Advanced Treatment
Joint Preservation
Heal and Recondition Through Advanced Orthobiologic Treatment
Exploring the Pathology of Osteoarthritis and Chondromalacia
How Osteoarthritis Starts
With the goal of joint preservation, we have researched the physiology of osteoarthritis and the resulting pathology known as chondromalacia, observing critical steps in this process of joint degeneration.
Initial Trigger:
The initial injury to start the process is mechanical trauma, either from recurrent non-cyclical motions like jumping and running or from a specific injury. Interestingly, prior arthroscopic surgery to "repair" a tear or other joint defect is also defined as an injury.
This initial trauma sets in motion a cascade of physiological events that, over time, leads to progressive joint damage. Understanding this progression is key to developing interventions that can interrupt the cycle.
The Lifecycle of Joint Degeneration
From Youth to Chronic Pain
Teenage Years: Early Warning Signs
As a teenager, running and playing may result in some stiffness or even mild aches and pains. These early symptoms indicate the beginning of the inflammatory cycle, though the protective hyaline cartilage remains largely intact.
What's Happening: Initial mechanical trauma triggers localized inflammation. Sensory nerves (genicular nerves in the knee) begin to signal distress, but the hard protective cartilage still shields most nerve endings from direct mechanical forces.
Decades of Inflammation
When this arthritic cycle of inflammation continues for decades, the hard, protective hyaline cartilage begins to wear in spots, creating thin areas or "potholes," also known as chondromalacia.
What's Happening: Chronic inflammation damages the cartilage matrix. The protective enamel coating develops cavities, similar to dental cavities, gradually exposing the underlying bone and its nerve endings.
Adulthood: The Cycle of Pain
As we get older, similar activities like running or jumping may again result in stiffness, but now there is also significant joint pain. This is because of the worn areas of hyaline cartilage and decreased protection of the nerve endings in the underlying bone.
What's Happening: Exposed nerve endings now directly sense mechanical trauma. Every step, every movement triggers pain signals that release inflammatory proteins (cytokines and interleukins), creating more inflammation and accelerating cartilage breakdown.
Sensory Nerves and Early Symptoms of Joint Pain
Nerves Within the Bone
Every joint in our body has sensory nerves that transmit pain signals. In the knee, these nerves are known as the Genicular nerves. These nerves reside within the bone itself, protected under normal circumstances by the hard hyaline cartilage coating.
Normal Joint Function
Intact hyaline cartilage acts as a protective barrier, shielding sensory nerve endings from mechanical forces during movement.
Result: Pain-free movement, minimal inflammation, healthy joint environment.
Chondromalacia Development
Worn cartilage with cavities exposes nerve endings to direct mechanical trauma with each movement.
Result: Pain signals activate inflammatory cascade, creating a self-perpetuating cycle of damage.
The Cycle of Joint Degeneration and Pain in Adulthood
Cavities Expose Nerve Endings
The pain generated by these compromised nerve endings triggers proteins called cytokines and interleukins to induce even more inflammation inside the joint. This cycle of arthritic joint injury and inflammation leads to progressive joint degeneration and chondromalacia.
The Vicious Cycle:
Exposed Nerves → Pain Signals → Cytokine/Interleukin Release → More Inflammation → More Cartilage Damage → More Exposed Nerves → More Pain
Breaking this cycle requires more than just pain management. It requires addressing both the pain signaling mechanism and the inflammatory environment simultaneously—which is precisely what AROmotion was designed to do.
AROmotion's Approach to Treating Chondromalacia
Turn Off the Pain
AROmotion addresses the underlying factors that have resulted physiologically in chondromalacia and clinically as joint pain, swelling, and weakness. Once the joint has been deemed mechanically intact, RFA (Radiofrequency Ablation) is performed on the base of the sensory nerves affected by the chondromalacia.
Mechanism: By disrupting the signal of pain transmitted by these nerves, the feedback loop of cytokine and interleukin activation has also been stopped.
Stop the Inflammatory Cascade
Pain is not just a symptom; it is the root cause and instigator of joint degeneration. By stopping pain signals, we simultaneously stop the production of Substance-P, the key neuropeptide responsible for the inflammation (arthritis) occurring inside the joint.
Effect: This creates a healthier, calmer joint environment where healing processes can function optimally.
Introduce Orthobiologics in Optimal Environment
With inflammation reduced and Substance-P production stopped, fragile orthobiologic treatments (such as hyaluronic acid or stem cell therapies) can now be placed in this calmed, non-toxic joint environment.
Result: Maximum effectiveness of orthobiologics, which would otherwise rapidly degrade in an inflamed joint. These treatments activate the chondrocyte matrix to regenerate the protective cartilage enamel.
Enable Joint Reconditioning
With pain eliminated and inflammation controlled, patients can immediately begin reconditioning the muscles and ligaments surrounding the joint without the compensatory gait patterns that had developed to avoid pain.
Outcome: Return to normal heel-to-toe walking patterns instead of shuffle gait, strengthening supporting structures and improving long-term joint stability.
