The most common type of Arthritis in human population is Osteoarthritis and commonly seen in elderly age group due to age related degeneration of joint. It is associated with chronic pain, stiffness in the joint, deformity of the knee joint and physical disability. It comprises a major healthcare problem in all over the world.
Till now we have multiple options to treat Osteoarthritis with the pros and cons of individual treatment. In the initial period of disease, person with knee pain due to osteoarthritis are suggested for rest, body weight management, physiotherapy, bracing, local application of heat and local and oral pain killer medications. Persons resistant to above conservative treatment are then considered for intra-articular injections like steroids, hyaluronic acid and plasma rich protein (PRP). Steroid injections although can provide a good short term relief of pain but is associated with significant local and systemic side effects. Steroid injection in diabetic patient can raise the blood sugar level leading to complications and is given in caution. Hyaluronic acid injection has variable result and can be an option for early osteoarthritis in younger patient with minimal degenerative changes in the knee. Hyaluronic acid injection works better in dry knee rathe than swollen knee with significant effusion. According to the recent studies, PRP is providing a promising result in the treatment of early osteoarthritis knee in young patient. The overall effect generally lasts for 6 to 9 month period. But is is relatively costlier and has variable result in elderly population with advanced arthritic change. The surgical procedure called high tibial osteotomy can be an option for early osteoarthritis in which alignment of knee is corrected by bone cuts and it has also variable result.The last resort of treatment of knee Osteoarthritis is knee replacement surgery. It is a salvage procedure which involves resurfacing of the knee joint with metallic implant after taking out the degenerative and worn out knee surface to create an biomechanically stable, well aligned artificial joint. it is a successful surgical procedure and practised all over the world with good outcome. However , it also associated with expected surgical and anaesthetic serious complications like pulmonary embolism, cardio vascular complications, infection and surgical wound problem.
Botulinum toxin (BoNT) is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It generally blocks the receptor at the neuromuscular junction and prevents the release of the neurotransmitter acetylcholine from axon endings and thus causes flaccid paralysis, which cause a disease called botulism. Scientist have taken the advantage of the molecule and BoNT is commonly used as muscle relaxant in the treatment of spasticity, muscle contracture and movement disorders since long. Now recent studies have shown that, BoNT also release several neuropeptide transmitters like Substance P, Glutamate and Calcitonin gene-related peptide to decrease peripheral as well as central sensitisation of pain receptors resulting in pain relief for longer duration. the first clinical trial of BoNT was done in 2006 and after that many studies have come up with good outcome and clinical efficacy. Now BoNT is gaining popularity in treatment of Osteoarthritis of knee. It is quite safe and intra articular injection of BoNT has no risk of any muscle paralysis. It is relatively cheaper than PRP and studies have shown that the pain relief lasts up to 17 month after injection of BoNT. According to current practice, a 100-unit of BoNT injection to the affected knee joint can provide a long term pain relief, reduces physical disability and increases functional score of the patient. It is proving promising result in patient with painful Osteoarthritic knee but further study in the form of randomised control trial and meta analysis may be warranted, to provide clinical guidance in the management of patients with Osteoarthritis knee and justification of the BoNT treatment.
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