Facing the challenges of bone-on-bone osteoarthritis, especially in joints like the shoulder, can be daunting. As traditional treatment options such as joint replacement surgery loom large, many patients are left wondering about less invasive alternatives. In this blog, Dr. David Guyer, a triple board-certified orthopedic surgeon and expert in sports medicine and regenerative treatments, dives deep into the potential of regenerative injections like stem cells and exosomes, alongside cortisone shots, to manage osteoarthritis symptoms. Though these treatments are considered experimental by the FDA, Dr. Guyer sheds light on their pros and cons, offering a glimpse at how they might provide pain relief and delay the need for surgery. Join us as we explore these promising avenues for enhancing joint health and quality of life.

Understanding Bone-on-Bone Osteoarthritis

Bone-on-bone osteoarthritis, a condition where the cartilage has worn away to the point where bones are in direct contact within the joint, can cause debilitating pain and severely limit movement. This condition is often a turning point for many patients, as traditional medical advice typically leans towards surgical intervention, such as a joint replacement. However, surgery is not an appealing option for everyone due to its invasive nature and the recovery time required. In such cases, exploring other treatment avenues becomes crucial.

The Role of Cortisone Shots

One such avenue is the use of cortisone shots. Cortisone injections are a traditional treatment method aimed at reducing inflammation and pain in joints affected by arthritis. However, there is a significant concern regarding the long-term use of cortisone, as repeated injections can actually accelerate the deterioration of cartilage and bone. Not only does it speed up the arthritic process, but cortisone can also weaken soft tissues such as tendons, which can complicate future surgeries. While cortisone may provide short-term relief, its use in a bone-on-bone scenario is often viewed as a temporary measure, as its effectiveness diminishes with the absence of cartilage.

Exploring Regenerative Medicine

On the other hand, regenerative medicine offers a more modern approach to osteoarthritis treatment. This includes therapies such as stem cell therapy, exosomes, and platelet-rich plasma (PRP) injections. These treatments aim to stimulate the body’s natural repair mechanisms to heal damaged joint tissues. Stem cells, harvested from the patient’s own body or donated sources, have the potential to differentiate into various cell types, potentially regenerating damaged cartilage. Exosomes, small vesicles that play a key role in cell communication and repair processes, may enhance the healing effects of stem cells and modulate inflammation.

Considerations for Regenerative Treatments

However, it’s essential to acknowledge that while these regenerative therapies hold promise, they are still considered experimental by the FDA. The evidence supporting their efficiency in regenerating cartilage to the extent required for normal joint function is not yet conclusive. Regenerative injections may not fully restore the joint to its original state, but they might offer pain relief and improve joint function temporarily. This can be appealing for patients looking to delay surgery or improve quality of life.

• Effectiveness: While regenerative injections may provide some relief and delay surgery, they are unlikely to restore joints to their condition in youth. This is particularly true for severely arthritic joints.
• Safety and Risks: As with any medical procedure, there are risks involved with regenerative treatments. These can include infection, immune response to foreign cells, or complications from the injection itself.
• Cost: Since these treatments are experimental, they often come at a high out-of-pocket cost and are typically not covered by insurance.
• Consultation with Professionals: It’s crucial to have a detailed discussion with your orthopedic surgeon or a specialist in regenerative medicine to understand the potential benefits and limitations of these treatments in your specific case.

Viscosupplementation, another treatment option, involves the injection of hyaluronic acid into the joint to provide temporary lubrication and cushioning. However, its effectiveness in bone-on-bone arthritis is limited and may not significantly alter the course of the disease.

When considering your options, it’s important to weigh the potential benefits against the risks and costs involved. While regenerative therapies are at the forefront of medical research, their current role in treating severe osteoarthritis is primarily centered around symptom management rather than a cure.

Conclusion

In summary, managing bone-on-bone osteoarthritis involves navigating a complex landscape of traditional and innovative treatments. Cortisone injections can offer some relief but come with significant downsides. Regenerative therapies present an exciting frontier with potential benefits but are not yet a proven solution for reversing arthritis. Ultimately, the strategy for managing osteoarthritis should be tailored to the individual, factoring in personal health goals, the severity of the condition, and professional medical advice.