Positive Health Online

Osteoarthritis is the most common musculoskeletal condition in older people. It is estimated that a third of people aged 45 years and over in the UK have sought treatment for osteoarthritis, amounting to a total of 8.75 million people. Knees account for almost half of the recorded cases of osteoarthritis with the Arthritis UK charity estimating it to rise to 5.4 million in 2020, and reaching 6.4 million by 2035.

The condition is a considerable burden on the NHS with an average of 90,000 knee replacements taking place each year in the UK at an average cost of £6,500 each, amounting to a total cost of over £580MILLION each year.

What is Osteoarthritis of the Knee?

With the knee being the largest joint in the body it is also the most complex. Its functions are to allow the leg to bend, straighten and rotate, and it works with the ankles and hips to carry the weight of the body.

When a joint is affected by arthritis it becomes damaged, painful and stiff. This occurs due to the breakdown of cartilage and its inability to repair and regenerate as efficiently as other structures in the body such as muscle and skin. This inability to repair is as a result of its lack of blood supply. As the cartilage wears down, the gap between the bones narrows, causing the bones to begin to rub and form bony spurs (osteophytes). The knee joint has an inner layer called the synovium, which can thicken and result in excess fluid building up, the most common cause of swelling in an arthritic knee. Swelling creates pressure in the knee, which can also contribute to the pain already caused by the friction of the bones rubbing. Arthritis of any joint causes that joint to become unstable, so the supporting structures of the joint are then forced to work harder to stabilize it, leaving them susceptible to injury themselves. The supporting structures of the knee include muscles, tendons, ligaments and the meniscus. Pain and lack of mobility can have a profound impact on an individual’s life physically, socially and mentally.

What Causes Knee Arthritis?

There are many factors involved that predispose an individual to knee osteoarthritis. Much of the population are under the impression that it’s genetics that play a large role but research is now showing other factors have more of an influence such as nutrition, lifestyle, body alignment and our environment.

Harvard University inspected the skeletons of 1,581 people who lived during the 19th century, and who were aged 50 or more, and compared them to those of 819 similar people who lived in the 20th century. After taking into account age and body mass index, cases of knee arthritis had doubled in the latter group, which suggests that something other than age and body weight had something to do with the increase.

The big difference between the two centuries has been the rise of chemicals in our environment, foods and our cosmetics, which may well have more of an impact on the disease than the current culprits that medicine believes are responsible, the researchers say.

Statistics show that knee replacements are considerably less successful than hip replacements and they only last an average of 9 years. This leads sufferers of the condition desperate to seek alternative ways to help keep surgery at bay by both reducing pain and maintaining the health of the cartilage they have left.

Medical Ozone Therapy

In recent years, intra-articular Medical Ozone injections have been making a name for themselves within the medical community for their studied ability to prevent risky knee replacement surgery. Research has proven their pain relieving, anti-inflammatory and regenerative properties for individuals suffering from knee arthritis. The natural treatment uses Medical Ozone and specific nutrients to promote the regeneration and rebuilding of cartilage, alongside other structures within the knee that have suffered degeneration or become painful and weak. The reason cartilage degenerates is because it is one of the only structures in the body that doesn't have a blood supply. When you cut your skin, it heals over and grows back as it has a blood supply. Unfortunately cartilage doesn't have that luxury. Oxygen is the main component within our blood that helps body tissue to heal and regenerate. Medical Ozone is a concentrated form of oxygen. The injected Medical Ozone has been shown in studies to stimulate stem cell production; these are the primary cells the body uses to repair and regenerate damaged body tissue, including cartilage. The stimulated stem cells are deposited in the form of mesenchymal progenitor cells called chondroblasts, which then convert into chondrocytes. These cells are the pre-curser building blocks of cartilage. Medical Ozone injections have shown to not only reduce pain, inflammation and stimulate cartilage growth, but also to repair and strengthen the ligaments within the knee, which have been put under additional strain from the instability arthritis causes within a joint. This increase in cellular repair activity both strengthens and stabilises the knee joint as a whole and, in the majority of cases, significantly reduces pain and stiffness. Medical Ozone is naturally anti-bacterial, so deemed one of the safest injections on offer within medicine. Its impeccable safety record has been the reason why thousands of doctors and practitioners around the world are now adopting it as an effective, non-invasive alternative to risky knee replacement surgery. To fully understand how medical ozone works you first need to understand what causes chronic pain.

What Causes Chronic Pain?

We regularly damage our connective tissues in day-to-day activities, even exercise. When tissue is damaged it attracts growth factors, blast cells and stem cells. These cells help repair the injured area. There are some injuries though where this natural process struggles to perform its job effectively. These injuries then become chronic and cause dysfunction not just in the injured area but often in neighbouring areas of the body. These area struggle to heal due to a decrease in oxygen utilization, meaning the injured structure has been subject to a lack of oxygen and has struggled to utilize enough to heal. Simply put, If the area is supplied with oxygen again it will help facilitate healing and regenerate exactly as it was supposed to.

