Billesberger Lisa M, Fisher Kyle M, Qadri Yawar J, Boortz-Marx Richard L
Private Practice, London, ON, Canada.
Duke Anesthesiology, Duke University School of Medicine, Durham, USA.
Pain Res Manag. 2020 Feb 18;2020:3873098. doi: 10.1155/2020/3873098. eCollection 2020.
Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.
膝关节骨关节炎是一种常见的疼痛性退行性疾病，影响着加拿大的老年人群。除了疼痛和残疾外，骨关节炎还与抑郁症、糖尿病等合并症以及护理负担加重有关。预计到2031年，加拿大医疗系统将为此花费76亿美元。尽管其成本高昂且患病率高，但医学界对于治疗膝关节骨关节炎的最佳疗法仍存在争议。多种药物，如非甾体抗炎药和阿片类药物，可能会导致严重的副作用，而益处有限。全膝关节置换术虽然是一种确定性的治疗方法，但存在术后感染、翻修和慢性疼痛等风险。由于副作用更安全，且比关节置换侵入性小得多，新型注射疗法作为药物的替代方案正受到关注。富血小板血浆开始取代更常见的关节内注射皮质类固醇和透明质酸疗法，但需要更大规模的试验来证实这种效果。小型研究已经对注射疗法和干细胞疗法进行了研究，并显示出一些益处。涉及膝状神经阻滞手术的试验取得了成功。随着治疗方法的不断发展，注射疗法可能为膝关节骨关节炎患者提供一条安全有效的途径。
