Osteoarthritis in the Knee

Osteoarthritis can affect any joint in your body. When arthritis occurs the cartilage that covers the ends of the bones and make up a joint, break down leaving the ends of the bone exposed. This causes pain, deformity, swelling and loss of range of motion. When non surgical treatment has failed, surgery is an option.

If the arthritis involves more than one compartment of the knee, a total knee replacement is a surgical treatment option. A total knee replacement is a major surgery that requires a prolonged course of recovery. Knee replacement surgery can be a life altering procedure to restore range of motion, reduce pain and correct angular deformities. It can be a double edged sword in the sense that there is a high risk in patients who are morbidly obese, smokers, diabetics, and or have vascular disease. Some patients that undergo total knee replacements do not get good results, studies have revealed that up to 23% of patients are unhappy with their total knee.

Dislocated Knee Cap

It’s not good to completely dislocate your knee cap. When this occurs it can knock off pieces of the cartilage that covers the undersurface of the patella. Images below outlined in green show a piece of cartilage knocked off and were floating around the knee joint. The blue outline is the donor site.

 

“Break A Leg”

In the spirit of the Hamilton tickets that went on sale in Louisville… I have never quite understood the phrase, “break a leg” as a good luck statement. Especially from an orthopedists point of view.

This is what I envision when I hear that phrase…

This image is of a person that broke a leg.

This is a normal femur.

This is after an intramedullary rod has been placed to fix the fractured femur.

#breakaleg #femurfracture #hamilton

 

Surgical Treatment Options for Knee Arthritis

Arthritis by definition is loss of the articular cartilage that covers the ends of the bone that make up different joints in your body. The knee is one of the largest joints in the body. Arthritis is caused by the natural aging process, morbid obesity, genetics and trauma.

When non operative or conversation treatment has been tried and failed the next option is surgical intervention. The knee is made up of 3 compartments. A total knee replacement is when all three compartments become replaced or resurfaced. A uni-compartment knee replacement is performed when only one of the three compartments are replaced.

The most minimally invasive surgical treatment for knee arthritis is a knee arthroscopy. This has fairly narrow indications. In some cases of knee arthritis when pieces of cartilage break off it can cause mechanical symptoms such as catching and locking. It can be extremely painful when the knee locks, catches or pops.

If this is the situation a knee arthroscopy is indicated. The knee scope is completed to remove the loose or unstable pieces of articular cartilage. This is a pretty quick surgical procedure that takes about 15 minutes to complete. It does require a general anesthesia and the patient does go complete asleep for the procedure. There is typically not much pain associated with it and a quick recovery is standard. Usually within 10-14 days return to normal activity is achieved.

The knee arthroscopy done in a patient for knee arthritis will not improve range of motion, stiffness, straighten out the angled leg or regenerate new cartilage. The scope is performed to get rid of mechanical symptoms. The red arrows in the following image point to loose cartilage.

Patient of The Month Teanna Curry

Teanna Curry is a 21 year old student athlete at Lindsey Wilson College where she plays the position of point guard for their basketball team. Teanna has a history of ACL injury in both her left and right knee. Her first ACL injury occurred in 2012 in her left knee, and she underwent surgery for that injury by another orthopaedic surgeon. After returning back to play however, she injured her opposite knee in November of 2018.

This injury occurred when another player charged her and her right knee gave way with acute onset pain and swelling. Unfortunately, this resulted in a tear in her right knee’s ACL. After seeing Dr. Stacie Grossfeld, an ACL reconstruction was recommended. Teanna underwent her ACL surgery on December 20th, 2018. During the surgery Dr. Stacie Grossfeld also placed stem cell recruitment therapy in her knee.

She has recovered from her surgery very well but what is even more inspiring is her story regarding her future. Ms. Currry got her college tuition 100% paid while attending Lindsey Wilson College from her basketball scholarship so she will graduate completely debt free. It is extremely hard to play a sport full time in college and obtain a college degree. Not only did she attend school during her knee surgery recovery, she is graduating from college in December of 2019. She will then start working on her Master’s degree while teaching.

Teanna plans on becoming a principle and will work on her advance certification after teaching as  a requirement to be admitted to that program. We are very proud of her and she is a great example for our future young #girlboss patients!

What is Hyaluronic Acid?

This is an injection that is given for knee osteoarthritis. It is called by many names. Here are a few names my patients have called it: rooster comb injection, chicken fat shot, cock comb injection, jelly shot, gel shot, cushion injection, just to name a few… It’s brand name depending on the company that produces it is: monovisc, synvisc, gel one and its generic name is hyaluronic acid or shortened to HA.

What is this mysterious multiple named injectable material???

A little background information, first. HA is a naturally occurring fluid in your knee joint. It is a thick viscous fluid that lubricants the knee joint. The fluid is produced by the cells lining the wall of the knee called synoviocytes.

When a knee becomes arthritic the synoviocytes start producing a fluid that is very thin and water like which does not lubricate the knee very well. The principle behind injecting the HA into the knee is it tricks the synoviocytes to start producing a thicker fluid for 5-6 months which makes the knee feel better. Eventually the arthritic knee goes back to producing the water like fluid again which is why the injection is given about every six months.

