Knee Replacement- The Cartilage Crisis

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Knee Replacement- The Cartilage Crisis

_http://www.prolonews.com/knee_pain1.htm_

(http://www.prolonews.com/knee_pain1.htm)

 

The cartilage crisis directly parallels the increase in the incidence of

arthritis. There are now 40 million people in the United States with arthritis

and this number is expected to grow to 60 million by the year 2020. The

cartilage crisis is so bad that the number of admissions to hospitals is

directly

related to the number of people with _osteoarthritis_

(http://www.prolonews.com/osteoarthritis__prolotherapy_e-newsletter_archives.htm\

) , as this is the

third most common reason for hospital admission in the United States.

Additionally, 120,000 _hip replacements_

(http://www.prolonews.com/hip_replacement_alternatives.htm) and an incredible

245,000 _knee replacements_

(http://www.prolonews.com/prolotherapy_can_help_people_with_artificial_knees.htm\

) are

performed each year, making the odds one in 14 that you will get a hip or knee

replaced.

Why Are We In a Cartilage Crisis?

This is not too difficult to figure out just from the figures of the number

of people needing joint replacement surgery as directly correlated to the

number of people who are developing arthritis, which is directly related to the

number of people who have received _cortisone injections_

(http://www.prolonews.com/prolotherapy_e-newsletters_cortisone_shots.htm) ,

_arthroscopy_

(http://www.prolonews.com/arthroscopic_surgery_alternative.htm) , _RICE

treatment_

(http://www.prolonews.com/r_i_c_e_therapies_and_sports_injuries.htm) , and

_anti-inflammatory medications_

(http://www.prolonews.com/can_i_take_anti-inlammatory_agents.htm) over the past

40 years. These treatments accelerate

_cartilage_ (http://www.prolonews.com/knee_ligaments_and_cartilage.htm)

breakdown

tremendously, and thus also accelerate the arthritic process.

What is the Cartilage Crisis?

Most of the joints in the body are synovial joints, that is movable,

lubricated joints which are able to provide normal pain-free movement because

of the

unique properties of the _articular cartilage_

(http://www.prolonews.com/connective_tissue_damage_the_underlying_culprit_of_chr\

onic_pain.htm) . The

articular cartilage covers and protects the ends of the bones in joints. The

knee

is the largest synovial joint.

At the top of the knee are the massive quadricep muscles which cause the

knee to extend. The _hamstring muscles_

(http://www.prolonews.com/ischial_tuberosity_pain.htm) are at the back of the

knee and cause it to flex. The knee

joint has a synovial membrane, which is tissue that lines the noncontact

surfaces within the joint capsule. This tissue secretes lubricating synovial

fluid, which nourishes all the tissues inside the joint capsule. The knee has

internal _ligaments_ (http://www.prolonews.com/ligament_and_tendon_laxities.htm)

(_cruciate ligaments_ (http://www.prolonews.com/acl_mcl_pcl.htm) ) and

external joint ligaments (collateral ligaments) which stabilize the joint,

especially during movement. The knee also has _menisci_

(http://www.prolonews.com/meniscal_injury.htm) , pads of fibrous cartilage

which help the weight-bearing

bones absorb shock. The ends of the tibia, femur, and _patellar_

(http://www.prolonews.com/prolotherapy_knee_cap_disorders.htm) bones of the

knee joint are

covered by articular cartilage. This is the structure that is in crisis.

Articular cartilage allows near frictionless motion to occur between the

surfaces of two bones. Furthermore, articular cartilage distributes the loads

on

the joint articulation over a larger contact area, thereby minimizing the

contact stresses, and dissipates the energy force associated with the load.

Articular cartilage is made of specialized protein structures, called

_Proteoglycans_

(http://www.prolonews.com/connective_tissue_damage_the_underlying_culprit_of_chr\

onic_pain.htm) , water, and _collagen_

(http://www.prolonews.com/connective_tissue.htm) . The cells (_chondrocytes_

(http://www.prolonews.com/connective_tissue_damage_the_underlying_culprit_of_chr\

onic_pain.htm) ) of

articular cartilage are responsible for the synthesis of both the collagen and

proteoglycans that make up the cartilage and have the ability to synthesize all

the various components of the specialized proteins that make up the

proteoglycans.

This ability of these chondrocytes to replicate is really the key question

when considering the potential of cartilage to proliferate or to repair

itself. It has been shown in studies on adult human cartilage that there is no

decrease in cell counts, even in individuals of advanced age. This fact alone

suggests that chondrocytes have the ability to proliferate and repair.

Additionally upon certain injury such as mild compression, osteoarthritis, or

lacerative injury, the chondrocytes are capable of mitotic division, indicative

of

growth and proliferation.

The notion of damaged cartilage having no regenerative properties is

responsible for many people being subjected to arthroscopies with subsequent

joint

replacements. This falsehood or myth occurred because healthy cartilage cells

have very little, if any, mitotic activity, thus very little or no ability to

proliferate.

A bulk of research on articular _cartilage regeneration_

(http://www.prolonews.com/degenerative_joint_disease_prolotherapy.htm) was

performed in the

1980s and 1990s. Dr. H.J. Mankin discovered that the chondrocytes reaction to

injury was to change into a more immature cell, called a chondroblast, which was

capable of cell proliferation, growth, and healing. This key fact is vital

to understanding the power of _Prolotherapy_

(http://www.prolonews.com/what_is_prolotherapy.htm) in proliferating cartilage

regrowth.

