Massage Therapy Journal Summer 2026

46 • Massage Therapy Journal

AMTA Continuing Education

molecules. The conditioned serum is injected into affected joint(s). This procedure is also usually performed by an orthopedic surgeon or a pain management physician, and may be a one-time injection or done once a week for three to five weeks, or even twice a week for three weeks. It is not covered by health insurance, and a series of injections can cost as much as $10,000. Like PRP, studies show only symptom relief—no evidence of tissue regrowth. Scott Rodeo, MD, co-director of the Tissue Engineering, Regeneration and Repair Program at Weill Medical College of Cornell University in New York says that it could theoretically be used in any form of arthritis, not just OA, but most of the studies have been done on people with knee OA. 59 Stem cell/autologous fat injections. Stem cells used in this procedure can be collected from either bone marrow or fat tissue, concentrated by separating them from other tissue components, and then injected into a painful joint. The theory is that the stem cells will initiate tissue regeneration in the joint. Dr. Rodeo says, however, that: “The number of true stem cells in those tissues are vanishingly small.” In the United States, regulations prohibit doctors from isolating and growing stem cell cultures in the lab. “Patients are led to believe they’re getting concentrated stem cell injections,” Dr. Rodeo explains. “But they are not.” Treatments are not covered by health insurance and can cost several thousand dollars per injection or more. 59 Joint aspiration (arthrocentesis). A syringe draws excess fluid from a joint to ease swelling and pressure. A local anesthesia may be injected first to numb the area, and in certain situations an ultrasound may be used at the same time to help guide the needle. A sample of the synovial fluid is sent for testing to determine the cause of the fluid buildup, such as the presence of infection or inflammation. Arthrocentesis can be used as a tool in diagnosing RA. Aspiration is most commonly done on knees, but it may be used in elbows, shoulders or other joints. The procedure may need to be repeated if fluid

buildup recurs. The cost of this procedure is generally a few hundred dollars and is typically covered by health insurance. Removing excess fluid typically eases joint pain and stiffness and improves flexibility. Knees are the most common sites for aspiration, but the procedure may be used in any joint except axial joints (the vertebra and rib cage). 59 Surgical Procedures for Patients with RA Surgeries for people with RA are performed to repair or replace joint parts or an entire joint. Such surgeries are not without risk and even controversy, complicating the decision-making for RA patients. The range of surgeries currently in use for people with RA include : Arthroscopy involves making small incisions through which specialized instruments and a tiny camera are used to fix tears in soft tissues around the knee, hip, shoulder and other joints, to repair damaged cartilage and ligaments, and to remove broken, free-floating cartilage pieces. Arthroscopy for RA treatment is supported by some doctors and rejected by others. The Arthritis Foundation suggests getting a second opinion before undergoing arthroscopy. 60 Joint resurfacing , unlike total joint replacement, replaces just part of a knee or hip joint with a prosthetic implant. In the hip, the socket is replaced with a metal cup, and the damaged femur head is reshaped and capped with a metal, dome-shaped prosthesis, like a crown on a tooth. While conserving the femur makes subsequent surgery simpler, joint resurfacing has a higher complication and failure rate than conventional implants, and the metal-on-metal hip system poses the same serious health risks as other all-metal hip replacement systems do. Joint resurfacing is not recommended for women or men with a slender build or with osteoporosis. 60 Osteotomy involves cutting and removing bone or adding a wedge of bone near a damaged

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