Quadriceps-sparing total knee replacement is a contemporary approach to knee arthroplasty that preserves the quadriceps tendon and limits trauma to surrounding soft tissues. By avoiding a large incision through the quadriceps tendon, this technique is intended to support early mobility, reduced postoperative pain, and help patients resume daily activities sooner. Below, learn how the procedure works, how it compares with traditional methods, the Jiffy Knee approach, and who may be a good candidate. For patients searching for the latest in knee replacement surgery, the quad sparing total knee replacement technique is a thoughtful, evidence-informed choice that our team carefully considers for each individual.
Quadriceps-Sparing Total Knee Replacement: What to Know
What Is Quadriceps-Sparing Total Knee Replacement?
This procedure replaces damaged joint surfaces in the knee while maintaining the integrity of the quadriceps tendon and extensor mechanism. Surgeons work around the tendon rather than through it, navigating between natural tissue planes to access the joint and accurately position implants. In plain terms, if you have wondered, “are muscles cut during knee replacement surgery?” the goal with a quad sparing knee replacement is to avoid cutting the quadriceps tendon and minimize disruption of surrounding muscle fibers whenever safely possible.
The technique evolved from approaches developed in the early 1990s.1 As specialized instruments and imaging guidance improved, surgeons refined methods to avoid splitting the quadriceps tendon without compromising implant alignment or stability. It is commonly used to treat severe osteoarthritis and other advanced degenerative conditions that cause pain, stiffness, and loss of function when non-surgical measures are no longer effective. Among the types of knee replacement available today, quad sparing total knee replacement is considered part of the latest in knee replacement surgery, focused on soft tissue preservation and early function.2
Benefits of a Quadriceps-Sparing Approach
- Faster early recovery: Preserving the quadriceps tendon can facilitate earlier straight-leg raises, walking, and stair climbing.3
- Less muscle disruption: Protecting the extensor mechanism may help maintain strength and knee control, supporting a more efficient rehabilitation process and a quicker return to a normal gait. Patients often ask, “are tendons and ligaments cut during knee replacement?” With a quadriceps-sparing technique, the aim is to protect the entire quadriceps mechanism to reduce postop dysfunction.4
- Reduced early pain and swelling: Limiting soft tissue trauma often improves comfort in the first weeks after surgery and may reduce the need for inpatient rehabilitation.3,5
All surgical procedures carry risks such as infection, blood clots, stiffness, implant loosening, and anesthesia-related issues. Careful surgical technique, multimodal pain control, and early mobilization help mitigate many of these risks. Long-term outcomes with quadriceps-sparing techniques are comparable to traditional approaches when performed by experienced surgeons. If you have concerns about “how are muscles reattached after knee replacement,” rest assured that when muscle or tendon detachment is required in other approaches, surgeons use robust suture techniques to reattach and protect healing; with quad sparing knee replacement, the intention is to avoid muscle separation in the first place.
How It Differs From Traditional Knee Replacement
Surgical exposure: Traditional total knee replacement often uses a midline incision with a split in the quadriceps tendon separating the vastus medialis from remaining three quadriceps muscles to access the joint. Quadriceps-sparing techniques use a muscle sparing approach to avoid cutting the tendon, preserving the extensor mechanism. This directly addresses concerns such as “are muscles cut during knee replacement surgery,” as the quad sparing total knee replacement approach is designed to minimize that need.
Rehabilitation and function: Because the tendon remains intact, patients can typically begin active knee extension earlier. Many experience less early pain and greater confidence with movement, which can translate into smoother physical therapy sessions and faster achievement of mobility milestones.2,3,4,5
Outcomes: Early recovery measures—pain, range of motion, and function—have been shown to be improved with quadriceps-sparing methods. Long-term implant performance and overall function are similar to traditional techniques when alignment and soft tissue balancing are precise around 1 year postoperatively. For those asking “how are muscles reattached after knee replacement,” traditional methods may require tendon repair; quadriceps-sparing methods are designed to avoid that step while maintaining accuracy.
