When pain, stiffness, and limited range of motion in your knee keep you from your daily activities, you may need a knee replacement. For patients with osteoarthritis, the most common source of debilitating knee pain, the goal of knee replacement is to restore function and decrease pain. A partial knee replacement (or unicompartmental knee replacement) is an option for patients with osteoarthritis in just one part of the knee. Unlike total knee replacement surgery, this less invasive procedure replaces only the damaged or arthritic parts of the knee. According to the American Academy of Orthopedic Surgeons (AAOS), multiple studies have shown that partial knee replacement performs very well in the vast majority of patients who are appropriate candidates. Advantages over full knee replacement include quicker recovery, less pain, and less blood loss.

Knee Anatomy

The knee functions as a hinge joint. The joint is made from the end of the thigh bone (femur), where it meets the shin bone (tibia), and the knee cap (patella). Normally, the cartilage coating over the bones makes the joint move smoothly and provides an additional shock-absorbent cushion. In an arthritic knee, the cartilage surface wears out and begins rubbing bone on bone which causes joint pain, stiffness, and swelling of the knee joint. The knee is divided into three major compartments: the medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patellofemoral compartment (the front of the knee between the kneecap and thighbone). In a partial knee replacement, only the damaged compartment is replaced. The healthy cartilage and bone in the rest of the knee remain intact.

Evaluation

Your doctor may recommend joint replacement surgery if conservative treatment methods have not relieved your knee pain or allowed you to continue with daily activities. An orthopedic surgeon will give you a thorough evaluation that includes your medical history, a physical exam to test range of motion, ligament, and muscle strength, and to identify the source of the pain. He or she will order imaging tests such as x-ray or MRI to see where the arthritis is and to evaluate the cartilage. A good candidate for partial knee replacement will only have osteoarthritis in one compartment of the knee.

Mako Robotic-Arm Assisted Surgery

Mako Robotic-Arm Assisted Technology can be used for partial knee replacements. It provides patients with a personalized surgical plan based on your unique knee anatomy. By accurately targeting the damaged part of your knee and leaving the healthy, unaffected parts intact, your knee is able to move smoothly and without pain again.

How Mako Robotic-Arm Assisted Surgery works:

1. Personalized Plan

A CT scan is used to generate a three dimensional virtual model of your knee anatomy. This virtual model is loaded into the MAKO robotic-arm software for your orthopedic surgeon to create your personal pre-operative plan.

2. Operating Room

Using your personalized pre-operative plan, the surgeon guides the robotic arm within the pre-defined area and helps prevent the surgeon from moving outside the boundaries. This allows your surgeon to align, position, and secure the knee implant with extreme accuracy.

3. After Surgery

After surgery you will be taken to the recovery room, where you will remain until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You will begin putting weight on your knee immediately after surgery. A walker, cane, or crutches will be necessary at first until you gain strength. Your physical therapist will give you exercises to help maintain range of motion and restore strength. You will continue to see your orthopedic surgeon for follow-up visits until you are able to return to normal activities.

Muscular dystrophy (MD) is a group of diseases that cause muscles to weaken and deteriorate over time. MD is caused by a gene abnormality, or mutation, that interferes with the body’s production of proteins needed to create healthy muscle. There are more than 30 different types of muscular dystrophy. Most types of MD affect voluntary muscles that control movement in the arms, legs and torso. MD may also affect involuntary muscles, such as the heart or respiratory system. 

Causes and risk factors 

Muscular dystrophy (MD) is a genetic disorder that is often inherited from parent to child. However, it is possible for muscular dystrophy to occur due to a new genetic abnormality, or spontaneous mutation. Certain genes in our bodies are involved in making proteins that protect our muscles from damage. Muscular dystrophy occurs when these genes are defective. Each type of muscular dystrophy is caused by a genetic mutation particular to that type of the disease. The most common variety of MD, Duchenne Muscular Dystrophy, occurs more commonly in young boys than girls. 

Symptoms 

The main sign of muscular dystrophy is progressive muscle weakness. Different signs and symptoms may begin at different ages, and in different muscle groups, depending on the type of MD. Symptoms might include:

• A waddling gate
• Late or abnormal walking
• Frequent falling or stumbling
• Difficulty running or jumping
• Large calf muscles
• Difficulty standing up from a sitting position

Symptoms for certain types of MD begin in early childhood, while symptoms for other types of MD may not appear until the teenage years or later. Generally speaking, it is a good idea to speak with your doctor if you notice signs of muscle weakness in your child. Muscular dystrophy is a progressive disease, meaning that the condition worsens over time. Depending on the type of MD, children or adults may gradually lose physical abilities. In later stages of the disease, heart and breathing difficulties may develop if the involuntary muscles are affected. 

Treatment

There is currently no cure for MD, but there are treatment options to slow the rate of muscle degeneration and improve function. Certain medications may help to increase muscle strength and delay the progression of some types of MD. Physical and occupational therapy are often used to improve function and assist in daily activities. Braces or other mobility aids may be recommended to increase function and mobility. Some patients benefit from a pediatric neurosurgeon performing a procedure that releases tight muscles or tendons, or a surgery that is related to conditions of the spine.

