DEGENERATIVE JOINT DISEASE IS THERE A NON-SURGICAL ANSWER?

DEGENERATIVE JOINT DISEASE AND JOINT REPLACEMENT

Getting old has nothing to do with chronic pain. Chronic pain has it causes, yes, but they do not include advancing age! Pain is a signal that something is wrong, something has become injured or weakened. For most, this is a signal that the ligaments that stabilize joints have become lax or weak. This pain is signalling then the onset of most Degenerative joint disease.

Following an injury to the ligaments, the bones in the joint, the knee for example, are no longer held in a stable position. This leads to instability in the knee and the bones start crunching. Crunching in a joint is a sure sign that the joint stabilizing structures are in a weakened state. If the joint instability is not treated, the degeneration in the joint will continue. Eventually this will lead to articular cartilage (see also Articular Cartilage Growth) breakdown with the articular cartilage eroding to a point that the knee will become stiff and painful because the knee is now functioning as a bone on bone" joint.

OSTEOARTHRITIS/DEGENERATIVE JOINT DISEASE (DJD)

Osteoarthritis is the most common form of arthritis affecting most of the population over the age of 50. It is also termed degenerative joint disease because osteoarthritis involves the deterioration of the articular cartilage that lines the joints and related changes in adjacent bone and joint margins. This deterioration occurs because the supporting structures of the joints, primarily the ligaments, become injured. Once this happens the joint has some instability and starts moving excessively. This causes some crunching noises from the joint where the bones start hitting together. The areas where the bones start hitting causes an overgrowth of bone (generally at the joint margins). This overgrowth of bone along with the articular cartilage (see research paper) damage along with it is called osteoarthritis or degenerative joint disease (DJD).

The most frequent sites involved are the weightbearing articulations of the spine, hips, and knees, and the distal interphalangeal joints of the hands. Symptoms of DJD usually include brief joint stiffness upon awakening and joint pain or tenderness following usage, and are associated with the typical characteristic findings on X-Ray.

CAN ARTICULAR CARTILAGE REGENERATE?

Most of the joints in the body are synovial joints, movable, highly versatile, lubricated joints. They provide pain free movement because of the unique poperties of their articular cartilage. In synovial joints, such as a knee, the articular cartilage covers and protects the bone ends, preventing friction between the bones, and acts a "shock absorber," distributing the loads of weight over a larger contact area.

Articular cartilage has no blood vessels or nerves. It is composed of a few cells (chondrocytes) that are embedded in a sea of collagen, water and a specialized protein structures called Proteoglycans. It is the condrocytes, that are reponsible for the synthesis of both the collagen and proteoglycans that make up the cartilage.

The ability of the chondrocytes (see research paper) to replicate is really the key question when considering the potential of cartilage to proliferate or to repair itself. It has been shown in studies on adult human cartilage that there is no decrease in cell counts, even in individuals of advanced age. This fact only suggests that condrocytes have the ability to proliferate and repair. The prevailing notion that damaged cartilage having no regenerative properties is reponsible for arthroscopies and then subsequent joint replacements. The falsehood that the cartilage could not repair itself occured as a result of studies that seemingly confirming this in the early 1960’s. Coincidentally, the first total hip replacement was performed during this period and shortly followed by the first Arthroscopy.

Much of the research on articular cartilage regeneration has been done in the 1980’s and 1990’s. It wasn’t until the early 1980’s that Dr. H.J. Mankin discovered that the condrocytes reaction to injury was to change into a more immature cell called a chondroblast which was capable of cell proliferation, growth and healing.  His research is so-well excepted that two of his papers on this subject were published in The New England Journal of Medicine.

CAN CARTILAGE REGENERATION BE ACCELERATED?

As seen through research, the chondrocytes, upon injury, gain the ability to replicate, proliferate, and generate new cartilage. This key fact is vital to understanding the power of Prolotherapy in proliferating cartilage.

Prolotherapy involves the injection of various substances including hypertonic dextrose, sodium morrhuate (extract of cod liver oil), various minerals, Sarapin (extract of the pitcher plant), and various other substances many of which act by causing a mild irritation at the site of the injection. It is believed that in regard to cartilage that this irritation acts as an "ignition" to cartilage regeneration. Empirically this is supported by the numerous patients with no cartilage or those set for hip/knee replacements, we have seen in our clinic, who never need them because of Prolotherapy.