Quadriceps-Sparing vs. Jiffy Knee
Jiffy Knee is a branded, muscle-sparing total knee replacement approach that emphasizes limited disruption to the quadriceps and surrounding soft tissues. Both quadriceps-sparing and Jiffy Knee aim to reduce early pain and speed recovery by protecting the extensor mechanism through the same medial subvastus approach to the joint. Patients comparing a quad sparing knee replacement to a jiffy knee replacement will find overlapping principles focused on soft tissue preservation.
| Feature | Quadriceps-Sparing TKA | Jiffy Knee |
|---|---|---|
CORE PRINCIPLE | Avoids incising the quadriceps tendon; uses tissue planes to access the joint | Branded muscle-sparing technique with similar tendon-preserving goals |
INCISION AND EXPOSURE | Medial subvastus muscle sparing approach; standard instruments or specialized tools | Proprietary instruments and protocols may be used through the same medial approach and a more medial incision |
RECOVERY FOCUS | Earlier straight-leg raises, walking, and confidence with movement | Marketed for rapid recovery with early function and reduced pain |
OUTCOMES | Early advantages with comparable long-term results to traditional TKA | Similar expectations: outcomes depend on surgeon expertise and implant alignment |
In practice, the similarities are greater than the differences. Both rely on the concept of a muscle sparing approach to the knee, careful soft tissue handling, and precise implant positioning. The best choice is often the technique your surgeon performs most frequently and effectively, tailored to your knee anatomy and goals. When considering what technique might suit your knee replacement best, our guidance remains individualized and focused on safety and function.
Who Is a Good Candidate?
- Advanced knee osteoarthritis or other degenerative conditions causing significant pain and mobility limitations despite non-surgical care
- Favorable soft tissue quality and alignment that allow adequate exposure without cutting the quadriceps tendon
- Realistic expectations and willingness to participate in a structured rehabilitation program
Both younger, active adults and older patients can be candidates. Suitability depends more on joint damage, bone quality, and overall medical fitness than age alone. Active individuals may appreciate faster early recovery, while older adults may benefit from reduced pain and earlier independence. Not every knee is appropriate for a quadriceps-sparing or jiffy knee replacement approach; some patterns of deformity or prior surgery may necessitate alternative types of approach to knee replacement.
The evaluation typically includes a full medical history, physical examination, weight-bearing X-rays, and sometimes advanced imaging. If you have questions like “are tendons and ligaments cut during knee replacement,” we will explain how quadriceps-sparing techniques aim to preserve these structures while still achieving proper alignment and stability.
What to Expect
Most patients begin walking with assistance the day of their surgery and start physical therapy focused on range of motion, swelling control, and progressive strengthening within a week. Many can perform basic daily activities within a few weeks, though full recovery varies based on individual factors and adherence to rehabilitation. Your care team will provide guidance on wound care, medications, activity progression, and long-term joint protection. As part of the latest in knee replacement surgery, our protocols emphasize comfort, safety, and steady progress.
If you are considering knee replacement and want to know whether a quadriceps-sparing total knee replacement is right for you, schedule a consultation with Dr. D. Alex Forrester, who specializes in quadriceps-sparing knee replacements. A personalized assessment can help determine the safest technique that aligns with your anatomy, goals, and lifestyle—whether that is a quad sparing total knee replacement or another evidence-based option among the types of knee replacement we offer.
References:
- Hofmann, A.A. ∙ Plaster, R.L. ∙ Murdock, L.E. Subvastus (southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res.1991; 70-77
- Stubnya B, Kocsis K, Váncsa S. Subvastus Approach Supporting Fast-Track Total Knee Arthroplasty Over the Medial Parapatellar Approach: A Systematic Review and Network Meta-Analysis. Journal of Arthroplasty, 2023; 38, 2750-2758
- Roysam GS, Oakley MJ. The Subvastus Approach for Total Knee Arthroplasty Resulted in Better Short-Term Outcomes than Did the Parapatellar Approach. A prospective, randomized, and observer-blinded trial. J Arthroplasty. 2001;16:454–457. doi: 10.1054/arth.2001.22388.
- Chang CH, Chen KH, Yang RS, Liu TK. Muscle torques in total knee arthroplasty with subvastus and parapatellar approaches. Clin Orthop Relat Res. 2002;98:189–195. doi: 10.1097/00003086-200205000-00027
- Sastre S, Sanchez MD, Lozano L, Orient F, Fontg F, Nun˜ez M. Total knee arthroplasty: better short-term results after subvastus Approach. A Randomized, controlled study Knee. Surg Sports Traumatol Arthrosc. 2009;17:1184–1188. doi: 10.1007/s00167-009-0780-6.
