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Platelet-rich plasma (PRP) for Knee Pain

Platelet-rich plasma (PRP) is an emerging treatment in a new health sector known as "Orthobiologics." The philosophy behind Orthobiologics is to merge cutting edge technology with the body's natural ability to heal itself. PRP is a specialized process by which the growth factors from a patient's own blood are injected into the site of inflammation to stimulate the healing process to decrease pain.

Blood is made of red blood cells, white blood cells, plasma and platelets. Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. Cumulatively, these growth factors accelerate tissue and wound healing. By increasing these platelets, we are able to deliver a powerful mixture of growth factors that can dramatically enhance tissue recovery.

PRP injections have been used extensively on professional athletes for a wide variety of injuries, and the early results are very exciting. Although more data is still needed, PRP may provide an alternative to surgery or to other types of injections.

Procedure

First, a small amount of blood is drawn from a patient's vein. The blood is then placed in a centrifuge that spins the blood for approximately 15 minutes to remove the plasma, white and red blood cells, as these are not primarily responsible for healing. What remains is an increased concentration of platelets, rich in healing properties called growth factors. While this process is underway, the patient receives either local anesthetic (injected) or conscious sedation (via IV), as determined beforehand by the physician and patient. Using musculoskeletal ultrasound or other imaging techniques, the ankle joint is identified and the injection is performed with ultrasound guidance to ensure that the injection goes into the joint.

Recovery

After the injection, the patient rests for five to ten minutes and is discharged home with post procedure instructions. It is not uncommon to experience increased pain for approximately seven days following the injection, as this represents part of the healing process. Follow up is usually in four weeks.  Patients are encouraged to participate in physical therapy following the injection to enhance and speed recovery.

Visco-Supplementation

Although there is no cure for osteoarthritis of the knee, there are many treatment options available. The primary goals of treatment are to relieve pain and restore function.

In its early stages, arthritis of the knee is treated with nonsurgical methods.
One treatment option which may be recommended by your Hinsdale Orthoapedics’ knee specialist is a procedure called viscosupplementation. In this procedure, a thick fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and act as a shock absorber for joint loads.

People with osteoarthritis ("wear-and-tear" arthritis) have a lower-than-normal concentration of hyaluronic acid in their joints. Viscosupplementation may be a therapeutic option for individuals with osteoarthritis of the knee.

Viscosupplementation has been shown to relieve pain in many patients who have not responded to other nonsurgical methods. The technique was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997. Several preparations of hyaluronic acid are now commercially available.

Immediate Effects

  • Hyaluronic acid does not have an immediate pain-relieving effect.
  • For the first 48 hours after the shot, you should avoid excessive weightbearing on the leg, such as standing for long periods, jogging or heavy lifting.
  • You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the shot. These symptoms generally do not last long. You may want to apply an ice pack to help ease them.
  • Rarely, patients may develop a local allergy-like reaction in the knee. In these cases, the knee may become full of fluid, red, warm, and painful. If this occurs, contact your doctor immediatelyInfection and bleeding are also very rare complications of this procedure.

Longer Term Effects

  • Over the course of the injections, you may notice that you have less pain in your knee.
  • Hyaluronic acid does seem to have anti-inflammatory and pain-relieving properties. The injections may also stimulate the body to produce more of its own hyaluronic acid.
  • Effects may last for several months.
  • Visco-supplementation may be effective in relieving the symptoms of arthritis, but has never been shown to reverse the arthritic process or re-grow cartilage.

During the procedure, if there is any swelling in your knee, your doctor will remove (aspirate) the excess fluid before injecting the hyaluronic acid. Usually, this can be done at the same time, with only one needle injected into the joint, although some doctors may prefer to use two separate syringes. Depending on the product used, you will receive one to five shots over several weeks.
 

Total Knee Replacement

Normally, all of the parts of the knee joint work together and the joint moves easily and without pain. However, disease or injury can disturb the normal functioning of a joint, which can result in knee pain, muscle weakness, and limited movement. With longer life expectancies and greater activity levels, joint replacement is being performed in greater numbers.  Artificial joint technologies, which many are provided by the experienced knee surgeons at Hinsdale Orthopaedics incorporate the latest in joint replacement to help patients experience less pain and improved function.

