Physiology of Joint Pain

Words Matter

Misconceptions in Orthopedic Language and Their Implications

Over-prescribing surgical procedures
In Medicine, where using the 'wrong words' could lead to unnecessary procedures; we found the phrase of a knee being “shot” was defined differently from a surgeon’s perspective vs a non-surgical physician's. The surgeon views the problem as purely mechanical; it was simply a matter of which surgery would be the most suited to treat the issue, but when pressed for deeper reasoning, there is little substance regarding what precisely defines a joint as being “shot.”
Specifically, when the joint was narrowed or “bone on bone” the surgeon views the joint as beyond arthroscopic surgical repair and that either living with the pain or total joint replacement surgery were the only options he could offer as an orthopedic surgeon.

The Orthopedic Surgeon's Toolbox

Cutting, Sawing, and Implantation
It became clear that there are essentially two tools in the 'orthopedic toolbox', arthroscopy and total joint replacement. Arthroscopic repair is a cutting and grinding surgery to remove pieces of the meniscus that may be “flip-flopping” and get stuck inside the joint, causing pain compared to a rock getting stuck in one’s shoe.
However, if the surgeon felt that there was little or no joint space on imaging, then there was nothing to get stuck to cause the mechanical pain and, therefore, no role for arthroscopy. The cause of the joint pain must then be secondary to arthritis and wear and tear of the hard articular cartilage that coats the ends of the bone. These cavities in the hard enamel are identical to dental cavities and the resulting pain is also the same. This is known as chondromalacia.

Prior Treatments Before AROmotion

Limited Options in Traditional Orthopedic Surgery
Prior to AROmotion, the only options available were living with pain, addictive medications, or total joint replacement surgery. There is no role for the cutting and shaving of an arthroscopy since the underlying problem is chondromalacia or cavities of the articular cartilage enamel protecting the underlying bone. The only orthopedic surgical option for this problem is total joint replacement.

Understanding Joint Cartilage and Pain Signaling

There are two types of cartilage in your joints.
  • Fibrous cartilage, which is much like a leathery pad which makes up the meniscus which is an extra cushion for the joint.
  • Articular cartilage, which is a hard enamel that coats the ends of the bones that make up the joint.
This hyaline cartilage or Type 2 collagen is the same hard white enamel covering your teeth. Its purpose is twofold, to provide a slick hard surface for the joint to slide over and to protect the underlying living bone from the mechanical trauma of the joint performing its function.
The fact is that the only place where there are sensory nerve endings that can transmit pain in the joint is inside the bone. Again, these nerve endings are protected by the same hard white enamel protecting your teeth; you will also find this hard hyaline cartilage at the end of a chicken bone.
Chondromalacia is the medical term for wearing out of this cartilage in small divots or cavities. The process is exactly like a dental cavity and the nerve pain is the result of the lack of enamel for protection. These exposed sensory nerve endings underneath the compromised enamel now sense the pressure and trauma of daily activity. Communicating to the brain the sensation of pain.

Clarifying the Real Cause of Joint Pain

Cavities and unprotected nervers
So simply stated, if there is not a mechanical issue like a flip-flopping torn piece of the meniscus or a loose fragment of bone floating inside of the joint, there is only one other thing that can be causing the knee pain, chondromalacia, or cavities in the protective enamel, resulting nerve irritation and pain. From a strict orthopedic perspective, there are two treatment options, arthroscopy, and total joint replacement.
If the X-Ray appears to be “bone on bone” and the patient’s clinical exam does not exhibit a mechanical cause of the pain, the cause must be chondromalacia. Since these “potholes” are the source of the pain, there is no role for an arthroscope as it is a cutting and grinding instrument.

90% of Total Joint Replacement Patients Have Mechanically Functional Joints

Cut out the pain, not the joint
If the joint is collapsed, disfigured, or subluxated to a degree that the “hinge” of the joint is not mechanically capable of functioning, then total joint replacement is the best solution. However, today, over 90% of people who undergo total joint replacement have mechanically functional joints and are typically walking without the assistance of a cane or walker.
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AROmotion has achieved rapid and lasting pain relief for thousands of patients, including those who were told they were 'bone-on-bone' and that their only orthopedic option was total joint replacement.
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Making Sense of OA

Exploring the Misconceptions in Orthopedic Language: How 'Words Matter' in Diagnosing Joint Pain and the Limited Options of Traditional Surgery

AROmotion vs Total Replacement

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From Disappointment to Discovery: AROmotion’s Road to Revolutionizing Patient Outcomes in Joint Health.
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