Injections or infiltrations? This is the dilemma that plagues the many patients struggling with knee osteoarthritis, just like the one that is causing so much suffering to Pope francesco. In fact, for doctors there are no doubts at all. Before reaching the more “extreme” solution, the surgical replacement of the joint with a prosthesis, it is possible to intervene first, both on the symptoms and on the causes. It is what it is Ezio Adriani, director of the UO of Sports Traumatology and Knee Surgery of the A. Gemelli IRCCS University Hospital Foundation in Rome, defines “joint conservation”. In practice, it is a question of intervening to “save” the cartilage before prosthetic surgery becomes the only option.
What is osteoarthritis
Arthrosis, in fact, is nothing more than the “consumption” of cartilage, that sort of cushion that covers the bones of the knee joint and allows for a fluid movement. As cartilage wears down, joint function gradually decreases. “When the cartilage has completely disappeared – explains Adriani – you can only partially or totally replace the cartilage. But before reaching this point, today we can do a lot to preserve it”.
Because cartilage wears out
Cartilage wears out for genetic reasons, on which it is not currently possible to intervene, and for a series of risk factors, such as overweight or a deviation of the limb (knee varus or knee valgus), which both determine an overload on the articulation. “It is also very important to maintain healthy – explains Adriani – the structures that protect the cartilage, in particular the menisci and cruciate ligaments. Early diagnosis of damage to these structures allows them to be repaired”. The guiding symptoms of knee joint damage are pain, swelling, and reduced movement, up to joint blockage.
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Pain and swelling
When the pain and swelling begins many patients find themselves at a crossroads: do an intramuscular injection or an intra-articular infiltration? “The injection is a palliative, a means of getting a drug, such as an anti-inflammatory or a pain reliever, close to the cartilage,” explains Adriani. “Usually it is an option that is used in the acute phase, when the patient reports severe pain: it works against the symptoms, but it is not decisive”, he adds.
The infiltrations
Intra-articular infiltration, on the other hand, is a valid option both against the symptoms and, many times, also against the causes. “We can bring this medical act, infiltration, into that new branch of medicine we call orthbiology, which promotes the repair of the tissues of the musculoskeletal system, stimulating the body’s natural resources”, explains Adriani. “Unlike injections, the infiltrations go directly to the joint which, when it is not yet completely worn out, can be stimulated to regenerate,” he adds. With orthbiology it is possible to exploit the properties of some synthetic substances such as hyaluronic acid and some resources that are hidden within our own organism, such as growth factors and stem cells.
The platelet “jelly”
“On the other hand, the so-called ‘platelet jelly’ or PRP can be extracted from the blood – underlines Adriani – a concentrate rich in growth factors, proteins that stimulate cell proliferation and differentiation, in order to repair damaged tissue. PRP promotes the repair and regeneration of cartilage, delays the degeneration processes and reduces inflammation, at the basis of the painful symptoms of arthrosis “.
Cellular therapies
Through the infiltrations it is possible to administer cellular therapies that exploit the action of stem cells taken from fat or bone marrow. “Stem cells promote tissue repair both directly and by ‘dialoguing’ with the cells already present in the tissue to be repaired, in order to stimulate an orderly regeneration of the same”, Adriani emphasizes. The fat to be used (taken from the abdomen, hips or thighs) is mechanically filtered to concentrate the stromal vascular fraction, rich in stem cells; this is the part that is injected into the joint.
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Wear of the cartilage
“In the event that we were already faced with a complete wear of the cartilage – explains Adriani – at that point orthobiology has only a symptomatic effect (that is, it takes away the pain), but not regenerative. Orthbiology can maintain efficacy on symptoms for 5-10 years; the duration depends a lot on the progress of the arthrosis. To date it is used as an adjuvant in the reparative treatment of tissues which, due to age or intrinsic characteristics, have less healing capacity. meniscus of a 50-60 year old, who has fewer chances of healing, with the addition of orthbiology we are able to increase its reparative capacity “.
The prosthesis
When the cartilage of the knee is partially damaged, it is possible to resort to a “partial” prosthesis, or mono-compartmental prosthesis, ie a partial replacement of the joint. “This – explains Adriani – has the great advantage of keeping all the ligaments of the knee intact and therefore it is a more performing and less invasive intervention. One night’s hospitalization is enough, the patient walks immediately and has almost complete functionality of the joint. last over 20 years “.
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Prevention
However, the best way remains that of prevention, when it is possible. “In fact, if little can be done against age-related wear and tear, we can instead do a lot already before the age of 40 in cases of trauma or wrong lifestyles”, underlines Adriani. “For example, if a meniscus or cruciate ligament breaks – he continues – we must repair it before the damage to these structures over time consumes the cartilage. Or in case of overweight it would be advisable to try to lose a few pounds by lightening the load. on the knee “. In the long run all of this can be worth more than a thousand injections or infiltrations.