Knee osteoarthritis: new developments in treatment

In recent years, there has been a significant advance in terms of the therapeutic arsenal to treat osteoarthritis of the knee. This progress has been achieved both in conservative treatments, that is, non-surgical treatments, as well as in surgical ones. Depending on the age and functional status of the patient, in addition to the de-limitation of the limb, it is decided which treatment of these two is the most convenient.

Among the main non-surgical treatments are two basic elements: platelet growth factors and hyaluronic acid. Growth factors are proteins with a key function in the process of repair and regeneration of tissues. Its application stimulates and accelerates the process of healing and regeneration of most tissues of the body. They are factors that are located inside the platelets and in the serum. Platelets, by their ability to secrete a set of proteins, can act by regenerating and repairing tissues, in addition to regenerating the cell matrix.

We follow a strict protocol: 4 hours fast. Under strict aseptic measures, blood is drawn from the patient. These tubes are centrifuged at 1,800 rpm for 8 minutes, to obtain the separation of the different components of the blood. This way we obtain the lower platelet area, which is the one with the most cellularity, we activate it with calcium chloride and it is ready to be inserted into the knee, by means of joint puncture.. The treatment is done with three infiltrations, each one of them separated in two weeks, and the patient can walk without problems after the infiltration, with a slight discomfort, due to a slight swelling of the knee.

On the other hand, hyaluronic acid is a substance found in our joints that support load and whose function is to lubricate and cushion. In osteoarthritis of the knee , the content of hyaluronic acid in synovial fluid decreases. The infiltrations of this acid increase its concentration again, which decreases the friction between the bones and the patient notices a considerable relief of pain. The treatment is usually done with a weekly injection for five weeks.

For knee osteoarthritis , our options for surgical treatments are knee osteotomies , for young people with osteoarthritis, and prosthetic surgery. The osteotomy consists of realigning the axis of the leg, and it is in this aspect where our modern fixation plates clearly mark the difference with the old ones.

As for the prosthesis, they can be unicompartmental, advisable in those knees that maintain a correct ligament balance and a small axial deviation , or total prostheses , consisting of two or three pieces, depending on whether the patellar component is to be replaced or not.

The prostheses are offering a positive result. The materials and the designs evolve in a constant way, they are more and more resistant and anatomical, which leads to a more physiological movement, and the patient has a better gait and better functionality in stairs and uneven terrains. The degree of knee flexion has also been improved, which gives the patient more agility.

The progress made in knee prostheses has been enormous and constant over the last twenty years, so it is to be assumed that advances continue at least at the same pace, which will guarantee our patients with degenerative pathology of the knees a safety even greater in the treatment of his ailment.