Surgery-free fix for knees

Special cement is injected into bone

(Ivanhoe Newswire) - More than 600,000 total knee replacements were performed in 2008. A study this year shows that's up 134% since 1999. One doctor says some people are getting them, when they could benefit from something much simpler.

Casey Lodge has always been an active guy.
"I get bored sitting around," Casey said.

But constant knee problems have forced him to sit out.
"It's just been a cycle for 10, 12, 15 years now," said Casey.

He's had four surgeries to repair the problems and developed bone marrow edema.
"It was just a constant deep pain," said Casey.

"The traditional answer has been a knee replacement," Dr. Preston Wolin, Surgeon and Director of Sports Medicine of the Chicago Center for Orthopedics, said.

But doctor Preston Wolin had another option for Casey's arthritic knee.

"So the patient instead of getting a plastic and metal knee gets to keep their knee for a longer period of time," Dr. Wolin explained.

It's called subchondroplasty. This device guides the doctor to the part of the bone near the joint that's causing pain. A small incision is made and special cement is injected.

"Right into the bone," Dr. Wolin said.

Done by itself Dr. Wolin says recovery time is six weeks compared to four to six months for a knee replacement.


Casey had it along with another procedure to help with a knee mal-alignment.

"So the hope is that this will make that operation better and last longer," Dr. Wolin said.

Wolin says the outpatient procedure can extend the life of knees by five to ten years, but it's not for everyone.

"It's not a substitute for a knee replacement if there's advanced arthritis," Dr. Wolin said.

For Casey it was the answer to his painful problem.

The doctor says the bone cement used in subchondroplasty dries in about 30 minutes. If not combined with another procedure, a lot of patients can walk right after the procedure.

Research Summary


BACKGROUND: The knee joint is made up of bone, cartilage, ligaments, and fluid, as well as muscles and tendons which help the knee joint move. Knee problems occur when one of these structures is hurt or diseased and this can cause pain or difficulty walking. (Source: http://www.nih.gov/)


TYPES: Various diseases and injuries can cause knee problems, but below is a list of some of the more common causes of knee problems:

 

  • Osteoarthritis - This is the most common type of arthritis and is occurs when the cartilage in the knee deteriorates with use and age.
  • ACL injury - This occurs when the anterior cruciate ligament is torn, which is one of four ligaments connecting the shinbone to the thighbone. This is a common sports injury, especially for people who play basketball or go downhill skiing because it's linked to a sudden change in direction.
  • Patellar tendinitis - This is an irritation or inflammation of one or more tendons and inflammation of the patellar tendon is often seen in runners, skiers, and cyclists.
  • Pseudogout - This is caused by calcium pyrophosphate crystals that develop in the join fluid and knees are the most common joint affected by pseudogout.

TREATMENT: Treatment for knee problems and injuries varies. Sometimes patients are given medications to alleviate the pain or treat underlying conditions such as gout, other times physical therapy to strengthen the muscles around the knee is recommended. Other treatments for knee problems include corticosteroid injections to reduce the symptoms and pain of osteoarthritis for a few months, and orthotics and bracing to shift pressure away from the side of the knee most affected by osteoarthritis. Some knee injuries and even arthritis may require surgery such as arthroscopic surgery, where the doctor uses a fiber-optic camera and long narrow tools in small incisions around the knee to remove loose bodies and repair torn cartilage or ligaments. Another surgery for knee problems is either a partial or total knee replacement, where the damaged portion of the knee or the entire knee joint is removed and replaced with an artificial piece. (Source: Mayo Clinic)


SUBCHONDROPLASTY: A subchondroplasty is used when the patient has experienced a bone marrow edema, which is a bone microfracture, in their knee and other treatments short of knee replacement surgery have not worked. First the patient is given an MRI to confirm that they have a BME. Then the defect is filled in with a bone substitute. This not only relieves pain, but there is also a high success rate for this procedure and a shorter recovery time than if the patient were to do knee replacement surgery. (Source:     www.lancastergeneralhealth.org)

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