRP is obtained from peripheral blood and MSC's are obtained from bone marrow. These are then placed within the joint in the same session under local anesthesia.
They have the capacity to provide pain relief without surgery. These signaling cells and platelet rich plasma supply growth factors to the arthritic joint, boosting its natural repair capacity by several mechanisms. They alleviate pain and enhance quality of life. The duration of pain relief lasts for months to years.
Biological treatments may be valuable for the young, very elderly and those with co-morbidities.
Biological treatments have been proven to be safe in studies. However, they are still considered investigational. Careful case selection, expert treatment, evidence, objective evaluation, maintenance of case records, follow-up and publications are needed to change their status from investigational to valid.
Performance of both types of procedure in the same patient allowed a comparison to be made. Objective measurements of pain relief and function in both knees were recorded by the patient prior and post treatment. He has been followed up for two and half months after knee replacement and three weeks after biological treatment. Both procedures had a successful outcome in the short term with respect to their goal, which is pain relief. Further investigations will be performed to observe the progress later.
In summary, biological treatments are an emerging alternative to knee replacement for osteoarthritis.