Most of the joints in the body are synovial joints, or freely movable joints. These joints function as a result of the unique properties of the articular cartilage that covers and protects the ends of the bones. If the cartilage is damaged or removed, so is the functioning of the joint, which suffers as bone rubs against bone instead of cartilage over cartilage.
Surgery can be broadly classified into open repair, in which a surgical incision is made for direct access and visualization of the injury site, and closed, or arthroscopic, repair, in which a miniature camera is used to look into the joint through a small hole, and specially designed tools are used to repair the tissue. Surgery almost always involves the removal of bone, ligaments and tendons. Many different types of surgery are common, including:
- rotator cuff surgery: arthroscopic surgery to clean scar tissue and damage to the joint surfaces, as well as repair the tear of the rotator cuff
- hip replacement: replacement of the joint in which the diseased bone tissue and cartilage is removed from the hip joint, replacing the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts; the healthy parts of the joint are left intact. Learn more about Prolotherapy as a hip replacement alternative.
- knee surgery, also called arthroscopy: although intended to “explore” the knee joint to determine the cause of the problem, it usually involves some scraping, burning and/or cutting of valuable cartilage
- laminectomy: the most common back surgery, which involves the surgical removal of the posterior arch of a vertebra; results in problems similar to those of a discetomy (see below)
- lumbar spinal fusion: fuses vertebrae together, which often leads to ligament laxity and spinal instability as other parts of the spine attempt to compensate for this new, rigid section
- ankle fusion: similar to a spinal fusion, it fuses the shinbone to the talus, immobilizing an area to eliminate pain, but often leading to more pain due to ligament laxity and compensation in other areas and joints. Please see our article Prolotherapy, PRP and Stem Cell treatments for ankle pain.
- discectomy: a disc is removed to alleviate lower back pain; this often results in more back pain as the surgery causes ligament laxity and instability of the spine
Reasons patients avoid surgery:
- Surgery is traumatic; it puts stress on the body and could cause the individual to feel less confident using the surgerized limb.
- Surgery irreversibly alters the individual’s anatomy.
- Surgery potentially involves all kinds of complications.
- Surgery can lead to long-term arthritis due to the removal of significant tissue that is needed to help the body bear weight, such as cartilage, meniscus and disc tissue.
- Rehabilitation is much longer after surgery than for more conservative measures, such as Prolotherapy.
- Surgery does not always resolve the pain, which either means it did not address the cause of the pain, or that it caused another problem.
Prolotherapy Treatment Goals
What are the goals of Prolotherapy treatments?
- Function Is the patient’s ability to function in activities of daily living improved? Is the patient able to perform previously painful activities without pain? Is the person able to do things that he/she could not do prior to Prolotherapy?Patients are typically advised to continue to receive Prolotherapy treatments until able to stably perform that certain function pain and cracking-free. For example, if a patient can now climb two flights of stairs without knee pain after Prolotherapy, whereas prior to the Prolotherapy this would cause excruciating pain, then we know that Prolotherapy is helping improve function.
- Strength Ligament and tendon injury may cause muscle strength to decline. When a person receives Prolotherapy, one of the noticeable effects of the treatment is that strength improves in the injected areas.
- Pain Pain is one of the most common reasons patients receive Prolotherapy. Thus, a noticeable decrease in pain shows the benefit of successful Prolotherapy.
- Stiffness Patients commonly experience stiffness upon morning rising or after performing a certain activity. This stiffness is commonly felt in the lower back or neck, but could involve any area of the body. A great sign that Prolotherapy is working is that stiffness has subsided. Once Prolotherapy helps stabilize the area involved, the muscles no longer have to provide this stability so they relax. Once they relax, the stiffness subsides.
- Physical Examination An experienced Prolotherapy doctor should be able to assess whether the Prolotherapy is working by simple physical examination. The physician can also listen for crepitation or crunching in the joints which can often be audibly heard by moving the joint. The joint that doesn’t crunch is also improving. X-rays and MRIs are poor indicators that Prolotherapy is working, the reason being that most ligaments do not show up well on these tests. Some improvements from Prolotherapy can be seen with x-rays and MRI’s, but it isn’t always necessary or advantageous to rely solely on those indicators due to their high incidence of inaccuracies.
Prolotherapy Side effects and risks
Prolotherapy Side effects and risks
- Bleeding in the area
- Bruising in the area
- Increased pain
- Joint effusion
- Nerve injury
- Puncture of a lung
- Spinal headache
- Tendon/ligament injury
Because Prolotherapy causes inflammation, the person will often note some bruising, pain, stiffness and swelling in the area after receiving Prolotherapy. Typically this lasts 1 to 7 days. On rare occasions it lasts longer. Lasting longer is not necessarily bad, some people just inflame more easily. Since the treatment works by inflammation, lingering pain after Prolotherapy can be a sign of healing. If the pain is severe after Prolotherapy, then call the office where the Prolotherapy was done. Prolotherapy should not cause excessive, severe pain. Severe pain after Prolotherapy, especially accompanied by a fever, could indicate an infection. Infection after Prolotherapy is the most serious risk that we have seen.
The risk of infection after Prolotherapy is between 1 and 1000 to 1 and 10,000 procedures. The most common infection with Prolotherapy is an infection in the skin. This type of infection typically responds to an antibiotic taken by mouth. If a joint or blood infection results, then intravenous antibiotics will typically be needed for six weeks.
Since some of the risks with Prolotherapy relate to the actual technique done, it is important to go to a clinic with a lot of experience.
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