Cartilage Loss in People With Arthritis

Doctor pointing with pen to show joint and cartilage on model

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Joint or articular cartilage is the type of cartilage most familiar to arthritis patients. This type of cartilage is also found in the nasal septum and trachea (windpipe). In osteoarthritis, cartilage loss is a significant factor that contributes to disease progression. What is cartilage loss? What predicts rapid cartilage loss? Can anything be done to prevent it or to replace lost cartilage?

Why Do You Need Cartilage?

Articular cartilage serves as the cushion within the joint and as a shock absorber. When cartilage is damaged or worn away, the affected joint becomes painful, stiff, and limited in its range of motion.

These are the symptoms that then lead you to see your doctor to find out what can be done for your joints. That will often lead to further testing and a diagnosis of osteoarthritis.

What Is Cartilage Loss?

Cartilage loss is defined by a decrease in cartilage volume and thickness. It occurs after cartilage wears away or deteriorates.

With the cartilage loss of severe osteoarthritis, the joint space narrows and bone rubs on bone after cartilage loss occurs (sometimes referred to as bone-on-bone). At that point, there is little or no cartilage left to do its job as a shock absorber. In the case of knees and hips, replacement surgery is the solution.

Factors That Predict Cartilage Loss in the Knee

Researchers have analyzed cartilage loss in the knee joint and found that three factors predict it -- medial meniscal damage, lateral meniscal damage, and varus malalignment (bow-legged) of the knee joint.

Another study concurred, revealing that top risk factors that contribute to rapid cartilage loss include cartilage damage, meniscus tears, other injuries to the meniscus, and severe lesions observable on MRI. Synovitis and joint effusion also were predictors of cartilage loss. Interestingly, excess weight was a significant factor as well. For every 1-unit increase in body mass index (BMI), the risk of rapid cartilage loss increased by 11%.

Methods to Slow Cartilage Loss

What can be done to slow or repair cartilage loss? The conservative treatment involves measures to relieve pain and inflammation and reduce the stresses on the joint. There is no evidence that these lead to more growing more cartilage, but it may slow the loss of cartilage.

These tactics include weight loss, bracing, physical therapy exercises, NSAIDs, hormones, supplements (such as glucosamine and chondroitin phosphate), steroid injection into the joint, and Synvisc to replace hyaluronic acid.

Methods to Restore Articular Cartilage

Operative treatments to try to restore cartilage rather than replace the joint are most commonly done for younger patients.

  • Arthroscopic procedures include microfracture, drilling and abrasion arthroplasty, all of which cause small areas of damage and encourage regrowth of cartilage.
  • Grafting procedures implant new cartilage cells or whole sections of cartilage. These include autologous chondrocyte implantation, which harvests your own cartilage cells to implant where they are needed. Osteochondral transplantation takes plugs or blocks of tissues either from the patient or a cadaver donor and grafts them into the joint where they are needed.
  • Research is ongoing into using stem cells, gene therapy, and tissue engineering to restore cartilage.
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