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Potential Causes and Treatment Options for Knee Pain
Vic Goradia, MDOrthopedic Surgeon
G2 Orthopedics and Sports Medicine
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About My Practice
❑Expertise❑Personalized Care❑Convenience
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My Background
❑Board Certified w/ CAQ in Sports Med❑Fellowship- Union Memorial Sports Med Clinic, Baltimore❑In practice since 1999❑Chair - Online CME for Arthroscopy Assoc. of N. Am❑Past Associate Editor for Journal of Arthroscopy❑Regularly teach advanced knee and shoulder surgery
courses to orthopedists around the U.S.
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Your Knee Joint
❑Femur – thigh bone❑Patella – knee cap❑Tibia – shin bone❑Cartilage ▪ tissue between bones that
provides cushioning❑Synovium ▪ tissue that provides
lubricating fluid to joint❑Ligament ▪ flexible tissue that holds knee
joint together
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What Causes Knee Joint Pain?
❑Ligament injury❑Torn Cartilage❑Sprains/strains❑Overuse❑Arthritis
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Ligaments Sprains
❑Ligaments ▪tough, non-stretchable fibers ▪Hold bones together
❑ACL Ligament ▪connects the thighbone (the femur) to the shinbone (the tibia) ▪helps stabilize the knee joint.
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ACL Tear
❑One of the most common sport-related injuries
▪ Typically happens by sudden twisting movements, slowing down from running, or landing from a jump
▪ You may hear a popping sound at the time of injury. Your knee may give way and begin to swell and hurt.
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ACL Repair
❑Without surgery▪Brace▪therapy
❑Surgery▪Reconstruct ligament
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Meniscus
❑Shock-absorber ▪cushions
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Meniscal Tear
❑Pain, swelling, and catching❑Anti-inflammatory pills❑Cortisone❑MRI❑Tears don’t heal❑Arthroscopic surgery
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ARTICULAR CARTILAGE
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Down to Bone—Grade IV
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Cartilage Damage→ Osteoarthritis
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What is Arthroscopy?
❑Small incisions ❑Pencil-sized instruments
inserted that ❑Small lens and lighting
system ❑Magnify and illuminate the
structures inside the joint.
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Arthroscopy
❑Rotator cuff repair❑Repair or remove torn cartilage (meniscus) ❑Reconstruct knee or shoulder ligaments❑Removal of loose bone or cartilage in knee, shoulder,
elbow, ankle, wrist.
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Activities Most Affected by Arthritis & Joint Pain2
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Arthritis
❑ Osteoarthritis: • degenerative arthritis• “wearing out” • breakdown of cartilage
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Types of Arthritis❑ Rheumatoid:
• Involves joint lining – synovium • It swells• invades surrounding tissues• produces chemicals that attack
the joint surface
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Osteoarthritis Symptoms❑ May develop suddenly or very slowly❑ Pain and stiffness❑ Swelling❑ Simple tasks may be difficult to do
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Nonsurgical Options❑ Diet and Exercise❑ Physical Therapy❑ Medications❑ Glucosamine❑ Visco-supplementation❑ Cortisone injections❑ Bracing
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Knee Replacement
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Myths and Truths about
Joint Replacement Surgery
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www.g2orthopedics.comMyth
Knee replacement implants are only good for about 10 years.
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Currently, more than 90% of modern total knee replacements are still functioning with a high level of satisfaction after 15 years. (1)
Truth 24
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I’ll have to stay in the hospital a long time after joint replacement surgery
Myth 25
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Today, patients put weight on their new hip or knee hours after their surgery and many go home after 2-3 days. (4)
Truth 26
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You can't really exercise or participate in sports activities after joint replacement surgery
Myth 27
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Actually being active is encouraged after joint replacement surgery. Your doctor will advise you on what is appropriate (5)
Truth 28
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3 compartments of the knee
Medial Compartment
Lateral Compartment
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Normal Knee X-ray Arthritic Knee X-ray
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Total Knee Replacement❑ End surface of thigh
bone replaced with metal
❑ End surface of leg bone replaced with metal
❑ Plastic liner is inserted between them
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Replaced Knee X-rayFront View Side View
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The GetAroundKnee is
❑ designed to work much like a healthy knee
❑ designed to replace the knee’s naturally circular motion.3,4,9
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Potentially improves fit for women
❑ Narrower implants accommodate the female bone structure
❑ Wide range of sizing options to more closely match the male and female anatomy8
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Computer Navigation
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Stryker Knee Navigation
❑ Navigation helps the surgeon with more accurate placement of the artificial knee
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How it Works
❑Similar to GPS▪ Infrared sensors act like satellites
❑Information supplies the surgeon with the measurements of your unique anatomy.
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Benefits to Your Surgeon
❑ Allows adjustments within a fraction of a degree▪ helping to ensure optimal fit and improved
performance of your implant
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Potential Benefits to Patient
❑Reduced bleeding immediately after surgery
❑Easier to regain knee motion
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Total Knee Replacement
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• Considered the Gold Standard for Advanced Knee OA
• Best for late-stage OA➢Removes healthy bone, cartilage, and
tissue
Total Knee Arthroplasty (TKA) Isn’t Always The Solution
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Partial Knee Resurfacing
▪If arthritis affects only one compartment of your knee, PKR may be an option for you.
