Treatment of Osteoarthritis

Hyaluronic Acid vs. Platelet-Rich Plasma vs. Orthokine®

Osteoarthritis, or joint degeneration, is one of the most common diagnoses in orthopaedic practice. The knee, hip and joints of the hands are particularly susceptible to wear and degeneration, but any joint can be affected, causing pain and restricted movement and thereby reducing a patient’s quality of life.

Typical symptoms of osteoarthritis include pain when starting to move and during weight-bearing activities, particularly in the morning and after longer periods of rest, often accompanied by stiffness. Pain and stiffness usually improve after the first movements in the morning but may return or increase with prolonged activity. In more advanced stages, patients may also experience pain at rest and during the night.

The typical restriction in movement results from the loss of cartilage within the joint as well as changes in the joint capsule, tendons and muscles surrounding the joint.

Diagnosing osteoarthritis requires a careful medical history, a physical examination and, if necessary, an X-ray.

There are various treatment options available. Maintaining a healthy body weight and avoiding excessive or inappropriate strain on the affected joint can often help to reduce pain.

Activities that place less stress on the affected joint, such as cycling or swimming, are recommended. Walking on softer surfaces, such as forest paths or grass, possibly with the use of walking poles or crutches, may also provide relief.

Physical measures such as ice or cold applications for acute pain or swelling, as well as heat applied to the surrounding muscles, can be soothing and help relieve symptoms.

Physiotherapy and, for example, acupuncture are important complementary treatments. Acute pain and significant inflammation during an arthritic flare-up can temporarily be treated with non-steroidal anti-inflammatory drugs (NSAIDs), provided there are no contraindications, such as certain cardiovascular or gastrointestinal conditions or blood-clotting disorders.

If these measures do not provide sufficient relief, injection therapies into the affected joint may be considered.

There are several different injection treatment options.

Treatment with Platelet-Rich Plasma (PRP) has shown good results in patients with mild to moderate osteoarthritis. For this treatment, blood is drawn from a vein in the arm. Through centrifugation and the use of an anticoagulant, the plasma is separated from the other blood components. The plasma, which contains anti-inflammatory components and growth factors that support regenerative processes, is then injected into the joint under sterile conditions, where it can act on the cartilage and the often inflamed synovial membrane.

PRP therapy can also be very effective in the treatment of overloaded or chronically inflamed tendons, such as tennis elbow, Achilles tendon irritation and muscle injuries.

In cases of moderate or advanced changes to the joint cartilage, the lubricating, shock-absorbing and nutritional functions of the synovial fluid can be improved with hyaluronic acid injections. Usually, a single injection is administered and may provide symptom relief for approximately 6–12 months.

In cases of advanced osteoarthritis, particularly when inflammation is a predominant factor and/or when hyaluronic acid injections have not provided satisfactory results, treatment with Orthokine® may be considered. This treatment is usually administered as 3–4 injections, approximately one week apart, into the affected area (see below).

Surgery involving the implantation of an artificial joint replacement should generally only be considered in cases of so-called treatment-resistant osteoarthritis, when conservative treatments have not provided sufficient relief and the patient has a strong desire to proceed with surgery.

Ultimately, the decision always lies with the patient, who should weigh the potential improvement in quality of life against the risks and expected outcome of surgery.