What if the joint is the last place osteoarthritis begins?
The case for looking beyond wear and tear, and building a stronger foundation for care.
PERSPECTIVE · OSTEOARTHRITIS
Most people are introduced to osteoarthritis with a picture of a damaged joint. They are shown the narrowing space between two bones, perhaps told that the cartilage has worn away, and given a menu of pain relief, injections and, eventually, replacement surgery. The image may be accurate. The conclusion people take from it often is not: My joint is wearing out. I had better use it less. Nothing meaningful can change until I have surgery.
That conclusion can cost someone years of movement, strength and participation in life. It also rests on an incomplete idea of what a joint is.
A joint is living tissue. Cartilage is maintained by cells. Bone remodels. The joint lining communicates with immune cells. Muscles alter the forces passing through the joint. All of these tissues respond to the wider conditions of the body. Osteoarthritis is the visible result of many processes interacting over time, not simply a tally of how many steps a person has taken.
So when somebody comes to me with osteoarthritis, I want to know what is happening around the joint as well as within it. What has happened to their strength? How is their metabolic health? Is there excess visceral fat or insulin resistance? Have pain and poor sleep changed the way they move? Is there an old injury? And what might still be possible if we improve the conditions in which that joint has to function?
Wear and tear does not explain the whole picture
Mechanical load matters. An injured knee is more vulnerable, and excess body weight can place greater demands on a hip or knee. But load does not operate in a vacuum. Osteoarthritis also develops in hands, which do not bear body weight. Higher body weight is associated with hand osteoarthritis too. [4]
That observation points to a second conversation: the immune and metabolic state of the person. Fat tissue does more than store energy. It releases signals that influence inflammation. [5] Insulin resistance and metabolic syndrome are being investigated for their roles in joint disease. In one large cohort, metabolic syndrome’s association with knee osteoarthritis progression was no longer statistically significant after accounting for BMI. [6] That is a reason to study these relationships carefully, not to dismiss the broader metabolic picture or claim that one blood marker explains an individual’s arthritis.
Inside the joint, the story becomes more interesting. Laboratory research is examining mitochondrial stress and impaired cellular recycling in cartilage cells. [7] In people undergoing knee replacement, investigators have found an association between fibrosis of the joint lining and reduced range of motion. [8] These are windows into an important shift: the joint has a biology, and that biology can become less capable of maintenance and repair. Neither finding establishes a treatment that reverses osteoarthritis.
The question that follows is the one I think medicine should be asking more often.
Before we attempt to stimulate repair, what sort of environment are we asking that repair to occur in?
Regenerative readiness
I use the term regenerative readiness to describe the practical work of improving health and function before rehabilitation and, where appropriate, a medical or regenerative intervention. It is a working framework, not a validated measure of treatment response or a claim that lost cartilage can be restored by changing one’s diet.
Consider two people with the same knee X-ray.
PERSON ONE
Has stopped moving because every flare convinces them they are doing damage. Their leg muscles have weakened, sleep is poor, visceral fat has increased and their blood glucose is drifting upward.
PERSON TWO
Has a progressive strength programme, better metabolic control, good support through pain and a clear plan for what to do when symptoms fluctuate.
Their images may look alike. Their ability to function and participate in life may be very different.
That is why our work at Simplr Health does not end with a number on the scales. We look at body composition, metabolic markers, strength, function, sleep, nutrition and the barriers that have made change difficult to sustain. We help people change that terrain and connect the work with the right physiotherapy, medical and orthopaedic input. Where an emerging approach may be relevant, we help them understand the evidence and access an appropriate clinical conversation.
This is not an argument to postpone a needed joint replacement. For some people surgery is the best path. It is an argument for arriving at each decision with the strongest body and the clearest understanding of the options available.
What can change now, and what is still emerging
We already have strong evidence that exercise can improve pain and function in osteoarthritis. For people with knee or hip osteoarthritis who are above their healthiest weight, weight reduction can help too, particularly alongside exercise. [1] A substantial trial found that combining dietary weight loss with exercise improved outcomes in people with knee osteoarthritis and overweight or obesity. [2] An Australian telehealth trial also found benefits from exercise and a modest additional benefit from a dietary programme. [3] Those results matter even when an X-ray does not transform.
At the same time, regenerative orthopaedics is advancing. Platelet-rich plasma, cellbased therapies and other biological approaches are being investigated and, in some settings, offered to patients. A small randomised cell-therapy trial reported improved pain at nine months, while a substantial placebo-controlled platelet-rich plasma trial found no significant advantage for pain or cartilage volume at twelve months. [9, 10] These mixed findings make the choices more consequential, not less.
QUESTIONS THAT MATTER BEFORE ANY TREATMENT
Which approach fits this person’s diagnosis and stage of disease?
What exactly is being prepared and injected, by whom, and under what standards?
Where will it be placed, and how?
What is the evidence for a meaningful improvement in pain, function or quality of life for a person like this one?
What will happen before treatment, and who is responsible for rehabilitation and follow-up afterwards?
