Avoiding or Delaying Osteotomy
Biologic Joint Solutions May be an Option
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Biologic Joint ReplacementArticular Cartilage Regeneration
Meniscus Transplant
ACL Reconstruction
Osteoarthritis of the Knee - General Information
Rehabilitation Programs
Osteotomy, or correction of bow legs or knock knees, is sometimes recommended for people with arthritis. The osteotomy procedure involves cutting the top of the tibia or the bottom of the femur and either removing a pie-shaped wedge of bone or adding one in to change the angle of the joint. There are many variations of how to fix the new angle, with plates and screws, wedges, or external fixators. These procedures have a high rate of complications and when done to diminish knee pain in the setting of arthritis, last only 5 - 7 years when successful. We believe that many of these procedures might be avoided if instead of changing the alignment, a new shock absorber (meniscus cartilage) in combination with re-growing the articular surface (paste grafting) is performed. Sometimes an osteotomy is required (especially when the angle of the knees exceeds 10º from straight) but often when less than that angle, we have found the risk and the prolonged recovery to exceed the benefits gained. Biologic treatments such as cartilage replacement combined with joint lubrication, glucosamine, and a careful exercise program comprise modern biologic joint reconstruction.
If you have been advised to have an osteotomy, there may be biological solutions that can be applied first.
To determine if you are a candidate for these procedures, please take a look at our appointments page, then e-mail us at avoidingosteotomy@stoneclinic.com
About Knee Arthritis Treatments:
Knee joint arthritis is generally grouped into inflammatory arthritis (rheumatoid, gouty, psoriatic, etc), osteoarthritis (which may be genetic), and traumatic arthritis (usually from injury or loss of the meniscus cartilage).
We focus our discussion here on osteoarthritis and traumatic arthritis. In these conditions, the white shiny surface that covers the ends of the bones in joints is worn away or damaged exposing the bone underneath the cartilage surface; similar to wearing the rubber down to the steel band in your car tire. When the cartilage surface wears off, small fragments of cartilage are sprayed around the joint. The fragments irritate the synovial lining cells in the capsule of the joint. Those cells produce fluid (swelling). The fluid contains enzymes that accelerate the breakdown of the cartilage and cause pain. Most arthritis treatments are focused on diminishing the swelling and reducing the pain. When they fail, surgeons have resorted to realignment procedures, such as osteotomy, which changes the angle of the joint and the location of the most force, or to artificial joint replacement procedures. (Total Knee Replacement)
Biologic joint reconstruction procedures are focused on two strategies: non-operative optimization of the joint health and operative replacement of the damaged tissues with biologic structures such as re-growing the cartilage surface and when necessary, replacing the fibrous shock absorber in the knee called the meniscus cartilage. (Viscosupplementation in the Symptomatic Treatment of Osteoarthritis)
The non-operative approaches include treatments to increase the lubrication in the joint. Two methods exist: oral glucosamine which increases the natural production of joint lubricants and lubricating injections such as Hyalgan, Supartz, OrthoVisc, and Synvisc, to name a few. At The Stone Clinic we use both methods.
Exercise programs are designed to decrease the force placed upon the joint. The stronger the muscles around the knee joint, the less force is driven into the joint surfaces. Gait is improved because limping further damages both the affected joint and the surrounding joints including the hips and back. With each step, a person puts 1 - 5 times their body weight on the joint. Decreasing body weight by losing 10 pounds can decrease the force on the joint by up to 50 pounds with each of the 2 - 3 million steps a person takes every year.
Physical therapy programs that focus on manual treatment of the tissues around the arthritic joints improve the range of motion of the joints, and improve gait, balance, strength, and overall function. All patients with arthritis benefit from a careful physical therapy assessment and a custom-designed program. All of our patients participate in physical therapy to avoid surgery or to recover from it with a better outcome than if they had surgery alone.
Diet plays a role by optimizing weight, increasing joint lubrication by consuming glucosamine, increasing bone strength with ingestion of calcium and Vitamin D, and decreasing abnormal forces across the joint.
Biologic joint treatments are the future of joint replacement. By restoring healthy tissue to damaged joints, you can regain an active, athletic lifestyle.
If you have been advised to have an osteotomy, there may be biological solutions that can be applied first.
To determine if you are a candidate for these procedures, please take a look at our appointments page, then e-mail us at avoidingosteotomy@stoneclinic.com
About Knee Arthritis Treatments:
Knee joint arthritis is generally grouped into inflammatory arthritis (rheumatoid, gouty, psoriatic, etc), osteoarthritis (which may be genetic), and traumatic arthritis (usually from injury or loss of the meniscus cartilage).
We focus our discussion here on osteoarthritis and traumatic arthritis. In these conditions, the white shiny surface that covers the ends of the bones in joints is worn away or damaged exposing the bone underneath the cartilage surface; similar to wearing the rubber down to the steel band in your car tire. When the cartilage surface wears off, small fragments of cartilage are sprayed around the joint. The fragments irritate the synovial lining cells in the capsule of the joint. Those cells produce fluid (swelling). The fluid contains enzymes that accelerate the breakdown of the cartilage and cause pain. Most arthritis treatments are focused on diminishing the swelling and reducing the pain. When they fail, surgeons have resorted to realignment procedures, such as osteotomy, which changes the angle of the joint and the location of the most force, or to artificial joint replacement procedures. (Total Knee Replacement)
Biologic joint reconstruction procedures are focused on two strategies: non-operative optimization of the joint health and operative replacement of the damaged tissues with biologic structures such as re-growing the cartilage surface and when necessary, replacing the fibrous shock absorber in the knee called the meniscus cartilage. (Viscosupplementation in the Symptomatic Treatment of Osteoarthritis)
The non-operative approaches include treatments to increase the lubrication in the joint. Two methods exist: oral glucosamine which increases the natural production of joint lubricants and lubricating injections such as Hyalgan, Supartz, OrthoVisc, and Synvisc, to name a few. At The Stone Clinic we use both methods.
Exercise programs are designed to decrease the force placed upon the joint. The stronger the muscles around the knee joint, the less force is driven into the joint surfaces. Gait is improved because limping further damages both the affected joint and the surrounding joints including the hips and back. With each step, a person puts 1 - 5 times their body weight on the joint. Decreasing body weight by losing 10 pounds can decrease the force on the joint by up to 50 pounds with each of the 2 - 3 million steps a person takes every year.
Physical therapy programs that focus on manual treatment of the tissues around the arthritic joints improve the range of motion of the joints, and improve gait, balance, strength, and overall function. All patients with arthritis benefit from a careful physical therapy assessment and a custom-designed program. All of our patients participate in physical therapy to avoid surgery or to recover from it with a better outcome than if they had surgery alone.
Diet plays a role by optimizing weight, increasing joint lubrication by consuming glucosamine, increasing bone strength with ingestion of calcium and Vitamin D, and decreasing abnormal forces across the joint.
Biologic joint treatments are the future of joint replacement. By restoring healthy tissue to damaged joints, you can regain an active, athletic lifestyle.