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Diseases

Knee osteoarthritis — are injections and surgery the only option?

Sources: 10 · Article: 13 869 characters

Jan Jaśkowski points out that after one and two years, patients after arthroscopy felt similar to those treated conservatively.

  • In the study he cites, real surgery did not improve pain or mobility more than sham surgery.
  • Jaśkowski recommends good rehabilitation and an assessment of mobility in the feet, hips, and spine, because dysfunctions in these areas can cause knee symptoms.
  • Andrzej Frydrychowski recommends regular movement and, in the case of excess weight, weight reduction and low-impact exercises such as swimming or riding a stationary bicycle.
  • Henryk Różański describes intra-articular administration of hyaluronic acid as a method that may improve joint mobility and reduce pain.

What the authors write

Jan Jaśkowski

After one and two years, patients after arthroscopy and conservative treatment felt similar; the initially small difference in pain after surgery disappeared.

„As it turned out, both groups of patients felt the same after one and two years following the treatment used. Although after 3 and 6 months patients after arthroscopy felt less pain, this difference was extremely small and disappeared 12 months after the surgical intervention.”Jak się okazało obie grupy pacjentów czuły się tak samo po roku i dwóch latach po zastosowanym leczeniu. Co prawda po 3 i 6 miesiącach pacjenci po artroskopii czuli mniejszy ból, jednak ta różnica była niezwykle mała i zanikała po 12 miesiącach od interwencji chirurgicznej.
Dlaczego unikałbym operacji stawu kolanowego. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
Jan Jaśkowski

In the study, real surgery did not improve pain or mobility more than sham surgery.

„Patients were followed for two years after the procedure. As it turned out, regardless of which group they were assigned to, the patients felt the same. No statistically significant differences in pain perception or joint mobility were found between the participants! Meniscal injuries.”Pacjentów obserwowano przez dwa lata po zabiegu. Jak się okazało, niezależnie od grupy do której trafili, pacjenci czuli się tak samo. Nie stwierdzono statystycznie istotnych różnic w odczuwaniu bólu czy ruchomości stawu pomiędzy badanymi! Uszkodzenia łąkotek.
Dlaczego unikałbym operacji stawu kolanowego. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
Jan Jaśkowski

Jan Jaśkowski recommends seeking good rehabilitation and assessing mobility of the feet, hips, and spine when determining treatment for knee pain.

„And a proper diagnosis requires an analysis of the mobility of both foot joints, both hip joints, and the spine. Only on this basis is appropriate treatment introduced. To schedule an appointment, click: https://osteopatagdansk.pl/rezerwacje/ A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee Bruce Moseley, M.D., Kimberly O’Malley, Ph.D., Nancy J.”A prawidłowa diagnoza wymaga analizy ruchomości stawów obu stóp, obu stawów biodrowych, a także kręgosłupa. I dopiero na tej podstawie wdrażane jest odpowiednie leczenie. Aby umówić się na wizytę kliknij: https://osteopatagdansk.pl/rezerwacje/ A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee Bruce Moseley, M.D., Kimberly O’Malley, Ph.D., Nancy J.
Dlaczego unikałbym operacji stawu kolanowego. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
Jan Jaśkowski

Jan Jaśkowski writes that dysfunctions of the foot or hip may cause knee symptoms.

„Can foot dysfunction therefore cause knee symptoms? Absolutely! Can limited mobility in the hip joint limit mobility in the knee joint? Of course! The vast majority of knee joint problems result from dysfunction of the foot and hip!”Czy zatem dysfunkcja stopy może powodować dolegliwości kolana? Jak najbardziej! Czy ograniczenie ruchomości w stawie biodrowym może ograniczać ruchomość stawu kolanowego? Oczywiście! Zdecydowana większość problemów ze stawem kolanowym jest wypadkową dysfunkcji stopy i biodra!
Dlaczego unikałbym operacji stawu kolanowego. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
Andrzej Frydrychowski

Andrzej Frydrychowski points to regular movement as a way of supplying cartilage with nutrients from synovial fluid.