What is the total cost, including the possibility that it will not help?
These are difficult questions for a health consumer to answer from a clinic website or a testimonial. The modality matters. Product preparation and quality matter. Diagnosis, procedural skill and the condition of the joint matter. So do the strength, movement and metabolic health a person brings to treatment, and the plan for rebuilding function afterwards. No injection can be expected to carry the entire burden of recovery or prevent future degeneration by itself. And symptom improvement must not be presented as proof that cartilage has regenerated; there is
still no established injection that reliably rebuilds an arthritic joint. [11]
This is not a field I came to recently. Since 2014 I have been actively involved in the clinical application of cell therapies, particularly for osteoarthritis. I created and led early in-clinic workshops in which physicians were trained in these procedures. That experience taught me how much the outcome depends on the details that patients rarely get to see: the diagnosis, the clinician’s technique, what has been prepared for injection and what happens after the procedure.
My work has since brought me alongside regenerative medicine colleagues in the United States and into Japan, where I help patients navigate its cell-therapy pathways and the clinical decisions that come with them. Earlier this year I delivered a keynote at the 5th Regenerative Medicine Orthopaedic Summit in Tokyo, sharing the immunometabolic approach to regenerative preparedness that we have developed through years of clinical work. The conversations there reinforced something I have long believed: advances in a procedure mean more when the person’s wider health and rehabilitation are part of the plan.
The team at Simplr Health makes that expertise and those connections available, especially to people in Australia and New Zealand. We help put the pieces together: assess the broader biological picture, improve readiness where possible, examine the evidence and quality behind proposed treatments, connect with appropriate clinicians here or overseas, and plan rehabilitation and follow-up for the individual. We weigh likely benefit against cost and uncertainty. The objective is a well-chosen, coordinated pathway with the best realistic chance of improving function and quality of life.
A more useful future than “manage it until surgery”
The biggest loss in osteoarthritis is not always cartilage. It may be the walk a person no longer takes, the trip they decline, or the growing conviction that their body has become unreliable. Pain can gradually reorganise a life around avoidance.
There is no honesty in promising to reverse every structural change. There is also no reason to accept that an X-ray has already decided what the next decade will feel like.
We can assess what is driving the problem. We can restore strength and metabolic health where they have been lost. We can improve function, build regenerative readiness, and make informed decisions about treatments as the science develops. If surgery is needed, we can prepare for it and recover with purpose.
This is the work I want Simplr Health to make available: the full picture, the latest credible possibilities, and a practical pathway forward while life is still happening.
— Dean Kilby, Founder, Simplr Health
SIMPLR HEALTH
Build readiness, weigh the evidence, and plan a coordinated pathway for your joint.
RESEARCH AND CLINICAL GUIDANCE
Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220–233. doi.org/10.1002/art.41142
Messier SP, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis: The IDEA Randomized Clinical Trial. JAMA. 2013;310(12):1263–1273. pubmed.ncbi.nlm.nih.gov/24065013
Bennell KL, et al. Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis: A Randomized Trial. Ann Intern Med. 2022;175(2):198–209. pubmed.ncbi.nlm.nih.gov/34843383
Yusuf E, et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis. 2010;69(4):761–765. pubmed.ncbi.nlm.nih.gov/19487215
Urban H, et al. The role of fat and inflammation in the pathogenesis and management of osteoarthritis. Rheumatology (Oxford). 2018;57(suppl 4):iv10–iv21. pubmed.ncbi.nlm.nih.gov/29444323
Szilagyi IA, et al. Metabolic syndrome, radiographic osteoarthritis progression and chronic pain of the knee among men and women from the general population: The Rotterdam study. Semin Arthritis Rheum. 2024;69:152544. pubmed.ncbi.nlm.nih.gov/39288696
Fang G, et al. FUNDC1/PFKP-mediated mitophagy induced by KD025 ameliorates cartilage degeneration in osteoarthritis. Mol Ther. 2023;31(12):3594–3612. pubmed.ncbi.nlm.nih.gov/37838829
Hodgeson S, et al. Differences in synovial fibrosis relative to range of motion in knee osteoarthritis patients. J Orthop Res. 2022;40(3):584–594. pmc.ncbi.nlm.nih.gov/articles/PMC8553814
Lee BW, et al. Intra-Articular Injection of Human Bone Marrow-Derived Mesenchymal Stem Cells in Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Trial. Cell Transplant. 2025;34:9636897241303275. pubmed.ncbi.nlm.nih.gov/39874108
Bennell KL, et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021;326(20):2021–2030. pubmed.ncbi.nlm.nih.gov/34812863
Brandt MD, Malone JB, Kean TJ. Advances and Challenges in the Pursuit of Disease-Modifying Osteoarthritis Drugs: A Review of 2010–2024 Clinical Trials. Biomedicines. 2025;13(2):355. doi.org/10.3390/biomedicines13020355
This article is general information and is not a substitute for individual medical advice. Please discuss treatment decisions with a qualified clinician.
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