Immediate and Long-Term Benefits of RFA Treatment
Normalizing the Joint Environment
Rapid Improvement:
Within days of the RFA procedure, the volume of inflamed fluid inside the synovial joint capsule diminishes, and mobility improves.
The nerves are disrupted for approximately one year, during which time a much more "normal" non-toxic joint environment is present. This extended period allows for substantial healing and reconditioning.
Secondary Benefits: Immediate Reconditioning
There is a secondary benefit of the RFA which is immediate reconditioning of the muscles and ligaments that move the joint. This is because we have "turned off" the nerves that have been causing the joint pain and altering their gait to a shuffle versus normal walking heel-to-toe.
Patients often don't realize how much they've compensated for pain until it's gone. With pain eliminated, natural movement patterns return, allowing proper strengthening and conditioning of supporting structures.
Historical Context and Advancements in RFA for Joint Pain Relief
Building on an Established Pain Management Treatment
1939: RFA First Introduced
The use of RFA to temporarily treat joint pain was first introduced in 1939. However, it was used sporadically because RFA alone did not provide long-lasting relief—pain would return once nerves regenerated without addressing the underlying inflammatory environment.
The Gap: Decades of Limited Application
For decades, RFA remained a niche pain management technique, used occasionally but never achieving widespread adoption due to its temporary nature and lack of comprehensive approach to joint pathology.
2017: AROmotion's Breakthrough
Our exclusive AROmotion methodology goes far beyond simple pain relief. We not only utilize the known value of RFA but have also developed additional steps for placing Orthobiologics inside the joint capsule. This step is critical in activating the chondrocyte matrix which generates the hard enamel that protects the nerves.
The Key Differentiation:
These additional steps differentiate AROmotion as it provides a true healing opportunity versus a simple procedure that may only provide temporary pain relief. We're not just managing pain—we're creating conditions for actual cartilage regeneration.
Enhancing Orthobiologic Treatments with RFA
Why Traditional Orthobiologic Use Often Fails
The current use of Orthobiologics is mainly by Orthopedic Surgeons as a "last ditch" effort to help with knee pain. It typically fails because the fragile Orthobiologic is placed in an angry, inflamed OA knee joint environment resulting in rapid degradation.
Traditional Approach (Fails)
Orthobiologic injected into inflamed joint → Hostile environment with high Substance-P → Rapid degradation of treatment → Minimal to no benefit → Patient disappointment
AROmotion Approach (Succeeds)
RFA stops Substance-P production → Calmed joint environment → Orthobiologic injected → Maximum effectiveness → Chondrocyte activation → Cartilage regeneration
Unique Position:
AROmotion is the only group in the U.S. that combines the RFA with hyaluronic acid or other Orthobiologics to create an augmented environment for healing. This combination therapy approach addresses both the symptom (pain) and the cause (inflammatory environment and cartilage damage).
Clinical Data
Patients Achieve Lasting Pain-Relief
In early 2017, we initiated the first cases of AROmotion, a pioneering nonsurgical alternative to total joint replacement, combining radiofrequency ablation, orthobiologic therapies, and total joint reconditioning. We have treated over 8,000 joints. AROmotion is one of the largest providers of nonsurgical RFA with orthobiologic procedures and patient-centric reconditioning protocols.
8,000+
Joints Treated
9 Years
Of comprehensive longitudinal data
Exceeds TJR
Outcomes surpass total joint replacement
Clinical Case Series
Our physicians are trained observers conducting a multi-year, structured research protocol measuring both pre- and post-procedural outcomes in our over 8,000 cases. The results since launching our clinical case series show that AROmotion has consistently outperformed total joint replacement surgery.
We follow each patient's pre- and post-procedure data using the WOMAC Data Model, collected for 9 years. Our improvement in scores unequivocally shows lasting improvement that exceeds patients who have undergone total joint replacement surgery.
The WOMAC Index: Gold Standard Assessment
Comprehensive Outcome Measurement
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely used in the evaluation of Hip and Knee Osteoarthritis. It is a self-administered questionnaire consisting of 24 items divided into 3 subscales. WOMAC Index was developed in 1982 at Western Ontario and McMaster Universities and is available in over 65 languages with full linguistic validation.
Pain Assessment (5 items)
- • During walking
- • Using stairs
- • In bed
- • Sitting or lying
- • Standing upright
Stiffness Assessment (2 items)
- • After first waking
- • Later in the day
Physical Function (17 items)
- • Using stairs
- • Rising from sitting
- • Standing / Bending
- • Walking
- • Getting in/out of car
- • Shopping
- • Putting on/off socks
- • Rising from bed
- • Getting in/out of bath
- • Heavy/Light duties
Why WOMAC Matters:
This comprehensive assessment captures the full spectrum of patient experience—not just pain reduction, but actual functional improvement in daily life activities. Our superior WOMAC scores demonstrate that AROmotion patients experience better overall outcomes than those who undergo total joint replacement.
Talk with our Doctors
Find out if you are a candidate
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.