I have written many a Blog based on my objection to the epidemic of arthroscopic intervention for arthritis at the hip and the knee. Now comes scientific evidence not only that it doesn’t make sense but also rather accelerates the degenerative process. A recent scientific paper published in Norway reviews the notion of Femoral Acetabular Impingement (FAI) as an excuse for arthroscopic intervention. Until about 10 years ago, the teaching had been that a shallow acetabulum (dysplastic) was bad and over coverage of the femoral head was good. Then the theory changed, over coverage as seen on X-ray might lead to a pincer impingement and predispose to osteoarthritis. The net result was an epidemic of arthroscopic intervention to shave away the osteophyte (bone spur) allegedly predisposing to osteoarthritis. I never subscribed to this change of theory whereby over coverage was bad. I spent part of my post residency fellowship specializing in children’s orthopedics and developmental diseases of the hip and, firmly believed and believe that osteoarthritis is associated with a shallow or dysplastic acetabulum in the atraumatic setting, 70% or more of the time. This was pretty much born out during my career of performing hip replacement. Now scientific investigation reconfirms that it is under rather than over coverage that predisposes to hip disease.
Let’s review the process of degenerative arthritis of any major joint. The trigger may be mechanical, congenital, traumatic or acquired. No matter what the cause, the hallmarks clinically are pain, limited motion, altered functional capacity, compromised quality of life and occasionally deformity. On the X-Ray, one sees joint space narrowing, osteophyte formation (spurs) and subchondral sclerosis (thickening of bone supporting the joint). This process both clinical and documented on imaging occurs to some degree in any joint afflicted by arthritis. In the hip, the osteophyte formation (spurring) has led to the epidemic of arthroscopic shaving so as to “prevent” arthritis when in fact the occurrence of that lateral spur is a hallmark of arthritis already developed and could be treated with methotrexate, for example. It is not the cause of a future arthritic process. That’s what I have always based my orthopedic recommendations on and that’s what the recent scientific paper from Norway reinforces. If one additionally factors in the infection and inherent complication rate of any surgical intervention, I believe that for arthritis of a Grade 2 or 3, the increasing evidence supports saying “Yes” to stem cells.
The same holds at the knee. The notion that a knee pain followed by an MRI and then an arthroscopic shaving of the frayed meniscus is flawed. The frayed or torn meniscus is part of the arthritic cascade and the situation six months after an arthroscopic debridement is much worse than before the invasive procedure. Our preliminary results using the new Same Day Plus technique have been great; and for those earlier patients who are returning for a booster, the Platelet Lysate booster is a real game changer. 847 390 7666 to make an appointment.