Knee Replacement and Prolotherapy

Ross Hauser, MDRoss Hauser, MD

This is an article from Dr. Hauser, M.D., that was written for the 1st volume of his book on Prolotherapy, Prolo Your Pain Away. Since the writing of this article Dr. Hauser has published his own research on the growth of articular cartilage in knees and this article is available on this website: Cartilage Regeneration in Five Degenerated Knees.

There are now 40 million people in the United States with arthritis and this number is expected to grow to 60 million by the year 2020.

Knee cartilage damage pandemic?

Is there a pandemic of patients suffereing fromknee cartilage damage?  Obviously as figured by the number of people needing joint replacement surgery (120,000 hip replacements and 245,000 knee replacements as directly correlated to the number of people who are developing arthritis, which is directly related to the number of people who have received cortisone, RICE treatment, and anti-inflammatory medication over the past 40 years. These treatments accelerate cartilage breakdown tremendously, and thus also accelerate the arthritic process.

Knee cartilage damage crisis?

Most of the joints in the body are synovial joints, that is movable, lubricated joints which are able to provide normal pain-free movement because of the unique properties of the articular cartilage. The articular cartilage covers and protects the ends of the bones in joints. The knee is the largest synovial joint.

At the top of the knee are the massive quadricep muscles which cause the knee to extend. The hamstring muscles are at the back of the knee and cause it to flex. The knee joint has a synovial membrane, which is tissue that lines the noncontact surfaces within the joint capsule. This tissue secretes lubricating synovial fluid, which nourishes all the tissues inside the joint capsule. The knee has internal ligaments (cruciate ligaments and external joint ligaments (collateral ligaments) which stabilize the joint, especially during movement. The knee also has menisci, pads of fibrous cartilage which help the weight-bearing bones absorb shock. The ends of the tibia, femur, and patellar bones of the knee joint are covered by articular cartilage. This is the structure that is in crisis.

Articular cartilage allows near frictionless motion to occur between the surfaces of two bones. Furthermore, articular cartilage distributes the loads on the joint articulation over a larger contact area, thereby minimizing the contact stresses, and dissipates the energy force associated with the load.

Articular cartilage is made of specialized protein structures, called Proteoglycans, water, and collagen. The cells (chondrocytes) of articular cartilage are responsible for the synthesis of both the collagen and proteoglycans that make up the cartilage and have the ability to synthesize all the various components of the specialized proteins that make up the proteoglycans.

This ability of these chondrocytes to replicate is really the key question when considering the potential of cartilage to proliferate or to repair itself. It has been shown in studies on adult human cartilage that there is no decrease in cell counts, even in individuals of advanced age. This fact alone suggests that chondrocytes have the ability to proliferate and repair. Additionally upon certain injury such as mild compression, Osteoarthritis, or lacerative injury, the chondrocytes are capable of mitotic division, indicative of growth and proliferation.

The notion of damaged cartilage having no regenerative properties is responsible for many people being subjected to arthroscopies with subsequent joint replacements. This falsehood or myth occurred because healthy cartilage cells have very little, if any, mitotic activity, thus very little or no ability to proliferate.

A bulk of research on articular cartilage regeneration was performed in the 1980s and 1990s. Dr. H.J. Mankin discovered that the chondrocytes reaction to injury was to change into a more immature cell, called a chondroblast, which was capable of cell proliferation, growth, and healing. This key fact is vital to understanding the power of in proliferating cartilage regrowth.

The Role of Prolotherapy in Cartilage Growth

Prolotherapy involves the injection of substances, such as hypertonic dextrose,sodium morrhuate (extract of cod liver oil), various minerals, Sarapin (extract of the pitcher plant), and various other substances including Growth Hormone, which act by stimulating the structures to repair. (The actual substances injected depend on the individual case and the physician.) The current theory of cartilage regeneration is that this irritation acts in the same mechanism as above in inducing the chondrocytes into the chondroblastic stage of development capable of proliferation and repair. The numerous patients, who had no cartilage or were set for hip/knee replacements who never needed them because of Prolotherapy, support this fact.

Can It Be Proven That Prolotherapy Regenerates Knee Cartilage?

Research has shown that Prolotherapy resulted in safe, substantial improvement in knee osteoarthritis. In another study Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis

Ross Hauser, MD practice Prolotherapy in Oak Park, Illinois