Common structures that suffer a decrease in oxygen utilization when they are attempting to repair are ligaments, tendons and cartilage. The reason being that ligaments and tendons have a poor blood supply and cartilage doesn’t have a blood supply at all. The main component of blood is oxygen which is why they struggle to heal as efficiently as muscles which have an abundant blood supply. A further issue is a decrease in blood circulation with age.

The following list is of studies conducted using medical ozone for the treatment of knee osteoarthritis:

Review Study: Medical Ozone as a Feasible Future Treatment in Osteoarthritis of the Knee
Conclusion:  There is long term evidence (four decades of clinical use) of the use of Medical Ozone on many diseases and especially on treating musculoskeletal disorders such as knee osteoarthritis. Medical Ozone is able to inhibit inflammatory cytokines, MMP (mineral metalloproteinases), NO (nitric oxide), PGs and to stimulate anti-inflammatory cytokines, growing factors, chondrocytes and stem cells. Medical Ozone diminishes inflammation and favours the trophism, vascularisation and repair of articular cartilage and subchondral bone. The action of Medical Ozone over different targets on knee osteoarthritis postulates it as a promising and wonderful therapeutic weapon capable to diminish pain, articular destruction and recover function and quality of life. Because of all the expected potentials attributed to Medical Ozone therapy in different medical specialties (including knee osteoarthritis), there is the hope that Medical Ozone therapy will be part of medicine in all public hospitals as it is in ours.
View Full Review Study: http://fhgst.es/wp-content/uploads/2016/06/could-ozone-be-used-as-a-feasible-future-treatmentin-osteoarthritis-of-the-knee.pdf

Study: Medical Ozone Improves Pain Relief, Function and Quality of Life in Patients with Knee Osteoarthritis: A Prospective Quasi-Experimental Before-After Study
Results: Our findings indicating that after 3 sessions of injections (1 per week) of 10 mL Medical Ozone at a concentration of 30 ug / mL, a success rate of 80% in pain and stiffness reduction, and functional capacity improvement measured by the WOMAC scale. Medical Ozone is a safe and effective treatment able to significantly reduce pain and stiffness, and to improve function, as measured by VAS/WOMAC scales, in patients with knee osteoarthritis. The results of this study show a good level of evidence as well as a good grade of recommendation, which allows us to use Medical Ozone as a conservative therapeutic option in the treatment of osteoarthritis of the knee.
View Full Study: https://www.researchgate.net/publication/308971612_Ozone_Improves_Pain_Relief_Function_and_Quality_of_Life_in_Patients_with_Knee_Osteoarthritis_A_Prospective_Quasi-Experimental_Before-After_Study

Study: Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis
Results: "Medical Ozone is an efficient therapy in the treatment of damaged articular cartilage in Osteoarthritis. Medical Ozone inhibits the inflammatory milieu which effects the cartilage matrix and induces apoptosis of chondrocytes in osteoarthritis. It produces its beneficial effects by normalizing the cellular redox balance and through the actions of cytokines."
Full Study: http://www.sciencedirect.com/science/article/pii/S1319562X16000498

Study: The Application of Medical Ozone Therapy in patients with Knee Osteoarthritis
Results: "Combined ozone therapy diminished the oxidative stress, achieving an intra-articular redox balance, as well as a significant reduction of pain, with a maintained satisfactory response in 80% of patients in 1-year follow-up. An increase in the quality of life of patients with knee osteoarthritis was observed, without the presence of side effects.
View Full Study: http://download.xuebalib.com/xuebalib.com.9062.pdf

Study: Therapeutic Effect of Low Concentration Medical Ozone on Knee Osteoarthritis
Results: 62 patients presented the symptoms of pain and activity limitation of knee joint and the diagnosis was verified by radiological examination. They were treated by injection of medical ozone(concentration 35μg/mL). 21 males and 41 females with average age of 65.5 years were included. The VAS and HSS score system was used with a success rate of symptom reduction in 72% of patients. In conclusion the injection of low concentration medical ozone into the articular cavity of the knee was a safe and effective method for treating knee osteoarthritis.
View Full Study: http://en.cnki.com.cn/Article_en/CJFDTotal-LZXB201004009.htm

Study: Role of intra-articular medical ozone in osteoarthritis of the knee for functional and symptomatic improvement
Results: " Intra-articular Medical Ozone injections achieved an 80% success rate of a reduction in pain and stiffness which was still apparent during a 6 month patient follow-up."
View Full Study: http://www.austinozone.com/wp-content/uploads/Ozone-Therapy-Intra-Articular-for-Osteo-Arthritis.pdf