A torn meniscus is a common knee injury, causing knee pain and limited mobility. The meniscus is a wedge shaped piece of cartilage that acts as a shock absorber between your thighbone and shinbone. Menisci tear in different ways. Sports injuries often cause sudden meniscus tears from direct contact, or as a result of twisting or turning the knee. Older people are more likely to have degenerative meniscus tears. As the cartilage weakens over time, twisting while squatting or getting up from a chair can cause a tear.

Symptoms of meniscus tears:

• Feeling a “pop” in your knee
• Knee pain
• Stiffness and swelling on or around knee
• Catching or locking of your knee
• Limited range of motion

Diagnosis and treatment:

Along with the type of meniscus tear you have, your age, activity level, and any related injuries will factor into your treatment plan. Nonsurgical treatment includes the RICE protocol and taking non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter pain relievers, such as ibuprofen and aspirin. They are popular treatments for muscular aches and pains as well as arthritis and help in reducing swelling, pain, and joint stiffness. Surgical treatment usually involves arthroscopic surgery. An orthopedic surgeon will insert a small camera and instruments in two or three tiny incisions around your knee, repair the meniscus, and/or trim away damaged tissue.

What is a medial collateral ligament (MCL) injury?

Your knee ligaments connect your thighbone to your lower leg bones. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are found on the sides of your knee. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection. Because the knee joint relies just on these ligaments and surrounding muscles for stability, it is easily injured. Any direct contact to the knee or hard muscle contraction — such as changing direction rapidly while running — can injure a knee ligament.

Causes and risk factors

Knee ligament sprains or tears are a common sports injury.  Athletes who participate in direct contact sports like football or soccer are more likely to injure their collateral ligaments. The MCL is injured more often than the LCL. Due to the more complex anatomy of the outside of the knee, if you injure your LCL, you usually injure other structures in the joint, as well.

Symptoms

• Pain at the sides of your knee. If there is an MCL injury, the pain is on the inside of the knee; an LCL injury may cause pain on the outside of the knee.
• Swelling over the site of the injury.
• Instability — the feeling that your knee is giving way.

Diagnosis and treatment

Injuries to the MCL rarely require surgery. If you have injured just your LCL, treatment is similar to an MCL sprain. But if your LCL injury involves other structures in your knee, your treatment will address those, as well.

Ice. Icing your injury is important in the healing process. The proper way to ice an injury is to use crushed ice directly to the injured area for 15 to 20 minutes at a time, with at least 1 hour between icing sessions. Chemical cold products (“blue” ice) should not be placed directly on the skin and are not as effective.

Bracing. Your knee must be protected from the same sideways force that caused the injury. You may need to change your daily activities to avoid risky movements. Your doctor may recommend a brace to protect the injured ligament from stress. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. Your doctor may suggest strengthening exercises. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

If the collateral ligament is torn in such a way that it cannot heal or is associated with other ligament injuries, your doctor may suggest surgery to repair it.

Frozen shoulder, also called adhesive capsulitis, occurs when the tissues of the shoulder capsule become thick, stiff and inflamed. It is most common in people between the ages of 40 and 60, and occurs in women more often than men.

Causes and risk factors

The cause of this condition is not fully understood. It may occur after the shoulder has been immobilized for a period of time due to a surgery or injury. Frozen shoulder occurs more in people with diabetes and certain medical problems such as Parkinson’s disease, hypothyroidism, hyperthyroidism and cardiac disease.

Symptoms

• Limited motion (or freezing) of the shoulder
• Can be accompanied by a dull, aching pain in the outer shoulder area

Treatment

Most patients improve with non-surgical treatment options, including anti-inflammatory medications, cortisone injections and physical therapy. Surgery may be recommended if the condition does not improve.

What is De Quervain’s tenosynovitis?

De Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Causes and risk factors

Chronic overuse of your wrist is commonly associated with this condition. Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.

• If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s tenosynovitis than do other age groups, including children.
• The condition is more common in women.
• The condition may be associated with pregnancy.
• Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
• Jobs or hobbies that involve repetitive hand and wrist motions may contribute.

Symptoms

• Pain near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
• A “sticking” or “stop-and-go” sensation in your thumb when moving it

Treatment

Treatment for De Quervain’s tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence. If you start treatment early, your symptoms should improve within four to six weeks. If your De Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding. If your case is more serious, your doctor may recommend outpatient surgery.

Congenital spine conditions are disorders of the spine that develop in children before birth. Usually, in these cases, the spine does not develop correctly early in fetal development, causing structural issues with the spine or spinal cord. Many spine abnormalities in children cause no problems and may only be discovered during x-rays done for other reasons. Sometimes, congenital spine conditions are progressive and can result in more serious complications. Some of these conditions our pediatric neurosurgeons treat include:

• Scoliosis
• Spina Bifida
• Tethered Spinal Cord
• Kyphosis
• Lordosis

Causes and risk factors

Medical experts do not know the exact cause of congenital spine conditions. These conditions usually affect the vertebrae that make up the spine. When present, the vertebrae may be partially formed or misshapen, fused together, or missing.

