Surgical options for early arthritis in young persons and athletes: the role of meniscus transplants, microfracture, Osteoarticular Transplants (OATs), Autologous Chondrocyte Implantation (ACI) and osteotomy
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, June 30, 2006
Preparing for surgeryPreparation Surgical cartilage restoration is considered for healthy
and motivated individuals in whom pain and mechanical symptoms interfere with
normal function and activity.
Successful surgery depends on a partnership between the
patient and an experienced knee surgeon.
When possible, patients should optimize their health to prepare for
surgery. Smoking should be stopped prior
to surgery and avoided altogether for at least three to six months following
surgery. Any heart, lung, kidney,
bladder, tooth, or gum problems and concomitant injuries to the skin or
extremity should be managed before the surgery.
Any active infections will delay elective surgery to optimize the
benefit and reduce the risk of joint infection.
The surgeon should be made aware of any health issues, including
allergies and non-prescription and prescription medications being taken. Some medications will need to be held or
stopped prior to surgery. For instance,
aspirin and anti-inflammatory medications (Advil®, Motrin®, Aleve®, and other
NSAIDs) should be discontinued as they will affect intra-operative and
postoperative bleeding. (Discuss this with the doctor who prescribed the
medications.)
Before surgery, patients should consider the limitations,
alternatives, and risks to surgery.
Patients must recognize that the procedure is a process and not
an event: the benefit of the
surgery depends largely on the patient’s willingness to participate
inrehabilitation after surgery.
Patients must plan on being less active and functional for
12 to 16 weeks after the surgery.
Driving, shopping, lifting, walking, jogging, and running will be
difficult or impossible if the surgery involves the weight-bearing joints. Plans for the necessary assistance need to be
made before surgery. For individuals who
live alone or those without readily-available help, arrangements for home help
should be made early. If the surgery
involves the knee or ankle, patients will be able to walk with support devices
immediately after surgery, but they will be unable to bear weight on the
operated leg for up to six weeks.
Jogging is generally discouraged and is rarely resumed before 24
weeks. It takes 9 to 12 months for a
full recovery. Costs The surgeon’s office should provide a reasonable estimate
of:
- the surgeon’s fee
- the hospital fee, and
- the degree to which these should be covered by the
patient’s insurance (some procedures, like ACI are not covered by many
insurance carriers)
Surgical team Cartilage restoration procedures (microfracture, OATs,
ACI, meniscal transplantation, and osteotomies) are technically demanding
procedures that must be performed by an experienced, specially trained orthopaedic
surgeon and skilled surgical team in a medical center accustomed to performing
complex knee, shoulder, elbow and ankle procedures on a weekly basis.
The
surgical team of an orthopaedic surgeon and certified physician assistant (PA-C)
can dramatically improve the quality of care received by the patient. The interdependent physician-PA team ensures
continuity of patient healthcare, commitment to personalized treatment, and
makes certain patients will have greater access to care. The goal of this team is to magnify the
efficiency and safety in the operating room and clinic, and to make certain the
patient in receiving superior and quality care.
Patients
should ask about the specific training and experience the surgeon and surgical
team has undergone to perform such procedures (i.e. a fellowship-trained,
sports medicine specialist familiar with arthroscopic techniques and
equipment). Finding an experienced surgeon While surgeons who are capable of performing simple
arthroscopic procedures are relatively easy to find, complex cartilage
replacement surgeries in the knee demand a degree of highly-specialized
training. Many capable surgeons will
have completed a fellowship (additional year or two of training) specifically
in arthroscopic techniques, knee surgery, shoulder surgery, and sports
medicine. A qualified sports-medicine
surgeon should be comfortable with both open and arthroscopic techniques and
tailor the appropriate treatment to injury.
Fellowship-trained surgeons may be located through university schools of
medicine, county medical societies, or state orthopaedic societies. Other resources include professional
societies such as the American Orthopaedic Society for
Sports Medicine (AOSSM) or the Arthroscopy
Association of North America (AANA), and the American Academy of Orthopaedic Surgeons (AAOS).
Facilities Cartilage restoration is usually performed in a qualified
ambulatory surgical center or major medical center that performs such
procedures on a regular basis. These
centers have surgical teams, facilities, and equipment specially designed for
this type of surgery. Patients will
usually require an overnight stay, and these centers have nurses and therapists
trained to assist patients in their recovery from these procedures.Surgery for Arthritis, osteochondral defects (OCD lesions), meniscus transplantation and cartilage loss in the knee. at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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