In the realm of treating bone-on-bone osteoarthritis, many patients find themselves at a crossroads—do they choose traditional methods like cortisone shots that offer temporary relief but may expedite the wear and tear on their joints, or do they consider alternative regenerative injections such as stem cells or exosomes? In this blog, we delve into these options through the expert lens of Dr. David Guyer, a triple board-certified orthopedic surgeon and regenerative medicine specialist. Dr. Guyer not only shares insights into the potential benefits and limitations of these treatments but also emphasizes the importance of individual consultation with your orthopedic surgeon. As part of the “Ask the Doctor” series, the blog offers clarity on whether regenerative injections can provide meaningful pain relief and improved function, delaying the need for joint replacement surgeries. Join us as we explore these cutting-edge interventions and their role in managing advanced osteoarthritis.

Cortisone Injections: Relief with Caveats

Bone-on-bone osteoarthritis represents one of the most challenging stages of joint degeneration. Characterized by the complete erosion of cartilage, the bones in affected joints rub directly against each other, causing severe pain and functional limitations. Once a person reaches this stage, treatment decisions often revolve around the balance between short-term pain management and long-term joint preservation.

Cortisone injections have long been a standard method for managing osteoarthritis pain. While they can provide temporary relief, these injections come with significant caveats. Repeated cortisone shots may exacerbate the deterioration of cartilage and bone, particularly in the shoulder, where they might also weaken the rotator cuff tendons. This deterioration not only accelerates the progression of arthritis but can also complicate any eventual surgical interventions. With cortisone shots, there is a delicate balance between obtaining immediate pain relief and possibly hastening the need for joint replacement.

Exploring Regenerative Treatments

In contrast, regenerative treatments such as stem cells and exosomes present a more novel approach to managing osteoarthritis. These treatments are designed to harness the body’s natural healing mechanisms to potentially repair and regenerate damaged tissues. Stem cells, when injected into the joint, can differentiate into various cell types, potentially aiding in tissue repair. Exosomes, tiny vesicles derived from stem cells, carry proteins and other molecules that can modulate inflammation and possibly stimulate tissue repair processes.

The potential benefits of regenerative treatments in bone-on-bone osteoarthritis, however, are tempered by their experimental nature. The FDA has not yet approved these therapies specifically for osteoarthritis, and ongoing research is necessary to fully understand their efficacy and safety. That said, some patients have reported improvements in pain and function, suggesting these treatments might delay the need for invasive surgeries.

Regenerative Approach: Promise and Limitations

• Stem Cells: These cells can potentially regenerate cartilage, although the process is not guaranteed to restore joints to a pre-arthritic state.
• Exosomes: Considered more promising by some experts, they might reduce inflammation and enhance tissue repair, offering pain relief and improved mobility.
• Platelet-Rich Plasma (PRP): Though not emphasized as a major solution for severe arthritis, PRP injections could still contribute to pain management and joint function.

Despite their potential, it is crucial to have realistic expectations about what regenerative treatments can achieve. Bone-on-bone conditions signify advanced degeneration, meaning complete restoration of joint function is highly unlikely. Instead, these treatments may offer symptomatic relief and an improved quality of life, allowing some patients to postpone surgery.

For individuals who want to avoid surgery or cortisone injections, engaging in a conversation with their orthopedic surgeon about these experimental treatments is essential. Personalized care plans should consider a patient’s specific condition, health goals, and willingness to undergo experimental therapies.

Integrated Management Strategies

Ultimately, osteoarthritis management requires an integrated approach. While cortisone injections and regenerative treatments are viable options, they should be supplemented with other strategies:

• Physical Therapy: Targeted exercises help maintain joint mobility and strength, potentially alleviating pain and improving function.
• Lifestyle Modifications: Weight management and activity adjustments can reduce stress on joints.
• Alternative Therapies: Acupuncture and dietary supplements like glucosamine and chondroitin might offer additional relief.

While the debate between conventional and regenerative therapies continues, ongoing research will eventually shed more light on the long-term benefits and potential of these innovative treatments. For now, patients must weigh the pros and cons of each option, with guidance from their healthcare providers, to find the most suitable approach for managing their osteoarthritis.

The path to managing bone-on-bone osteoarthritis is undoubtedly complex, requiring a careful consideration of all available options. As the medical community continues to explore new treatments, it remains crucial for patients to stay informed and actively participate in their care decisions.