An estimated 27 million Americans suffer from chronic pain and reduced mobility due to osteoarthritis, a condition characterized by the breakdown of cartilage lining and protecting load-bearing joints such as the knee. While conservative therapies for osteoarthritis do little to address the underlying cause of knee pain, traditional surgical techniques do so at the expense of the entire joint, as in the case of total knee replacement. Consequently, subchondroplasty may be the best option for treatment.
In recent years, attention has shifted towards addressing the structural breakdown of bone in the knee that occurs during the early stages of osteoarthritis and contributes to pain and disease progression. Now, an innovative treatment known as subchondroplasty is designed to do just this. Subchondroplasty is a safe, effective, and minimally invasive procedure that resolves bone defects, promotes new bone growth, and helps prevent the need for more invasive arthritis treatments such as total knee replacement.
The Knee Surgery Center of Excellence boasts a highly credentialed and experienced team of the best orthopedic surgeons in Los Angeles, specializing in cutting-edge therapies for a variety of knee injuries. As leading experts in the field of joint preservation and restoration, our surgeons utilize a number of innovative biologic therapies, including subchondroplasty, to ensure that each patient receives optimal relief from their knee pain and discomfort.
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What is Bone Marrow Edema?
Bone marrow edema (BME) is defined as swelling in the soft bone just underneath the joint’s surface (subchondral layer) as a result of microscopic bone defects. New research suggests that BME is present in a large percentage of patients with knee osteoarthritis and is a strong predictor of increased pain, faster cartilage destruction, and greater likelihood of requiring total knee replacement. Bone marrow lesions will not heal without treatment, and instead will continue to cause irritation and damage to articular cartilage and progression of knee arthritis.
Who is a Candidate for Subchondroplasty?
Subchondroplasty is a very effective treatment for individuals who suffer chronic knee pain as a result of bone marrow edema (BME) surrounding microscopic insufficiency fractures within the upper layer of bone. Patients with chronic knee pain due to other conditions within the knee are not likely to benefit from this procedure. Through physical examination and MRI imaging, our experienced orthopedic surgeons can determine your eligibility for a subchondroplasty. General criteria for candidacy includes:
- Knee pain that has affected mobility and quality of life
- Failure to achieve relief with bracing, injections, NSAIDs, or physical therapy
- Failure to achieve relief after previous surgery, such as knee arthroscopy
- 40-75 years of age
- No severe malalignment of the joint
- BMI less than 40
As a minimally invasive arthroscopic knee procedure, subchondroplasty is performed on an outpatient basis, allowing our patients to return home several hours after surgery. While under general anesthesia, our orthopedic surgeons will make three tiny incisions in the knee. A slender fiber-optic device is then inserted into the joint, transmitting live video feed that our surgeons use to precisely navigate the joint and locate the areas of bone defect. Using fluoroscopic guidance, a biologic cement known as biomimetic bone substitute material (BSM) is then injected at the site of the bone marrow lesion. Within 20 minutes, the biologic cement hardens to resolve the bone defect and alleviate the painful and irritating symptoms of bone marrow edema.
Depending on the extent of BME and number of microscopic insufficiency fractures, the procedure can take 1-2 hours. Following subchondroplasty, our surgeons advise patients to avoid walking without the support of crutches for up to two weeks in order to ensure proper healing. After about six weeks, most patients are able to return to activity pain-free and may go on to physical therapy to improve strength and mobility of the knee.
Frequently Asked Questions
Q: Do I have bone marrow edema?
A: Bone marrow edema (BME) is a source of knee pain that may contribute to progression or worsening of osteoarthritis symptoms. BME can only be confirmed through MRI imaging of the knee. If BME is the source of your chronic knee pain, you may be eligible for the subchondroplasty procedure.
Q: What is recovery like following subchondroplasty?
A: As an outpatient procedure, you will be able to return home the same day of surgery. Patients are advised to use crutches for up to two weeks after surgery to reduce weight-bearing load on the knee and ensure proper healing. Typical post-operative recovery time is six weeks, much less than the four to six months required for a knee replacement.
Q: Will subchondroplasty affect my eligibility for a knee replacement in the future?
A: No, subchondroplasty will not limit your candidacy for a total knee replacement should you opt to have this procedure done in the future. For many patients, subchondroplasty eliminates or greatly reduces the risk of needing a total knee replacement due to knee arthritis.
Contact an Orthopedic Specialist in Los Angeles
The Knee Surgery Center of Excellence boasts a team of renowned orthopedic surgeons who are leading experts in a variety of advanced knee procedures. From state-of-art facilities and equipment to a comfortable and private atmosphere, our goal at the Knee Surgery Center of Excellence is to provide each patient with individualized, high-quality healthcare.
To learn more about the subchondroplasty procedure or to schedule your initial consultation, you may call (888) 429-6865 or fill out our online contact form.
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