From healthline.com
- Nearly 1 in 4 Americans are living with arthritis.
- Many people have to turn to joint repair and replacement procedures for treatment.
- A range of technological innovations and advancements in treatment have emerged in recent years to create more long-lasting, effective treatments to repair joints affected by arthritis.
For the millions of Americans who live with arthritis (inflammation of the joints that can affect one or multiple joints), the condition can significantly impact one’s quality of life.
For those who have osteoarthritis, the degenerative disease is caused by the regular mechanical wear-and-tear on the joints over time. Those who have rheumatoid arthritis find the autoimmune disease causing pain and inflammation throughout their body, with their own immune systems attacking the tissue lining in their joints.
Arthritis can affect one’s ability to get around easily, perform common everyday tasks, and simply live in comfort without inflammation and pain.
About 24% of all adults in the United States have arthritis, which is a leading cause of work disability, leading to a total annual cost of wages lost and escalating medical bills totalling $303.5 billion,
Many may have to turn to joint repair and replacement procedures as a way to treat their arthritis. It’s so common that about 790,000 total knee replacements and 450,000 hip replacements are performed each year in the U.S., a number that will only keep growing as the nation’s population ages, reports the American College of Rheumatology.
To address this need, a range of technological innovations and advancements in treatment have emerged in recent years to create more long-lasting, effective treatments to repair joints affected by arthritis.
Healthline spoke with experts about the latest advancements — from growing new cartilage cells to using injectables to spur more efficient healing — in joint repair for arthritis, and what’s next as we look to the future of the field.
When asked to assess the overall state of the field of joint repair and replacement, Dr. Susan Goodman, an attending rheumatologist at the Hospital for Special Surgery in New York, said she believes we are “looking at a future with no need for joint replacements.”
But to get to that point, she told Healthline that “there are several significant hurdles ahead.”
“For a condition such as rheumatoid arthritis [RA], the problem of joint damage develops from the unchecked inflammation that erodes cartilage. For patients with RA, it is critical to control the inflammatory disease so that the “new” or engineered cartilage doesn’t get damaged in the same way,” Goodman said. “For the time being, since artificial/engineered tissue has only been used in small areas of the damaged joint, it would not be a solution for patients with inflammatory arthritis who have abnormalities in their entire joint.”
When it comes to joints like the knee, which “are very susceptible to mechanical forces of weight and impact,” a condition like obesity “will also lead to damage in the engineered joint.”
Dr. Kristofer Jones, a board-certified, fellowship-trained orthopaedic surgeon who specializes in sports-related musculoskeletal injuries of the knee, shoulder, and elbow, told Healthline that we are ahead of where we were 10 to 15 years ago and “a lot of new research has come out” along with a lot of new products that look at “alternative ways to resurface new cartilage,” with either a patient’s own cells or using allograft tissue, or transplanted tissue between patients.
“The research shows these new tissue types are certainly durable and provide patients with long-lasting pain relief, but the issue is the progression of joint degeneration in other areas of the knee,” Jones added.
He said it’s not uncommon to have performed a cartilage transplant procedure to address one part of the knee and then two or three years later see the same patient experience degeneration in other areas, with new symptoms.
“We are good right now at resurfacing small-to-medium size lesions with the durable tissue, but we haven’t quite figured out how to turn off the ‘button’ that has started in some of these patients where you are looking at progressive joint degeneration in other areas,” Jones explained.
From his perspective, Dr. Sid Padia, a specialist in vascular and interventional radiology at UCLA Medical Centre, told Healthline that, in general, there really “has been no significant impact or change in the standard of care for patients with joint disease.”
There’s been no seismic shift reorienting how we view the treatment of people with joint disease, but there have been “several promising and new therapies that have shown potential benefits in the treatment of various joint diseases. That being said, much of these potential new therapies currently being studied “have not come to fruition with respect to long term clinical benefit,” he said.
“Many of the new minimally invasive therapies have shown in studies or have shown short term benefit and that’s because these studies have not assessed long-term outcomes and have not compared it [the given procedure] to a control group, so it’s hard for the medical community to really accept these new treatment options,” Padia added. “So, I think there is a tremendous opportunity for a breakthrough treatment simply because in many of these patients, the treatment options are still quite limited.”
Injectables for joint pain
Jones said one of the current advancements that stands out the most to him is the use of “biologic injectables,” or orthobiologics.
