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Author Topic: 'Laundering' the knee - debridement and lavage  (Read 18549 times)

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Offline The KNEEguru

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'Laundering' the knee - debridement and lavage
« on: September 30, 2002, 03:14:43 AM »
Hi all
I thought this might interest you:
http://www.uphs.upenn.edu/ortho/oj/1998/oj11sp98p90.html
The article advocates more minimalistic surgical intervention in degenerative joint disease, showing the positive effects from simply clearing out the fronds of degenerate material and giving the knee a good wash, compared to more radical managements.
--
KNEEguru

Offline mj/usa

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Re: 'Laundering' the knee - debridement and lavage
« Reply #1 on: October 01, 2002, 05:09:44 AM »
Hi Kneeguru!

I find it odd that you quote this article---there was an interesting one in the August 24,2002 NY TImes Title: "V.A. suggests halt to kind of knee surgery" (author Gina Kolata) stating the exact opposite.  Any positive effect from debridement and lavage appears to come only from the placebo effect!!!!
There is also another article on this subject that can be found at:
www.abc.net.au/health/minutes/stories/s647706.htrr

Your article dates from 1998 and it appears that there has been a significant change of opinion, at least in the American medical community, as to the efficacy of this very common surgery.  

MJ
plica excision 05/01,  followed by OATS 09/02

Offline enuff81020

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Re: 'Laundering' the knee - debridement and lavage
« Reply #2 on: October 03, 2002, 11:55:23 PM »
Hi!

As a teacher, I have learned that it is possible to find research to show virtually anything you want to show.  Yet, I felt a bit of relief in this.  I get no small amount of grief from others (not doctors) who seem to always know what I need and what is best for me etc, etc, etc...  It drives me crazy.  I need to trust my doc--and I do, but I do it with the most well-informed questions I can muster up.  

I know that I do not believe that knees are an exact science any more than teaching a small child to read.  We have ideas and lots of experience, but the route for each individual is paved a bit differently.  The toolbox of ideas to try needs to be big and continue to grow.  I'm hoping that the toolbox forknees soon has the right tool in it for me.

Thanks for sharing this, Sylvia
Both kneesOA.
Scope on rt knee,9/00;2/01
scope w/ LR and debridement rt knee 2/02
left knee same5/02
Patellar problems
LeftTKR12/16/02
Right TKR7/14/03
Complications MUA 8/14/03
R TKR revisio

Offline Janet

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Re: 'Laundering' the knee - debridement and lavage
« Reply #3 on: October 11, 2002, 11:46:36 PM »
Dear MJ:

Not everyone agrees with the study you are referring to and the method they used to come to their conclusions. See a rebuttal from Medscape Orthopaedics and Sports Medicine, 7/19/02. You can read it at

www.medscape.com/viewarticle/438436

It's good to keep up on the latest studies, but we "regular people" don't know enough about the medicine to come to our own conclusions. We must find a doctor we trust and believe they will do the best thing for each of us in our situation.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline mj/usa

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Re: 'Laundering' the knee - debridement and lavage
« Reply #4 on: October 12, 2002, 05:42:09 AM »
Dear Janet--

Thank you for pointing out this article to me!! I guess I took the NY times at its word, obviously not the case all the time.  I have heard of the Carleton facility in Ottawa, they are really top-notch, so what Dr Johnson says obviously carries a lot of weight. Thanks too for reminding me that we don't have anywhere near the knowledge that a good os has.  
I guess I was angry because my experience withthe debridement was so totally negative and  frustrating.

cheers
MJ
plica excision 05/01,  followed by OATS 09/02

Offline ConnieV

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Re: 'Laundering' the knee - debridement and lavage
« Reply #5 on: July 03, 2003, 05:10:24 AM »
Yeah, when I read the NY Times article, I thought, well, my previous debridements didn't seem like placebo effects -- I had much better function and lots less giving way after them.  So I went to read the published report and was concerned about the patient selection procedures.  This is a good example of how the media can aid in misleading the public.

I'm scheduled for another debridement Aug 11.  I had a Maquet TTT 1.5 years ago and I have this funny catching and colapsing problem (actually it is not funny at all) and the xrays that we just took clearly show an odd spot that looks like it could be causing the problem. So, rather than thinking the TTT was a failure, if the debriedement helps, I can consider that the TTT just needed an accompanying joint tune up.  Certainly not a placebo.

I'd much rather a quick debridement than a TKR with possible continued patella problems!
Grade 4 Chondromalacia Patella/Patello-femoral Arthritis, left knee.  TTT December, 2001.