Total Knee Replacement

A knee replacement involves removing the damaged areas of the knee and replacing them with new components to restore the function and surface of the knee.  During the procedure, the worn surfaces at the end of the thighbone and shinbone (femur and tibia) are removed using special instruments.  The bone is then shaped to prepare for the new covering.  The worn surface is removed and a new metal surface is placed on the remaining bone areas.   Towards the end of the surgery after the implants have been secured, your experienced HOA knee surgeon will move your knee joint to make sure it moves normally and to confirm it works in tandem with the supporting muscles and ligament tissues. 

Diagnosis

Our knee specialists bring a compassionate and caring approach to every condition and injury assessment.  During your assessment they will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.

How Do I Know If Joint Replacement Is Right For Me?

When joint pain is severe and interferes with daily activities and work, joint replacement may be an option. The pain you experience from arthritis and joint degeneration can:

  • Be constant or intermittent
  • Occur when you are moving or at rest
  • Be located in one spot or in many parts of your body

The pain and the stiffness of joint degeneration may be worse during certain times of the day, or after certain activities such as:

  • Walking
  • Climbing stairs
  • Getting in and out of a chair

Individuals with arthritis may even feel uncomfortable or have pain while resting or sitting in a chair or lying down. They may be uncomfortable at night, and the pain may wake them up.

The pain of joint degeneration can limit many everyday activities, such as:

  • Walking
  • Bending
  • Going up and down stairs
  • Getting in and out of a car
  • Getting dressed
  • Sexual activities
  • Joint degeneration can eventually make it extremely difficult for individuals to work and enjoy themselves. It also can make it difficult for individuals to care for themselves.
     

Revision Total Knee Replacement

Revision Total Knee Replacement is the replacement of the previously failed total knee prosthesis with a new prosthesis. It is a complex procedure that requires extensive preoperative planning, specialized implants and tools, and mastery of difficult surgical techniques to achieve a good result. Your highly-trained Hinsdale Orthopaedics knee surgeon is fellowship-trained in this surgical technique and has experience in complex knee joint revision arthroplasty.

A knee replacement involves removing the damaged areas of the knee and replacing with new components and restoring the function and surface of the knee.  During the procedure, the worn surfaces at the end of the thighbone are removed using special instruments.  The bone is then shaped to prepare for the new replacement arts.  The worn surface is removed and a new metal surface is placed on the remaining bone areas.   Towards the end of the surgery after the implants have been secured, your experienced HOA knee surgeon will move your knee joint to make sure it moves normally and to confirm it works in tandem with the supporting muscles and ligament tissues.
 

 

Posterior Crucial Ligament (PCL) Reconstruction

The PCL has been described as one of the main stabilizers of the knee.  It is broader and stronger than the ACL.  It connects the femur (thigh bone) to the tibia (shin bone).  PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing.  A forceful hyperextention of the knee or a direct blow just below the knee cap will disrupt the PCL.  For example, the football player who is tackled with a direct hit to the knee may hyperextend the limb and rupture the PCL.  The basketball player who lands on the court directly on a bent knee may tear his/her PCL. 

Patients may complain of the shifting of the tibia with running. These patients benefit from a PCL reconstruction, which reestablishes stability to the knee. These ruptured ligaments cannot be repaired.  It must be reconstructed using a graft. This can be from the injuried patients own body or from a donor. The graft is attached through drill holes in the tibia and femur, using arthroscopic techniques, to reestablish the posterior cruciate attachment.

This is an out patient procedure allowing the patient to walk with crutches and a brace in their home. Return to sports is restricted for 10 to 12 months, allowing the knee to rebuild strength and function.


 

Partial Knee Replacement

Normally, all of the parts of the knee joint work together and the joint moves easily and without pain. However, disease or injury can disturb the normal functioning of a joint, which can result in knee pain, muscle weakness, and limited movement. And with longer life expectancies and greater activity levels, joint replacement is being performed in greater numbers on younger patients thanks to new advances in artificial joint technologies, which many are provided by the experience knee surgeons at Hinsdale Orthopaedics.

How Do I Know If Joint Replacement Is Right For Me?

When joint pain is severe and interferes with daily activities and work, joint replacement may be an option. The pain you experience from arthritis and joint degeneration can:

  • Be constant or intermittent
  • Occur when you are moving or at rest
  • Be located in one spot or in many parts of your body

The pain and the stiffness of joint degeneration may be worse during certain times of the day, or after certain activities such as:

  • Walking
  • Climbing stairs
  • Getting in and out of a chair

Individuals with arthritis may even feel uncomfortable or have pain while resting or sitting in a chair or lying down. They may be uncomfortable at night, and the pain may wake them up.

