Joint Preservation Blog

January 6, 2009

Orthopedic Knee Surgery?

Orthopedic knee surgery no better than placebo surgery?  Two recent research articles have questioned whether orthopedic knee surgery is effective.  In fact, one study performed in 2002 showed orthopedic knee surgery was no better than sham surgery and the second published in 2008 showed orthopedic knee surgery no better than physical therapy and SynVisc shots.  Why?  The concept of arthroscopic surgery for the knee makes some sense.  Remove the offending parts and the knee will move more smoothly.  However, that seems to be the problem with orthopedic knee surgery, as removing parts of the meniscus or cartilage only make the knee get arthritis much more quickly.  In addition, another study has also questioned if meniscus tears are in fact a normal part of aging, showing that 60% of people with no knee pain had meniscus tears on MRI.  The video below explains some of this:

So wouldn’t it make more sense to put the cartilage back in or repair the meniscus by healing it? That’s the goal of new stem cell therapies for the knee:

To learn more about how to avoid orthopedic knee surgery…

recovery time shoulder surgery

As a doctor, recovery time from shoulder surgery can be prolonged. 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 or ligament tear, newer and much less invasive methods of treatment may be the answer, as with less trauma from the procedure comes faster 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 shoulder tendon, get the patient’s own 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 a science fiction novel? Not really, as this procedure using your own stem cells to repair the shoulder damage is now being used reduce recooperation times. No surgery, less recovery.

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 14, 2008

Torn Achilles Tendon Physical Therapy

A tear in the Achilles tendon can be either partial or complete.  Torn Achilles tendon physical therapy depends greatly on how the tendon is treated.  Surgical repair usually means significant immobilization.  This is a two edged sword.  On the one hand, immobilization can help the tendon mend, on the other, it also dramatically weakens the strength of the natural repair.  For a complete tear of the tendon (when it’s disconnected), aggressive casting may be the only way to promote even weak repair.  However, when the ligament is partially torn, the rehabilitation and recovery plan can vary widely depending on treatment method.

The rehab plan depends on if surgery is needed or not.  If the tendon is sewn back together, rehab will have to be non-weight bearing (on crutches) so at least 4-8 weeks.  However, there is a better way that can allow for quicker return to activities.  Recent research has shown good results when implanting the patient’s own adult stem cells into the tear.  This treatment technique is available now to patients in the first link above.  This is an injection of stem cells to heal the partial tendon tear.  If the Achilles tendon is repaired by this method, activity can start immediately as it helps stem cells differentiate into fibroblasts to repair the tendon.

For our patients, it’s critical to get rid of myofascial trigger points in the gastrocnemius muscle.  This can be accomplished by IMS.  This allows the muscle to function normally and allows for quicker strengthening of this critical muscle.

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