بعض العلاجات الجديدة لآلام الركبة
cooled radiofrequency ablation for chronic knee pain
A new, non-invasive knee procedure could bring some relief for patients suffering from debilitating chronic pain, for whom surgery is not an option.The treatment, recently approved by the Food and Drug Administration, is called “cooled radio frequency ablation” and is a less drastic option for people with moderate to severe osteoarthritis pain who are not ready to have knee replacement surgery, or who have health conditions that don’t make them a good candidate for surgery.
Marketed as "Coolief", the procedure uses radio frequency to target and mute the nerves responsible for sending pain signals from the arthritic knee to the brain. Coolief doesn’t repair arthritis in the knee, but eases the pain, helping patients go back to activities without discomfort and fewer medications.“What we're changing is the wiring of the knee — so we're taking away the pain signal and interrupting it," Dr. Amin Sandeep, a pain specialist at Rush University Medical Center in Chicago who performs the procedure, told NBC News.One 2016 study compared Coolief to popular cortisone injections, with patients reporting greater, longer-lasting pain relief with the new treatment than injections. Coolief reduces pain for about to 6 to 12 months, depending on how fast the nerves in the knee regenerate.
Osteoarthritis can affect any joint when the cartilage wears off over time, often striking big joints like the knee, causing pain, swelling and stiffness. According to the American Academy of Orthopedic Surgeons, nearly 10 million Americans had osteoarthritis of the knee in 2010.The three current recommended approaches for knee arthritis pain are physical therapy, non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, or the opioid painkiller tramadol.
But those didn't help Felicia McCloden, a 65-year-old grandmother from outside of Chicago. The excruciating pain in her right knee made simple tasks like grocery shopping impossible.
“I had inflammation, swelling, and my knee was like the size of a golf ball, McCloden told NBC News. "The arthritis was so bad that I could barely step down without severe pain.”Because she wasn’t eligible for a knee replacement she tried cortisone injections, physical therapy, medications — nothing relieved her pain."I thought I was going to limp for the rest of my life," she said.
In May, McCloden underwent the Coolief treatment and the result was instant.“I couldn't even imagine first of all, not having the pain," she said. "It erased all of that.”
The outpatient procedure typically takes about 40 minutes, is performed with local anesthesia and doesn’t require an incision. Instead, doctors use specialized needles that emit radio frequencywaves into the knee. The cost of the treatment is between $2,000 and $4,000. Because it was just approved by the FDA in April, the treatment is not widely available yet, but pain centers across the country are beginning to offer it.Some of the reported risks from the procedure include bleeding and infection. "Though patients have a risk of the physician hitting the wrong nerve, that is extremely rare in the hands of an experienced professional”, Amin said.
Recovery time is minimal, with most patients walking immediately after the procedure and resuming normal activities in a day or two.
For some patients with structural problems of the knee, the procedure won't help, said pain specialist Dr. Edgar Ross, associate professor of anesthesia at Brigham and Women’s Hospital.
"But let’s say a patient is younger, instead of going for a total knee replacement early, which might have to be repeated later on, Coolief can postpone the need for the total knee replacement," Ross told NBC News.
Coolief can be repeated if necessary, but it's not a permanent solution. While it reduces pain, it can't stop the progression of osteoarthritis.
"While it can delay total knee replacement, knee replacement may still eventually be necessary in a big number of patients," said Dr. Dennis Cardone, associate professor of orthopedic surgery at NYU Langone Medical Center.
https://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-arthritis-pain-without-surgery-n771221
https://www.webmd.com/osteoarthritis/knee-arthritis-treatment-advances
https://www.healthline.com/health/osteoarthritis/treatment-options-osteoarthritis-knee
https://health.usnews.com/health-care/for-better/articles/new-treatments-for-knee-pain
What’s New in Knee Osteoarthritis Treatments?
Knee osteoarthritis is very common, especially as people age. It happens when the cartilage that cushions the knee joint starts to wear down. That can happen as you get older or because of an old injury or other stresses on the joints.Although there’s no cure, you can treat the pain. Your doctor may prescribe painkillers such as acetaminophen, nonsteroidal anti-inflammatory medicines (like aspirin, ibuprofen, or naproxen), or even narcotics. But long-term use of these drugs can lead to serious side effects in some people.
