What If We Have Been Treating the Wrong Part of Knee Arthritis?
- cassis101
- Jul 2
- 4 min read
By Deborah Westergaard, M.D. Dallas | Regen Experts Dallas & Plano
What If We Have Been Treating the Wrong Part of Knee Arthritis?
The Traditional Arthritis Conversation
If you've been told you have "bone-on-bone" arthritis, you've probably heard the same treatment options repeatedly:
- Anti-inflammatory medications
- Cortisone injections
- Physical therapy
- Activity modification
- Eventually, knee replacement surgery
For many patients, these options can be helpful. But what if there is another way to think about arthritis?
Recent research suggests that osteoarthritis may not simply be a cartilage problem. In fact, some scientists now believe that changes within the bone beneath the cartilage may play a major role in pain, function, and disease progression.
This shift in understanding is changing how physicians and researchers view joint preservation.
The Problem: Cartilage May Not Be the Whole Story
Most arthritis discussions focus on cartilage loss.
However, a healthy knee is much more than cartilage.
The knee functions as an integrated system consisting of:
- Cartilage
- Subchondral bone
- Menisci
- Ligaments
- Tendons
- Joint capsule
- Synovial tissue
When one part fails, the entire system can become dysfunctional.
Research has shown that bone marrow lesions and abnormalities within the subchondral bone often correlate with pain and progression of osteoarthritis. This has led many researchers to ask whether treating cartilage alone is enough.
The Solution: A Whole-Joint Approach
Rather than focusing exclusively on cartilage, a whole-joint approach evaluates all of the structures that may be contributing to pain and dysfunction.
This may include assessing:
- Joint alignment
- Meniscal integrity
- Ligament stability
- Tendon health
- Cartilage condition
- Subchondral bone changes
Advanced image-guided orthobiologic procedures are designed to target specific tissues within the joint using the patient's own biologic materials.
In appropriate candidates, these procedures may be performed without large incisions, surgical dissection, or joint replacement surgery.
The goal is not simply to manage symptoms. The goal is to support joint health, improve function, and help patients remain active whenever possible.
Why the Bone Beneath the Cartilage Matters
One of the most intriguing developments in orthopedic research comes from studies examining treatment of the bone beneath the cartilage surface.
Research by Philippe Hernigou, MD, and colleagues has demonstrated encouraging long-term outcomes when biologic therapies are delivered into subchondral bone in selected patients with knee osteoarthritis.
These findings have helped fuel growing interest in the concept that osteoarthritis may be a disease of the entire joint rather than cartilage alone.
As research continues to evolve, physicians are increasingly recognizing the importance of evaluating both cartilage and the supporting structures beneath it.
Is a Joint Preservation Evaluation Right for You?
You may benefit from a comprehensive evaluation if you:
- Have been told you have knee arthritis
- Want to avoid or delay surgery if appropriate
- Continue to experience pain despite conservative treatment
- Have been advised that cortisone injections are your only option
- Want to understand all available treatment approaches
Not every patient is a candidate for orthobiologic procedures. The first step is determining the true source of your pain and identifying which structures are contributing to your symptoms.
Frequently Asked Questions
Is this a stem cell procedure?
Orthobiologic procedures may utilize various biologic preparations, including platelet-rich plasma (PRP) and bone marrow concentrate (BMC), depending on the clinical situation.
Can orthobiologic procedures regrow cartilage?
No treatment can guarantee cartilage regeneration. Current research is ongoing, and outcomes vary among patients.
Can these procedures replace knee replacement surgery?
Not necessarily. Some patients remain candidates for joint replacement, while others may benefit from joint-preservation strategies. A comprehensive evaluation is necessary to determine the most appropriate approach.
How do I know if I am a candidate?
A detailed history, physical examination, imaging review, and structural assessment are required before determining candidacy.
About Dr. Deborah Westergaard: What Makes Her Different?
Deborah Westergaard, M.D. is a board-certified Pain Medicine physician with nearly 30 years of experience performing image-guided musculoskeletal and spine procedures.
After graduating from LSU School of Medicine, she completed her Anesthesiology training at UT Southwestern Medical Center and went on to complete advanced fellowship training in Pain Management at Texas Tech University under internationally recognized pioneers Dr. Gabor Racz, Dr. Prithvi Raj, and Dr. Miles Day.
What distinguishes Dr. Westergaard's approach is her emphasis on identifying the structural causes of pain rather than simply treating symptoms.
Rather than focusing exclusively on where the patient hurts, she performs a comprehensive evaluation of the joint, including cartilage, ligaments, tendons, menisci, and subchondral bone. This whole-joint perspective helps identify potential contributors to pain that may otherwise be overlooked.
Her practice focuses on joint preservation, functional restoration, and advanced image-guided orthobiologic procedures for appropriately selected patients seeking non-surgical options.
Schedule Your Executive Joint Preservation Evaluation
If knee pain is limiting your mobility, exercise, golf game, travel plans, or quality of life, the most important question may not be "Where does it hurt?"
The better question may be:
Why does it hurt?
A comprehensive structural evaluation can help identify the true pain generators within the joint and determine what treatment options may be appropriate for your specific condition.
Call today to schedule your Executive Joint Preservation Evaluation and learn whether a personalized non-surgical treatment strategy may be right for you.
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