The pain of joint degeneration can limit many everyday activities, such as:

  • Walking
  • Bending
  • Going up and down stairs
  • Getting in and out of a car
  • Getting dressed
  • Sexual activities
  • Joint degeneration can eventually make it extremely difficult for individuals to work and enjoy themselves. It also can make it difficult for individuals to care for themselves.

Diagnosis

Your Hinsdale Orthopaedics knee specialist brings a compassionate and caring approach to every condition and injury assessment.  During your assessment they will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.

Partial Knee Replacement

A knee replacement involves removing the damaged areas of the knee and replacing with new components and restoring the function and surface of the knee.  During the procedure, the worn surfaces at the end of the bones are removed using special instruments.  The bone is then shaped to prepare for the new covering.  The worn surface is removed and a new metal surface is placed on the remaining bone area.   Towards the end of the surgery after the implants have been secured, your experienced HOA knee surgeon will move your knee joint to make sure it moves normally and to confirm it works in tandem with the supporting muscles and ligament tissues. 

Meniscus Repair

When a grade III injury occurs, patients usually wear a knee immobilizer and protect weight bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.

Once the patient can flex the knee at least to 100 degrees, they may begin riding a stationary bicycle. The crutches can be discontinued once the patient is able to walk without limping. Jogging can begin once the patient has regained 60% of their quadricep strength (compared to the opposite side), and agility drills can begin once they have regained 80% of their strength. Complete rehab from a grade III MCL tear can take 3 to 4 months.
 


 

Medial Collateral Ligament (MCL) Treatment

The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).

The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents "opening-up" of the knee.

Treatment of a MCL injury rarely requires surgical intervention. Almost always, some simple treatment steps, along with rehabilitation, will allow patients to resume their previous level of activity. The time before an athlete is able to return to their sport corresponds to the grade of the injury.

Grade I MCL Tears

Grade I sprains of the MCL usually resolve within a few weeks. Treatment consists of:

  • Resting from activity

  • Icing the Injury

  • Anti-inflammatory medications

Most patients with a grade I MCL tear will be able to return to sports within 1-2 weeks following their injury.

Grade II MCL Tears

When a grade II MCL sprain occurs, use of a hinged knee brace is common in early in early treatment. Athletes with a grade II injury can return to activity once they are not having pain over the MCL. Patients with a grade II injury often return to sports within 3 to 4 weeks after their injury.

Grade III MCL Tears

When a grade III injury occurs, patients usually wear a knee immobilizer and protect weight bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.

Once the patient can flex the knee at least to 100 degrees, they may begin riding a stationary bicycle. The crutches can be discontinued once the patient is able to walk without limping. Jogging can begin once the patient has regained 60% of their quadricep strength (compared to the opposite side), and agility drills can begin once they have regained 80% of their strength. Complete rehab from a grade III MCL tear can take 3 to 4 months.
 

MAKO-Assisted Orthopaedic Knee Surgery

History

Total knee replacements are among the most common and successful orthopaedic operations. The reasons for joint replacement are well established and the quality of patient outcomes are well documented. Pain relief, increased joint motion, improved joint function and durability are predictably achieved in the majority of patients. Surgical goals are accomplished using techniques that mechanically or visually reference anatomical landmarks to reconstruct the damaged joint. Computer Assisted Orthopaedic Surgery (CAOS) is a new technology designed to either compliment or add information during joint replacement surgery. CAOS has the potential to improve the accuracy and reproducibility of joint replacement operations. 

The surgeons at Hinsdale Orthopaedics perform the MAKOSurgical Computer/Robotic Assisted Orthopaedic surgical technology.

Frequently asked questions:

Q: What is Osteoarthritis?

A: Osteoarthritis (OA) is a form of arthritis and a degenerative joint disease characterized by the breakdown and eventual loss of joint cartilage. Cartilage is a glycoprotein substance that serves as a cushion between the bones of a joint. With OA, the top layer of cartilage breaks down and wears away, allowing bones under the cartilage to rub together.

Q: What causes OA of the knee?

