Osteoarthritis (Arthrosis)

 This simplified definition is also used by producers of supplements, medications, and other “treatments” aiming to “restore” cartilage. Unfortunately, with the current state of medical science, this is not possible. Anyone who claims otherwise is either inadequately informed or has motives that do not prioritize the patient’s well-being.

There are two types of osteoarthritis. One is post-traumatic, occurring when fractures, sprains, ligament tears, or other external forces alter joint mechanics. This initiates a process of overloading the joint’s soft tissues and bones, leading to osteoarthritis. The second is the so-called primary osteoarthritis, for which the cause remains unclear. It appears to have a hereditary component, though more as a predisposition to its development than a clear gene-dependent factor.

Osteoarthritis is characterized by changes throughout the joint, from the synovial lining and cartilage to the bone itself. It seems to start with cartilage that becomes softer, reducing its ability to cushion the subchondral bone (the bone on which the cartilage “rests”) against stress. Subjected to increased mechanical pressure, the subchondral bone defends itself by densifying with more calcium. The problem with this reaction is that it further weakens the cartilage. Cartilage has no blood vessels or nerves. This means it must obtain nutrients and oxygen from its surroundings. In this case, it is the subchondral bone and joint fluid. The bone is well-vascularized and, in a normal environment, satisfies much of the cartilage’s needs through perfusion. Cartilage also receives nutrients from joint fluid, acting like a sponge during movement. In this scenario, reactive “thickening” and hardening of the bone reduces perfusion, which further weakens and softens the cartilage, closing the vicious cycle. It can be influenced by slowing the degradation process through various physical therapy techniques, which slightly vary between joints but share the basic principles: promoting cartilage nourishment from joint fluid, stabilizing the joint through specific exercises to reduce bone stress, improving local circulation, and encouraging regular targeted physical activity. These steps help reduce pain, maintain mobility, and delay major surgical procedures.

Unfortunately, nothing taken orally, regardless of the active ingredient, will benefit your cartilage (including glucosamine, hyaluronate, collagen, turmeric, bovine gelatin, shark cartilage, ground Pacific shellfish, and whatever else).

In non-surgical treatment, we also use four types of injections directly into the joint:

-Cortisone – a synthetic hormone in various forms. It can be very helpful when inflammation, pain, and joint swelling are severe. Its effect is short-lived, lasting from a few days to a few weeks.
-Hyaluronic acid – helps reduce pain with longer-lasting effects. Its function is dual; hyaluron acts as a lubricant and also somewhat nourishes the remaining cartilage.
-PRP (Platelet-Rich Plasma) – The patient’s blood is drawn and separated into plasma and blood cells, and the prepared plasma, with certain modifications, is injected into the joint. The idea is to stimulate healing of damaged tissue, though its mechanism in osteoarthritis is not fully understood. Some patients respond well to this treatment, with pain relief lasting for months, but they are not the majority.
-Stem cells – available in various forms, though recently those derived from the patient’s own fat tissue, typically taken from the abdomen, processed, and injected into the joint, are most popular. Initially, the idea was for stem cells to restore damaged cartilage. Today, we know they cannot do this. Although some patients experience less pain and improved mobility lasting several months, the mechanism likely involves a temporary strengthening of the remaining cartilage, making it more resilient to physical stress by altering its own composition. It appears that similar effects can be achieved with appropriate exercises.

So, why is the idea of regenerating cartilage in osteoarthritis flawed from the start? Perhaps everything written so far is still too complex. I compare joint cartilage to a dense lawn for my patients. The quality of the grass depends mainly on the quality of the soil it grows from, which in this analogy is the bone. In osteoarthritis, the “soil” beneath the grass hardens, almost turning to concrete. You can plant grass seed on concrete, fertilize it, and water it. Some blades of grass may sprout, but it will not be a lawn. It is the same with cartilage in a joint affected by osteoarthritis.

On this website, you will find advice and procedures that can reduce pain and slow the progression of osteoarthritis in each joint we treat. Because each joint’s anatomy and function are unique, so are the methods we use. These procedures are based on scientific principles and confirmed through practical application with thousands of our patients. They require an active role from the patient, meaning passive treatments like manual therapy, physical therapy devices, and injections only reduce pain and prepare the joint for exercise, which is the central part of our interventions and the most effective. We understand that regular exercise can be challenging, tedious, exhausting, and even uncomfortable. But as hundreds of studies have confirmed, it is also the most purposeful approach to treatment.

Surgical therapy in osteoarthritis has two components. One is arthroscopic joint cleaning where possible and appropriate. This involves removing loose bodies, cartilage fragments, smoothing rough areas, etc. This procedure is minimally invasive with quick recovery, though the results may not always align with the expectations of both the patient and the surgeon. Even then, it is only symptomatic, with the goal of reducing pain, allowing physical therapy to continue its work. When nothing else works, pain is severe, and mobility is minimal, it is time for arthroplasty, or joint replacement surgery where and when feasible. For more on this, see specific joint-focused texts on this website.