Bone-On-Bone Joint Arthritis

Biologic treatments for “bone-on-bone” knee and shoulder arthritis.

One question that comes up in our clinic on a daily basis is whether or not there is anything that can be done for knee or shoulder arthritis that is already “bone-on-bone” other than replacing the joint or repeatedly injecting harmful steroids that cause cartilage damage and steadily worsen the joint condition.

Often, patients present with the belief that their condition is “bone-on-bone”. Frequently, however, review of their X-rays reveals that not to be. In either case, we are typically able to offer a natural biologic procedure that provides lasting relief and extends the useful life of the knee, shoulder or any other joint. Even when X-rays do demonstrate “bone-on-bone” changes, there is still an excellent chance for success using the most modern biologic techniques. These techniques involve the concentration of large, molecular inflammatory modulators in addition to the harvest of mesenchymal stem cells from the bone marrow. The ability to concentrate these inflammatory modulators has only been translated to clinical use within the last month and offers great promise to patients with “bone-on-bone” disease in particular. We are pleased to be the only clinic in the state to offer this advanced biologic application.

Molecular and cellular biologic treatment for joint arthritis has two main components. The molecular aspect of the procedure involves concentration of the plasma to capture large molecular inflammatory modulators in addition to growth factors and other proteins that stimulate cellular growth, proliferation, healing and cellular differentiation. Many of the molecules suppress the release of natural pain-causing and cartilage-damaging chemicals that are part of the degradative process in a diseased joint. This mechanism is felt to be at least partly responsible for the pain relieving effect of stem cell therapy in patients with “bone-on-bone” joint arthritis.

The cellular component of the procedure involves the aspiration of mesenchymal stem cells from the bone marrow using a procedure designed to be painless and bloodless. The mesenchymal cell concentration is mixed with a biologic scaffold that is constructed from your plasma proteins and thrombin, resulting in a fixed cellular relay station where cells become anchored to themselves and to an extracellular matrix they produce. The relationship between the cells and the extracellular matrix is intimate and subject to mechanical deformation of the newly formed tissue. The complex interplay involving specific and redundant signaling pathways remains incompletely understood and much more work remains until the exact mechanisms are uncovered. What is clear, however, is that this cellular machinery functioning at the molecular level is responsible for the excellent clinical results that have been forthcoming in the setting of “bone-on-bone” arthritis as well as in more mild cases.