Evidence-Based Medicine
Research & Clinical Studies
Peer-reviewed research and clinical studies supporting the science behind AROmotion joint procedures, while highlighting critical issues in orthopedic surgery, including persistent post-replacement pain, complications, inappropriate patient selection, and limitations of conventional treatments for degenerative osteoarthritis.
Understanding Osteoarthritis
Pain in osteoarthritis results from erosion of joint cartilage
Marshall Devor. (2024). Pain in osteoarthritis: Driven by intrinsic rather than extrinsic joint afferents and why this should impact treatment. Interventional Pain Medicine.
Molecular mechanisms regarding osteoarthritis and pain
Andrew S. Lee, Michael B. Ellman, Dongyao Yan, Jeffrey S. Kroin, Brian J. Cole, André J. van Wijnen, & Hee Jeong Im. (2013). A current review of molecular mechanisms regarding osteoarthritis and pain. Gene, 527(2), 440–447.
Synovial inflammation contributes to osteoarthritis progression
Sanchez-Lopez, E., Coras, R., Torres, A., Lane, N. E., & Guma, M. (2022). Synovial inflammation in osteoarthritis progression. Nature Reviews Rheumatology, 18(5), Article 5.
Synovial Macrophages regulate the progression of osteoarthritis
Haiyan Zhang, Daozhang Cai, & Xiaochun Bai. (2020). Macrophages regulate the progression of osteoarthritis. Osteoarthritis and Cartilage, 28(5), 555–561.
Cartilage Can Heal
Mechanism on the repair of articular cartilage
Issei Ishii, Hiroshi Mizuta, Akira Sei, Jun Hirose, Satoshi Kudo, & Yuji Hiraki. (2007). Healing of full-thickness defects of the articular cartilage in rabbits using fibroblast growth factor-2 and a fibrin sealant. Journal of Bone and Joint Surgery-British Volume, 89(5), 693–700.
Micro-fragmented adipose tissue for treatment of knee osteoarthritis
Jennifer R. Arthurs, Catherine Desmond, Sarvam P. TerKonda, & Shane A. Shapiro. (2018). Micro-fragmented adipose tissue for treatment of knee osteoarthritis with Baker's cyst: A case study. Case Reports, 2018, 224426.
The basic science of articular cartilage: Structure, composition, and function
Allison M. Fox, Asheesh Bedi, & Scott A. Rodeo. (2009). The basic science of articular cartilage: Structure, composition, and function. Sports Health: A Multidisciplinary Approach, 1(6), 461–468.
Radiofrequency Ablation
Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial
Choi, W.-J., Hwang, S.-J., Song, J.-G., Leem, J.-G., Kang, Y.-U., Park, P.-H., & Shin, J.-W. (2011). Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. PAIN®, 152(3), 481–487.
Radiofrequency of genicular nerves is safe and significantly alleviates pain and disability in patients with severe degenerative disease
Erdem, Y., & Sir, E. (2019). The Efficacy of Ultrasound-Guided Pulsed Radiofrequency of Genicular Nerves in the Treatment of Chronic Knee Pain Due to Severe Degenerative Disease or Previous Total Knee Arthroplasty. Medical Science Monitor, 25, 1857–1863.
RFA provided sustained pain relief, improved function, and perceived positive effect through 24 months
Hunter, C. W., Davis, T. R. C., Loudermilk, E., Kapural, L., DePalma, M. J., & DePalma, M. (2020). Cooled Radiofrequency Ablation Treatment of the Genicular Nerves in the Treatment of Osteoarthritic Knee Pain: 18- and 24-Month Results. Pain Practice, 20(3), 238–246.
Orthobiologics
Clinical results of treatment with adipose-derived stem cells for knee osteoarthritis
Yong-Gon Koh, Yeonho Choi, Sae-Kwang Kwon, Yong-Sang Kim, & Jee-Eun Yeo. (2015). Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 23(5), 1308–1316.
Treatment of Knee Osteoarthritis With Autologous Mesenchymal Stem Cells: Two-year follow-up results
Orozco, L., Munar, A., Soler, R., Alberca, M., Soler, F., Huguet, M., Sentís, J., Sánchez, A., & García-Sancho, J. (2014). Treatment of knee osteoarthritis with autologous mesenchymal stem cells: Two-year follow-up results. Transplantation, 97(11).
A Randomized, Double-Blind, Controlled Study: Intra-Articular Injection of Mesenchymal Stem Cells to the Knee
C. Thomas Vangsness, Farr, J., Boyd, J. L., Dellaero, D. T., Mills, C. R., & LeRoux-Williams, M. (2014). Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: A randomized, double-blind, controlled study. Journal of Bone and Joint Surgery, American Volume, 96(2), 90–98.
Persistent Pain After Replacement
Patients report long-term pain after total hip or knee replacement
Beswick, A. D., Wylde, V., Gooberman-Hill, R., Blom, A., & Dieppe, P. (2012). What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2(1), e000435.
Up To A Third Of Knee Replacements Pack Pain And Regret
Szabo, L. (2018, December 25). Up To A Third Of Knee Replacements Pack Pain And Regret. KFF Health News.
