Joint Preservation Blog

January 14, 2009

Thumb Surgery

As a doctor, I see a lot of hand arthritis. With all of the Blackberry thumb and painful, and often disabling thumb joints out there, why don’t we see more thumb surgery? The reason is likely that the artificial joints in the hand seem to involve a long and often painful recovery with a lot of occupational therapy. Unlike a knee replacement, where you can still work with your hands, type, text, etc… a thumb joint replacement in your dominant hand means you’re totally out of commission in today’s modern hand-centered work force. As a result, we do see the occasional patients getting thumb surgery with a tendon (see Thumb Surgery Alternative post), but still the same issues above apply. Is there a way to avoid thumb surgery? Yes, we’ve had good experience with injecting the patent’s own adult stem cells into the joint. I’ve posted a patient testimonial below:

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January 3, 2009

Knee Replacement Surgery Recovery

Knee replacement surgery recovery is hard. As a doctor, I’ve seen everything from patients who can get back on their feet in weeks, to patients with months of severe pain requiring narcotics and ultimately poor outcomes (the knee area still hurts). Why? How can you tell who will do well and who will have a prolonged Knee replacement surgery recovery? After many years of seeing these patients, I think it comes down to why the knee hurts in the first place. Too often, the knee is diagnosed as the main pain generator, but much of the pain is really coming from somewhere else. For example, recent research has shown that while we see meniscus tears on MRI, they are often not the cause of knee pain. In addition, there is a mean serious complication rate from knee replacement surgery of 20%. This gets worse as the patient gets older, with severe consequences and complications (with protracted recovery) occurring in many more patients when they are over age 80. Even if the knee is the cause of the pain, you might consider trying non-surgical options before you pull the trigger on knee replacement. Many patients can get good results from SynVisc or other artificial joint lubricants. Some of my patients try prolotherapy. Even newer techniques are now available where the patient’s own stem cells are used to heal the problems in the knee. So one way to avoid a long Knee replacement surgery recovery watching re-runs of Oprah is to avoid the knee replacement altogether.

September 1, 2008

Thumb Surgery Alternative

As a physician with friends who have the dreaded “blackberry thumb”, a recent web search for thumb surgery alternatives turned up this illustration. This demonstrates a traditional tendon graft surgery where one of the bones at the base of the thumb is removed and a tendon is coiled up to add a cushion. No wonder my freinds are asking me about thumb surgery alternatives. I must say that this tendon transfer surgery is “nuts”. I remember a discussion with a plastic hand surgeon about blackberry thumb and what he had to offer. “Not much” was his reply, as he admited that traditional thumb surgery was pretty poor. We discussed stem cell alternatives to thumb surgery and he was excited, as he often talked patients out of thumb surgery for basal joint arthritis because of the poor results.

The CMC joint or “basal” joint of the thumb doesn’t have good prosthetic replacement options. In addition, since it’s nearly impossible to do much without a functional thumb, pain in this joint is much more disabling than other joints. If there ever was an easy joint to treat with adult stem cells, this would be it, as it’s small and doesn’t have to bear weight while healing. While an injection of stem cells into this joint may seem like science fiction, it’s already here (thumb surgery alternative). So don’t let anyone pull out an important bone in your hand if this thumb surgery alternative might work.

August 21, 2008

What is joint preservation?

Joint preservation is both an unknown and new medical science.  It literally means what it sounds like, preserving a joint via a number of tools rather than replacing all or part of that joint.  So instead of a total knee replacement, fixing as many issues as possible to make sure the joint still functions.  Why do this?  Joint replacement is big surgery with big risks, so many of us would like to avoid these risks.  In addition, from a psychological perspective, one knows they are truly “old” when a surgeon cuts out what used to a perfectly good joint and replaces that with metal and plastic.  So this blog is dedicated to my clinical experience and the tools I use to save joints, hence joint preservation.

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