Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Abstract

Objectives Knee osteoarthritis (OA)1 is a debilitating condition that may ultimately require total knee arthroplasty (TKA)2. Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI)3. The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. Methods A literature search was executed using Medline, Cochrane, and Embase with keywords ”knee osteoarthritis” and “injection.” Specifically, articles discussing intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP)4 and mesenchymal stem cells (MSC)5, were analyzed. Results Forty-five publications were scrutinized. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5. Papers included animal models. Local anesthetics have potential side effects and may only be effective for four hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to one months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation. Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. Conclusions Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.

Autologous cell-free serum preparations in the management of knee osteoarthritis: what is the current clinical evidence?

“…To date, the outcomes of 1229 patients involved in studies evaluating the effect of injection of ACS/APS have been reported ( Table 2). The adverse reactions noted in these patients have been similar to the intraarticular administration of other therapeutic agents [17,40]. Additionally, they have been of a transient and self-limiting type [12,41].…”

A promising novel formulation for articular cartilage regeneration: Preclinical evaluation of a treatment that produces SOX9 overexpression in human synovial fluid cells

“…The intra-articular administration of corticosteroids produces a short-term improvement. However, the repeated use of corticosteroids may facilitate tissue atrophy, joint destruction or cartilage degeneration (44). Hyaluronic acid derivatives produce apparent effectiveness 5–13 weeks following treatment.…”

Is there a treatment protocol in which platelet-rich plasma is effective?

“…[37][38][39][40] When the studies in which PRP was obtained from autologous blood in clinics were considered, it was found that it was prepared from 10 to 20 min. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Nevertheless, it takes time to apply it to cases, which makes its bioactive and effective treatment results controversy.…”

“…[16][17][18] Some manuscripts indicated that PRPs with different contents are superior in clinical treatment. 19 There was no well-proven study in which PLT and leucocyte (WBC) rates were separately discussed in PLT concentrations in PRP content. There was not enough evidence regarding how much WBS is responsible from curative or negative effect in clinics.…”