What to ask about non-surgical arthritis treatment Surprise

What to ask about a joint shot

A steroid shot may calm soreness for a while. It isn't meant to rebuild a worn joint. Ask how long relief usually lasts and when to review it.

A clinic may also offer hyaluronic acid gel inside the joint. Studies found average relief too small for most people to notice. Think of the gel as oil on a hinge, not a new hinge.

You'll need to tell the provider about blood thinners and past reactions. Mention any recent illness or skin problem too. Your health details can change which procedure is safe.

What to know about regenerative choices

Platelet-rich plasma, or PRP, comes from your blood after it's spun to gather platelets. The prepared part then goes back into your sore joint. One large study found PRP no better than salt water, while other studies disagree.

QC Kinetix offers visits about regenerative treatments for ongoing soreness. These non-surgical procedures can use prepared material from your own body. Its medical providers are clinic staff who examine you and perform treatment.

The clinic calls these choices orthobiologics, meaning prepared body material used in joint care. Concentrated PRP is a version prepared to contain more platelets. Ask what it costs, which risks matter, and what happens afterward.

When to ask for another opinion

Get another opinion when a treatment claim sounds certain. Be careful when anyone promises to reverse joint wear. No honest visit can predict your personal result.

Joint preservation means trying non-surgical care before joint replacement. Ask QC Kinetix about knee or hip surgery alternatives. A surgeon can still explain the operation and recovery.

You'll need your reports at each serious appointment. Write down your main question before you go. This keeps the talk focused when several treatments come up.

Sources

1. In a two-year double-blind randomized trial of 140 patients with symptomatic knee OA and ultrasonic synovitis, intra-articular triamcinolone 40 mg every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

2. A BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found that in the pre-specified main analysis of 24 large placebo-controlled trials (8,997 participants), viscosupplementation reduced pain by only SMD -0.08 (95% CI -0.15 to -0.02) - about 2.0 mm on a 100 mm scale - with the confidence interval excluding the minimal clinically important difference of -0.37. Trial sequential analysis indicated conclusive evidence of clinical equivalence to placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

3. The RESTORE randomized clinical trial (n=288) compared three weekly intra-articular injections of leukocyte-poor PRP with saline placebo in symptomatic mild-to-moderate medial knee OA. At 12 months the mean change in knee pain was -2.1 versus -1.8 points (difference -0.4, 95% CI -0.9 to 0.2, P=.17) and the mean change in medial tibial cartilage volume was -1.4% versus -1.2% (P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

4. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

5. CMS covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only when the patient is enrolled in an approved clinical research study under the coverage-with-evidence-development National Coverage Determination. There is no national Medicare coverage for PRP in osteoarthritis of any joint.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS Coverage with Evidence Development, 2014.

6. A BMJ systematic review of nine randomized trials found arthroscopic surgery for degenerative knee disease gave only a small pain benefit versus control (effect size 0.14, 95% CI 0.03 to 0.26, equal to 2.4 mm on a 0-100 mm scale), present at three and six months but not later up to 24 months, with NO significant benefit on physical function.

   Thorlund JB, et al. — Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.. BMJ, 2015. DOI: 10.1136/bmj.h2747.

7. In the only randomized trial of total knee replacement (100 patients with moderate-to-severe knee OA), the surgery group improved more on the KOOS4 score at 12 months than the non-surgical group (32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) - but had four times the serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group chose surgery within the year while 74% did not.

   Skou ST, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. N Engl J Med, 2015. DOI: 10.1056/NEJMoa1505467.