These are injectable substances used by orthopaedic surgeons to help your injuries heal more quickly. They can be used for tendons, ligaments, and broken bones, for example, and are derived from substances that naturally occur in your body, according to the American Academy of Orthopaedic Surgeons.
Jones cited injectable therapies like those using platelet-rich plasma (PRP), where the plasma is injected right into a tissue, and bone marrow aspirate concentrate, which uses bone marrow cells, as two examples.
“PRP, bone marrow aspirate concentrate, amniotic suspension allograft injections — these are all things that we are studying to determine how we can best utilize them to treat patients who have knee pain from arthritis,” he said.
Jones explained that many of these injectable therapies that are being developed are to augment surgical procedures to move the healing process along and also better create “more favorable cell homeostasis so further joint degeneration doesn’t happen.”
He said we can expect to see a lot more of these kinds of injections available in the coming years to treat symptomatic knee pain. Jones cited a Phase III trial for which he is the principal investigator at UCLA.
“At UCLA we have this Phase III FDA trial that is looking at one of these products, the trial ended and we are currently crunching the numbers to look at the data to see if there are no adverse patient events,” he said.
At UCLA, Padia has been working on an alternative to knee replacement that could offer pain relief to those individuals who might not be candidates for surgery.
You might not qualify for knee surgery due to a medical complication that puts you at high risk or if you are at advanced age, for instance. Younger people might also delay surgery due to the fact they’ll ultimately need another knee replacement surgery or procedure within the next 20 years.
The procedure is called genicular artery embolization. It’s a minimally invasive procedure during which particles that are smaller than grains of sand are injected by way of a small catheter into enlarged knee arteries. This only takes two hours to perform and you can head home the same day and return to regular physical activities later that day.
“We’ve published our results, done randomized trials that show genicular artery embolization in the knee can lead to reduction in pain and we’ve adapted this procedure for people with tennis elbow, which is something fairly common in people who play racket sports,” Padia explained. “Given the increase in the use of pickleball, we are starting to see a lot more people with tennis elbow.”
He added that treating something like tennis elbow is fairly limited and surgical correction “is rarely done.” As a result, steroid injections are often the mainstay treatment for this condition, offering a short-term benefit.
“People are often left with no other option than to quit their physical activity, so we’ve developed this procedure for tennis elbow and it’s had a very promising effect in people,” he said.
A
The researchers behind this gel say it can be pulled and pressed with more force and weight than naturally occurring cartilage. This substance is also three times more resistant to the regular wear and tear that often fuels osteoarthritis and joint pain.
A company called Sparta Biomedical is developing this “hydrogel” product and testing them on sheep, with human clinical trials expected to start this year, according to a press release.
To put in perspective how powerful this material is, natural cartilage can handle 5,800 to 8,500 pounds per inch “of tugging and squishing” before hitting its breaking point. The hydrogel is reportedly 26% stronger than natural cartilage in suspension and 66% stronger in compression, reads the release.
When asked what is exciting to him in the field outside of surgery right now, Jones pointed to synthetic forms of cartilage that are as durable if not more durable than the real thing.
“We are a little further away from seeing that being used clinically, the issue is trying to figure out how to get those different synthetic tissue types to adhere to bone and be durable for the long term,” Jones explained. “That may be something that down the line is a possible alternative to traditional joint replacement. The whole point of all of this is to preserve your joint and the natural feel for it.”
In late 2022, research from The Forsyth Institute was published in the journal Science Advances, pointing to a potential mechanism for generating new cartilage cells.
“The goal of this study was to figure out how to regenerate cartilage. We wanted to determine how to control cell fate, to cause the somatic cell to become cartilage instead of bone,” Dr. Takamitsu Maruyama of Forsyth said in a release.
The research contributes to a growing body of research that suggests future of joint repair to treat arthritis might be at the cellular level.
“I think the greatest potential [for the future] are the use of stem cells,” Padia said. “The use of stem cells is, number one, a relatively straightforward minimally invasive procedure. It does have the potential to have significant impact on people with joint diseases. The key is there needs to be an appropriate and accurate way to select the ideal patients who benefit from a stem cell treatment, there needs to be comparative studies ideally with a placebo studies conducted with adequate amount of time for long-term results.”
https://www.healthline.com/health-news/joint-replacement-repair-advancements
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