Bone on Bone Knee Arthritis on Xray- What does that mean?

Bone on bone knee arthritis on xray does not necessarily mean knee pain.
In this video I discuss a study from Korea looking at advanced knee arthritis on xray vs pain.
-Treat the patient, not the image.
-Demystifying “Bone on bone” arthritis.
-Understanding the Regenerative medicine approach to treating the knee.
Treat all pain generators.
There are layers of pathology, treat all layers.
BMC Musculoskelet Disord. 2020 Sep 29;21(1):640.

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:

– Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast is October 7th, 2020. Thank you for everyone’s time and I hope everyone’s doing well. So on this broadcast, I discuss concepts that are important with what we do here at Chicago Arthritis and Regenerative Medicine where we specialize in evaluation and management with nonsurgical options for arthritis, tendonitis injuries and back pain. So interesting study that came out recently that I think really exemplifies a lot of what Regenerative Medicine is about is an article that came out from Korea in the BMC Musculoskeletal Disorders Journal where they essentially looked at what does it mean to really have advanced osteoarthritis of the knee? So they looked at three large national databases in South Korea. They had a total of 20,000 people and roughly 10% of them had advanced knee osteoarthritis on x-ray. That’s probably to be expected in a large enough cohort of people that 10% of them would have KL4 degree osteoarthritis. And what they found that was that up to 30% of them were asymptomatic without any symptoms of pain or loss of function that they were describing due to their knee arthritis. That’s interesting because for physicians we frequently talk about how you should treat the patient and not treat the image. And yet it’s very frequent when it comes to musculoskeletal medicine that people will look at someone’s knee x-ray and will tell them “Well, you actually have bone on bone, knee arthritis, and you should consider knee replacement surgery.” And that’s regardless of how significant our pain is or dysfunction is or if they’ve even failed other treatment options. And so that concept of treat the patient not the image is really exemplified here because just having severe osteoarthritis on the X-Ray did not necessarily mean that you’re going to have really significant pain. And in this article, they have this last line where they say, “Treatment options focusing solely on cartilage engineering should be viewed with caution.” It’s a really great line because there is a developing industry in orthopedics that’s based on actually trying to repair small cartilage lesions. The idea being that a person’s pain is coming from the amount of cartilage damage, as opposed to the stress on the bone or the other soft tissue structures. And this is a great study because you know that even when you have someone that has advanced arthritis of the knee that that’s someone who can still respond very well with regenerative medicine approach to treatment. In fact, the evidence out there shows that the degree of arthritis in the knee does not make a difference when it comes to utilizing your own bone marrow derived STEM cells when it comes to treating that knee arthritis. On the other hand platelet rich plasma sometimes can be worse and not as effective in some of those more advanced arthritis, but your own bone marrow cells definitely can still be helpful. So, and part of that comes from an understanding of how regenerative medicine works. Meaning number one, you want to treat all the pain generators. It’s not just looking at how much cartilage wear there is but it’s also what else is going on in that joint. Is there any degree of chronic inflammation? Is there any sort of chronic stress on soft tissue structures, meniscus, ligaments, tendons? Is there any sort of nerve or muscle related issues? How can you maximize? Not only the cellular health within the joint. How can you produce chronic inflammation. How can you improve stability of the joint by improving the soft tissue structures as well. And really improving the overall joint and what’s driving pain. Understanding that degenerative process in a knee is not just how much wear there is on the cartilage that you see on an X-Ray or an MRI but really it’s the entire structure that’s pathologic. And how do you actually make that whole structure better. And the last part of that is understanding that there’s layers of pathology in someone that’s got degenerative arthritis of the knee, and you need to address all those layers. And so a classic mistake that I see from physicians who dabble in regenerative medicine, is that when it comes to treating an arthritic joint they’ll only inject cells into the joint. They don’t actually treat the whole structure meaning all those other soft tissue structures and those layers and layers of pathology. It can make a big difference from someone who has a average or even mediocre result from treatment to somebody who has a really great result to treatment. That understanding that it’s not just what is an X-Ray look like on a knee, but treating that whole structure and the whole patient as well. And so understanding that you treat the patient and not the image is something that I think for everyone out there it’s important to understand that because even if your physician says that and believes that a lot of times your actions don’t necessarily showcase that. And a proper regenerative medicine expert really understands that and will do a better job of treating the whole structure, the whole joint to give you pain relief and functional improvement. Great, well, I hope that clarifies some understanding of bone on bone arthritis that’s described on x-rays frequently. As a reminder, we do this on Mondays and Wednesdays. In addition, I’m doing a webinar today 5:00 PM central standard time on regenerative medicine treatments for the knee. If you’re interested, just see our link attached to this video. And until next time have a good day and live well, bye bye.

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