Osteoarthritis: new cartilage transplantation technique

Osteoarthritis is an unpleasant condition that is difficult to cure or prevent. Fortunately, the bright spot in the darkness is getting bigger and bigger, thanks in part to a new cartilage transplant technique. Thanks to this new treatment method, osteoarthritis is no longer a matter of wear and tear! Osteoarthritis is wear and tear in one or more joints. The condition has a high morbidity, which means that many people are afflicted with it. According to the Flemish Reumiga, no less than 90 percent of all people over 60 have osteoarthritis to a greater or lesser extent. This is 20 percent of the over-50s. Osteoarthritis is the most common condition in the elderly, especially women. Young people can also suffer from it: in Belgium, around 20,000 people between the ages of 25 and 44 are osteoarthritis patients.

Orthopedist Dr. Almqvist from Ghent University Hospital: In healthy joint tissue there is an automatic and constant renewal process, in which there is a balance between breakdown and build-up. In osteoarthritis, this balance is disturbed: the balance shifts to the mechanisms that break down the joint tissue. The cartilage (the white, elastic tissue that covers the joint head and joint shell at the level of the joint) becomes more brittle, thinner and softer because the cartilage cells produce less cartilage matter. The cartilage is therefore worse both quantitatively and qualitatively.
Because the cartilage breaks down (fractures occur in the cartilage surface, and the cartilage can even crumble completely or partially), a hardening of the bone under the cartilage occurs, causing mechanical pain. This results in a narrowing of the joint and an irregular joint surface. The bone also responds: the bone tissue around Target starts to grow, to improve the joint, as it were. The bone widens and cysts develop on the bone just below the joint.

Under normal conditions, the cartilage that lines the ends of the bones in joints is smooth. In osteoarthritis , this cartilage develops a rough, irregular surface, which makes the joint less easy to move and causes pain (stiffness).

Depending on the cause – which is not always clear – osteoarthritis can be divided into two groups: primary and secondary osteoarthritis . We speak of secondary osteoarthritis if the wear and tear is the result of a triggering factor, such as an injury (a fracture of the knee joint) or incorrect posture. This is not the case with primary osteoarthritis and the condition develops spontaneously, often in several joints. Primary osteoarthritis can be hereditary.

No arthritis!

Osteoarthritis is also sometimes called wear and tear rheumatism (the ending ose indicates wear and tear or degeneration), but this disease should not be confused with rheumatism or the various forms of rheumatism or other inflammatory conditions that are inflammation of the joint membrane. With osteoarthritis there is no inflammation of the joint membrane as with arthritis. The pattern of complaints is also completely different: osteoarthritis is a mechanical pain. The pain manifests itself in the morning (tightness), but severe pain flares can also occur.

The pain can vary greatly from person to person. Some people only have pain when getting up, others are constantly plagued by severe pain. Painful and stiff joints can seriously hinder someone’s normal daily activities. Mobility decreases sharply. The pain is also often referred pain: for example, hip osteoarthritis can cause knee problems.

The sponge

Unfortunately, we do not know what causes the articular cartilage to change its structure. Various factors can play a role, such as predisposition, heredity, the structure of the joint and the load on the joint due to posture or working posture. It has been scientifically shown that obesity (overweight) is an important factor for the development of osteoarthritis. It appears that certain enzymes play a role in the breakdown of articular cartilage , but it has not yet been possible to figure out how to stop or reverse this breakdown process. In any case, the cartilage has lost its water-binding properties, which reduces its resilience.

We can compare the articular cartilage with a sponge. By regularly squeezing the sponge, the joint is supplied with nutrients and the sponge remains flexible. If this does not happen, the sponge will dry out and crumble, but the sponge will also break if the load is too heavy. The trick is therefore to find a balance between overload and underload.

Who and where?

Osteoarthritis mainly occurs in the spine, hips, fingers and knees. Elbows, ankles and wrists can also be affected by osteoarthritis, but this is less common. Osteoarthritis is more common in aging people. People at an increased risk of osteoarthritis are overweight people, people with a harder bone structure (such as those who suffer from Paget’s disease, a bone disorder) and people with congenital joint abnormalities, such as hip dysplasia (congenital poor development of the knee joint). . Knee osteoarthritis is more common in people in professions that involve heavy physical labor (kneeling, squatting and heavy lifting), such as gardeners.

Because it is a condition that evolves slowly, osteoarthritis usually develops later in life. Previous trauma can also promote the development of osteoarthritis. For example, a year after a perfect knee operation, someone can still suffer from osteoarthritis. Osteoarthritis is becoming more and more common: firstly because the population is getting older, but also because the population is getting fatter and there is more obesity. So you could call osteoarthritis a lifestyle disease.

