We offer an assortment of treatments for various injuries to the knee and hip. These include:
Important Notice: Millsap Valley does not endorse any treatments or procedures referenced in this article. This information is provided as an educational service and is not intended to serve as medical advice. If you are seeking specific orthopedic advice, you should schedule an appointment with Dr. Rose or another qualified physician.
Arthritis of the hip can occur through progressive wear and tear over time, traumatic injury, or as a result of rheumatoid arthritis destruction. Total hip arthroplasty is a replacement of the femoral head as well as the cup and the pelvis. These are reconstructed using components made of metal and/or plastic or ceramic. Total hip arthroplasty is meant to be a pain relieving procedure, where the artificial joint can allow for weight bearing without the arthritic pain. A typical hospital stay is a minimum of three days after surgery. Progressive gait training is performed with physical therapy. Many times precautions are required for the first several months to allow for good healing of the joint capsule. Patients are normally able to return to a fairly active lifestyle after proper therapy and strengthening.
Hip bursitis is generally in the side of the pelvis, where there is a bursa underlying a muscle that crosses over the side of the hip bone. Bursitis can occur from tight musculature as well as bony spurring and/or trauma. Hip bursitis is generally treated through physical therapy with stretching and modalities. Anti inflammatories are also used. If conservative measures do not resolve the issue, an injection of Cortisone into the hip bursa can also be of assistance. If these measures do not resolve the problem, sometimes surgical release is required to take pressure off of the bursa as well as to remove bony spurring.
Arthritis of the knee can result from wear and tear over time, traumatic injury, or rheumatoid arthritis. Generally after a loss of cartilage on the joint surface, knee pain can increase substantially due to abrasive wear. Marked pain and swelling is also noted in the joint with crepitation. Treatments for arthritis of the knee include external supports and/or bracing; injections, including steroid and/or Viscosupplementation; physical therapy; external support also includes a cane, crutches, or a walker. Ultimately, progression of arthritis can lead to a joint arthroplasty, where the femur, the tibia, and often the patella are resurfaced with metal and/or plastic or ceramic components to allow for increasing activity without joint pain. A patient’s hospital stay can be as long as three to four days, while physical therapy can extend for several months to improve range of motion and strengthening before returning to normal activities.
ACL and PCL injuries occur through a direct blow to the knee and/or a rotational injury. Oftentimes it can occur through a non-contact type of injury. These are usually verified through MRI studies. Arthroscopically assisted ACL or PCL reconstruction is done using the scope as well as instruments that are placed arthroscopically to recreate tunnels and anatomic locations of the affected ligaments. Both tissue from the patient as well as allograft tissue from a cadaver can be used to reconstruct these ligaments. The preferred method should be discussed with your surgeon. Bone-patellar tendon-bone is typically considered the gold standard in the industry and allows for good bony healing in the tunnels as well as restoration of stability to the joint through the patellar tendon. Several months of healing and therapy are required before returning to general activities, including athletic endeavors.
Knee arthroscopy for meniscectomy is a common procedure performed today as a result of a twisting injury to the knee. The meniscus is an elastic type of cartilage that allows for a shock absorber effect to the knee to try to prevent injury to the joint cartilage. A tear, depending on the configuration, can cause popping, catching, and locking or simply pain and swelling with weight bearing activities. Knee arthroscopy allows for good visualization of the entry, and instruments are available to trim and remove the area that is injured without removing the entire meniscus that was performed many years ago through an open procedure. Return to full activity is generally three to six weeks post-operatively after physical therapy for range of motion and strengthening.
Knee arthroscopy with chondroplasty is often performed for injury through wear and tear or a traumatic fall or blow to the knee. The cartilage of the joint is very smooth and allows for very low friction movement through the knee joint. After a chondral injury, it can start to delaminate off the bone and allow for catching or popping and swelling. Chondroplasty can help trim some of these damaged edges to help smooth the transition zone to allow for better range of motion without catching or locking. Typically after knee arthroscopy with chondroplasty, return to full activity would ensue three to six weeks after physical therapy for range of motion and strengthening.
Knee arthroscopy with microfracture is performed when there has been an injury to the joint cartilage, usually due to a traumatic event. Microfracture usually requires good, healthy cartilage around the area of injury. Microfracture is a technique where small holes are placed into the bone to allow for fibrous healing into the region. Range of motion is usually performed for six to eight weeks with limited weight bearing, depending on the location of the microfracture. Generally the fibrocartilage it forms is not as strong and durable as the normal joint cartilage but can allow for good restoration of function and use for several years in a pain-free fashion.
The OATS procedure is performed either arthroscopically or through small mini-incisions. The OATS procedure allows for grafting of a cartilage bone plug into an area where there has been previous cartilage injury. There is also a technique to backfill areas where bone cartilage plugs are harvested to place into these regions. This procedure generally requires a period of limited to non-weight bearing and range of motion while healing takes place. Then physical therapy is performed to allow progressive strengthening and range of motion, prior to returning to full function.
Patella realignment for patella dislocation and/or maltracking is performed through arthroscopic release as well as a small open procedure. More advanced techniques for very malaligned patellas may require more extensive procedures, including osteotomies to cut bone and realign the insertion site of the patellar tendon. This would allow for better centralization of the patella to reduce pain and improve strength and patella tracking.
A tibia plateau fracture normally results from a load directly to the tibia plateau as well as from stress from either side of the knee. When there is displacement of the joint surface, typically open reduction with internal fixation is required. Minimally to non-displaced tibia plateau fractures can be treated with a knee immobilizer or a cast and early range of motion as dictated by x-ray follow up. After open reduction with internal fixation, physical therapy is required to restore range of motion and strength. Oftentimes after severe tibia plateau fractures, traumatic arthritis sets in due to the injury to the joint cartilage in the process of the original injury, and oftentimes patients progress to total knee arthroplasty ten to fifteen years after their initial traumatic injury.
Viscosupplementation for arthritis of the knee is a hyaluronic acid injection into the knee that allows for better gliding and less friction and wear to the joint cartilage. Currently, the FDA only approves Viscosupplementation injections into the knee. There are many different brands, including Synvisc, Hyalgan, Euflexxa, and Orthovisc. These are usually injected between one and three times over a three week period to allow for improved function and reduced pain. It is generally recommended to try corticosteroids and/or Viscosupplementation before proceeding with total knee arthroplasty. If good relief is found, the patient can return and have the series of injections repeated as close together as six months at a time.