Disease Information

1. A chronic, progressive musculoskeletal disorder characterized by gradual loss of cartilage in joints, which results in bones rubbing together and creating stiffness, pain and impaired movement

2. Worldwide, some degree of knee OA is likely in 10-15% of people >60 years of age

3. Radiological evidence of knee OA observed in ~70% of woman > 65 years of age

4. As per the National Health Portal of India report,22-39% of Indians are affected by knee OA

5. Knee OA, the commonest type of arthritis, typically caused due to wear and tear and progressive loss of the articular cartilage

Classification

The Kellgren & Lawrence (KL) classification attempts to establish a radiographic classification scheme for knee OA and helps healthcare providers in clinical decision-making, specifically defining which patients are likely to benefit most from surgical interventions.5

Diagrammatic
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Radiolographical
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Doubtful JSN*
with possible
osteophyte formation
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Possible JSN*
with definite
osteophyte formation
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Definite JSN*,
moderate osteophyte
formation, some sclerosis,
and possibe
deformity of bone ends
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Severe JSN*,
large osteophyte formation,
marked sclerosis,
and definite deformity of
bone ends

*JSN: Joint Space narrowing

Classification

The Kellgren & Lawrence (KL) classification attempts to establish a radiographic classification scheme for knee OA and helps healthcare providers in clinical decision-making, specifically defining which patients are likely to benefit most from surgical interventions.5

Need for treatment

A large number of knee OA patients ignore their disease symptoms and try to carry on their normal life despite experiencing an aggravation of symptoms.6
The disease being progressive in nature, symptoms usually become more severe, more frequent and more debilitating with time.4
The rate of disease progression varies from individual to individual.4

Current treatment challenges

Current treatment challenges

Gaps in current treatment

In the long-term management of Knee OA,the current therapeutic options have several disadventages.
Oral analgesics
There may be a risk of adverse hepatic, gastrointestinal, cardiovascular, and renal side effects owing to long term use
corticosteroid injection
Administration of intra-articular corticosteroid has been shown to be associated with acceleration of arthritis due to decreased protein and matrix synthesis, fibrotic changes in the hyaline matrix, clumping of collagen, chondrocyte shape changes, increased cytotoxicity, chondrocyte loss, reduced cartilage growth and repair, formation of articular cartilage cysts, and deterioration or destruction of the articular cartilage.
Hyaluronic Acid(HA) injection
HA has been shown to only provide temporary relief from knee OA-related pain.It neither slows down the progression of the disease nor treats the damaged cartilage.
Platelet Rich Plasma(PRP) injection
The PRP composition varies from individual to individualand with the device used to prepare it, the storage method and time until used, and interactions with other materials or biologics. It can lead to fibrous connective tissue and scar formation. Additionally PRP, is not osteoinductive. Its effect only lasts for 3 weeks and reduces thereafter.
Autologous Chondrocyte Implementation
(ACI)
It is very expensive and is technically tedious.Under conventional cell culture conditions, the in vitro expansion of chondrocytes is inevitably associated with chondrocytes dedifferentiation. The dedifferentiated chondrocytes lose or show reduced ability to form cartilage tissue in vivo. This two-surgery procedure has a long waiting time of 3-4 weeks for culture of the harvested cells before implantation.
Total Knee Replacement
(TKR)
The risk associated with TKR include blood loss; wound complications; formation of clots that can lodge into vital organs and threaten their blood supply; damage to the ligament, blood vessels and/or nerves; dislocation; loosening of the implant; breakdown of the bone; instability; fracture in the vicinity of the artificial joint; wrong alignment; infection; and stiffness

References:

  1. Rastogi A. Osteoarthritis. National Health Portal [Internet]. 16 Feb 2017. Available from: https/www.nhp.gov.in/disease/musculo-skeletal-bone-joints-/osteoarthritis Accessed on 16 Sep 2022.
  2. ain VK. Dharmanand BG. Burden of osteoarthritis in India. In: Ravindran V, editor-in-chief. Handbook of rheumatic diseases osteoarthritis. New Delhi: Evan Publishing, 2020. p. 11.
  3. Pal CP, Singh P. Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50:518-22. 4. Hsu H, Siwiec RM. Knee osteoarthritis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: 2022 Jan.
  4. Hsu H, Siwiec RM. Knee osteoarthritis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: 2022 Jan.
  5. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016;474:1886-93.
  6. Chan KKW, Wu RWK. Symptoms, signs and quality of life (QOL) in osteoarthritis (OA). In: Rothschild BM, editor. Principles of osteoarthritis-Its definition, character, derivation and modality-related recognition. Croatia: InTech. 2012. p. 25-40.
  7. Loo SJQ, Wong NK. Advantages and challenges of stem cell therapy for osteoarthritis (Review). Biomed Rep. 2021:15:67.
  8. Hauser RA. The deterioration of articular cartilage in osteoarthritis by corticosteroid injections. J Prolotherapy. 2009;1(2):107-23.
  9. Kim YS, Guilak F. Engineering Hyaluronic Acid for the Development of New Treatment Strategies for Osteoarthritis. Int J Mol Sci. 2022;23:8662. 10. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy-future or trend? Arthritis Res Ther. 2012;14:219
  10. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy-future or trend? Arthritis Res Ther. 2012;14:219
  11. Thej C. Gupta PK. The role of mesenchymal stromal cells in the management of osteoarthritis of the knee. In: Al-Anazi KA, editor. Update on mesenchymal an induced pluripotent stem cells. London: IntechOpen. 2020.
  12. Kapoor M, Mahomed NN. Osteoarthritis: Pathogenesis, diagnosis, available treatments, drug safety, regenerative and precision medicine. Cham: Springer International Publishing. 2015. p. 214, 238-9
  13. Mao Y, Hoffman T, Wu A, Kohn J. An innovative laboratory procedure to expand chondrocytes with reduced dedifferentiation. Cartilage 2018;9(2):202-11.
  14. Ronn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis, 2011:2011:454873.
  15. Healy WL, Della Valle CJ, lorio R, Berend KR, Cushner FD, David F. Dalury DF, et al. Complications of total knee arthroplasty: Standardized list and definitions of Knee Society, Clin Orthop Relat Res. 2013:471:215-20

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