A simpler fix for knee problems

In 2008 more than 600,000 total knee replacement surgeries were performed.

A study released this year shows that the 2008 figure was up 134-percent from 1999. But one doctor says that many people could benefit from something much simpler.

Casey Lodge has always been an active guy, but constant knee problems have forced him to sit out. Thus far, Casey has undergone four surgeries to repair the problems. As a result, he has developed bone marrow edema.

“It was just a constant deep pain,” says Casey.

Dr. Preston Wolin, a surgeon at the Chicago Center for Orthopedics says that the traditional answer to knee problems has been knee replacements.

But Dr. 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.”

It is called Subchondroplasty, and a device guides doctors to the part of the bone near the knee joint that is causing pain, a small incision is made and special cement is injected.

The procedure has a recovery time of six weeks, whereas a traditional knee replacement takes four to six months to heal. Casey, however, had it done along with an additional procedure to help with a knee ma-alignment and his recovery time was a little longer.

Dr. Wolin says the outpatient procedure can extend the life of knees by five to ten years. He adds that it is not for everyone, "It's not a substitute for a knee replacement if there's advanced arthritis."

For patients like Casey, it can be the answer to a very painful process.

He says, "Got her fixed! It feels great."

The doctors say the bone cement used in Subchondroplasty dries in about 30 minutes. If done alone, many patients are able to walk right after the treatment is complete.


REPORT: MB # 3536

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: 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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Preston Wolin, MD
Weiss Memorial Hospital
(773) 248-4150

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