Joint Preservation

Heal and Recondition

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.

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.

Sensory Nerves and Early Symptoms of Joint Pain

Nerves within the bone

Every joint in our body has a sensory nerve that tells us there is pain. In the knee, these nerves are known as the Genicular nerves. As a teenager, running and playing may result in some stiffness or even mild aches and pains.

But, when this arthritic cycle of inflammation goes on for decades, the hard, protective hyaline cartilage wears in spots, creating thin areas or "potholes," also known as chondromalacia.

The Cycle of Joint Degeneration and Pain in Adulthood

Cavities expose nerve endings

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.

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.

AROmotion's Approach to Treating Chondromalacia

1st 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 is performed on the base of the sensory nerves affected by the chondromalacia.

By disrupting the signal of pain transmitted by these nerves, the feedback loop of cytokine and interleukin activation has also been stopped. Pain is not just a symptom; it is the root cause and instigator of joint degeneration.

Immediate and Long-Term Benefits of RFA Treatment

Normalizing the joint environment

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. 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 vs. normal walking heel-to-toe.

Historical Context and Advancements in RFA for Joint Pain Relief

Building on an Establish pain management treatment

The use of RFA to temporarily treat joint pain was first introduced in 1939 and has been sporadically used as RFA alone did not provide long-lasting relief. 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. These additional steps differentiate AROmotion as it provides a true healing opportunity versus a simple procedure that may only provide temporary pain relief.

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 surpassed 4,000 procedures. AROmotion is the largest and only provider of nonsurgical RFA with orthobiologic procedures and patient-centric reconditioning protocols.

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 4,000 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 7 years. Our improvement in scores unequivocally shows lasting improvement that exceeds patients who have undergone total joint replacement surgery.

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:

Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing upright
Stiffness (2 items): after first waking and later in the day
Physical Function (17 items): using stairs, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic duties, light domestic duties.

WOMAC Index was developed in 1982 at Western Ontario and McMaster Universities. WOMAC is available in over 65 languages and has been linguistically validated..