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Does lack of cartilage in knee require surgery?

Q: My 26 years old friend's X-ray of right knee shows lack of cartilage. For this she has been prescribed these medicines – Duralone, Mexate-7.5, Lorsaid, Zorbfer, Motivit, Lycored, Folvit, Rockbon. Can my friend recover with these medicines or will she require some surgery?

A:You have mentioned that your friend’s X-ray shows lack of cartilage. You have mentioned only right knee joint being affected. So, I presume none of the other joints have been affected. You also mentioned that in treatment she is taken a long list of medicines which are normally given for patients with rheumatoid arthritis or such similar inflammatory arthritis. If she actually has arthritis and the cartilage is damaged sufficiently show on X-rays then there is very little that medicines can do to restore the cartilage. You need to be in consultation with a rheumatologist regarding medicines to keep the arthritis under control so that further damage does not take place. This is important as she is young and she needs to protect and preserve whatever little cartilage she has. A number of new medicines have come out in the market which claims to help regeneration of cartilage. However, there is no sufficient evidence to actually demonstrate that damaged cartilage regenerates in response to these. Number of these is actually nutritional supplements which may help in people with deficient diet. As it there is no medicine which can really help regeneration of cartilage. If the cartilage loss is in a small restricted area then surgical intervention of transplanting cartilage from other areas may help. But this is usually done in cases with cartilage loss in select cases. Such surgeries (known as mosaicplasty) are also not widely popular. Because surgery in such joints always carries a risk of additional stiffness. You have also not mentioned anything about your friend’s range of movement and stiffness, if any, in the knee joint. Stem cells are being considered in some centers. However, this is still experimental and this could be the future of cartilage regeneration/repair. As of today, I think the best hope for your friend is to be in touch with a good rheumatologist who should be able to:

  • Clinically assess her for the activity of the arthritis that she has by looking at morning stiffness, swelling, etc.
  • Bio-chemically assess her by looking at blood tests like; ESR
  • Keep the activity of her arthritis under control by giving drugs like; Mexate (Methotrexate), HCQS, these are known as disease modifying drugs.
  • Guide her on physical activity and physiotherapy to keep her muscle tone and coordination and range of movement as near normal as possible.
  • Refer her if there is any indication for surgical intervention.

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