Professor Ali Ghoz, a consultant trauma and orthopaedic surgeon at the Cromwell Hospital in London, is treating increasing numbers of patients from the Middle East for knee osteoarthritis.
“Much of my work specialises in hip replacements, anterior cruciate ligament (ACL) and ligament reconstruction, but I’m also seeing increasing numbers of patients who require knee replacement surgery as a result of osteoarthritis.
“Rates of arthritis, and particularly knee osteoarthritis, are increasing worldwide and I’ve seen a marked uplift in patients from the Middle East. This is no doubt related to the fact that cases of osteoarthritis are increasing at a faster rate in the region than anywhere else in the developed world. Between 1990-2019, the incidence of arthritis in the Middle East increased by almost 10%, with osteoarthritis the most common cause [1].
“There are a number of causes of knee osteoarthritis: higher than average BMI; previous knee injuries; repetitive use of the joint; low bone density; muscle weakness; joint laxity; and ageing. It’s also important to stress that knee osteoarthritis is not an “old person’s” condition – it is most common among those aged 40+, with women more susceptible than men.”
In the Middle East specifically, Vitamin D deficiency has been linked as an increased risk, with approximately 80% of the population suffering from this. Other studies have suggested that lifestyle, diet, and cultural habits – for example, common sitting positions – make the population here more susceptible.
“Until recently, common treatment options for patients, regardless of where they are in the world, have included physiotherapy, weight-loss regimes, neuromuscular and proprioceptive training programmes, knee braces, injections, pain management and, as a last resort, knee replacement surgery. The latter often becomes inevitable and, rightly, is met with significant trepidation among my patients, as it can bring with it complications, a hospital stay, a lengthy recovery period, and time off work.
“The good news for sufferers of knee osteoarthritis is that new treatments are emerging which can mitigate the need for surgery. As a specialist in orthopaedics for many years now, I am very interested in non-surgical procedures, such as therapy injections, to ensure my patients can benefit from a full ‘portfolio’ of treatment options, dependent on the severity of their condition.
Intra-articular polyacrylamide hydrogel injection
“I’m particularly excited by a new European treatment, Arthrosamid, which is an intra-articular polyacrylamide hydrogel injection (iPAAG). Unlike previous forms of injections which contained steroids and hyaluronic acid to simply mask the pain temporarily, Arthrosamid is offering a far more holistic solution for patients. A single, minimally invasive, 6ml injection of 2.5% polyacrylamide hydrogel can negate the need for invasive surgery, which is a game-changer in the orthopaedic sphere and one of the most exciting developments in years.”
Although the medication is not yet approved in the UAE or any other GCC country, it was granted European approval in 2021 for the symptomatic treatment of patients with knee osteoarthritis.
The results since have been very encouraging, and a recent long-term study [2], presented at the Osteoarthritis Research Society International (OARSI) World Congress in March, revealed that a single injection maintained a statistically significant reduction in pain in patients three years after treatment. Its ‘mechanism’ of action compared to other injections makes it so unique and all the more promising. In simple terms, the hydrogel is permanently integrated in the synovial tissue of the inner capsule (the soft tissue lining of the knee), blocking inflammation and lubricating the joint. Its action is physical, not chemical, and results in decreased stiffness, reduced pain and improvement in overall function of the knee.
“I have recently reached the ‘100 patient’ milestone with the treatment in my London clinic. Equal success rates have been experienced across the age range of 40 to 90 years, depending on the severity of the arthritis. There are a variety of levels of improvement, from 100% pain relief, to those experiencing between 50 to 80%.
“As a safe form of treatment, with no side-effects or complications, I’ve seen first-hand how it is helping patients to improve their knee function and mobility, offering them a valuable alternative and long-acting respite from the pain and immobility of knee osteoarthritis.
“Of course, this cannot take away from the importance of educating patients about early preventative approaches to help manage any future health, economic and quality of life crises as a direct result of osteoarthritis. Key preventative measures I would personally recommend for anyone concerned about developing the condition include regular, low-impact exercise – such as walking, swimming and cycling, and maintaining a healthy weight. Specifically for those living in the Middle East, I would advise wearing proper footwear and avoiding sitting in one position. Ensuring vitamin D and calcium intake is also vital.
“The positive news for those who have knee osteoarthritis, however, is that treatment for this extremely painful and debilitating condition is improving and evolving at an impressive rate. Intra-articular polyacrylamide hydrogel injections are setting a new benchmark and offering hope to the growing number of people living with the condition.”
