Knee 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, more athletic.

      "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 of arthritis.

      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.