Symptoms

Congenital spine conditions can typically be detected at birth by your medical provider. In some cases, physical symptoms may not be present until early childhood as the condition begins to worsen. Symptoms might include:

• Abnormal curvature of the spine
• Uneven shoulders, hips, or legs
• Difficulty walking

Treatment

Treatment depends on your child’s specific condition, symptoms, and severity. Treatment plans are usually focused on preventing the condition from worsening, rather than completely correcting the condition. Treatment options might include:

• Bracing or casting
• Physical therapy exercises
• Surgery

­­It is estimated that one in four children sustain an unintentional injury requiring medical attention each year. Caring for pediatric injuries requires special knowledge and expertise. Children and adults have important anatomical, physiological, and psychological differences that are important to consider when treating an injury. Children tend to have less body fat, more elastic connective tissue, and a growing skeleton. The force of an impact can be transmitted widely throughout the body, resulting in multiple injuries. If your child suffers a traumatic injury, you want a medical provider who is experienced in pediatric care. For serious or life-threatening traumas, seek emergency medical attention. For traumatic injuries related to the bones, joints, muscles, and supporting structures such as broken bones, concussions, sports injuries, or motor vehicle accidents, The Center is pleased to offer our NOWcare walk-in injury clinic.

Clubfoot is a common birth abnormality that occurs in one infant out of every 1,000 births. It is a condition where the tendons that connect the leg muscles to the foot bones are short and tight, and cause the foot to turn inward. It can occur in one or both feet. It is not painful to the infant, but it does require treatment so the child can walk, wear shoes, and enjoy physical activities without pain.

Causes and risk factors

While there is no known cause of clubfoot, there is an increased risk in families with a history of clubfeet. It also occurs more often in males than females.

Symptoms

Clubfoot is diagnosed at birth but can often be detected at a prenatal ultrasound.

• Appearance of the foot is turned inwards and/or upwards
• Deep crease on the bottom of the foot
• Foot and leg are usually shorter than normal
• Calf is thinner than normal
• Foot size is smaller than normal

Diagnosis and treatment

Although it is possible to treat in older children, treatment usually starts shortly after birth and generally does not require surgery. A set of long-leg casts (toes to thigh) is applied weekly for 6-8 weeks. It gently stretches the foot until it reaches a neutral position. A small procedure is usually necessary to lengthen the Achilles tendon after the last cast is removed. After treatment, the baby wears a brace that looks like shoes attached to a bar to maintain the neutral foot position. If the baby does not wear the brace, clubfoot can come back. The brace needs to be worn consistently for three months and then only during naps and at night for several years. This method of treating clubfoot is long and can be difficult for parents, but it has proven to be very effective. If clubfoot can’t be corrected by this method or if it recurs, surgery may be necessary to lengthen or move tendons.

The St. Charles Center for Orthopedics & Neurosurgery is committed to ongoing research and development in the fields of orthopedic, neurosurgical and rehabilitation care. The physicians at St. Charles are currently involved in the use and/or development of cutting-edge technology and procedures. In order to advance medical knowledge and practice, St. Charles participates in a variety of device registries and device clinical trials. In addition, our own physicians often have novel ideas about new treatments that may improve outcomes for our patients. The Center facilitates the development of these ideas into research projects by coordinating studies and identifying potential funding sources. Research findings are reported through publications and presentations to other physicians, health care professionals and patients with the goal of improving patient care.

Clinical trials

The National Institutes of Health (NIH) defines a clinical trial as research study in human volunteers to answer specific health questions. At the St. Charles Center for Orthopedics & Neurosurgery, the majority of our studies are interventional as we test new treatments and devices under controlled environments to determine if the intervention is safe and effective. Participants in clinical trials often gain access to new treatments before they are widely available and help others by advancing medical research. If you are interested in participating in a research study or curious about the St. Charles Center’s clinical trials, below is a list of procedures and conditions that we study.

Clinical research study for patients with frozen shoulder

Principal investigators: James Verheyden, M.D., Tim Bollom, M.D., James Nelson, M.D.

Ascension MCP finger implant post-approval study

PyroCarbon Metacarpophalangeal Joint Prosthesis. Clinical Study Protocol #CP-MCP-002 Principal investigator: James Verheyden, M.D.

Sapphire WW

Stenting and Angioplasty with Protection In Patients at High-risk for Endarterectomy SAPPHIRE WW – P06-3603 Principal investigator: Raymond Tien, M.D.

Cordis enterprise

Vascular Reconstruction Device and Delivery System Principal investigator: Raymond Tien, M.D.

Neuroform

Neuroform Microdelivery Stent System, Humanitarian Device Exemption (HDE) Principal investigator: Raymond Tien, M.D.

Onyx

HD500 Liquid Embolic System Principal investigator: Raymond Tien, M.D.

Wingspan stent system

with Gateway PTA Balloon Catheter, HUD #03-0101 Principal investigator: Raymond Tien, M.D.

Jump test

Comparison of Single leg Squat Test to Jump Test as a Predictor for Risk of Lower Extremity Injury in Older Children and Adolescents Principal investigator: Viviane Ugalde, M.D. Contact our center for more information: (541) 330-8653 or Email us here.