Knee replacement vs Signaling cell treatment India

Knee replacement vs Signaling cell treatment IndiaA comparison of both in same patientDr.A.K.Venkatachalamwww.kneeindia.com

Knee replacement vs Signaling cell treatment India

Knee replacement versus signaling cell treatment for osteoarthritis in same patient

Case report- A 72-year-old gentleman suffering from osteoarthritis of both knees was treated with a total knee replacement in one leg and signaling cells in the other. He has obtained pain relief in both legs and has regained full function. The rationale for doing a knee replacement in the right knee was correction of severe deformity, pain relief and restoration of normal gait. The rationale for performing a biological treatment in the left knee was pain relief without correction of a less severe deformity. Both the treatments were chosen by the patient after inputs by the surgeon.

Discussion Osteoarthritis of the knee is a very common condition in India. It causes pain, deformity and affects mobility. The permanent treatment after exhausting all conservative measures is surgical, usually a total knee replacement. 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 which doesn't involve a 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. Although it is a common-place operation, some patients are skeptical or fear a major surgery under anesthesia. Others have comorbidities like heart, lung, kidney disease or neurological complications, diabetes which may increase 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. Total knee replacement is a tested operation and it has a 95% success rate. It can correct the deformity and provides a good quality of pain relief. It is invaluable in young patients who have got very severe post traumatic arthritis stemming from a road traffic accident. In those patients are medically fit and are willing to undergo knee replacement it is the operation of choice due to its sanction by usage and success rate.

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 (MSCs). 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. 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.

In this case, objective measurements of pain relief and function 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. Further investigations will be performed later to record the course Objective scoring and investigations are essential to record the post treatment course.In summary, biological treatments are an emerging alternative to the time tested joint replacement for knee osteoarthritis.

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