HA is not an injection that restores health to the knee like stem cells. It is a “bandaid” in the sense that it helps for a while to reduce pain but eventually stops working and the injection will have to be repeated. As the osteoarthritis worsens or advances, which all arthritis does, the injection may become ineffective.

An Overview of The New Fitness Trend F45

Originating out of Australia, F45 is a group training facility designed to help members reach their health and fitness goals. With a new location now open in Middletown, Kentucky, those interested in a workout that offers structure, motivation as well as a sense of community, all in a realistic time frame, can attend classes starting April 20th.

What does F45 stand for?

F45 combines high intensity interval training, circuit training and function training; three methods that have proven most effective for burning fat and building lean muscle. High intensity interval training consists of rapid fire exercises that shock the body into shape. Circuit training involves strength training, cardiovascular and muscular endurance. The “F” in F45 stands for function training. F45 describes function training as, “exercises that mimic or recreate everyday movement.” The “45” is how long each workout takes: exactly 45 minutes.

With 31 45 minute workouts and 3,000 variations, members never get the same workout twice. Each routine is challenging and utilizes the whole body as well as all it’s joints and muscle groups. In support of day to day activities, the workouts focus on movements such as lifting, squatting, jumping, twisting, pulling, pushing, punching, kicking, rowing and biking. Stations are stocked with items like barbells, ropes, rowing machines, mats, stationary bikes, sandbags and bosu balls.

At the beginning of each class, two instructors demonstrate each exercise. Further instruction is shown on monitors around the room. As for the 31 workouts, they are each themed around movement patterns for various sporting activities. Some of the most popular include:

Brooklyn: Boxing A mix of boxing, MMA and martial arts.

Brixton Brooklyn’s sister workout is structured to mimic the training of a fighter and features a mixture of MMA, combat, and self defense.

Foxtrot: Cardio Based A military style resistance workout.

Atheltica An agile focused workout.

Romans: Resistance It is scientifically proven that resistance based training can actually burn more calories than cardio.

Hollywood Circuit and West Hollywood Although these are a whole hour, they’re perhaps the most popular and well known for their fun curated playlists.

So I’ve Torn My Meniscus, Why Should I Have My Knee Scoped?

1. The meniscus is the major shock absorber in your knee.
2. Once there is a tear in the meniscus it can easily propagate.
3. If the tear gets larger, more meniscus has to be removed at the time of surgery, resulting in a greater force to the articular cartilage of the knee joint, increasing your risk of early onset arthritis.

What is a Baker’s Cyst?

Unfortunately it has nothing to do with chocolate cake…A Baker’s cyst is a collection of fluid that accumulates in the back of the knee. It typically occurs from one of three different sources.

1. The most common reason people develop a Baker’s cyst is from osteoarthritis. If you have an arthritic joint that gets inflamed, and is in the inflammatory stage, it produces fluid. The fluid can leak out of the knee joint and accumulate in the back (posterior) part of the knee outside of the actual knee joint.
2. The second source of a Baker’s cyst is a tear of the meniscus. When you have a meniscal tear fluid can leak out of the knee joint. It creates a one way valve where fluid leaks out and cannot get back into the knee joint. Therefore it collects and forms a cyst.
3. You can also have a tear in one of your tendon sheath that surrounds your hamstring tendons and fluid can leak out in that area and create a Baker’s cyst as well.

Can Baker’s cyst get bigger and smaller?

Yes, if your arthritis goes into a non-inflammatory stage. When the knee joint produces less fluid, the baker cyst will get smaller and sometimes completely resolved. Baker’s cysts can also get so big that they rupture on their own. If you have a meniscal tear and you undergo surgery, the bakers cyst tends to go away on its own.

Frequently Asked Questions:

1. Can a Baker’s cyst become malignant or cancerous? – No
2. If a Baker’s cyst is drained will it come back? – Yes, you must stop the source of the fluid that’s creating the Baker’s cyst. Simply draining the cyst with a needle will decompress the cyst for a short period of time typically less than 24 hours and then the fluid will accumulate again. If you have arthritis, reducing the inflammatory phase of the arthritis will reduce the size of the Baker’s cyst. If you have a meniscal tear, having a knee arthroscopy will eliminate the Baker’s cyst.
3. Can a Baker’s cyst be surgically removed? – Yes, but they tend to come back very quickly if you don’t stop the source of the fluid that is causing the bakers cyst to occur.
4. What is inside of a Baker’s cyst? – Synovial fluid, located inside of your knee joint that helps to lubricate your knee.
5. Will you remove the Baker’s cyst at the time of a knee arthroscopy which is being done for a meniscal tear? – No, the Baker’s cyst is actually located outside of the knee joint and outside of the capsule of the knee. You cannot access the Baker’s cyst from the inner part of the knee joint while doing a knee arthroscopy. By resecting the meniscal tear the Baker’s cyst typically will go away.

What Happens If You Remove the Whole Meniscus?

1. The force on the cartilage in the knee joint increases by almost 300%.
2. This huge increase of force accelerates the wear of the articulations cartilage which ultimately results in early onset osteoarthritis.
3. Prior to knee arthroscopy: pre 1980’s, Orthopaedic surgeons would remove the whole meniscus when there was a tear and a large majority of those folks went on to develop advance osteoarthritis in their knee; resulting in knee replacement surgery at an early age.