University of Iowa orthopedics experts are working with specialists from Iowa State University to develop a new approach to prevent post-traumatic osteoarthritis (PTOA). Todd McKinley, MD, associate professor of orthopedics and rehabilitation at University of Iowa Hospitals and Clinics, talks about the research and potential new treatment plan:
What is post-traumatic osteoarthritis or PTOA?
Post-traumatic osteoarthritis is arthritis that develops in a joint after the joints have been injured. Arthritis is a generic term for joint destruction. A lot of things can cause arthritis. If there's a severe joint injury such as a fracture that goes into the joint or a severe ligamentous injury, eventually the joint may develop arthritis. So PTOA is arthritis that develops after a serious injury to that joint.
Approximately how many people suffer with PTOA?
That's a good question and recently a study from Iowa by a couple of my colleagues made an estimation based on how much arthritis we see in the state of Iowa and what percent of that happens because of injury. To the best of our estimations, we think somewhere between five and six million people in the United States have this annually.
What is the current treatment for PTOA?
Currently, treatment centers around treating the original injury. If you have a fracture that goes into a joint, current treatment is to try to prevent it by restoring the anatomy of the joint. You break your knee. You do an operation to try to restore the normal anatomy of the knee to keep the joint smooth to prevent post-traumatic osteoarthritis. However, what we've learned is that doesn't always work. So once you've developed post-traumatic osteoarthritis, there's really no good treatment.
What has changed to look at developing a new treatment plan?
What we've done is looked at how current treatments have succeeded over years and even decades. What we've found is that over the last 50 years—even though the technology has improved—the idea of just going in and restoring the normal alignment and smoothness of the joint hasn't improved the results at all. We've taken a look and said, well if that's not getting any better, there's got to be a different way of treating this. We've taken a whole new approach, concentrating on treating the injured cartilage immediately after the injury to prevent it from wearing out.
How do recent findings in biomaterials and biological mechanisms change the way you look at treatment for PTOA?
Previous treatments were kind of macroscopic, just trying to restore anatomy. Now we're looking at it on a tissue level and even a cellular level, recognizing that the cells inside the cartilage are injured and potentially salvageable if we treat them. So the line of investigation we're going down is working on developing materials that we can apply directly into an injured joint, to go in and try to treat the cartilage cells to keep them alive and the ones we do keep alive, keep them more productive to keep the cartilage healthy.
What will researchers at Iowa State University bring to the study?
They have a world-renowned department in Material Science and Engineering. Several of their investigators have particular interest in biologic materials. To make a long story short, the materials we need to be developed to do these things have fairly sophisticated mechanical and biologic properties that we're going to have to modulate. We're going to need people who are true materials experts to run experiments and work on developing these materials, and so we decided to collaborate with our partners across the state who are experts in doing this.
With this collaboration, what is the hopeful outcome?
The outcome is to eventually come up with a material that is used immediately after someone sustains a fracture and they end up in an emergency room, a material that can be injected into a joint as soon after the injury as possible to prevent ongoing cartilage damage. To keep the cartilage we save as healthy as possible to prevent the long-term problem of arthritis.
How would potential outcomes from research like this affect people who currently have PTOA?
It probably wouldn't affect people who currently have PTOA. Once you develop arthritis, your options change from trying to prevent it to treating it. These people eventually will either have joints replaced, or sometimes we fuse or realign joints. None of these options are great, so the current treatment we're working on is to prevent it from its inception so it doesn't get to the point where we have to treat arthritis.
Could this new treatment plan also serve a purpose in preventing PTOA from occurring?
That's exactly what it's conceived to do. We've looked at people who sustained joint injuries and realized that if they develop arthritis, then there's going to be a lot of long-term problems. What's more important is that most the people that sustain these bad joint injuries are young. And it's these young we really want to prevent this from occurring. Joint replacements are great operations if you're older and you're a little bit less active. But if you're 25 and you sustain a bad fracture and go on and develop arthritis, there's a lifelong dose of disability waiting for you. So the sole purpose of current treatments we're working on is to prevent post-traumatic osteoarthritis from happening.
How long will this collaborative research take to determine if it is viable?
I'm guessing, optimistically, we're on probably a three to five to seven year scale right now. If we had a material in-hand where we could go in and do some live animal testing within two-three years, I think that would be optimistic but doable. So I'm looking at this as probably a five-seven year endeavor before we'll really be able to go to the next step. |
