treatment steps for younger patients
by Dr. Rock Positano
Daily News - July 1, 2001
Spotlight on Health
Special to the News
Millions of Americans suffer from arthritis of the knee. And while
total knee replacement is an excellent solution for an elderly person
with severe arthritis, it is not necessarily best for the younger,
"There are better, conservative options for younger patients
with moderate arthritis," said Dr. Robert Rozbruch, an orthopedic
surgeon at the Hospital for Special Surgery in Manhattan.
Rozbruch and his colleagues have developed a treatment program that
includes new, less invasive surgical options.
Many patients with arthritis of the knee have an acute deterioration
of normal function. Often, an acute cartilage tear is the cause of
mechanical irritation of the knee. Arthroscopic surgery, in which
surgeons make small incisions to identify fragments of cartilage in
the knee and clean up the area, can be effective.
A new technique called PIC drilling has been used with success to
treat local areas of cartilage loss in the knees of younger patients.
"We make a few tiny holes in the underlying bone to stimulate
a little bleeding," says Rozbruch. "This allow stem cells
from the bone marrow to reach the surface of the joint, which then
have capacity to grow into new cartilage."
In patients in whom only one side of the joint has deteriorated, a
procedure know as a realignment osteotomy (bone cut) can be helpful.
Osteotomy is used to realign the leg and transfer the weight-bearing
stress to the healthy part of the knee, thus preventing the progression
Knee realignment osteotomy is a minimally invasive technique. Thorugh
1/4 inch skin incisions, the bone is cut and a frame is applied to
the leg. Gradual adjustments of the frame straighten the leg.
The procedure, which is done under regional anesthesia, takes about
one hour and involves an overnight stay in the hospital. The frame
is required for three months, until all bone is healed.
Crutches are used for the first two months. Physical therapy is encouraged.
The procedures described above are designed for young people with
moderate arthritis of the knee.
They can help relieve current pain and prevent progression of arthritis
that could otherwise lead to the need for total knee replacement.
Dr. Rock Positano, M.S., M.P.H. D.P.M., is on the faculty and
staff of the Weill Medical College of Cornell University.