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 6, 2009

recooperation from shoulder surgery

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

As a doctor, recooperation from shoulder surgery can be tough. The problem is that the severe degree of immobilization that’s needed (that big blue pillow) makes that arm/hand useless. Is there a better way? Well, if you have a rotator cuff tear, newer and much less invasive methods of treatment may be the answer, as with less trauma from the procedure comes quicker recovery times (read no blue pillow). How can this be possible? Trade the scapel for a needle. Rather than trying to sew ligaments back together or sewing a torn rotator cuff tendon, get stem cells to repair the damge. The doctor simply places the cells in the damaged area with an injection. Little trauma, little recovery. Sounds like science fiction? Not really, as this procedure using your own stem cells to repair the damage is now being used reduce recooperation times. No surgery, less recovery. To learn more, click the video below:

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.

December 23, 2008

How to save a knee…

Filed under: knee — Tags: , , , , , , , — D @ 2:14 pm

This is a case of a 72 yo male who makes fangs.  Yep, he is a professional dental prothesis maker for everyone from Hollywood actors to Goth kids who just want to add a little Dracula look to their black attire.  His knee is for all intents and purposes trashed (what we would call grade 4 Kellgren osteoarthritis).  How did we make his knee functional again, what were the steps?

First, he had significant problems with myofascial trigger points in his muscles and loose collateral ligaments (the duct tape that holds a joint together).   Before we could do anything else, we needed to solve these issues.  IMS therapy helped get rid of these muscle knots and prolotherapy injections helped tighten his knee ligaments.  The big difference here was that he felt like his knee was more stable and not “moving around” all the time while he made his fangs.  However, he still had significant pain especially with standing for a long-time.  So the next step was to look at his cartilage on an MRI.  His knee was a mess, with severe cartilage loss and meniscus loss.  While there is no way to “grow” him a new knee, we could use his own adult stem cells to help rebuild some cartilage and improve the health of what is still left.  As a result, we collected his stem cells, sent them to the lab for culture expansion (to grow to bigger numbers) and then injected those into the knee.  His pain with standing went from about a 7/10 to a 4/10.  While this was significant, his MRI provided a clue to another issue.  Because he was unable to fully extend the knee (due to his severe arthritis related bone destruction through the years), he was standing by stressing his quadiceps and patellar tendon (the tendon that holds the knee cap and attaches below the front of the knee).  This happens in some patients who have this lack of knee extension (can’t get their knee stright) because straightening the knee allows us to use no energy when we stand.  When you can’t “take the weight off” by fully extending the knee you hand on the quadiceps muscle and it’s patellar tendon.  As a result, his patellar tendon was constantly getting overstressed.  To help this we injected this area to attract stem cells to help beef up the tendon.  This finally helped the rest of his pain and allowed him to stand longer while making his fangs.

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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