What to Do After An Injury | Orthopedic Guidance from Your Phone
When pain disrupts your day or an injury raises questions, timely answers make all the difference. CSOG 24/7, powered by HURT, connects you with orthopedic guidance any time of day, anywhere you are. Our team of orthopedic specialists is here to give you peace of mind and provide fast, expert support so you can make informed decisions at the time of injury and throughout the following days. Not sure what to do after an injury? Wondering if it’s a sprain or something more serious? Start with CSOG 24/7 powered by HURT! – part of Colorado Springs Orthopaedic Group.
What is CSOG 24/7 Orthopedic Guidance?
Simply open CSOG 24/7 powered by HURT via app or browser, describe symptoms, share photos of the injured area, and in just minutes, connect with our specialists who will review your symptoms, provide recommendations for immediate care, and next steps. Leave the conversation knowing how to care for the injury at home, or if urgent care or a scheduled in-person evaluation is needed. Nights, weekends, and holidays, our team is here 365 days a year, 24 hours a day.
What to Do After an Injury, Sprain, or Pain
| Wondering how to tell if ankle is broken or sprained? | Start with CSOG 24/7 powered by HURT! |
|---|---|
| Is it broken? | Start with CSOG 24/7 powered by HURT! Our specialists can help determine the signs of a fracture and what type of next steps may be needed for your injury |
| Should I see a doctor for knee pain? | Start with CSOG 24/7 powered by HURT! Without leaving your home, our specialists will help you determine what to do after a knee injury or with persistent knee pain and when you should see an orthopedic doctor for in-person evaluation. |
| Shoulder pain when lifting your arm or reaching overhead? | Start with CSOG 24/7 powered by HURT! Gain guidance on whether it’s a strain, impingement, or something that needs further evaluation. |
| Lower back pain after activity or lifting? | Not sure if it’s a strain or something more serious? Start with CSOG 24/7 powered by HURT to understand what to do next. |
| Hip pain when walking or standing? | CSOG 24/7 powered by HURT! can help determine the cause of your pain and whether imaging or in-person care is recommended. |
| Wrist pain after a fall or repetitive use? | Start with CSOG 24/7 powered by HURT! Find out if it’s a sprain, strain, or possible fracture and what steps to take next. |
Do You Need to See a Doctor for an Injury? Why Immediate Guidance Matters
- Quicker triage for new injuries
- Less time away from work or school
- Early guidance can support better recovery outcomes.
For many concerns, virtual guidance provides the clarity to manage pain, protect healing tissues, and determine whether imaging or an in-person evaluation is necessary. If you are asking should I see a doctor for knee pain, back pain or what to do after a sports injury, CSOG 24/7 powered by HURT! was designed for these scenarios and expedite the road to recovery.
The goal of CSOG 24/7 powered by HURT! is to provide convenience and improve your recovery outcome. If an in-person visit is recommended, our team will navigate you to the right level of care—saving time, and unnecessary ER visits. If home management is appropriate, you’ll leave the conversation with a clear plan that supports healing and longevity. CSOG 24/7 powered by HURT was designed to meet you where you are no matter the time, or day of the week.
Common Injuries That Need Orthopedic Guidance (Knee, Shoulder, Back, Hip, Ankle, Wrist)
You’re likely asking, what type of orthopedic issues is CSOG 24/7 designed for? The answer:
- Joint pain in the knee, hip, shoulder, ankle, and wrist
- Back and neck pain from acute strains or ongoing conditions
- Sports injuries such as sprains, strains, tendon irritation, and overuse
Why Choose CSOG 24/7? Orthopedic Advice From a Specialist—Without Leaving Home
- Specialized expertise: Board-certified specialists experienced in all musculoskeletal, bone and joint injuries and conditions. You’ll receive guidance based on current best practices and tailored to your needs, including clear answers to when you should see an orthopedic doctor for an in-person evaluation or if it’s appropriate to monitor at home.
- User-friendly technology: Connect from your phone, tablet, or computer; share images securely; and receive next steps individualized to your injury. Integrated scheduling streamlines transitions to in-person visits when needed, minimizing delays and unnecessary wait times.
- Ongoing support: If your condition changes, our team is available 24/7 to reassess and adjust your plan—delivering trusted answers fast and guiding you to the right care at the right time.
- All from your phone, any time of day, any day of the week.
