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Single Portal Arthroscopy

Arthroscopy is a minimally invasive procedure during which the internal structure of a joint is examined for diagnostic and treatment purposes. In an arthroscopic examination, small incisions are made in the patient’s skin through which miniature surgical instruments and a pencil-sized instrument with a small lens and lighting system, called an arthroscope, is passed. A single-portal arthroscopy is a new technique that uses a modified arthroscope and instruments to adequately carry out the procedure through a single portal thus improving healing and recovery time.

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PRP Therapy

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.

Indications

PRP is a relatively new method of treatment for several orthopaedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.

Procedure

Your doctor will first draw about 10 cc’s of blood from the large vein in your elbow. The blood is then spun in a centrifuge machine for about 10 to 15 minutes to separate the platelets from the remaining blood components.

The injured part of your body is then anesthetized with a local anesthetic. The platelet-rich portion of your blood is then injected into your affected area. In some cases, your doctor may use ultrasound guidance for proper needle placement.

Post-Procedural Care

  • It is normal to feel some discomfort at the injection site for a few days after your procedure.
  • You will be prescribed pain medications by your doctor.
  • You may use cold compresses to alleviate your symptoms.
  • You will be instructed to stop any anti-inflammatory medications.
  • You may resume your normal activities but should avoid any strenuous activities such as heavy lifting or exercises.

Risks and complications

There are very minimal risks associated with PRP injections. Some of the potential risks include

  • Increased pain at the injection site
  • Infection
  • Damage to adjacent nerves or tissues
  • Formation of scar tissue
  • Calcification at the injection site

Summary

Platelet-rich plasma injections are a promising technique to help relieve painful orthopedic conditions and promote healing. It is a relatively new concept and most patients benefit with alleviation of symptoms and a quicker recovery.


Cartilage Replacement & Transplant Surgery

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.

Cartilage restoration is a surgical procedure where orthopedic surgeons stimulate the growth of new cartilage that restores the normal function. Arthritis condition can be delayed or prevented through this procedure.

Several techniques are employed for cartilage restoration including dietary supplements, microfracture, drilling, abrasion arthroplasty, osteochondral autograft, and allograft transplantation.

Dietary supplements: Dietary supplements such as glucosamine and chondroitin are the non-surgical treatment options for cartilage restoration. Chrondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Chrondroitin sulphate and glucosamine obtained from animal sources are available as over the counter products and are recommended for cartilage restoration. Apart from these various other nutritional supplements are also recommended such as calcium with magnesium and vitamin D as a combination, S-Adenosyl-Methionine and Methylsulfonylmethane.

Microfracture: In this method numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates healing response by creating new blood supply. Blood supply results in growth of new cartilage.

Drilling: In this method, a drilling instrument is used to create holes in the injured joint surface. Drilling holes creates blood supply and stimulate growth of new cartilage. Although the method is similar to microfracture, it is less precise and the heat produced during drilling may damage other tissues.

Abrasion Arthroplasty: High speed metal-like object is used to remove the damaged cartilage. This procedure is performed using an arthroscope.

Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the injured joint place. This method is used for smaller cartilage defects.

Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Allograft technique is recommended if larger part of cartilage is damaged.

Autologous Chondrocyte implantation: In this method, a piece of healthy cartilage from other site is removed using arthroscopic technique and is cultured in laboratory. Cultured cells form a larger patch which is then implanted in the damaged part by open surgery.

Osteoarticular transfer system (OATS): Osteoarticular transfer system (OATS) is a surgical procedure to treat isolated cartilage defects which usually 10 to 20mm in size. The procedure involves transfer of cartilage plugs taken from the non-weight bearing areas of the joint and transferring into the damaged areas of the joint.

This procedure is not indicated for wide spread damage of cartilage as seen in osteoarthritis.

The procedure is usually performed using arthroscopy. During the procedure, the plugs taken are usually larger and therefore only one or two plugs are needed to fill the area of cartilage damage. The area of damaged cartilage is prepared using a coring tool which makes a perfectly round hole in the bone in the area of damage. The hole is drilled to a size that fits the plug. Next the plug of normal cartilage is harvested from a non-weight bearing area of the knee, is then implanted into the hole that was created in the damaged area. The size of the plug used should be slightly larger than the hole so that it fits into the position. This procedure allows the newly implanted bone and cartilage to grow in the defected area.

Possible complications of OATS include donor site morbidity causing pain, avascular necrosis, and fracture. Other complications such as hemarthrosis, effusion and pain may also occur. Following OATS rehabilitation is recommended by use of crutches and limiting the range of motion.


Sacroiliac Fusion

Introduction

The sacrum is a triangle shaped bone found in the base of the spine. The iliac bones are the two large bones that form the pelvis. The sacrum and the iliac bones or ilium are connected together by strong ligaments and the junction where these bones meet is referred to as the sacroiliac joint. The hip area plays an important role in supporting the entire upper body weight during body movements (standing, walking, sitting, bending, etc.). This generally leads to wearing and tearing of the cartilage at the sacroiliac joint resulting in sacroiliac joint dysfunction. The people suffering from sacroiliac joint dysfunction may experience low back pain, inflammation, stiffness and pain in the leg, thigh, groin and hip. This condition is initially treated non-surgically with anti-inflammatory and analgesic medicines, sacroiliac joint belt, physical therapy and cortisone injections. If the nonsurgical methods do not prove to be effective then your doctor might recommend you to undergo sacroiliac fusion. Sacroiliac fusion is a surgical procedure which involves fusing of the iliac bones and sacrum for stabilization.

Indication

Your doctor may recommend sacroiliac fusion surgery if you are experiencing severe sacroiliac joint dysfunction due to arthritis, injury due to accidents or falls, being overweight, uneven leg lengths, gout, and spondylitis.

Pre-Surgical Care

Sacroiliac joint dysfunction is diagnosed with X-ray, CT-scan and MRI. The medical history details are collected and you will have to undergo certain clinical examinations before surgery.

Surgical Procedure

The surgical procedure involves fusing of the painful sacroiliac joint. The articular cartilage is scraped from the ends of both bones. The two bones are held together with the help of screws and plates until they fuse (grow together into one bone). This actually stops the movement between the bones and hence annihilates the joint pain.

Post-Surgical Care

It might take 6 months for you to recover completely. You can start the rehabilitation program after 6-8 weeks of surgery. Your doctor may use heat/ice packs, massage, electrical stimulation and ultrasound to decrease the muscle spasms and provide pain relief. Physical therapists will guide you with safe exercises and you will be able to resume your daily activities gradually.

Risk and Complications

As with any surgery, risks and complications can occur. These may include:

  • Swelling
  • Infection
  • Nerve damage
  • Scarring

In many patients, the benefits of surgery outweigh the complications as the surgery can help relieve the debilitating pain and discomfort of sacroiliac joint dysfunction.

  • CSC
  • TSOC
  • Beaumont Hospitals
  • Kaiser Permanente
  • The American Board of Orthopaedic Surgery (ABOS)
  • Cottage Health