Sometimes I will come across a concept which I feel could be  revolutionary.  A few months ago I had just such a brainstorm.  I borrowed concepts from two fields I am very much familiar with.  This involves the field of Orthopedic Surgery and Regenerative Medicine.  Unlike some people in the Regenerative Medicine field who imply that they are Orthopedists when they are really trained in another speciality, I trained and became certified in Orthopedic Surgery.  This gives me a distinct advantage when looking a musculoskeletal conditions. I can see both worlds without looking through a looking glass.

I combined ideas as an Orthopedic surgeon and a Regenerative Medicine Specialist.  We have known in Orthopedics that for those people with osteoarthritis an arthroscopy would give temporary relief of symptoms.  This concept is well documented in the literature.  However, I did not then, nor do I now think it is wise to subject someone to an invasive operative procedure for temporary relief.  So this concept seems to have some merit if we can minimize the invasiveness and prolong the relief.  It is well known that certain inflammatory cytokines or growth factors are responsible for the swelling and the pain associated with osteoarthritis.  If we can disable these cytokines then we can eliminate many symptoms.  Just washing out the knee will not really accomplish this feat.  These bad growth factors are typically bound to the cell membrane receptors.  These bad cytokines can only be disabled by other types of cytokines.  The trick is to know which ones, what combinations, and what dosages.  Cytokines are not very forgiving and the wrong combination or dosage will have little if any effect.

The other idea is that we need to help improve function by allowing the joint to move more smoothly.  We know that hyaluronic acid many times can achieve this goal but this typically takes time and a number of injections.  We know that hyaluronic acid works fairly well but there is another lubricating compound that works much better.  This compound is called Lubricin.  Lubricin is also called “superficial zone protein” (SZP). Lubricin and SZP are now collectively known as Proteoglycan 4 (PRG4).  Lubricin (PRG4) seems much more efficient than hyaluronic acid.  Unfortunately, Lubricin is not easy to come by.  Like many great accomplishments we discovered the stimulating process by accident.  We get results in almost every patient which is fairly unusual in medicine.  We have treated a few patients with our proprietary lavage only, with excellent results.  I do not think that Artholavage is a long term solution (but than again I do not know). I do think that it will increase our overall success.  We have combined ideas from two distinct medical specialties and made one concept. I suspect it will catch on in time but it will be difficult to know the tricks that make it work.

Thanks Dr. P.