Biomedical Engineering Reference
In-Depth Information
84 CHAPTER 5. FUTUREDIRECTIONS
as often caused by sports injuries.Thus, this section discusses non-arthroplasty therapies, divided into
non-surgical and surgical techniques. Surgical transplantation of allogeneic or xenogeneic materials
is discussed in the next section with cartilage immunology, as the outcome of these transplants relies
heavily on whether the implant is accepted by the body.
5.3.1 NON-SURGICALMETHODS
Articular cartilage injuries can be caused by a variety of reasons, as reviewed in Chapter 2. Since
sports or improper loading are implicated, activity modification, weight and/or body fat loss, physical
therapy, or the use of a cane to lessen the load applied on the problematic joint are all non-surgical
methods in addressing discomfort. For instance, weight reduction in combination with strength
exercises have been shown to significantly reduce knee pain in overweight and obese individuals [
679
].
The reduction of body fat independent of weight loss has also been shown to be beneficial [
680
,
681
].
Injections include visco-supplementation (e.g., hyaluronan) and corticosteroids (though it has been
shown that some injections can soften the remaining cartilage [
162
]). Aspirin, ibuprofen, and a
variety of COX-2 inhibitors are medications that are also often used, as well as dietary supplements.
It has long been believed by many that items such as copper bracelets can alleviate joint pain caused by
arthritis. Whereas it has already been determined that the placebo effect is at work in this case [
682
],
the efficacy of other devices, such as magnetic bracelets [
683
], is still undergoing investigation.
The popularity of copper and magnetic bracelets stems from several desirable characteristics,
namely, the ease of use, non-invasiveness, the presence of few or no side effects, and the percep-
tion that these items are more “natural” than other therapies. Over-the-counter medication such
as aspirin and ibuprofen share many of these desirable characteristics, as do dietary supplements
such as glucosamine and chondroitin. The latter two are of particular interest due to their recent
surge in popularity. These products have been recommended by both OsteoArthritis Research So-
ciety International in 2007 [
684
] and the European League Against Rheumatism in 2003 [
685
]
while being the subject of conflicting results and heated debates. Questions have been raised about
study results with regard to design, sample sizes, publication bias, and the choices of controls, all
complicated by the overwhelming variety of formulations and derivatives available on the market.
The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) [
686
], funded by the National
Institutes of Health and published in 2008, showed that these supplements did not significantly
reduce pain as compared with a placebo, though this study has itself received similar criticism as
listed above. Efficacy is still under investigation, and these supplements have shown benefits in a
recent meta-analysis [
687
].
5.3.2 SURGICALMETHODS
Though it may be ideal to not have to compromise the joint by introducing foreign matter, surgical
methods also provide ways to alleviate pain and to restore function.
