This document provides an overview of knee arthritis and cartilage disorders presented by Dr. Christopher Inzerillo. It discusses knee anatomy, the different types of knee arthritis, symptoms, diagnosis through history, physical exam, x-rays and MRI. Treatment options discussed include non-surgical approaches like physical therapy, medications, supplements and bracing as well as surgical options like injections, arthroscopy, cartilage repair procedures, realignment surgeries, knee replacement and new techniques using robotics.
2. Background:
College: Duke University
Medical School: University of Toledo
Residency: University of Pennsylvania
Fellowship: Sports Medicine NYU/Hospital for
Joint Disease
MBA: Marist College
3. • Knee Anatomy
Largest joint in the
body
Most common joint to
have a problem
Three bones, femur,
tibia, patella
Four ligaments hold
bones together
Two menisci, “shock
absorbers”
Articular cartilage
“cushion”
4. Knee Arthritis
• Greek “Arthros” means Joint
• Greek “itis” means inflammation of
• Symptoms are pain, swelling,
stiffness, loss of function
• Many types: most common
osteoarthritis “wear and tear”
• Rheumatoid, septic, post traumatic,
gouty, psoriatic
• Cost to United States 303.5 Billion!!!
5. Knee History & Physical Exam
• History: acute injury vs slow
gradual onset of pain, history of
prior injury, family history,
• Inspection: alignment “knocked
knee, bow legs”
• Loss of range of motion, effusion
• Tenderness
6. Knee Arthritis
• Cartilage wears away,
normal cushion of the joint.
• Cartilage is avascular, has
minimal healing ability
• Different from Meniscal
cartilage injury
9. Treatment
Non-surgical always first!
• Non-surgical: Activity
modification, weight loss
• Physical Therapy, including
exercises for strengthening
and flexibility
• Medicines: NSAIDS,
steroids, no narcotics!!
• Supplements: glucosamine,
turmeric, arnica, etc.
• Anti-inflammatory diet,
alkaline diet
• Bracing, unloader, support
brace
10. Injections
• Steroid: (cortisone)
– Mixture of local anesthetic and
steroid
– Can be given 3-4 times per year
– Effective for most but not all
• Gel:
– Orthovisc, Synvisc, euflexxa,
supartz, hymovis, gelsyn,
– Large protein that attracts water
11. Injections
• PRP: (platelet rich plasma)
aggressive marketing, patient
demand, little evidence of
effectiveness, many different
types
• Stem cells: BMAC myth or
miracle? Sounds good in
theory, patient demand,
expensive, not proven, stay
tuned!
12. Platelet-Rich Plasma
• Procedure
Peripheral blood draw (autologous)
Blood spun down to isolate concentrate of platelets
Rich in growth factors
13. Is there a Role for Stem Cells?
• Autologous
Bone Marrow Aspirate Concentrate
(BMAC)
Adipose-derived Stem Cells (ASCs)
• Harvested from bone marrow or
adipose tissue
• Injected into injured joint/tissue
18. Robotic Surgery
• Preoperative CT scan
• 3D model of the knee
• Pre-operative plan
• In surgery, plan is
carried out using a
robot
19. Knee 3D Virtual Model
Knee CT scan
Total knee 3D model
Partial knee 3D model
20.
21. Advantages of Robotic Surgery
• Precision of the cuts
Accurate to with 0.5 mm
Adjust cuts in 1 degree increments
Allows for press-fit (cementless)
Greater longevity of replacements
UKA more accurate/reproducible
• Protect of soft tissues
• Less soft tissue dissection
Less pain? Faster recovery?
Decreased hospital stay?
Lower overall costs?
Cemented Uncemented
22. Thank You!
For more information on me, or to book an appointment
visit: smgortho.com or call 844-SMG-ORTHO, or the
Paramus office direct at 973-437-2615.
Hinweis der Redaktion
BMAC: take 60 cc from 3 different sites, usually get about 8cc
ACS: aspirate 30cc after injecting 120 tumescent anesthesia that has to be vacuumed back out, get about 9cc MFAT (microfragmented adipose tissue).