▪Approximately 70,000 Partial Knee Resurfacing procedures are done each year in the US*
*2008 Projection, Millennium Research Group, 2005.
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Stryker Implant Technology
Triathlon® PKR Knee System
Avon® Patellofemoral Knee System
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Total vs. Partial
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MAKOplasty®
Patient-specific Partial Knee Resurfacing Using Surgeon-controlled Robotic Arm Technology
Partial Knee Replacement
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MAKOplasty® Fills A Gap For Patients With Mid-Stage Osteoarthritis
Early-Stage Knee Pain Mid-Stage OA Late-Stage OA
MAKOplasty Partial Knee Arthroplasty OptionsTotal Knee ReplacementArthroscopy
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Prevalence of Partial Knee Osteoarthritis
• Unicondylar Disease− ≈ 43% of TKA patients may only have one area of
arthritis
• Patellofemoral Disease− 24% of patients may only have arthritis in kneecap
• Bicompartmental Disease− 40-65% of patients have arthritis in only 2 of the 3 parts of
the kneeBicomp disease
TKA Patients
Partial disease
Kneecap disease
OA Patients
OA Patients
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Before surgery a 3-D plan is created from a CAT scan of your knee
The MAKOplasty® Advantage
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• Patient-specific pre-operative 3-D plan enables accurate implant sizing and positioning consistently and reproducibly
• 3-D view improves surgeon visualization
• Proper implant alignment is assessed BEFORE procedure begins
• Optimal soft tissue balancing through entire range of knee motion is enabled
The MAKOplasty® Advantage
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MAKOplasty® PKU Overview
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MAKOplasty® PKR Surgery Overview
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• Offers The Following Potential Benefits:− Improved surgical outcomes− Less implant wear and loosening− Bone-sparing and soft-tissue preserving− ACL and PCL preservation
• Feels More Natural When Compared to Total Knee Replacement1
MAKOplasty® Clinical Value to Patients
(PKR= partial knee replacement)
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MAKOplasty® Provides More Accurate And Reproducible Implant Placement Than Conventional
Partial Knee Techniques
• Robotic arm assisted PKA leads to:− 2-3 times more accurate implant
placement than manual UKA1,2,3,4,5
− At least 3 times more reproducible implant placement than manual UKA1,2,3,4,5
− Fewer outliers than manual UKA6
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Conclusion: MAKOplasty Patients Had Significantly Less Pain than Oxford Patients Day 1 To Week 8
MAKOplasty® Demonstrates Less Post-Operative Pain Versus Manual PKR (Oxford® )1
Early Post-operative Pain
1. Jones B, Blyth M, MacLean A, Anthony I, Rowe P. Accuracy of UKA implant positioning and early clinical outcomes in a RCT comparing robotic assisted and manual surgery. CAOS International Conference, June 13-15, 2013, Orlando, Florida.
Oxford® is a registered trademark of Biomet, Inc.
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Conclusion: MAKOplasty patients showed improved function at 3 month follow-up based on AKSS
MAKOplasty® Demonstrates Improved Function Versus Manual PKR (Oxford® )1
1. Jones B, Blyth M, MacLean A, Anthony I, Rowe P. Accuracy of UKA implant positioning and early clinical outcomes in a RCT comparing robotic assisted and manual surgery. CAOS International Conference, June 13-15, 2013, Orlando, Florida.
Oxford® is a registered trademark of Biomet, Inc.
p=0.006
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Who Are Good Candidates For A MAKOplasty® Procedure?
Typical MAKOplasty Patients Share the Following Characteristics: • Knee pain with activity, on the inner knee, 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 treatment such as rest, weight loss, physical therapy and non-steroidal anti-inflammatory medication
• Best treatment option for each patient will be determined individually
BICOMPARTMENTAL PATELLOFEMORALUNICONDYLAR LATERAL
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Partial Knee Resurfacing
❑Suitable if only one half of the knee is diseased
❑Surfaces are replaced only on one side of knee
❑Implants are anatomically shaped
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Total Knee vs. Partial Knee
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Benefits of Partial Knee Resurfacing (PKR)
❑Recovery period may be shorter than total knee replacement*
❑Post-operative pain may be reduced*❑Smaller implants mean the surgical incision may
be smaller
* Newman, John H., Unicompartmental Knee Replacement, The Knee, 7 (2000), pp. 63-70.
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A Giant Step Forward in Joint Replacement
❑Computer-Assisted Surgery
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What are the potential risks?
❑Risks which are normally encountered in conventional TKA remain
❑Individual results and post-op activity levels vary
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Knee Implants
❑Longevity of knee implants is affected by many factors including: ▪Patient weight▪Activity level▪Bearing surface
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Knee Rehabilitation
❑Performing rehabilitative exercises may gradually return full flexibility and stability to your knee
❑Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation
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Conclusion
❑I start with non-operative options❑When pain and activity limitations effect the
patient then a replacement is discussed❑The use of technology permits me to more
accurately and reproducibly perform the surgery
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❑I like to offer the least invasive procedure that will provide the desired outcomes
❑Robotic technology permits accurate and reproducible outcomes
❑Future
Conclusion
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Thank You
Vic Goradia, MD
Office: 804-678-9000www.G2orthopedics.com