BONE ON BONE ARTHRITIS

BY FRED G. ARNOLD, NMD

Bone on bone arthritis refers to a severe narrowing of the joint space associated with osteoarthritis and is a condition that patients frequently have questions about. Osteoarthritis is characterized on x-ray by a thinning of the joint space between two bones and this thinning is related to a destruction of the joint cartilage. Other findings of osteoarthritis on the X-ray can include boney spur formation and increased whiteness at the joint, as the body tries to stabilize the deteriorating joint. Although there is no consensus as to why osteoarthritis occurs, influencing factors include sex (women, especially after entering menopause), low hormone levels, nutritional factors, obesity, ligament laxity, joint misalignment, and trauma. Although any joint in the body can potentially become bone on bone, the most common joints I find with this degree of degeneration are the knees, hips and shoulders.

Traditional Treatment
Injections of steroids and prescriptions of Nonsteroidal anti-inflammatory (NSAIDS) drugs are the traditional approaches for the treatment of osteoarthritis. Even though, numerous studies have shown the detrimental effects of each of these treatments, there use has increased since they were first prescribed. As the use of these treatments has increased, there has also been an exponential increase in knee, hip and back surgeries performed. Other traditional treatments for osteoarthritis include physical therapy and hyaluronic acid injections for the knee, referred to a Rooster Comb injections.

Regenerative Injections Therapy (RIT)
Different types of Regenerative Injection Therapies (RIT) include prolotherapy, prolozone, platelet rich plasma (PRP) and stem cell injections. Even though each of these injection types have been shown to provide significant relief to patients suffering from osteoarthritic joints, including bone on bone conditions, this type of medicine is normally not practiced by most traditional orthopedic doctors. In fact, some doctors will tell their patients that these injections will not help and would be a waste of their money. We recently had this exact situation happen when a patient received two prolotherapy regenerative injection therapy injections was told by her family medicine doctor and an orthopedic doctor that the regenerative injections would not help her. The patient was told this after she had received benefit from the injections. When patients receive incorrect conflicting medical advice this can be very confusing and prolong a painful condition resulting in the patient never receiving proper care for their condition.

Numerous Studies
Prolotherapy: In the Journal of Prolotherapy, 2009 issue, Dr. Ross Hauser, documents five degenerated knee cases, some with bone on bone, treated with Prolotherapy regenerative injection therapy. Before and after X-rays were available to document articular cartilage regeneration. In this study, there is significant improvement in the bone on bone joint space. 1
Prolozone: Dr. Frank Shallenberger , who is considered the “Father of Prolozone”, illustrates the success of treating a bone on bone knee condition in an article published in the Journal of Prolotherapy, 2011. There is obvious improvement in joint space narrowing in the before and after Prolozone pictures. According to Dr. Shallenberger, “I have never had a patient go to knee surgery in fifteen years of using Prolozone”. 2
Platelet Rich Plasma (PRP): Numerous other studies have shown the benefit of PRP for the repair of knee cartilage and they demonstrate significant improvements in osteoarthritis with pain and symptom relief. 3
Stem Cells: Most in-office stem cell procedures involve cells that are found in fat tissue or from bone marrow, such as the pelvis or knee. Writing in the medical journal Arthroscopy, researchers documented improvement with stem cell injections in patients with knee osteoarthritis. They noted significant reduction in pain, significant improvement in function and MRI documented cartilage growth. 4

Case History
We had a nice lady report to our office with knee pain and she was told that she needed knee replacement surgery because she had bone on bone. Her x-rays clearly demonstrated a severe narrowing of the joint space; however, she could walk with very little to any pain and she could perform her daily activities well. She was treated with prolotherapy, responded well, and did not need surgery.
It is not uncommon, for patients to be told they need surgery for osteoarthritic conditions, even though they have very little pain or discomfort. I do not understand why someone should have surgery for their arthritic joints if they are doing well.

Conclusion
Regenerative injections therapies are outpatient procedures that have the potential to reverse degenerative joint osteoarthritis, including bone on bone joint conditions. Despite the opinion of some medical professional, these procedures are successful in treating bone on bone conditions. RIT procedures promote regeneration of ligament, tendon and cartilage involving bone on bone conditions. RIT studies have documented joint repair, joint stabilization, improvement of radiographic studies, and improved quality of life for patients with osteoarthritis. Since RIT procedures provide long term solutions for degenerative joints and not just tempory pain relief, they should be considered prior to long term narcotic therapy, steroid injections or surgical intervention.

References:

• Hauser. R., Cukla, MD, Joseph, LPN, Standard Clinical X-ray Studies Document Cartilage Regeneration, Journal of Prolotherapy, Volume 1, Issue 1, February 2009
• Shallenberger, Frank, MD, HMD, ABAAM, Prolozone – Regenerating Joints and Eliminating Pain, Journal of Prolotherapy, Volume 3, Issue 2, May 2011
• Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B:Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study.Am J Phys Med Rehabil2010,89(12):961-969.
• Koh YG, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ. Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis. Arthroscopy. 2013 Jan 29. pii: S0749-8063(12)01884-1. doi: 10.1016/j.arthro.2012.11.017.