Arthroscopic knee surgery? Here is an alternative…

Update: this page has consistently received the most hits per day. I do find that the ozone injections most consistently help knee arthritis, then musculotendinous pain and trigger points, and less commonly severe OA of the shoulder. The page on the clinic website www.pannaturopathic.com describes more about this procedure.

By now, I am sure that many of you have read the recent report that arthroscopic knee surgery for degenerative arthritis or osteoarthritis knee pain does not work. Here’s an excerpt from the BBC that reports on the recently published study:

The operation involves inserting instruments through small incisions to try to flush out loose fragments of cartilage, and to smooth the surfaces of the joints, in the hope that this will relieve symptoms.

A group of 178 men and women, with an average age of 60, were enrolled in the trial at the University of Western Ontario.

All of them were given physiotherapy and painkilling drugs such as ibuprofen, but half of the volunteers were also given the “la

vage and debridement” procedure.

When their symptoms were compared at various poi

nts afterwards, the group who had the operation were faring no better than those who had not received it.

Guidelines breached

Dr Brian Feagan, one of the researchers, said: “This is definitive evidence that arthroscopic surgery provides no additional therapeutic value when added to physical therapy and medication for patients with moderate osteoarthritis of the knee.”

It should also be noted that osteoarthritis is a degenerative condition, m

eaning that it really is a “wear-and-tear” type of condition that is very difficult to reverse.

The common arthroscopic surgery aims to “clean up” the joint on the right of the above picture, smoothing out the rough edges. It does not really address the lack of cartilage and increased dependency on lubrication within the joint itself.

Natural alternatives

Most of my patients who want their knee pain addressed are already on the basics such as glucosamine sulfate and chondroitin sulfate. These are pretty good nutrients, and can be considered disease-modifying agents, in that they actually act to slow down the degenerative process.  Both glucosamine sulfate orally, and hyaluronic acid injected into the joint, have consistently been shown to reduce pain. A recent study published in BMC Musculoskelet Disord showed that glucosamine stimulated synovial cells (cells lining the joint) to produce hyaluronic acid. Hyaluronic acid is a lubricant within the joint.

Sometimes glucosamine isn’t enough, as the pain is still present. In these cases, often I will add in a herbal formula called Kaprex and Withania Complex, both of which have been shown to reduce the inflammation and associated pain in a subset of patients with degenerative arthritis or osteoarthritis. At this point, I do an exam to assess whether or not there is any ligament laxity or meniscal disc injury in the affected joint.

If there is an injury or weakened, stretched, ligament or a partially damaged meniscus, then ozone can be injected into the ligament in order to stimulate an ordered, natural inflammation. It is the localized inflammation that creates growth factors to stimulate healing. At times, if the condition is severe, ozonized platelets from the patient can be injected, as the platelets are a potent source of growth factors to stimulate the ligaments and the meniscus to heal.

History is very important as well. If there is a pre-pain history of trauma, either a single event, or repetitive strain, then often times the ligaments, menisci, or joint-supporting structures need to be treated. The menisci in the above pictures are pads where the weight is distributed at the knee, and are under pressure with flexion and twisting type motions. Thus, they are often susceptible to injury. Unfortunately, glucosamine alone or anti-inflammatories (drug or the above natural options) won’t cause repair. Ozone injections or platelet injections can.

For osteoarthritis, or purely degenerative joint disease though, the natural treatments are much simpler. It basically involves the injection of the same ozone or ozonated platelets but this time, instead of small amounts into specific ligaments or menisci, larger amounts are injected directly into the knee joint. The problem is within the knee joint, where structures are in contact with each other. The natural treatment involves stimulating the synovial tissue to produce more lubrication and to produce more cartilage.

Above is a picture of a knee being injected by ozone.

Here is some research that looks at the use of ozone in various cases of pain (I use it also in chronic myofascial and musculotendinous pain, or the trigger points and knots in the muscles.)

One study in the Saudi Medical Journal looked at 220 patients who had osteoarthritis of the knee or spine, and found that ozone injections twice a week for at least 12 sessions showed a significant reduction in pain at the 4th, 8th, and 12th injection. The reduction in pain was present at 10 months after the first treatment.  I would not tend to do the injections that frequently, instead I would do it usually once a week to once every two weeks.

A group in Taiwan published in Rheumatology International that ozone injections into the knee could even help with the destruction associated with rheumatoid arthritis. They found that injections of 3% or 5% ozone significantly decreased chemicals called cytokines that were associated with inflammation and rheumatoid arthritis. When I treat rheumatoid arthritis, I prefer to treat the blood system itself, using autohemotherapy to balance the immune system.

In a Chinese study, published in a journal that translates to Chinese Acupuncture and Moxibustion, showed that ozone injection was superior in pain relief compared to injection of fluid into acupuncture points and compared to electroacupuncture. This study involved 120 patients with low back pain, but did not specifically include only degenerative arthritis patients. I list this study because I have also found that injections of ozone can resolve many chronic myofascial and muscular pain.

In the journal Radiology, a study found that injections of ozone into to the low back was more effective than steroid and anesthetic alone. This effect was present even 6 months after treatment.

The American Journal of Neurobiology found also that injections of ozone were superior to injections of steroid alone for low back pain, at 6 months after the treatment. Patients were pain free after treatment in both groups but the ozone group had pain relief that lasted longer.

The list goes on – but I think you get the idea. Ozone is the way to go for knee (and other types) of pain. Usually the number of treatments necessary vary, but range from one treatment to up to 15, with most chronic patients needing 2-6 treatments. This, in combination with oral kaprex, withania complex, and glucosamine, can be profoundly helpful as a natural alternative for chronic degenerative joint disease, or osteoarthritis.