In Reply

In spite of concepts of causality, progressive cartilage destruction can so far not be stopped by means of medical drugs. Surgical-reconstructive approaches may delay the implantation of an endoprosthesis. Articular cartilage repair in the knee joint is the focus of clinical studies with high levels of evidence and guidelines, followed by the hip joint. In the face of the scarcity of evidence for other joints, the same conservative and medical therapeutic approaches apply there in principle.

Only very few high quality studies exist on the value of visco-supplementation for the treatment of osteoarthritis of the shoulder, as mentioned by Schröder.
A current review article includes this option, but the evidence is not satisfactory (evidence level IV), and randomized, double blinded studies are lacking (1). In the shoulder region, cortisone is usually injected into the gleno-humeral or acromio-clavicular joint, although the studies supporting such treatment are less conclusive.

In principle, marrow stimulation may be used in other joints, although the evidence is scarce. This applies primarily to the ankle. A recent review of the treatment of osteochondral defects of the talus reports a weighted success rate of 85% for marrow-stimulating techniques on the basis of 18 studies (388 patients) (2). Only few case reports exist for the hip joint.

The treatment of femoroacetabular impingement, which—owing to the deviations from the normal shape of the bony joint components—can, as a pre-osteoarthritic deformity, result in chronic stress on circumscribed areas of cartilage and subsequent hip osteoarthritis, could not be reflected in our manuscript because of the complexity of this subject. Several case reports exist, but only very few studies with higher evidence levels have been published. They report good clinical results after defining the indication correctly (3).

Data on other joints have thus far not shown with any degree of certainty whether these treatments inhibit the progression of osteoarthritis.

DOI: 10.3238/arztebl.2012.0266b

Prof. Dr. med. Henning Madry

Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung

Universität des Saarlandes, henning.madry@uks.eu

Dr. med. Ulrich Wolfgang Grün

Klinik für Orthopädie und Orthopädische Chirurgie

Universitätsklinikum des Saarlandes

Prof. Dr. med. Gunnar Knutsen

Klinik für Orthopädische Chirurgie

Universitätsklinik Nord-Norwegen, Universität Tromsø, Norwegen

Conflict of Interest Statement

Professor Madry is the principal investigator of Merck Serono’s randomized, double blinded, placebo controlled, international, multicenter, clinical phase II study “AS902330 in Cartilage Injury Repair” of the intra-articular efficacy of FGF-18 in cartilage defects.

Dr Grün holds shares in Orthogenics.

Professor Knutsen declares that no conflict of interest exists.