Individuals reported their outcome from TKR as good despite continued experience of pain and immobility
Gillian Woolhead, J L Donovan, Paul Dieppe. (2005). Outcomes of total knee replacement: A qualitative study. Rheumatology, 44(8), 1032–1037.
Persistent postsurgical pain is common after joint replacement
Vikki Wylde, Sarah Hewlett, Ian D. Learmonth, & Paul Dieppe. (2011). Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain, 152(3), 566–572.
Patient quality of life during the 12 months following joint replacement surgery
Fitzgerald, J. D., Orav, E. J., Lee, T. H., Marcantonio, E. R., Poss, R., Goldman, L., & Mangione, C. M. (2004). Patient quality of life during the 12 months following joint replacement surgery. Arthritis Care & Research, 51(1), 100–109.
Joint Replacement Complications
10-year revision rate of 10% for Total Knee Replacement and 7% for Total Hip Replacement
Victor M. Goldberg, Joseph A. Buckwalter, Michael Halpin, William A. Jiranek, William M. Mihalko, Michael S. Pinzur, B. Rohan, Thomas P. Vail, Peter S. Walker, Russell E. Windsor, & Wright, T. M. (2011). Recommendations of the OARSI FDA Osteoarthritis Devices Working Group. Osteoarthritis and Cartilage, 19(5), 509–514.
Replacement Revision leads to significantly greater likelihood of subsequent re-revisions
Kevin Ong, Edmund Lau, Jeremy F. Suggs, Steven M. Kurtz, & Michael Manley. (2010). Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty. Clinical Orthopaedics and Related Research, 468(11), 3070–3076.
Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure
S. Mehdi Jafari, Catelyn Coyle, Seyed Mohammad Javad Mortazavi, Peter F. Sharkey, & Javad Parvizi. (2010). Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure. Clinical Orthopaedics and Related Research, 468(8), 2046–2051.
Obese patients have a higher risk of complications following primary total knee arthroplasty
Chad D. Watts, Eric R. Wagner, Matthew T. Houdek, Douglas R. Osmon, Arlen D. Hanssen, David G. Lewallen, & Tad M. Mabry. (2014). Morbid obesity: A significant risk factor for failure of two-stage revision total knee arthroplasty for infection. Journal of Bone and Joint Surgery, American Volume, 96(18), 326–332.
Difficulties with Recovery from Joint Replacement
Limitations to mobility and impact on Recovery
Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: Systematic review and meta-analysis of benefits and harms. BMJ, 350, h2747.
Issues with Joint Replacement Patient Selection
Pain, function, and radiographic severity are not associated with a surgeon's recommendation for knee replacement
Gossec, L., Paternotte, S., Maillefert, J. F., et al. (2011). The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthritis and Cartilage, 19(2), 147–154.
The discordance between clinical and radiographic knee osteoarthritis
John Bedson & Peter Croft. (2008). The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskeletal Disorders, 9(1), 116–116.
Poor correlation between radiographic score, function, pain or muscle power
Karen Barker, Sarah E Lamb, Francine Toye, Sarah Jackson, & Sharon Barrington. (2004). Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clinical Rehabilitation, 18(7), 793–800.
High prevalence of superior labral tears in asymptomatic shoulders
Schwartzberg, R., Reuss, B., Burkhart, B., Butterfield, M., Wu, J., & McLean, K. (2016). High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulders. Orthopaedic Journal of Sports Medicine, 4(1), 232596711562321.
Prevalence of abnormal hip findings in asymptomatic participants
Register, B., Pennock, A., Ho, C., Strickland, C., Lawand, A., & Philippon, M. (2012). Prevalence of abnormal hip findings in asymptomatic participants. The American Journal of Sports Medicine, 40(12), 2720-2724.
Arthroscopy
Arthroscopy is no better than Sham Surgery for Degenerative Osteoarthritis
Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., Kalske, J., & Järvinen, T. L. N. (2013). Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. New England Journal of Medicine, 369(26), 2515–2524.
Meta-analysis does not support the practice of arthroscopic surgery for middle-aged or older patients with knee pain
Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: Systematic review and meta-analysis of benefits and harms. BMJ, 350, h2747.
Arthroscopic knee meniscectomy surgery is associated with a three-fold increase in the risk for future knee replacement surgery
Rongen, J. J., Rovers, M. M., van Tienen, T. G., Buma, P., & Hannink, G. (2017). Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: A multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthritis and Cartilage, 25(1), 23–29.
Limitations of Cortisone Shots
Intra-articular triamcinolone resulted in significantly greater cartilage volume loss than saline
Timothy E. McAlindon, Michael P. LaValley, William F. Harvey, Lori Lyn Price, Jeffrey B. Driban, Ming Zhang, & Robert James Ward. (2017). Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA, 317(19), 1967–1975.
The pain relief from corticosteroid injection is limited to weeks in duration
Clifford Tate Hepper, Jason J. Halvorson, Stephen T. Duncan, Andrew M. Gregory, Warren R. Dunn, & Kurt P. Spindler. (2009). The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: A systematic review of level I studies. Journal of The American Academy of Orthopaedic Surgeons, 17(10), 638–646.
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AROmotion has helped thousands of patients achieve rapid and lasting pain relief, including those who were told they were 'bone-on-bone' and that their only orthopedic option was total joint replacement.