Before you get knee arthroscopy, read this!

Or, "Try other therapies first before going under the knife for knee pain!"

Maybe you have osteoarthritis (OA) of the knees or other joints (hips, spine, etc). And I'll bet that if you don't you know more than one family member or friend who does. Also called Degenerative Joint Disease, it is very common, especially with those who are middle-aged or older. There are more than 3 million new cases diagnosed each year, in the US alone!

After years (decades even) of chronic low-grade inflammation, wear and tear, perhaps poor work or activity ergonomics, nutritional deficiencies and many other factors, joints try their best to repair and respond to these insults by replacing cartilage with bone.

Cartilage is a smooth connective tissue, with glass-like surfaces gliding together to give our knees their hinged movement.  Bone is tougher, more solid and also has a more bumpy, irregular surface, so is not the best gliding surface.

This is the essence of the development of OA.

So what can be done?

Well, being a Naturopathic Doctor, of course I want to treat the source and influencing factors (by correcting all those I mentioned above as much as we are able).

But then what can we do for the aches and pains that often come on with moderate to severe OA?

Conventional medicine will often offer physical therapy (which can be beneficial to be sure), and anti-inflammatory medications (such as Tylenol or Ibuprofen) or pain medication to be taken daily as needed. Then after years of that, a joint replacement will often be recommended.

Not only do those anti-inflammatories themselves accelerate the cartilage degeneration problem (see previous blog post and research link here), they do nothing to solve the situation.

And joint replacement surgeries are harsh, hard on the body, involve long recovery periods and are nothing to take lightly.

As an intermediate step, arthroscopy is often recommended. This is a minimally-invasive surgical procedure where visualization scopes are used for the surgeon to remove small bony growths seen within the joint capsule.

And does this work? Does this correct the OA?

In short, no. It has proven to be less effective than "sham surgery" (incisions in the skin alone with no further surgery) and less effective than physical therapy.

This is huge news. The most common procedure done for knee OA has basically been proven to be worthless. And this is no news flash, this research was published in 2008 in the New England Journal of Medicine. I included both the full document and a pdf link below as I think this is important information that needs to be disseminated and wanted you to be able to access it.

So if arthroscopy is shown to be basically ineffective, what can be done? (after you get your movement, nutrition, etc in order or at it's a work in progress)

That is exactly where Regenerative Injection Therapies can step in and truly help with restoration and healing of chronically degenerated knees (among other joints).

By stimulating the body to re-initiate its healing process, and by bringing stem cells and other healing factors to the exact location they are needed, real regeneration is possible.  I see it all the time, and am so grateful to be able to offer these techniques to my patients.

For research information, see the above RIT link (which has its own specific research links) and also this national organization's website has many more research citations.

Suffice to say, if "conservative care" hasn't worked well enough for you (PT, other movement therapies, NSAIDs, pain medication) and you are faced with surgical recommendations, do yourself the favor to at least see whether RIT techniques might be the right fit for you.

If you are in or travel to the Portland area, you can give our office a call to set up a consultation or new patient appointment. I look forward to helping you (and your joints!) reach their maximum potential!

To your best health,
Dr. Angela Cortal

koa_arthroscopy_ineffective_nejm_2008.pdf
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