TL;DR
| How does CSOG 24/7, powered by HURT, work? | Complete a short intake, connect with an orthopedic specialist virtually, and receive a personalized care plan with next steps. |
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| What technology do I need? |
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| Can virtual guidance replace an in-person visit? | Depending on the injury. CSOG 24/7 is Ideal for new injuries, joint pain, back/neck issues, and sports-related concerns as a first step. If the injury warrants in-person evaluation, our team will tell you so and help expedite the scheduling process. |
| Is CSOG 24/7 available after hours and on weekends? | Yes. CSOG 24/7 operates around the clock, including weekends and holidays. |
| Follow-up Care | CSOG 24/7 powered by HURT! is available for reassessment if symptoms change or don’t improve. |
When Should You See an Orthopedic Doctor? Start Here
CSOG 24/7, powered by HURT, is designed to simplify decision-making the moment it happens. By combining immediate access from your phone, orthopedic expertise, and coordinated follow-through, our goal is to deliver a more efficient, patient-centered approach to musculoskeletal, bone, and joint care.
If something doesn’t feel right, you don’t have to wait. Expert advice is within reach.
Anterior Hip Arthroplasty, Advancing Hip Replacement Outcomes and Longevity
Hip replacement surgery has come a long way since its inception with new techniques continuously evolving to improve outcomes, patient satisfaction, and implant longevity. One such advancement is the use of the anterior approach hip replacement surgery, a technique that differs from traditional approaches (posterior and lateral) and offers many unique benefits. Today, we’ll delve into:
– What Anterior Hip Replacements are
– The History of Anterior Hip Replacements
– How they differ from other techniques
– What recovery generally looks like
– Candidacy for this innovative procedure
What are Anterior Hip Replacements?
Anterior hip replacement surgery is a minimally invasive surgical technique used to replace a damaged hip joint with an artificial implant. Unlike traditional hip replacement surgeries that access the hip joint from the side or back (lateral or posterior approaches), the anterior approach accesses the joint from the front (anterior aspect) of the hip, through a small incision.
A Brief History
While the anterior approach to hip replacement is often considered a modern innovation, its roots can be traced back to the early 20th century. Dr. Marius Smith-Petersen, an American orthopedic surgeon, first discussed the anterior approach in the 1940s. However, it was not widely adopted due to technological challenges and the popularity of other approaches. The first anterior hip replacement surgery was performed in 1947. It wasn’t until the late 20th and early 21st centuries that advancements in surgical techniques, imaging technology, and implant design made anterior hip replacement a more feasible option. Since these advancements, the procedure has gained immense popularity among surgeons and patients alike.
How Anterior Hip Replacement Differs
The anterior approach offers several advantages over traditional lateral and posterior approach hip replacement techniques including:
- Muscle Preservation: One of the key benefits of the anterior approach is that it allows access to the hip joint without detaching muscles from the pelvis or femur. A muscle-sparing technique such as this, can lead to faster recovery times and in many cases, less postoperative pain compared to other techniques..
- Stability: Thanks to this muscle preservation, the anterior approach shows an increased stability of the implant due to the preservation of the surrounding soft tissues and muscles. This added stability can reduce the risk of dislocation.
- Additional Accuracy: The anterior approach provides excellent visualization of the hip joint, allowing for even more precise placement of the implant during surgery.
- Faster Recovery: Patients who undergo anterior hip replacement surgery may experience a quicker recovery compared to other techniques. This is primarily due to the muscle preservation benefits, which can lead to less damage to the surrounding structures and a faster return to normal activities.
Video credit to Stryker Orthopedics
Anterior Hip Replacement Recovery
Studies show recovery from Anterior Approach Hip Replacement Surgery enables the potential for early mobility. One of the primary advantages of the anterior approach is that it typically allows for early mobility. Patients may be able to walk with a cane or walker soon after surgery, often times within a couple hours of surgery. This is due to the muscle preservation nature of the approach, again, leading to less damage to the surrounding structures and a faster return to normal activities.
While hip precautions are often recommended for all types of hip replacement surgeries to prevent dislocation of the new hip joint, the specific precautions may vary depending on the surgical approach. For example, patients undergoing an anterior approach may be advised to avoid certain movements that could strain the front of the hip joint especially within the initial recovery period.
Rehabilitation following an anterior approach hip replacement surgery typically focuses on restoring range of motion, strength, and function. To kickstart the recovery process, Physical therapy begins soon after surgery to help patients regain mobility and strength in the hip joint and return to normal activities, including driving, quickly and efficiently.