The Role of Prolotherapy in Cartilage Growth

Prolotherapy involves the injection of substances, such as hypertonic

_dextrose_ (http://www.prolonews.com/dextrose_protherapy.htm) , _sodium

morrhuate_

(http://www.prolonews.com/prolotherapy__what_are_in_prolotherapy_injections.htm)

(extract of cod liver oil), various minerals, _Sarapin_

(http://www.prolonews.com/prolotherapy__what_are_in_prolotherapy_injections.htm)

(extract of

the pitcher plant), and various other substances including _Growth Hormone_

(http://www.prolonews.com/prolotherapy_and_hormones.htm) , which act by

stimulating the structures to repair. (The actual substances injected depend on

the

individual case and the physician.) The current theory of cartilage

regeneration is that this irritation acts in the same mechanism as above in

inducing the

chondrocytes into the chondroblastic stage of development capable of

proliferation and repair. The numerous patients, who had no cartilage or were

set

for hip/knee replacements who never needed them because of Prolotherapy,

support this fact.

Can It Be Proven That Prolotherapy Regenerates Knee Cartilage?

It is impossible to do a double-blind study on Prolotherapy because even an

injection of sterile water under the skin has a beneficial therapeutic

effect. Even if no injection was given on one side, as the control, sticking a

needle into a painful area is known to have a beneficial effect (this treatment

is called acupuncture). It is very difficult to prove using a traditional

scientific model, that Prolotherapy cures _chronic pain_

(http://www.prolonews.com/how_chronic_pain_occurs.htm) , _sports injuries_

(http://www.prolonews.com/sports_injuries.htm) , and regenerates cartilage

tissue.

One doctor trying to validate the treatment of Prolotherapy is _K. Dean

Reeves, M.D_ (http://getprolo.com/reeves_prolotherapy_kansas.htm) ., Physical

Medicine and Rehabilitation Specialist, in private practice in Kansas City,

Kansas. He has just completed three double-blind studies on using 10 percent

dextrose versus water injections on finger/thumb arthritis, _knee arthritis_

(http://www.prolonews.com/knee_arthroscopy_oak_park.htm) , and anterior cruciate

ligament injured knees. Injections were given every two months of dextrose or

water. After three injections, all patients were given the dextrose

proliferant for three more injections. In the knee studies, only one

intra-articular

(inside the joint) injection was given per knee at each session. As of this

writing, the x-ray readings at one year had just been completed. In the

finger/thumb arthritis study there was a 53 percent improvement in pain, and

eight

degrees of improvement in flexibility. In the knee arthritis study there was a

44 percent improvement in pain, 63 percent improvement in _swelling_

(http://www.prolonews.com/myths.htm) , and a 14-degree improvement in

flexibility.

There was an 85 percent reduction in knee buckling episodes. The loss of

cartilage not seen on x-rays by one year and bone spur measurements showed

improvement. Of interest was the fact that those without cartilage did nearly

as

well. In the knee laxity (ACL) study, pain improved 27.5 percent, swelling by

51

percent, and knee buckling episodes by 54 percent. X-ray studies at one year

showed improvement in two measures of bone spur and near-significant

improvements in thickness of cartilage in the knee. One should remember that

this

study involved just one knee injection per session and articular cartilage

growth was seen. Typically in actual practice, a person with laxity in the _knee

ligaments_

(http://www.prolonews.com/surgical_alternatives_to_knee_ligament_surgery.htm)

may get 20 injections per visit. Dr. Reeves summarized the

findings as " ...these double-blind studies with objective and measurable

endpoints

all show that simple injection of arthritic fingers or knees, or knees with

ACL laxity, with non-inflammatory levels of _osmotic_

(http://www.prolonews.com/prolotherapy__what_are_in_prolotherapy_injections.htm)

stimulants can bring

about favorable responses in pain, flexibility, and x-ray findings. "

Cartilage Regeneration with Human Growth Hormone

Despite the majority of Orthopedic Surgeons doubting that cartilage can be

regenerated, one physician in their own ranks has shown that cartilage growth

is possible. Alan Dunn, M.D., is an orthopedist in private practice in North

Miami, Florida, who has been studying cartilage regeneration for 30 years.

His innovative approach involves the injection of Human Growth Hormone into the

deteriorated joint. He reports, " In the rabbit studies that I conducted,

just one injection grew back the whole patello-femoral surface of the knee in

five to six weeks. These studies were biopsy confirmed. "

He is currently conducting a study on human knees using monthly _human

growth hormone (HGH)_ (http://www.prolonews.com/hormone_levels_prolotherapy.htm)

injections into knee joints with cartilage deterioration. Dr. Dunn says, " Over

half of the knees show major cartilage growth, and most of the rest have a

good result. The most amazing findings have been the near-complete relief of

pain in these degenerated knees. " Dr. Dunn has been giving a total of three

HGH injections into the knees at monthly intervals.

RELATED ARTICLES

 

_Prolotherapy and Knee Pain Part 1 _

(http://www.prolonews.com/knee_pain.htm)

_Prolotherapy and Pes Anserinus Tendons_

(http://www.prolonews.com/knee_pain_part_2.htm)

_Knee Cap - Patella Disorders and Prolotherapy_

(http://www.prolonews.com/prolotherapy_knee_cap_disorders.htm)

_Knee Injury and Cortisone_

(http://www.prolonews.com/knee_cortisone_prolotherapy_hauser.htm)

_Knee Braces_ (http://www.prolonews.com/knee_braces.htm)