JULY-AUGUST , 2022 | THE HEALTH

BONE TO PICK

BY DR JONAS FERNANDEZ

HAVE lost count of the times patients have walked into the consultation rooms complaining that their knees hurt . They often attribute this condition to the lack of “ lubricant ” in the knee joints ( the oft-used phrase is “ kurang minyak ”).

This pain they refer to is often due to osteoarthritis of the knee . The lubricant they refer to is the synovial fluid , a gel-like substance found naturally in the knee joint .

In simple terms , knee osteoarthritis is due to wear and tear ( of the cartilage in particular ). However , there are other causes of arthritis , like rheumatic diseases or the result of a knee injury .

From a molecular point of view , inflammatory processes play an essential role in the breakdown of these cartilages . There are multiple modalities at one ’ s disposal to treat this condition , ranging from medication and physiotherapy to injections and surgeries .

Injections

Let us zoom in on this particular treatment modality . Injections can be used to treat knee osteoarthritis and other types of orthopaedic conditions .

These conditions include shoulder impingement , De Quervain tenosynovitis , sciatica pain and many others . Different conditions often require a particular type of injection .

These include steroids , hyaluronic acid and / or processed blood products . Your doctor may prescribe the latter two in knee osteoarthritis , in isolation or in combination .

As an orthopaedic trainee at the University of Malaya , I had the privilege to work closely with some of the brightest minds in the Tissue Engineering Group at the National Orthopaedic Centre of Excellence for Research and Learning ( NOCERAL ).

Prof Dr Tunku Kamarul , Dr Chong Pan Pan and her team had developed a novel technique for treating osteoarthritis and other conditions using Platelet-derived Extracellular Vesicles ( PEV ).

As part of my thesis as a Master ’ s student , I evaluated its efficacy in treating patients with knee osteoarthritis and compared it to Hyaluronic Acid ( Hyruan ONE ).

PEV is produced by first obtaining the patient ’ s blood and then processing it by spinning the blood . The product of this process is a fluid that is richly concentrated in these extracellular vesicles .

Many previous studies have demonstrated that PEV plays a role in stimulating cartilage regeneration , reducing inflammation , and playing

a role in the homeostasis of the knee joint microenvironment .

The other choice of injection , as mentioned earlier , is the Hyaluronic Acid ( HA ) injection . HA is a molecule seen naturally within the cartilage and synovial fluid .

They function by providing lubrication and shock absorption . As with the PEV , they have antiinflammatory properties and help maintain knee homeostasis on a cellular level .

So do they really work ?

There are many studies to suggest that intra-articular knee injection of either blood products or HA can reduce patients ’ pain symptoms . In my thesis , this finding was no different .

We found that patients experienced lesser knee pain after the injection , which led them to be more mobile . As a result , they could go about their daily activities with

We found that patients experienced lesser knee pain after the injection , which led them to be more mobile . As a result , they could go about their daily activities with minimal fuss , leading to healthier physical well-being and an improved emotional and mental one .” minimal fuss , leading to healthier physical well-being and an improved emotional and mental one .

In combination with a local anaesthetic , a steroid injection is also often used in orthopaedic practice . Steroid plays a role in reducing inflammation , whereas the local anaesthetic helps alleviate pain symptoms .

Examples of their use include injections into the shoulder joint in cases of impingement syndrome , around the tendons and in some cases of spine diseases .

While all these injection options are meant to treat a patient ’ s

Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).

A cluster graph showing absolute efficacy vs relative efficacy among the treatment options using conventional , low MW HA ( Molecular Weight Hyaluronic Acid ), IACS ( Intra-Articular Corticosteroids ) and high MW HA by using a healthrelated quality of life interpretation published by Norman GR et al , 2003 .

symptoms , they don ’ t come entirely risk-free . That said , each patients ’ condition should be individualised and treated accordingly , as one shoe will not fit all . — The Health

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