It’s important to note that the recovery process can vary from patient to patient due to individual factors regardless of the surgical approach. Factors such as age, overall health, and the extent of joint damage can all impact the recovery timelines and overall outcome. Patients should follow their surgeon’s postoperative instructions and participate in any rehabilitation programs as prescribed to optimize their recovery.
Who Would Be a Candidate?
While anterior hip replacement surgery offers many benefits, not everyone is a candidate for this procedure. Ideal candidates for anterior hip replacement surgery typically include those who are:
- Physically Active: Patients who are physically active and in good overall health may benefit from the faster recovery times associated with the anterior approach.
- Of Healthy BMI: Patients who are within a healthy BMI generally have better outcomes with the anterior approach, as excess body weight can put additional stress on the hip joint and may impose greater risk of complications during and after surgery. Tune into our blog discussing The Link between BMI and Joint Health
- Motivated Patients: Patients who are motivated to actively participate in their recovery process, including following postoperative rehabilitation protocols, achieve better results with the anterior approach.
Candidacy for any hip replacement technique ultimately comes down to what is best for the individual patient and their lifestyle as discussed with their orthopedic specialist.
In conclusion, Anterior Hip Arthroplasty surgery is a modern hip replacement technique that offers several advantages. With its muscle preserving technique, increased stability, and faster recovery times, it has become an attractive option for many surgeons and patients seeking hip replacement surgery with hopes of returning to activities.
If you’d like to discuss your candidacy for an anterior hip replacement, give us a call at 719-632-7669 to schedule with one of our board certified Joint Replacement specialists.
The Fellowship Trained and Board Certified Difference
When it comes to Orthopaedic care, choosing the right physician is crucial for ensuring optimal treatment and recovery outcomes.
Amongst Orthopaedic physicians, there are different levels of training and certifications. Each can significantly impact their level of expertise and capacity for providing the full spectrum of comprehensive care. When looking at a physician’s bio, especially those that are apart of the team here at CSOG, you’ve likely seen the terms: fellowship trained and board certified. But what do these terms actually mean? What type of training has the physician gone through to receive these credentials?
Fellowship Training:
Specialization and Expertise
What does fellowship trained mean? Fellowship training is an additional period of intensive, specialized training that orthopaedic surgeons pursue after completing their residency program. During this fellowship, physicians focus on a specific area within orthopaedic surgery, such as sports medicine, joint replacement, spine surgery, foot and ankle surgery, or hand and upper extremity surgery, among others. These fellowship programs require physicians to participate in hundreds of specialized surgeries to develop advanced skills and expertise in their chosen subspecialty before they’re eligible to receive the fellowship trained credential.
Benefits of Fellowship Training
- Enhanced Knowledge and Skill Set: Fellowship-trained orthopaedic physicians possess a deeper understanding of their specific area of focus due to their additional, rigorous training that allowed them to gain extensive hands-on experience from leaders within the orthopedic world. This experience enables them to address complex cases and provide highly specialized, individualized care.
- Leaders of Orthopedic Advancements: Fellowships provide consistent access to the latest research, techniques, and technologies in the specific subspecialty. Not only does this exposure keep physicians abreast of recent advancements, it allows them to continue development upon such innovation to ensure patients receive the most effective and lasting treatment options.
- Collaboration and Networking: Fellowship programs often foster collaboration and networking among specialists, enabling physicians to consult with colleagues and share knowledge across the nation. This collaborative environment further enriches their expertise and promotes the exchange of best practices.
Board Certification:
Recognized Expertise and Quality Assurance
What does Board Certified mean? Board certification is a rigorous process that evaluates a physician’s knowledge, skills, and clinical experience in a particular medical specialty. To become board certified, orthopaedic surgeons must complete a specific number of postgraduate training years. Then, they are eligible to complete a comprehensive oral and written examination administered by the American Board of Orthopaedic Surgery (ABOS) or an equivalent board such as the American Osteopathic Association (AOA) for Doctor of Osteopathic Medicine (DOs).
Importance of Board Certification
- Expertise Verification: Board certification serves as an independent
validation of an orthopaedic surgeon’s knowledge and expertise in their specialty and demonstrates that the physician has met the meticulous standards set by the ABOS or the equivalent certifying body. - Commitment to Continuous Learning: Maintaining board ce
rtification requires ongoing professional development through continuing medical education (CME) credits. These CME requirements ensure that certified physicians stay current with advancements in their field and provide patients with the most up-to-date care. - Quality Assurance: Board certification acts as a quality assurance measure for patients, as it signifies that the orthopaedic physician meets or exceeds the established standards of practice.