„The only way is to put pressure on the joints through regular movement. Although running causes a number of micro-injuries and damage to muscle fibers, at the same time these exercises strengthen and repair the body, making it stronger and healthier.”Jedynym sposobem jest uciskanie stawów poprzez regularny ruch. Wprawdzie w czasie biegania dochodzi do powstania szeregu mikro urazów i uszkodzeń włókien mięśniowych, ale jednocześnie w wyniku tych ćwiczeń ciało wzmacnia się, naprawia, staje się silniejsze i zdrowsze.
Artroza i co dalej?
Andrzej Frydrychowski

For excess weight, Andrzej Frydrychowski recommends reducing it and, at first, doing low-impact exercises such as swimming or riding a stationary bicycle.

„Weight reduction is a key element of future quality of life. At first, low-impact exercises can be used, for example swimming or riding a stationary bicycle. A ketogenic diet is also very helpful. All types of injuries also contribute to inflammation.”Obniżenie wagi jest kluczowym elementem dalszego komfortu życia. Można stosować na początku ćwiczenia z odciążeniem np. pływanie czy jazdę na stacjonarnym rowerze. Bardzo pomocna jest także dieta ketogenna. Wszelkiego typu urazy również przyczyniają się do powstawania stanu zapalnego.
Artroza i co dalej?
Andrzej Frydrychowski

Andrzej Frydrychowski identifies injuries and overloading as factors that harm cartilage and recommends avoiding them.

„Be careful of all kinds of injuries (sudden impacts, overloading – obesity) and pro-inflammatory substances such as cytokines or leukotrienes (they arise in food intolerances, an unhealthy lifestyle – mainly through consuming excess carbohydrates and fats containing omega-6 and omega-9 acids, etc.).”Uważać na wszelkiego rodzaje urazy (gwałtowne uderzenia, przeciążenia – otyłość) oraz substancje prozapalne, takie jak: cytokiny czy leukotrieny (powstają w nietolerancjach pokarmowych, niezdrowym stylu życia – głównie przez spożywanie nadmiaru węglowodanów i tłuszczy zawierających kwasy omega 6 i 9 itd.).
Artroza i co dalej?
Paul Clayton

Paul Clayton links the risk of worsening cartilage condition with excess weight, chronic inflammation, and lack of movement.

„Today’s combination of excess weight, chronic inflammation, and lack of movement causes excessive cartilage breakdown. In addition, our nutritional status is seriously threatened by an ultra-processed diet. We commonly have deficiencies not only of anti-inflammatory polyphenols and long-chain omega-3 fatty acids, but also of most or all micronutrients needed to build articular cartilage. Therefore, cartilage regeneration is impaired, and because the process of destruction exceeds regeneration, our cartilage plates inevitably deteriorate over time.”Dzisiejsze połączenie nadwagi, przewlekłego stanu zapalnego i braku ruchu powoduje nadmierny rozpad chrząstki. Ponadto nasz stan odżywienia jest głęboko zagrożony przez ultraprzetworzoną dietę. Powszechnie mamy niedobry nie tylko polifenoli przeciwzapalnych i długołańcuchowych kwasów tłuszczowych omega-3, ale także deficyt większości lub wszystkich mikroelementów potrzebnych do budowy chrząstki stawowej.Dlatego regeneracja chrząstki jest osłabiona, a ponieważ proces niszczenia przewyższa regenerację, nasze płytki chrzęstne nieuchronnie z czasem ulegają degradacji.
Dlaczego często bolą nas kolana?
Henryk Różański

Henryk Różański describes intra-articular administration of hyaluronic acid as a method that may improve joint mobility, cartilage nourishment, and reduce pain.

„The most effective and rational method is intra-articular administration of hyaluronic acid, because the mobility of the degenerated joint improves and the process of cartilage nourishment is greatly enhanced. Patients also do not experience as much pain while using the affected joint.”Najbardziej efektywne i racjonalne jest dostawowe podawanie kwasu hialuronowego, gdyż ruchliwość zwyrodniałego stawu ulega poprawie, a proces odżywiania chrząstki znacznie usprawniony. Pacjenci nie odczuwają również tak dużego bólu podczas pracy chorego stawu.
Kwas hialuronowy – Hyaluronic Acid
Henryk Różański

Henryk Różański states that oral and skin-applied hyaluronic preparations have only a theoretical justification.

