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Twenty-seven million Americans have degenerative arthritis, called osteoarthritis. The rate of knee replacement surgery has dramatically risen, by a factor of ten in the last thirty years. Over 100,000 knee replacement procedures are performed every year. However, evaluation of knee x-rays has not confirmed an increase in radiologic abnormalities to coincide with the increase in surgical procedures. (Annals of Internal Medicine, Dec 6, 2011, pp. 725-731)

Presumably, the reason behind increasing surgery is an increase in pain. The authors propose that knee pain not due to arthritis might occur as a consequence of obesity. They did not consider unfavorable alterations in diet toward inflammatory foods such as sugar and sugar substitutes, and meat, and a paucity of anti-inflammatory foods like fruits, vegetables, and omega 3 fatty acids found in fish. They also did not mention that heavily utilized anti-inflammatory drugs, the NSAIDs, may inhibit healing of soft tissues, paradoxically leading to an increase in pain.

Arthroscopy, a procedure to clean out loose cartilage and torn tissues from the knee joint, is regarded as ineffective in the literature, although tens of thousands of these procedures are performed yearly. Some patients report good results from this arthroscopy, usually those who have sustained recent injury.

We have witnessed substantial reductions in joint pain through dietary changes and the addition of nutritional supplements, such as high dose omega 3 fatty acids. Knee injections with prolotherapy and platelet rich plasma are often effective, especially when x-rays reveal less evidence of joint degeneration. Early next year we plan to start injections with ozone, which reportedly is also effective in reducing joint pain.

Weight loss, maintaining range of motion, and a good physical therapy program, to include evaluation for myofascial trigger points, are likely to defer or prevent joint replacement surgery.

Allan Sosin MD

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