Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Doctor serving patients from Greater Houston through offices in Sugar Land, near First Colony Mall and Houston, near the Houston Galleria. If you’re feeling the effects of knee arthritis and would like an appointment with an experienced knee specialist, please call 281-633-8600.
This is the sixth part of a transcript of a radio show hosted by Dr. Bennett on 1560 The Game. With Dr. Bennett was Bob Lewis of 1560 The Game and Dr. Stephen Simonich of Katy Orthopedics in Katy, TX.
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DR. J. MICHAEL BENNETT — Now the cartilage, definition wise, we need to kind of clarify something here, because when you say, “I’ve got a torn cartilage” or “I’ve got an injury to my cartilage” there’s different types of cartilage in the knee joint. And I’d like Dr. Simonich here to break that down for you and exactly what arthritis is and what a cartilage tear is and what a meniscus tear is so you have an idea about that and then we can refer back to the joint injections.
DR. STEPHEN SIMONICH – Alright well I’ll try to tie that all together. Basically the meniscus is something that is in between the two bones, it’s a shock absorber between the knee and when it gets injured it can act like a hangnail, we use that analogy a lot, it can kind of get caught just like on your finger with a hangnail when you put it into your pocket and it hurts, but if you just trim that hangnail up all the pain goes away. And that’s what people talk about when they’re doing meniscus surgeries, some people call that the cartilage. The cartilage, however, is actually the stuff that’s on the end of the bone that helps support the knee bone itself. And that’s what gets injured or goes away when you have arthritis.
To the point about the different kinds of injections, there’s two types: the cortisone injection that Dr. Jay talked about, and this hyaluronic acid. To break that down for you you’ve got an anti-inflammatory injection that works really quick and lasts about three or four months and then you have what’s called a lubricant or nutrients, you’re basically giving a lubricant into the knee that has a nutrient quality to it and I think that’s the way to think about that. Those don’t work quite as quickly but can last longer and again, like Dr. Jay said, the patients that we see that are really bone on bone, we will offer this to them, but oftentimes if it doesn’t work they’re on their way to some other kind of procedure like a total knee replacement. To knee replacement surgery, I always tell my patients that they’re going to tell me when they’re ready for that. Please don’t let your doctor tell you when he’s ready for that or she’s ready for that because it’s really up to the patient and their symptoms.
BENNETT – Exactly, I mean that is 100 percent correct. When it comes down to it, what I tell patients is that if it affects your daily activities and your quality of life, when it becomes a quality of life issue and you can’t go out there and play with your kids, you can’t go out there and visit with your grandkids because you have knee pain, then you’ve got to think about doing something about it. If you come in and you get an X-ray that’s completely bone rubbing on bone, completely spurs and arthritis and it looks horrible, but you’re walking around talking and feeling fine, and you can continue to walk around talking and feeling fine, I wouldn’t touch you. I mean I think that that’s not an indication for surgery; I don’t treat X-rays — I treat your symptoms and your quality of life. The idea is to get you back out there and enjoying your life again. Anyway, going back to the “don’t believe the hype” segment here, Dr. Simonich, what’s your take on some of these new techniques that you’re hearing about regarding arthritis, platelet rich plasma, stem cells, all these injections that people are talking about?
SIMONICH – Well real quick at the University of Florida when I worked at the VA, one of my patients there suggested that I do a study on WD-40, and we didn’t do that study, that’s another “don’t believe the hype.” He was convinced that that would help. So don’t go spraying that on your knee. We talked about the two injections and there’s this one out there called the PRP injection, and I think that that can be helpful. It’s not necessarily dangerous. It’s basically taking your own blood and spinning down the cells that really help with repairing tissue and that can help. Now there have been some studies that show, recently, that it might not be as successful as we thought it was, but I don’t think that it’s necessarily dangerous. And if something’s not dangerous, then you just have to assess the cost of it and whether or not you want to try it and if it doesn’t hurt you and may help you, then I think it’s a reasonable option for somebody.
BENNETT – And that’s something to take into consideration. Insurance companies will not pay for this. I mean, for the most part, you’re going to be paying for it out of your pocket. And these injections are one to three injections, I believe, and they can go from $500 to $1,000 a pop. It’s pretty pricey, but I think there is a place for it like Dr. Simonich said, it’s very early right now in its stages, I think we’re trying to figure out how to prepare it appropriately, but I think it makes a big difference in muscular injuries as well as tendonitis and tendon authia. In regards to cartilage regeneration or cartilage replacement, because a lot of these patients that I see, if arthritis is bad enough, you actually get a structural deformity, because what happens is that cartilage, as Dr. Simonich mentioned, the lining of the knee is gone, you start to have some squaring of the chondials, and the chondials are supposed to be round and they start to square, and when you start having these structural changes in the knee, injections like that aren’t going to help build your cartilage back, I think at that point you’re more likely to get benefit from either the hyaluronic acid injections, a steroid injection, or eventually a total knee if you’re completely worn down. But there are a lot of studies out there recently in regards to physical therapy and how that can help in regards to knee arthritis.
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If you have knee arthritis, a knee injury or you have knee pain and would like an appointment for a knee evaluation with Dr. Bennett, please call 281-633-8600.