„The use of hyaluronic preparations orally and on the skin (around affected joints) has only a theoretical justification. Chemically, hyaluronic acid is a heteropolysaccharide (heteropolymer) made of glucuronic acid and N-acetylglucosamine.”Stosowanie preparatów hialuronowych doustne jak i na skórę (w okolice chorych stawów) ma jedynie teoretyczne uzasadnienie. Kwas hialuronowy pod względem chemicznym jest to heteropolisacharyd (heteropolimer) zbudowany z kwasu glukuronowego i N-acetyloglukozaminy.
Kwas hialuronowy – Hyaluronic Acid
Henryk Różański

Henryk Różański notes that the body does not direct orally absorbed ingredients precisely to the affected joint, and administration into the joint cavity may produce better therapeutic results.

„The body does not have the ability to direct an absorbed ingredient precisely to a particular organ (an affected one) and accumulate it there or incorporate it only there (this is how future smart drugs will work). After administration, for example, hyaluronic acid intravenously, it is distributed to all tissues, not only to the affected cartilage tissue in a specific area of the body, for example.”Organizm nie ma zdolności kierowania wchłoniętego składnika dokładnie do określonego organu (chorego) i tam kumulowania go lub tylko tam go wbudowywania (tak będą działać przyszłościowe leki inteligentne). Po podaniu, np.kwasu hialuronowego dożylnie rozprowadzony zostaje on do wszystkich tkanek, a nie tylko chorej tkanki chrzęstnej w określonej okolicy ciała, np.
Chondroitine Sulfuric Acid, chondroitin Sulphate – kwas chondrotynosiarkowy, siarczan chondroityny

Research from PubMed · Europe PMC

We selected 4 studies with the best, positive results. This is a selection, not a full review of all research.

Total number of studies on this topic in PubMed: 2 653.

A meta-analysis found that AD-MSC injections were associated with less pain and better function than control treatment, without a significant increase in adverse events.

Aim of the study: To systematically review randomized controlled trials and quantitatively evaluate the efficacy and safety of injections of autologous adipose-derived mesenchymal stromal cells (AD-MSCs) in patients with knee osteoarthritis (OA).

Results: Of the 1178 identified records, six randomized controlled trials, including 551 patients, were included. Compared with control, AD-MSC treatment was associated with lower WOMAC total scores at 3 months (mean difference [MD], -8.14; 95% confidence interval [CI], -13.33 to -2.95) and 6 months (MD, -8.07; 95% CI, -13.60 to -2.54), and lower pain VAS scores at 3 months (MD, -1.49; 95% CI, -2.45 to -0.54), 6 months (MD, -1.40; 95% CI, -2.08 to -0.73) and 12 months (MD, -1.80; 95% CI, -3.20 to -0.41). The pooled risk of any AEs was not significantly increased (risk ratio [RR], 1.12; 95% CI, 0.99-1.27), and SAEs were rare (RR, 0.48; 95% CI, 0.10-2.18). Intra-articular autologous AD-MSC injections for knee OA were associated with improvements in pain and WOMAC outcomes without a significant increase in AEs.

Autologous adipose-derived mesenchymal stromal cell injection for knee osteoarthritis improves pain and function without a clear increase in adverse events: A systematic review and meta-analysis of randomized controlled trials. · Knee Surg Sports Traumatol Arthrosc 2026
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studycombined analysis of many studies (meta-analysis)

“Not stated” does not mean nobody paid — the database does not always record it.

A meta-analysis of randomized studies found that mesenchymal cell injections improved pain and function after 6 and 12 months.

Aim of the study: The aim of this meta-analysis was to investigate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) alone for the treatment of unoperated knee osteoarthritis (OA).

