One of the most common questions I was asked, during my many years in practice in orthopaedic surgery, was “What about injections? I’ve heard that they can grow new cartilage back.”

Well, that would be nice. But unfortunately, that’s not the case. In fact, it’s a mish-mash of a couple of different techniques that are used in moderate to severe cases of arthritis.

Let me try to clarify things a bit.

There are several different kinds of injections. And there are a few different ways that we can grow “new” cartilage, but they DON’T work for arthritis.

Let’s look at injections, first.

The simplest injections are local anesthetics, use to numb the knee, as a whole, or at specific points, in and around the knee, like the attachment of the collateral ligaments. These shots are used not only for pain relief, but also to confirm a clinical impression of which structure is injured.

For example, if you believe there is a bursitis that is causing pain, injection of that bursa (“sac,” in Latin) and subsequent relief of pain confirms that indeed, that is the site of the injury.

Usually, such injections are combined with steroids (technically glucocorticoids, like cortisone). That way, there is not only immediate relief, but longer term relief, as well.

These steroids are used because they are very potent anti-inflammatory agents. But they are a double-edged sword: they also reduce the body’s ability to fend off an infection and they slow down any reparative processes in the articular cartilage. So they should be used sparingly and normally only when other, non-invasive measures have failed.

Another kind of injection is called viscosupplementation. This involves injection of hyaluronic acid, a normal constituent of joint fluid, into an arthritic joint. It sort of acts like injecting DW-40 oil into a rusty hinge or engine. It helps to lubricate the damaged surfaces and relieves pain about 75-80% of the time. It may provide relief of pain, when it works for 6-12 months. And it can be repeated, a number of times, if needed.

The downsides? Well, it’s expensive (though a LOT cheaper than surgery). It involves a minor invasion of the body, so infection, though exceedingly rare with good sterile technique, is a possibility. If you’re allergic to eggs, or chickens, it’s not for you. And it requires a series of shots, between three and five, a week apart, depending on the specific formulation.

But, it’s ideal for patients who would otherwise need joint replacement surgery, but who need to avoid or delay it, for social or medical reasons. And it burns no bridges-you can always do surgery, if need be.

But none of these injections address the underlying problem, which is progressive absence of cartilage on the weight bearing surfaces of the knee.

Now there ARE methods to “regrow” cartilage, but they have very limited application. Here’s why.

The techniques that have been developed are all surgical. They involve harvesting some cartilage cells from an arthroscopy and growing them in cell culture. Then, many weeks later, when the cells have grown, they are surgically implanted in a prepared “cup” within the cartilage. With luck, they will take root, so to speak, and grow new cartilage within that limited “cup.” For this to work, you need to have normal thickness cartilage all around, with only a localized defect (the “cup”), maybe 1-2 cm wide, maximum. If there are no “side walls” to make a receptacle    (ie., “cup”), the technique simple cannot work. Ditto for experimental stem cell methods.

That’s the problem-arthritis erodes broad areas of cartilage, so there is usually not enough thickness of cartilage to make any kind of receptacle to contain the cells.

These advanced techniques are ideal for young athletes who get a very limited area of cartilage loss, from a penetrating wound, or direct impact from an auto accident, let’s say. But they can’t work for those with arthritis. At least not at this time.

So you see, people hear about these different methods, kind of mix them up together, and get the idea that there is some kind of injection that can “grow new cartilage” in their knees.

I wish… But it’s just a common misunderstanding.

Now, there ARE techniques, including changes in diet, herbs, and specific supplements, like my JOINT HEALTH FORMULA

http://www.favoriteformulas.com/jointhealth

with New Zealand Green Lipped Mussel Extract that can reduce joint pain and help restore function. There are even local measures and very specific strategic exercises that can help to rid you of knee pain.

I’ve put a whole bunch of these non-operative measures together into a healing program called HOW TO AVOID KNEE SURGERY:

http://www.drbillsclinic.com/avoid_knee_surgery.html

It combines the best, most effective methods I’ve found, and those I’ve personally used, on myself or my patients, from across the entire medical spectrum, conventional, alternative and complementary. And best of all, these are methods that do no harm and do not preclude more aggressive measures, if they ever become necessary.

So, if you have chronic knee pain, especially if you have known arthritis, give these non-surgical treatments a try. You have nothing to lose but your pain.

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior”     TM