Musculoskeletal Care of the Mature Patient
The use of the phrase “I have Bone on Bone” by new patients in my office setting is dramatically increasing. These are people who are seeking second opinions and consultations as to whether to proceed to surgery or try Platelet Rich Plasma or even stem cell management first. My standard of practice each and every time I see a patient is to perform a historical medical review and a physical examination. I am still amazed at how many patients think they need a procedure when they are really experiencing the symptoms of referred pain from spinal stenosis or degenerative disc disease. If the patient has full and a symmetrical range of motion at the hip and knee, more probably than not the pain is referred in nature even if the X-ray is interpreted as “bone on bone”. If an intra-articular local anesthetic/cortisone “cocktail’ doesn’t relive the pain, I address the spine.
“Perception is everything; and new technologies lead to new concepts. Osteoarthritis is common and not necessarily a progressive disorder, with the condition stabilizing in most cases. This is obvious if we compare the number of people in the population with radiographic evidence of OA and the number who come to joint replacement. Recent research has indicated that physical activity optimizes cartilage health and is important in preventing the symptoms even in the presence of radiologic evidence of osteoarthritis.” The quotation is lifted from my blog of September 13.
A joint is an anatomical approximation of two bones separated by hyaline cartilage. That cartilage serves as a gliding surface. In the knee, there is a second form of cartilage, the meniscus. The meniscus distributes forces and stabilizes. Cartilage basically has no blood supply. The loss of the joint space on an X-ray suggests the loss of cartilage but only from a qualitative sense. The X-ray and even a standard MRI doesn’t allow for quantitative measurement of any remaining cartilage. That cartilage may have diminished in its integrity because of remote trauma, genetic factors, developmental and acquired conditions, obesity, predisposing diseases, chronic inflammation and autoimmune co-morbidities, etc. While Platelet Rich Plasma and Stem Cells are not going to cause re-growth of cartilage in a 55 year old plus individual, case studies from select sites around the world to relieve pain and restore function thereby avoiding surgery are compatible with outcomes sufficiently satisfactory to cause me to continue my initiative for bringing a clinical trial with stem cell treatment for arthritis to the Chicago. Not a shot and a fee but a scientific study of clinical outcomes under IDE auspices.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street, Chicago, Illinois 60610