Orthopedists as Bloodsuckers

18. December 2006

Out of the snuggery of alternative art of healing and into the canon of orthodox medicine? With own blood and beads, even established orthopedists are drawing attention now. The orthodox doctor turns into a vampire to protect joints.

"Blood is a special juice": What Count Dracula has always known, turns into a topic amongst the gild of orthopedists. Background is a disease which increases headaches in physicians and healthcare economists facing an increasing life-span of people: Arthrosis. The latest edition of the healthcare report submitted by the government documents the following data: "The cost units pay 25.2 billion Euro per year for chronic musculoskeletal disorders", says Dr. Carsten Dreinhöfer of the University of Ulm/Germany. Since the mid nineties, the number of hospital treatments of patients with this type of disorders has increase by 40 percent. Hospital treatments overall have increased only by 18 percent. Round about half of the hospitalization are due to joint disorders. And top of the list are degenerative joint disorders, such as arthrosis.

Simple calculation: Antiphlogistics = Blood + Globules

The first choice of arthrosis therapy are painkillers. If those do not suffice any more, usually follow – after a long career of suffering – endoprothetic replacements for knee and hip. Between those two extremes, there is a whole palette of procedures to try to influence the oppressed joints, to relieve the pain, to improve the function and to try and stop structural changes in the joint. Just as well-known but also controversial is the viscosupplementation with hyaluronic acid, which usually is not covered by public health insurances in Germany. Other options would be cortisone injections or various irradiation- and light exposure procedures. Just how effective the basis of evidence is with those methods, strongly depends on whether orthopedist and rheumatologists comment on it. Experiences with these methods certainly are not that good, to stop looking for alternatives. The injection of autologous, conditioned serum (ACS) takes out a loan on vampires here. That method was now studied by orthopedists of the Duesseldorf University – with the whole program of three levels, randomized as well as placebo- and verum controlled. As the name ACS indicates, autologous serum is used, or as an amateur would say: own blood. It is extracted from venous blood and is mixed with tiny glass beads. Those beads are supposed to confuse the white blood cells in the extracted serum so much, that they start, during an incubation time, to produce body's own, antiphlogistic cytokines, mainly Interleukin 1. The stimulating serum cocktail is centrifugated and then injected into the affected joint (of course without the glass beads) – in a way as an autologous, but clearly heterotopic serum transplantation.

Victory by scores against Placebo and Hyaluron

Even the Adj. Professor Axel Baltzer of Zentrum für molekulare Orthopädie (center for molecular orthopedics) in Duesseldorf, admits, that the whole thing sounds a bit adventurous. On the Orthopedics Congress in Berlin he recently reported about the results of the study. A total of 399 patients with arthrosis of the knee, symptomatic and proven by X-ray, participated in this study. Either they were treated with the new ACS method, or with intraarticular hyaluronic acid injections or alternatively with saline solution injections, i. e. placebo. "After seven, 13 and 26 weeks, the patients treated with ACS showed the most significant improvements in the scores for pain in the joint, function and stiffness as well as life quality and patient's satisfaction", say Baltzer. For example, in 71 percent of the patients, the pain was diminished by halves. That was about double compared to the placebo group, but also double compared to the hyularonic acid group. "To find out, that there was no significant difference between hyularonic acid and placebo, come as a surprise", said Baltzer.

Indeed, just a few months ago, Cochrane-Review published a tendentially positive testimony for hyularonic acid. One thing was criticized though: there are hardly any comparing studies about the various preparations. Which of course could cause us to start thinking again…. In any case, the Duesseldorf physicians have created data with their studies about the ACS method, which appears beneficial for ACS and contrary for the viscosupplementation. Further studies will fathom now, whether the therapeutic vampire has a positive effect on the joint structure.

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