Results: 8 RCTs and 502 patients with OA were included in the study. Compared with the control group, MSCs significantly improved 6-month WOMAC [MD = 7.44, 95% CI = (1.45, 13.42), P = 0.01] and 12-month WOMAC [MD = 10.31, 95% CI = (0.96, 19.67), P = 0.03]. MSCs also improved VAS and KOOS at 6 and 12 months in patients with OA. Subgroup analysis showed more significant efficacy of adipose source and high doses of MSCs. There was no significant difference between the adverse events in the MSCs group and the control group (P > 0.05). Intra-articular injection of MSCs alone could significantly improve knee pain and dysfunction in patients with unoperated OA. MSCs are expected to be an effective treatment for OA with enhanced delivery efficiency.

Efficacy and safety of mesenchymal stem cells in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. · Stem Cell Res Ther 2025
Money for the studygovernment, public institutions · Natural Science Foundation of Jiangsu Province, Natural Science Foundation of Jiangsu Province for Young Scholars, National Natural Science Foundation of China
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studycombined analysis of many studies (meta-analysis)

“Not stated” does not mean nobody paid — the database does not always record it.

The review indicates that exercise, weight reduction when needed, and education are the foundation of treatment, so methods other than injections and surgery are also available.

Results: Hip and knee OA are highly prevalent and disabling. Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. · JAMA 2021
Money for the studygovernment, public institutions · NIAMS, NIH, HHS
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studydiscussion of other studies

“Not stated” does not mean nobody paid — the database does not always record it.

The review compares arthroscopy with non-surgical treatment, including exercise and medications, showing that alternatives to surgery were studied.

Aim of the study: Arthroscopic knee surgery remains a common treatment for symptomatic knee osteoarthritis, including for degenerative meniscal tears, despite guidelines strongly recommending against its use. This Cochrane Review is an update of a non-Cochrane systematic review published in 2017.

Results: Sixteen trials (2105 participants) met our inclusion criteria. The average age of participants ranged from 46 to 65 years, and 56% of participants were women. Four trials (380 participants) compared arthroscopic surgery to placebo surgery. For the remaining trials, arthroscopic surgery was compared to exercise (eight trials, 1371 participants), a single intra-articular glucocorticoid injection (one trial, 120 participants), non-arthroscopic lavage (one trial, 34 participants), non-steroidal anti-inflammatory drugs (one trial, 80 participants) and weekly hyaluronic acid injections for five weeks (one trial, 120 participants). The majority of trials without a placebo control were susceptible to bias: in particular, selection (56%), performance (75%), detection (75%), attrition (44%) and selective reporting (75%) biases. The placebo-controlled trials were less susceptible to bias and none were at risk of performance or detection bias.

Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). · Cochrane Database Syst Rev 2022
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studyreview of many studies

“Not stated” does not mean nobody paid — the database does not always record it.

Perspectives and opinion materials

The content below presents the authors’ opinions, interpretations and hypotheses. It is not treated as equal to scientific studies and systematic reviews.

Orthomolecular Medicine News Service Opinion material
„For example, there are several medical centers that are advertising using stem cell injections for knee issues. The safest type is "autologous stem cell therapy" which uses the patient's own cells to minimize complications. 6. Orthopedic Surgery Two surgeons (Drs. Zalzal and Weening) do a really nice job of explaining knee pain issues from a surgeon's perspective at www.talkingwithdocs.com. They are big advocates of exercise, drugs in selected cases, and surgery as a last approach. Though they appear to be good, careful doctors, they do not appear to give diet much weight.”For example, there are several medical centers that are advertising using stem cell injections for knee issues. The safest type is "autologous stem cell therapy" which uses the patient's own cells to minimize complications. 6. Orthopedic Surgery Two surgeons (Drs. Zalzal and Weening) do a really nice job of explaining knee pain issues from a surgeon's perspective at www.talkingwithdocs.com. They are big advocates of exercise, drugs in selected cases, and surgery as a last approach. Though they appear to be good, careful doctors, they do not appear to give diet much weight.
Six Approaches to Treat Knee Pain

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