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There are a number of articles around OA and alternatives to joint replacement parts in the site learning portfoliohttps://www.kneeguru.co.uk/KNEEnotes/learning-portfolioUnfortunately for severe issues, the effective options are limited especially given your age. If happy to throw a lot of time and money at the problem, you might find some relief from injections, but ultimately if the pain is unliveable a PKR or TKR might be your only option. In reality, once the cartilage is gone in large amounts and the subchondral bone is damaged, there’s not much left in terms of getting it back. An osteotomy might be less drastic than a replacement but usually for patients too young for replacement.If it’s just medial pain on walking, have you invested in a professionally fitted unloader OA brace eg from Donjoy?Good luck
Well that’s good as you specifically mentioned walking painI’m a cyclist with tri compartment OA in one knee (20 years younger than you)… have you had your set up checked by a physiotherapist, especially cleats if you use them?I don’t think anyone here will be able to read your MRI, and not from just one slice…do you have an X-ray showing the joint space from the front?
What other treatment options are there for medial compartment OA? Thanks in advance!
Ubercool,I'd take a guess the partial meniscectomy you likely had was on the medial side. There is strong evidence partial meniscectomy increases the likelihood of arthritis. There is incontrovertible evidence full meniscectomy leads to arthritis. Pretty much all docs know that and I don't believe full meniscectomy is practiced anymore. Partial is, however, as it is sometimes unavoidable (e.g. dangling pieces). So much for the pathogenesis. Now, what to do.The hope that many people have for regenerative medicine is understandable. I (still) have it. This forum was brimming with euphoria ~ 8-9 years ago when PRP and stems came onto the market. There was this feeling that arthritis had finally been vanquished. The notion that stem cells, once injected, detect damage and morph into whatever cell type is needed to restore tissue is now known to be a fantasy. It has at least been shown that under current protocols stem cells don't do damage - no cancer formation or other major complications.PRP could ease some of your pain but will not reverse your arthritis. Also, the effect wears off after 3-6 months. No downside to PRP apart from cost. It is the least invasive "regenerative" modality to try. I've had about half a dozen PRP shots which neutralized inflammation and may have restored the natural homeostasis of anabolic and catabolic processes in the knee. But despite multiple growth factors in PRP I don't believe there is any regeneration. MRI imaging showed no effect on my chondromalacia and torn meniscus.There are multiple stem cell treatments. Anyone over 40 should not be looking at bone marrow, the yield is low. Fat's the way to go. The Korea study you quoted is with pure stems, this is not allowed in the US outside clinical trials. Dr Centeno took it offshore to the Caymans ~ 10 years ago - pure stems have failed to live up to the hype or he would've brought it back to the U.S. if there were evidence.Research continues.I think micro-fractured fat (a cocktail of stems and other bits) is the best there is at the moment but keep your expectations low. You may get pain relief that lasts longer than with PRP but actual tissue regeneration is a toss. Lipogems runs $3-4K. There are other similar systems.Longer term some look at genetic approaches but that generally remains at the pre-clinical stage. Both of us would run out of runway even if gene therapy ends up successful eventually.The U.S. sees about 800,000 total knee replacements annually, which is the currently accepted end-stage definitive knee arthritis "treatment".
Quote from: ubercool on December 18, 2021, 05:37:26 PMWhat other treatment options are there for medial compartment OA? Thanks in advance! I'll be totally honest; at 70, I think you could spend a lot of time and money on largely unproven and low-percentage regenerative techniques, or you could simply get a partial or full replacement with an extremely high % chance of success, which will very likely easily last your lifetime. But absolutely, it's a personal decision, and significant one.
There are a number of other solutions I’m still researching. You said you like lipogems, how about osteochondral autograft transplantation, osteochondral allograft, or autologous chondrocyte implantation? Or are these not applicable to OA?I will begin investigating total knee replacements. I’m sure that’s another science all its own.
Quote from: ubercool on December 20, 2021, 12:01:08 AMThere are a number of other solutions I’m still researching. You said you like lipogems, how about osteochondral autograft transplantation, osteochondral allograft, or autologous chondrocyte implantation? Or are these not applicable to OA?I will begin investigating total knee replacements. I’m sure that’s another science all its own.Cartilage repair techniques are pretty much reserved for smaller focal defects in younger (<40, 50 at a push) patients not widespread deep wear and tear, they need pristine cartilage around them. They also don’t work well if there’s any sort of malalignment as can occur with extensive loss of joint space (bow legged with medial arthritis).In terms of TKR, it’s important to find a super experienced surgeon with access to a wide range of replacement options and technology to suit the individual patient. As well as access to a top notch physio for prehab and rehab
The ASCs that emerged from MFAT were cultured for 7–21 days and representative cells were observed and photographed with light microscopy.
There is truncation of the inner free edge of the body, anterior, and posterior horn of the medial meniscus over a 3.5 cm segment with small severely macerated remnant portion of the meniscus suggesting prior arthroscopic partial medial meniscectomy.The lateral meniscus is intact without tear.Medial compartment articular cartilage shows severe full-thickness cartilage loss central weight-bearing region medial femoral condyle medial tibial plateau with exposure of subchondral bone and moderate subchondral stress response. There are tri-compartmental marginal osteophytes.