Offline tootall67

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Re: 'Laundering' the knee - debridement and lavage
« Reply #6 on: November 01, 2003, 11:54:45 AM »
And here I am thinking about an abrasion arthroplasty by Dr. Toft at the Alphaklinik, and the article "A Limited Role" by Joseph Bernstein, M.D seems to put a damper on the outcomes of this procedure.  Does anybody have any thoughts or experiences with this technique?  Looking forward to your discussion!

Offline Mikesk

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Re: 'Laundering' the knee - debridement and lavage
« Reply #7 on: December 03, 2003, 11:42:58 AM »
Hi all,
I could not read the article as it is not there anymore. However,  I can tell you this. My knees medial compartment is deveoped grade 2 and 3 condromalsia in 1.5 yrs after I lost the meniscus. My OS convinced me to do the scopy, debridement. I even have a vedeo tape of what he has done. Basically he shaved the cartilige looked like fur etc. My knee went bad. It is clicking, cracking, feeels like riding on a ridge and more pain I have to deal with in the medial compartment and new pain develped on the back of the knee and front. So, cleaning up the knee is not always good for you. It may help a percentage of people whose knee is sticking ( kissing) inside  or who have a bad tear inside. I am really upset with my OS..

Now I have to look for another level of treatment, possibly an Osteotomy and a taransplant of meniscus or somthing.

Offline Chander

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Re: 'Laundering' the knee - debridement and lavage
« Reply #8 on: April 24, 2004, 05:16:53 AM »
I had abrasion arthroplasty followed by ACl repair done on my left knee in 1983, when I was 36. It held up really well, allowing me to walk, and ride a bike without pain.  Had the same thing done on the right knee (AA and ACL repair) in 2001, and the right knee is also without pain now.  I was lucky in getting supposedly the best in the trade - Lanny Johnson who invented the procedure for the left knee, and Dr. Howard Sweeney (recommended by Dr. Johnson who had retired) for the right knee.  The key for success aside from the skill of the surgeon was staying completely off the leg for 6-8 weeks after the AA surgery, and slow rehab without any help from physical therapists. Dr. Juergen Toft in Munich recommends 3 months between surgery and weight bearing.  Dr's Johnson and Sweeney's regimens were pretty close to that.

My left knee is bothering me after 21 years of good service.  I am looking for someone in the Chicago area (or the Midwest U.S) where I live who can help me because both Dr. Johnson and Sweeney are retired, and no one I have seen so far seems to believe in AA, even when I tell them about the great success I have had.  Anyone outr there know a Dr. in the Chicago area that can help me ?  Thanks.

Chander

Offline Marie

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Re: 'Laundering' the knee - debridement and lavage
« Reply #9 on: April 25, 2004, 11:05:10 PM »
I found the following abstract by Dr. Johnson having to do with abrasion arthroplasy.  

Chander, I'm not sure if there's anyone currently in the U.S. or Chicago area performing this technique, but will let you know if I hear of anyone.  Good to hear you've had some success with the technique.  I've been curious about it.

~Marie

Quote
Clin Orthop. 2001 Oct;(391 Suppl):S306-17.  Related Articles, Links  
 
Arthroscopic abrasion arthroplasty: a review.

Johnson LL.

College of Human Medicine, Michigan State University, East Lansing, USA.

Arthroscopic abrasion arthroplasty is an elaborate description for an extensive multiple tissue debridement for patients seeking an alternative to total knee replacement. The operation is palliative, not curative. In patients seeking an alternative to total knee replacement, the definitive operation may be avoided or deferred in a high percentage of patients as many as 5 years. Because the abrasion portion of the operation is accompanied by multiple tissue type debridement, it is not known what clinical benefit the abrasion aspect contributes. Furthermore, no prospective randomized clinical studies have been done and most clinicians reporting on their experience with the procedure have varied the indications, technique, and/or postoperative treatment. Future investigation may answer these clinical questions. It is known that fibrocartilage forms at the abrasion site. The reparative tissue has many of the characteristics of cartilage, but does not have the biomechanical properties of articular cartilage. The fibrocartilage has shown durability for many years confirmed during opportunistic second look arthroscopy. The applications of growth factor science or genetic engineering may provide means of converting the regenerative tissue of abrasion arthroplasty to mature articular cartilage.

Publication Types:
Review
Review, Tutorial

PMID: 11603714 [PubMed - indexed for MEDLINE]
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!