Nonsurgical and Minimally Invasive Treatments
Regardless of your age, maintaining bone and joint health should be a priority. According to the Centers for Disease Control and Prevention (CDC), bone and joint disorders are the leading cause of disability in the United States. Fifty million adults in the U.S. struggle with everyday activities due to the devastating effects of arthritis, the most common joint disorder. And over half of those have osteoarthritis, a form of arthritis more common among older adults. Osteoarthritis is a degenerative condition and accounts for most of the joint replacement surgeries performed in the U.S.
UT Physicians orthopedic surgeon Kenneth Mathis, M.D., is affiliated with Memorial Hermann-Texas Medical Center and vice chairman of the department of Orthopedics at the Memorial Hermann Orthopedic & Spine Hospital. He explains that having knee or hip pain does not necessarily mean you are a candidate for surgery. “The patient’s primary care physician can provide an initial physical exam and, if recommended, have an X-ray or MRI done of the joint,” Dr. Mathis says. “When joints are damaged, either due to arthritis, other diseases or injuries, and the patient has pain, stiffness or swelling, there are many treatment options to explore.”
The team of affiliated specialists at each Memorial Hermann Joint Center offers the expertise and training to provide the most appropriate solutions for bone and joint pain. Treatment options can include anything from a new prescription, pain management techniques, physical therapy, joint injections or minimally invasive joint replacement surgery.
Nonsurgical Treatment Options
Let's take a look at some non-surgical treatment options that can be effective in reducing or eliminating your knee pain entirely.
Cortisone injections are a widely used option for reducing pain and swelling in an injured or deteriorating knee joint. They can offer an excellent interim solution if you might later be a candidate for knee replacement, or if you have pain that can be resolved by long-term strategies such as weight loss and exercise programs. Since too much corticosteroid without adequate recovery time between shots will degrade tissues, these are limited to up to four times a year.
"Rooster shots" actually derive their name from the fact that the active substance (hyaloronic acid) is often extracted from rooster combs. The hyaloronic acid contains a chemical equivalent to the synovial fluid excreted by the bursa to lubricate the knee joints. With age and more rough bone surface replacing smooth cartilage, the bursa can fall down on the job. Rooster shots can often help.
Working with a physical therapist to increase range of motion and flexibility can go a long way in strengthening your leg muscles and offsetting joint pain. Therapists can develop a personalized exercise routine to help you reduce pain and improve functioning.
Alternative therapy options include acupuncture, ultrasound and magnetic pulse therapy. These therapies work to block nerve pain (acupuncture) or stimulate blood flow to promote healing.
Minimally Invasive Knee Pain Treatments
Arthroscopic procedures are a common method for smoothing rough cartilage surfaces due to a tear or divet, removing bone spurs related to injury or osteoarthritis, and repairing torn ligaments. A camera and surgical instruments are inserted into the knee joint through 3-4 incisions of 1 centimeter each. These repairs are made on an outpatient basis and often under local anesthesia.
Autologous cell or stem cell injections and implantations are the exciting future of joint therapy. These treatments involve harvesting a person's own chondrocytes (bone marrow cells that form cartilage) or stem cells and growing them in the laboratory. Over months, injections of these cells into the knee can form new articular cartilage covering the joint. Particularly in young patients with traumatic knee injuries and/or a small defect (2 centimeters or less) in the cartilage, the autologous or stem cell injection treatments offer a good option prior to knee replacement.
Microfracture, performed arthroscopically, is a procedure where small perforations are made in the knee bone, causing the bone to bleed. This blood contains bone marrow cells that stimulate cartilage growth which protects the injured joint. Microfracture is currently reserved for younger patients, who grow tissue more quickly and require an alternative to multiple knee replacements over their lifetime.
Autograft mosaicplasty is an arthroscopic procedure where many tiny pieces of your own cartilage are transplanted to repair defects in the knee joint cartilage. When the cartilage defect is too large to be safely supplied by the patient, an allograft (sterilized cadaver cartilage) may be used instead.
Promising new knee therapies which may ultimately replace knee replacement surgery for certain patients are being developed and tested. Currently, we are starting to implant sterilized cadaver meniscus in patients who meet the criteria. Plastic meniscus implants are now in clinical trials. Still in the experimental phase is a procedure where an entire meniscus (cartilage pad between the bones) is grown from the person's own cells and implanted in the joint.
What to Expect After Treatment
After arthroscopy, you may be on crutches and in a boot for six to eight weeks. Some patients experience stiffness, but little pain, while others find they need relief through regular icing, compression or medications.
Physical therapy and home exercises over this period are crucial to healing and optimal mobility. However, if you cannot undergo physical therapy, your doctor may recommend use of a continuous passive motion machine (CPM), a device that is used to gently flex and extend the knee.
We offer physical therapy onsite and will closely monitor your progress using advanced quantitative MRI imaging.