EP 3: Knee Osteoarthritis 

PART 1:

Hello everyone, I’m Dr. Jay Bowen. I’m a board-certified physiatrist here at New Jersey Regenerative Institute, or NJRI. Last week, I shared the 8 most common knee problems I see in my office. Hopefully, this helped you begin to identify what is causing your pain. Today, I’m going to dive into more detail on the most common cause for knee pain that I’ve seen over the last 30 years – osteoarthritis. I hope you like this video, and if you do, don’t forget to like, subscribe, and leave a comment letting us know what other videos you’d like to see from us. Alright, let’s get into it! 

The most common knee problem we treat here is osteoarthritis or just arthritis. This refers to the wear, tear, and eventual breakdown of the articular cartilage that covers the ends of the bones. How would you know you have arthritis?  Most commonly you’ll have general achy discomfort or pain in the knee. Secondly, you may feel stiffness that’s usually worse in the morning or after prolonged rest. And third your knees may be swollen or feel full.

How do we know you have arthritis? When you come in for an evaluation to determine if your knee symptoms are from arthritis, I will review your complaints and conduct a physical exam. Typically, I might follow up with an x-ray or MRI. However, if there is a concern for something different as a cause of your pain, additional testing may be recommended. Most of the time imaging is only beneficial to make sure nothing else explains your symptoms such as a fracture or tumor. 

PART 2:

Ok now, how do we treat arthritis at NJRI and how does this differ from some other places? We see a lot of knee complaints and as specialists – people are often seen by other more general healthcare providers first. So, many of our patients have already been given various treatment options and come to us looking for something different, and often less invasive. 

For arthritis, there are multiple treatment options: First, physical modalities include ice, heat, sleeves or braces, alternative footwear, shoe wedges or orthotics, exercise for strength, flexibility, and weight loss, chiropractic or physical therapy.  These support or change mechanics to reduce force across the joint.  There are some other options for simply treating the pain that include electrical stimulation of various forms or red-light therapy. Medicinally,  you can treat via supplements like curcumin, Boswellia, or Bromelin. These can all be taken by mouth, or you can use topicals like CBD or menthol rubs.

PART 3:

With arthritis, it’s also important to examine your diet. Treats high in sugar lead to inflammation and increase arthritis pain. I recommend a low inflammation diet to all my arthritis patients. This diet largely avoids sugar, dairy, soy, and gluten. Try excluding some of these foods from your diet, it won’t cost you anything and may give you some relief!  Another easy fix is over the counter medications like Tylenol, ibuprofen/Motrin, naprosyn/Aleve. While these are good in the case of flare ups, long-term use is not optimal and discouraged. Pharmaceuticals prescribed by a physician could include higher dose anti-inflammatories than Motrin or Aleve with other options like Cymbalta, or opiates/narcotics. Again, long term or chronic use of these are not advised. For more long-term relief, medications can be injected. Most people have heard of cortisone or steroid injections, but these can increase your blood pressure and blood sugar and the benefits are usually transient. Viscosupplementation also known as gel shots, chicken shots, new oil, and lubricating injections are also commonly used. They are usually given in a series and provide about 6 months of benefit.

about 6 months of benefit.

Alternatives can include Acupuncture usually with a trial of 4-6 sessions and if beneficial maintenance treatments can continue  with little downside If the more conservative treatments do not provide adequate pain control for your desired function, there are more invasive treatments. Recently, injections to block the nerves around the knee have been tried. These are called genicular nerve blocks. If you respond well to this treatment, the nerve can be burned for more prolonged pain relief. This should likely be reserved as a last option if you cannot have surgery or continue to suffer from persistent pain despite a knee replacement. Sometimes, a “clean out” knee surgery is done for severe arthritis.  However, there is very little science supporting its benefit and improvement is only transient at best. Physical therapy seems to show the same benefits as this treatment. 

PART 4: (Video begins with blue, end of part)

Ultimately, a total knee replacement with metal and plastic is commonly performed on those with advanced arthritis. While this may be the only option if your pain is extremely severe and your function and quality of life is unbearably impaired, most times you don’t HAVE to HAVE a total knee replacement.

PART 5:

Most of my patients come in wanting to avoid a total knee replacement. For these patients, I recommend PRPs and M-FAT procedures depending on the severity of their arthritis. You may have heard the term “PRP” which stands for platelet rich plasma. This can be used for mild arthritis, and the duration normally lasts a year.

Occasionally, some people have a much longer duration of effect. Options for more advanced degeneration include injections from cellular sources such as bone marrow or fat. Both the bone marrow and fat are processed and then delivered to the desired location or locations with guidance via ultrasound and/or x-ray called fluoroscopy. In the United States, we are generally limited to autologous products. This means the source of the treatment comes from the same individual being treated. So, what we use to treat you comes from you and goes back to you so that we stay within these guidelines.

In addition to the injections, shockwave is used. This treatment provides acoustic energy to stimulate healing and can be an adjunct treatment addressing cartilage. Some physicians perform the injection procedures in isolation, but we want to maximize your potential for complete healing. So, we also include adjuncts such as nutritional and weight loss counseling, Prolozone, shockwave, peptides, and specific movement evaluations called functional movement screens. Here at NJRI, we will do whatever it takes to get you back to doing what you love. Our overall goal is to unlock your intrinsic ability to heal yourself!

PART 6: 

That’s all I have for today! Thanks everyone for listening and continuing to support us. If you like what you saw today, you know what to do … Hit that like button!  It costs you nothing and helps us. Also subscribe and click the bell so you will not miss any of our upcoming information. You can also find us on our website, TikTok, Facebook, Instagram, and X which are all in our link tree on our channel home page and pinned in the comments below. Feel free to leave a comment letting us know what you’d like to hear more about. Thanks for watching!