Some people also get shots of steroids to ease their symptoms. But they have side effects when used too long.When medication and physical therapy don’t give you enough relief, total replacement of the knee joint is a last resort. But this isn’t right for everyone. Some people shouldn't get this surgery because of their age or other conditions.
Researchers are looking for new ways to treat knee osteoarthritis. Some of the methods they’re trying include the following.
Hyaluronic Acid or Hyaluronate Injections
Also called viscosupplements, this treatment tries to restore synovial fluid, which is a slippery substance that helps lubricate joints.A major component of synovial fluid is called hyaluronate. For more than 20 years, doctors have tried to restore mobility and curb pain by injecting hyaluronate directly into the knee joint. But even after years of use, studies about the treatment have disagreed.One analysis, published in 2016 in the journal Systematic Reviews, noted that while there is general agreement that injections can help, there’s still debate over whether the possibility of serious side effects outweigh the benefits.
Platelet-Rich Plasma (PRP) Injections
In this treatment, your doctor takes a sample of your blood and spins it in a machine called a centrifuge to pull out your blood's platelets and plasma. When injected back into the joint, this super-concentrated mixture contains substances that could promote healing.Despite its popularity with some high-profile athletes, PRP injections still aren’t proven, and the treatment formulations can vary a lot.That said, a review of PRP was published in 2016 in Arthroscopy: The Journal of Arthroscopic and Related Surgery. The scientists concluded that, in general, people see “significant clinical improvements” with the treatment.be aware that while one recent study found that PRP fared better than corticosteroid shots, another found it was no better than viscosupplements.
Mesenchymal Stem Cells, or MSCs
This draws on the same concept as MSCs. Experts take cells from your body and use them to stimulate the healing process inside your knee.The advantage is bone marrow may be easier to obtain than MSCs, and also contains other substances involved in promoting cartilage regrowth and calming inflammation.While still a new approach, a review in the Orthopaedic Journal of Sports Medicine found “good to excellent overall outcomes” from 11 studies. The researchers noted that that some trials were tougher than others. So they recommended that the treatment be used cautiously since a lot is still unknown.
Your bone marrow makes these types of cells. They can grow into new tissues, including cartilage. By gathering these cells and injecting them into the knee joint, the hope is that they will give rise to new cartilage and reduce inflammation.It’s a hot area, with clinical trials going on. But most studies are still early.A review published in 2016 in BMC Musculoskeletal Disorders concluded that MSC-based therapies offer an “exciting possibility” for treatment, but further studies need to work out how they can best be used and how well they work. Also, they're expensive.
Bone Marrow Aspirate Concentrate
Autologous Cultured Chondrocytes
This is a procedure to repair injuries, which can lead to osteoarthritis. It involves collecting the cells that form cartilage from your own joints, growing the cells in a laboratory, and then injecting these cells into the knee.Invented in Sweden in the 1980s, the method has become common in orthopedic practices. The FDA approved the latest generation in December 2016. Called Maci, it puts the cells inside a dissolvable scaffold -- placed inside the knee -- that’s designed to grow new cartilage.In a study of Maci involving 144 people, more than 87% of those who got Maci had improvement in symptoms over 2 years, compared with 68% who got a different cartilage-stimulating procedure called microfracture.
Botox Injections
The Bottom Line
Botulinum is a toxin made by the bacterium Clostridium botulinum. Because it can shut down nerve cells, doctors can use it to ease muscle spasms.Some doctors are trying botulinum to help treat joint pain. The theory is that it might permanently deaden nerves and offer relief. But it wouldn’t affect the knee’s structure.Does it work? A review of 16 studies published in 2016 in the journal Joint Bone Spine found that the results were conflicting and the studies were too small to draw conclusions.
Water-Cooled Radiofrequency Ablation
This is another experimental procedure to treat pain. It aims to disable the nerves that are causing pain by heating them. “Water cooling” is a way to control the speed of warming. While it’s gotten a lot of publicity, studies so far are limited to small groups of people.
Promising new treatments are on the horizon. Unfortunately, it’s still too early to know how well they work. Much of the effectiveness may depend on the cause and severity of your arthritis. So talk to your doctor and read the fine print before you try a particular treatment.
https://www.webmd.com/osteoarthritis/knee-arthritis-treatment-advances
