The causes of arthrosis are many and its treatment is all the more delicate because the developmental stage at which we intervene plays a determining role. Between the initial stage, where traditional medicine offers only pain killers and anti-inflammatories – or even the withholding of treatment – and the final stage, where the prosthetic surgeon these days is the only solution, there is an intermediate stage where, each day, doctors are confronted by their patients’ complaints and a lack of effective treatments.
In our medical-surgical practice we discovered, very early on, a third way which allows us to limit the development of arthrosis, which is intolerable today, by completely reducing the inflammatory phenomena and pain associated with the destruction of the cartilage. In the 1990s, we started to use nutritional supplements. Criticized strongly at the time, these supplements were initially accepted by the EULAR (European League Against Rheumatism) under the term SYSADOA (Symptomatic Slow Acting Drugs in Osto-Arthritis) because of their encouraging results.
This came to light through direct observation of our patients and we were convinced that we were proceeding in the right direction. It was without fanfare or conceit, but with a certain amount of intellectual satisfaction that we witnessed, in 2010, the reimbursement of glucosamine-based nutritional supplements by the French Social Security system, when glucosamine had already been in use for 10 years.
At that time, we participated in some studies, neither random nor controlled, but undertaken by some small nutritional supplement laboratories. These studies marked the end of the development of arthrosis and the efficacy of glucosamine-based adjuvant treatments.
We knew, like everyone else, that arthrosis was a multi-faceted disease. We had, in the meantime, decided to focus on an aspect which seemed to us to be, at the same time, important yet simple to manage: the mechanical element of compression.
Moreover, our target group for research was chosen by degree of importance in terms of number of patients involved and the ease with which they could be reached.
We were committed to reducing the factors involved in destroying cartilage and the inflammatory pain of internal arthrosis of the knee in the case of bow-leggedness (genu-varum): in many of our adult patients with internal arthrosis, we installed different types of knee orthoses with a view to limiting the varus angle of the affected limb. The placement of such a material required an observation time of six weeks to have the first clinical results as well as a reduction of pain and the taking of pain-killers.
Of the 120 patients studied, we were able to delay, by two years, the date of an osteotomy operation. The failure rate was 10%, essentially due to non-observance.
We extensively studied the physiopathology of arthrosis due to excessive compression. Faced with results that were not very satisfying because we had used knee orthoses available on the market, we were led to the point of using an external medical apparatus that we had invented called the Dynamic Anti-Arthritis knee Orthosis (D2AO).
We called it “dynamic” because it involved two essential mechanical factors:
- decompression upon impact with the ground during walking
- re-establishing contact with articular surfaces, indispensable to the cartilaginous metabolism
We also considered it dynamic because the decompression, if it limits the destruction of the cartilage, does not involve an eventual scarring and reconstruction of the cartilaginous zone. During tibial valgisation osteotomies, the cessation of compression protects the internal compartment but puts pressure on the external one and there is no action of reconstruction or scarring on the internal compartment. This is due to the fact that for an active metabolism to participate in regenerating damaged articular surfaces, it requires not only to stop the force of the mechanical impact at the moment of impact when the foot contacts the ground but also favours a re-establishment of contact with the cartilaginous surfaces to permit the circulation of fluids inside the cartilaginous tissues.
Also, the D2AO, after discharge at the moment of contact, allows a re-establishment of contact with the articular surfaces at the time of knee flexing at a moment when the pressure-bearing forces are limited.
This type of dynamic knee orthosis, which combines protection by limiting the shock wave at the moment of contact and activation of the metabolism by limited pressure without force should be used as an adjunct therapy in new study areas such as hyaluronic acid and stem cell injection.
What we have observed here is a modern non-invasive therapeutic concept which is one of the most promising alternatives to osteotomy surgery and mono-compartmental prostheses but also a therapy capable of postponing total prosthetic replacement.