Pain-relieving treatments for osteoarthritis

The changes in the joints usually happen gradually. The patient does not feel ill, and there are no abnormalities in the blood. How do you know if you have osteoarthritis? The diagnosis is made clinically, namely after an interrogation and radiography, and not with scanners or other sophisticated equipment.

Dr. Almqvist: There is no curative treatment for osteoarthritis, only a pain-relieving treatment. Firstly, you can relieve osteoarthritis non-surgically by:

  • to exercise and exercise (especially cycling and swimming), to stay fit and active, and thus exercise the joints. Research in animals has shown that not moving the joint leads to accelerated breakdown of the articular cartilage. Sports that are less suitable include volleyball, tennis and badminton. The unexpected movements and jumping in particular place too much strain on the joints.
  • Avoid being overweight, overweight people should lose some weight to reduce the pressure on the joints.
  • reduce tension on the joints. This can possibly be done with the help of a walking stick.
  • strengthen the muscles that support the joints through physiotherapy .
  • medicines for pain (painkillers) and use medicines that affect the quality of the cartilage: glucosamines and chondroitin sulphates give a boost to cartilage production.
  • special support bandages that relieve pain (although there are conflicting findings about this).
  • injecting the joint with hyaluronic acid : this normalizes the joint and takes away the pain (the effect lasts about 6 months to 1 year).’

Surgical interventions for osteoarthritis

There are also a number of surgical treatments – usually of the lower extremities – that can help with osteoarthritis.

Dr. Almqvist: ‘In my opinion, arthroscopy has little effect. If it has any effect, it is very temporary.
What does help is osteotomy . The affected part is relieved by sawing through it. For example, if wear on the inside of the knee is associated with a bow leg, the lower leg can be sawn through just below the knee and moved outward. An x-leg is created, which causes the patient to walk more on the outside than the inside of the knee and has less pain. This technique is mainly used for people under the age of sixty. Prosthetics are also possible, both a half (only of the affected part) and a complete prosthesis, for example a whole hip or knee. In the case of a spinal column, small pieces or segments can be secured, causing decompression.

New cartilage transplantation technique for osteoarthritis

The above treatments actually do little to change the quality of the cartilage itself. This should change soon, through the early repair of cartilage damage (usually to the knee, after trauma) in young people, in order to prevent osteoarthritis later in life.
Dr. Almqvist: First, the cartilage damage in the joint surface is cleaned. Then (liquid) cartilage cells are injected between the bone and the periosteum , after which the periosteum is sutured. However, the risk is that if a tiny tear or opening occurs, the precious cartilage cells will leak out in the blink of an eye.
A major improvement on this was developed last year at the Ghent University Hospital: cartilage cells were grown here in the form of gel beads.

These are tiny pearl-shaped gel droplets in which the cartilage cells are kept stable: one bead is 1 to 1.5 millimeters in size and contains approximately 50,000 cartilage cells. They are used in operations to fill lesions in the articular cartilage. This was first applied to very local osteoarthritis, including in top athletes. If a football player takes hundreds of kicks to the kneecap, such injuries occur.

The gel beads have a number of advantages: they offer better resistance to compression. You can just brick them onto the bone. A bone membrane to keep the cartilage in place is therefore no longer necessary. After the operation, the patient follows a rehabilitation schedule. This gives the new tissue the opportunity to develop into full-fledged cartilage tissue. You also know in advance what the cartilage cells will do: produce good cartilage material. The Ghent University Hospital was recently presented with the world first of a real cartilage transplant with cartilage beads. Currently, this technique is mainly applied to the knee.

Cartilage cells are made from stem cells that are taken from the patient himself. However, this is not only a beneficial evolution in orthopedics, but also for cardiologists: because you can in fact mold cartilage cells into any shape, they can also be used to make heart valves. Or to make auricles in plastic surgery: there are many conceivable applications. To be continued for sure.

What’s worse than stiletto heels?

Osteoarthritis of the knee is almost twice as common in women than in men, although the pressure on the knee is the same in men and women who walk barefoot. One of the explanations would be wearing high heels: high heels increase the pressure on the knee by an average of 30 percent. But… shoes with high, wide heels could be worse than stiletto heels! According to a study in The Lancet, women who wear such shoes are at a higher risk of knee osteoarthritis than women who usually wear narrow high heels. The latter are also not recommended, but wide heels are even worse for the knee because they are more comfortable than regular high heels, which means you wear them longer and the risk of damage increases. It is best not to wear high heels at all: they force the foot into an unnatural position, causing the knee to have to twist and bend so that the cartilage eventually wears away.

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