To Stop Osteoarthritis, Fixing Cartilage May Not Be Enough

Fifty years ago, doctors knew little about osteoarthritis except that it damaged the joints and sometimes caused excessive pain. Today, the disease is far better understood—researchers have gained insight into the mechanical, genetic, and biochemical factors underlying osteoarthritis, and many pharmaceutical companies have long-standing programs devoted to the search for ways to prevent or slow the disease. However—notwithstanding the advent of surgery—most people with osteoarthritis today are little better off than those who had it 50 years ago.

There is still no way to stop the progress of osteoarthritis once it starts corrupting joints. Treatment is symptomatic, focusing on strategies to reduce pain and disability. Pain is commonly managed with over-the-counter and prescription pain-relieving medications. Doctors also counsel patients to lose weight, if needed, and to exercise; even modest weight loss among obese patients can reduce symptoms by taking stress off of joints, and walking and other exercises can help strengthen muscles and create more flexible joints. When all else fails and the disease causes serious pain and disability, some people require surgery. Without more effective treatment to stop painful osteoarthritis, the demand for surgery is expected to rise dramatically. A recent projection study prepared for the American Academy of Orthopaedic Surgeons estimated a 673% increase in total knee replacements and a 174% increase in total hip replacements by 2030 (1). The study also estimated that revision surgeries for total hip and total knee replacements would more than double over the next 2 decades.

Surgeons pioneered total joint replacement procedures in the 1950s and 1960s. Few doctors back then would have guessed that so much time would pass without the arrival of other ways to change the course of the disease. “In the intervening years since the development of total joint replacement, we have learned a lot about osteoarthritis. …