A: Although the root cause of OA is unknown, the risk of developing symptomatic OA is influenced by multiple factors such as age, gender and inherited traits that can affect the shape and stability of your joints. Other factors can include:

  • A previous knee injury
  • Repetitive strain on the knee
  • Improper joint alignment
  • Being overweight
  • Exercise or sports-generated stress placed on the knee joints

Q: What are the symptoms of OA of the knee?

A: Symptoms of OA of the knee include:

  • Pain while standing or walking short distances, climbing up or down stairs or getting in and out of chairs
  • Knee pain with activity
  • Start up pain or stiffness when activities are initiated from a sitting position
  • Stiffness in your knee joint after getting out of bed
  • Swelling in one or more areas of the knee
  • A grating sensation or crunching feeling when you use your knee

Q: How is OA treated?

A: Whether your OA is mild or severe, your physician will most likely recommend certain lifestyle changes to reduce stress on your knee joints. Additional disease and pain management strategies may include: physical therapy, steroid injections, over-the-counter pain medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain relieving creams.

Please speak with your physician if your symptoms aren’t responding to non-surgical solutions, or your pain can no longer be controlled by medication. You could be a candidate for surgery.

The most common surgical knee intervention performed for OA is a total knee replacement. During this procedure, the natural joint is removed and replaced with an artificial implant. This treatment option is usually offered to patients with advanced osteoarthritis of the knee.

Total knee replacement is not always optimal for patients with early to mid-stage osteoarthritis in just one or two compartments of the knee. For patients with partial OA of the knee, MAKOplasty® Partial Knee Resurfacing may be the more appropriate solution.

Q :What is MAKOplasty®?

A: MAKOplasty Partial Knee Resurfacing is an innovative treatment option for adults living with early to midstage OA in the medial (inner), patellofemoral (top), or lateral (outer) compartments of the knee. It is powered by the RIO® Robotic Arm Interactive Orthopedic System, a robotic system which allows for consistently reproducible precision in performing partial knee resurfacing.

During the procedure, the diseased portion of the knee is resurfaced, sparing the patient’s healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. MAKOplasty Partial Knee Resurfacing can:

  • Facilitate optimal implant positioning to result in a more natural feeling knee following surgery
  • Result in a more rapid recovery and shorter hospital stay than traditional knee replacement surgery
  • Be performed on an outpatient basis
  • Promote a rapid relief from pain and return to daily activities

Q: How may MAKOplasty benefit me?

A: The MAKOplasty Partial Knee Resurfacing procedure is designed to relieve the pain caused by joint degeneration and potentially offers the following benefits:

  • Joint resurfacing
  • Bone sparing
  • Smaller incision
  • Less scarring
  • Reduced blood loss
  • Minimal hospitalization
  • Rapid recovery

Q: How does MAKOplasty work?

A: The RIO Robotic Arm Interactive Orthopedic System features three dimensional pre-surgical planning. During surgery, the RIO provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. It is this optimal placement that can result in more natural knee motion following surgery.

Q: Who would be a good candidate for the MAKOplasty procedure?

A: Typically, MAKOplasty patients share the following characteristics:

  • Knee pain with activity, usually on the inner knee and/or under the knee cap, or the outer knee
  • Start up knee pain or stiffness when activities are initiated from a sitting position
  • Failure to respond to non-surgical treatments or nonsteroidal anti-inflammatory medication

Q: If I undergo MAKOplasty what can I expect?

A: MAKOplasty is most often performed as an inpatient procedure and your hospital stay average anywhere from one to two days.

In many cases, patients are permitted to walk soon after surgery, drive a car within weeks and return to normal activities shortly thereafter.  Your Hinsdale Orthopaedics’ knee surgeon will determine your custom rehabilitation plan.
 

Loose Body Removal Procedure

Typically, a Hinsdale Orthopaedics knee surgeon will schedule surgical management of the loose bodies if they fail to resolve during conservative treatment programs.  When the loose bodies are unstable or cause decreased function and pain, they can be surgically removed.  Your HOA knee surgeon can elect to remove these fragments by utilizing minimally invasive surgery such as arthroscopic surgery. 

During this procedure the HOA knee surgeon identifies the fragments through a small camera and removes them utilizing specialized instruments.  Additional measures to smooth out rough edges of the cartilage may also be included.  If you have several loose bodies and arthritis, these conditions are usually the result of severe degeneration of the knee and are usually addressed during a total knee replacement surgery.
 

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