A frequently heard story
At the onset of symptoms, patients go to the doctor. There they often receive an anti-inflammatory (ibuprofen, diclofenac) and a referral letter to the physiotherapist. If that does not help enough, they are referred to the orthopedic surgeon. They will have an X-ray taken, which shows wear and tear of the joint.
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Often the advice to have a new knee fitted (joint replacement) is not immediately given. There are several reasons for this: the patient is too young (a joint prosthesis has a limited lifespan), or surgery is not recommended on medical grounds (the patient is too old or too heavy). The most common reason is that the patient wants to postpone the operation as long as possible.
These people are looking for an effective and safe treatment that falls somewhere between the care of the GP and physiotherapist and that of the orthopedic surgeon.
Complaints of knee wear
- night pain in the knee
- start-up pain
- pain when walking for a long time
- difficulty going up and down stairs
- stiffness
- signs of inflammation, such as swelling, redness and warmth
The focus of the problems and complaints varies from patient to patient. The patient's wishes and goals, activity level and expectations also vary. With all these variables, treatment for one patient's worn-out knee can look very different from another.
The steps in our treatment
We distinguish a number of categories in the treatment of osteoarthritis and associated problems.
Step 1: prolotherapy, ozone treatment and corticosteroid injection
The first step in the treatment of painful joint wear and tear is to treat the inflammation in the joint (redness, painful stiffness, swelling), unstable ligaments, and painful tendons, muscle attachments and muscle knots around the knee joint. In many cases this is an indispensable step: the source of many pain complaints lies precisely in these structures.
If an injection with hyaluronic acid is chosen, this step is the preparatory phase to relieve the pain in every possible way.
Step 2: hyaluronic acid, a lubricant for stiff and worn joints
Hyaluronic acid works as a lubricant and as a natural, mild anti-inflammatory for the joint. In most cases, an injection with hyaluronic acid is given after a preparatory phase, in which the excess inflammation in the joint and the painful tendons and ligaments around the joint are first addressed.
Step 3: platelet rich plasma (PRP)
PRP is a concentrate of your own blood, from which we isolate the repair cells and growth factors. We inject this into the injury, in this case the worn knee. This provides a strong, natural stimulus to help damaged and painful tissue heal as best as possible. PRP is an advanced and strongest form of prolotherapy, which is currently being extensively researched. It is becoming increasingly clear that PRP can be used safely and effectively for joint wear.
What you can expect from the treatment
We cannot make a worn out joint new again. However, we can improve the circumstances as best as possible and ensure that the pain decreases as much as possible.
An arthritic, worn joint requires maintenance. It is not the case that the complaints and wear and tear go away with one shot and stay away forever — although there is an occasional exception that confirms the rule.
For more information, read the pages about the treatments, come to the information evening, or make an appointment so that we can assess which treatment is best for you.
Recognizable symptoms
- Pain in the knee that keeps you awake at night
- Start-up pain after sitting or lying down
- Pain as soon as you walk a little longer
- Difficulty going up and down the stairs
- A stiff knee
- A swollen, warm or red knee
Scientific references (12)
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- Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complement Ther Med. 2015 Jun;23(3):388-95.
- Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013 May-Jun;11(3):229-37
- Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of Platelet-Rich Plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2015 Jul 14.
- Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21.
- Hashemi M, Jalili P, Mennati S, Koosha A, Rohanifar R, Madadi F, Razavi SS, Taheri F. The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis. Anesth Pain Med. 2015 Oct 17;5(5):e27585
- Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD005321. Review. Update in: Cochrane Database Syst Rev. 2006;(2):CD005321. PubMed PMID: 15846754.
- Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD005328. Review. Update in: Cochrane Database Syst Rev. 2006;(2):CD005328. PubMed PMID: 15846755.
- Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013 Dec;29(12):2037-48. doi: 10.1016/j.arthro.2013.09.006. Review. PubMed PMID: 24286802.
- Rivera F. Single intra-articular injection of high molecular weight hyaluronic acid for hip osteoarthritis. J Orthop Traumatol. 2015 Oct 8. [Epub ahead of print] PubMed PMID: 26449357.
- Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, Anitua E. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013 Oct;29(10):1635-43. doi: 10.1016/j.arthro.2013.07.264. PubMed PMID: 24075613.
- Campbell KA, Erickson BJ, Saltzman BM, Mascarenhas R, Bach BR Jr, Cole BJ, Verma NN. Is Local Viscosupplementation Injection Clinically Superior to Other Therapies in the Treatment of Osteoarthritis of the Knee: A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Oct;31(10):2036-45.e14. doi: 10.1016/j.arthro.2015.03.030. Epub 2015 May 19. Review. PubMed PMID: 25998016.
- Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011 Nov;27(11):1490-501. doi: 10.1016/j.arthro.2011.05.011. Epub 2011 Aug 10. PubMed PMID: 21831567. Smith PA. Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis: An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial. Am J Sports Med. 2016 Apr;44(4):884-91. doi: 10.1177/0363546515624678. Epub 2016 Feb 1. PubMed PMID: 26831629.