The Doctor’s Timeline
Becoming a physician is no easy feat. Especially one with high distinctions of Fellowship Training and Board Certification. On average, in addition to completing a four-year undergraduate degree, a physician must complete four years of medical school. After medical school, they will complete a five-year residency program. Orthopedists such as ours within CSOG, then apply for a fellowship program. Only the best candidates are granted participating into these fellowships that typically last an additional year. To become board certified, the physician must meet their respective board’s mandated training hours. Depending on the board, this can take between 3-7 years. Added together, a fellowship trained and board-certified Orthopaedic physician has undergone anywhere between 17-21 years of training and education.
With their Fellowship training and the addition of a Board certification, physicians are focused extensively on specific subspecialties, with the advanced skills necessary to ensure high quality outcomes backed with quality assurance to their commitment of providing high-quality care. In the realm of orthopaedic care, patients can rest assured they’re in qualified hands when seeking specialized or complex treatments through fellowship-trained and board-certified orthopaedic physicians.
New FDA Approved Drug-Free Treatment for Painful Diabetic Neuropathy
New FDA Approved Drug-Free Treatment for Painful Diabetic Neuropathy
What is Diabetic Neuropathy?
Diabetic Neuropathy is chronic nerve damage in the upper and lower extremities caused by constantly high blood sugars. It is a chronic debilitating condition which can interfere with a person’s sleep, their functionality, and their overall quality of life.
Around 34 million Americans have diabetes (CDC, 2020) and roughly half of all adults with diabetes will suffer from Diabetic Neuropathy in their lifetime (Hicks, 2019). Of those, it’s estimated approximately 2.3 million will suffer from Painful Diabetic Neuropathy (PDN) with no relief by using current treatments and conventional medical management (Schmader, KE., 2020).
What are the Typical Symptoms of Painful Diabetic Neuropathy (PDN)?
Those who suffer from Painful Diabetic Neuropathy typically have daily continuous pain. Typical symptoms of include tingling, numbness, and pain in the extremities. This nerve damage can make patients more vulnerable to falls, burns, infections, ulcers, and long-term complications.
What Treatment Options are there to Relieve Chronic Pain from Diabetic Neuropathy?
Current treatment options aim to relieve the chronic pain that is frequently seen with Diabetic Neuropathy. These treatments often include pain medicines such as Tylenol or Aspirin. NSAIDS such as Ibuprofen or Advil, however, are not recommended for diabetic patients. Some patients with Diabetic Neuropathy are also treated with nerve medications including Neurontin (Gapapentin), Lyrica, and Topomax. When patients don’t respond to these medications, narcotics or opioids are often used.
Although narcotics can lessen pain, they have significant long term consequences including dependence, decreased benefit over time, and abuse. New federal guidelines aimed at reducing opioid misuse and abuse have resulted in many physicians denying or limiting opioid therapy for some chronic pain patients. Physicians are constantly looking to improve clinical and interventional tools to treat complex chronic pain. One of these advancements includes the development of Spinal Cord Stimulation (SCS).
Spinal cord stimulation has been available since the 1960s and uses a device called a Spinal Cord Stimulator to treat chronic pain. This small device is placed on the spinal cord to calm the spinal nerves and suppress the pain responses to the brain. As a result, pain lessens for the patient. Each device is programable to the individual patient’s needs. Additionally, Spinal Cord Stimulation allows for patients to go through a weeklong trial period to test their response to the device before permanent implantation.
There are many types of Spinal Cord Stimulators and the technology and programming options that come with them have made many advancements in recent years. These advancements have shown to provide better pain relief for many chronic pain conditions. Most recently, Spinal Cord Stimulation for Painful Diabetic Neuropathy (HFX™ for PDN) developed by Nevro, received FDA indication and approval to treat Painful Diabetic Neuropathy.
Who is HFX™ for PDN for and what does Spinal Cord Stimulator Surgery entail?
Patients suffering from Painful Diabetic Neuropathy specifically, who have not responded well to conventional medicine treatments are typically good candidates for a Nevro HFX™ for PDN Spinal Cord Stimulator trial. During this trial period, a temporary version of the stimulator is placed through a needle without undergoing surgery. The patient will then use this device for one week and monitor their pain levels, activity level improvements, and their need for pain medicine. At the end of the trial, the device is removed. Ninety percent (90%) of patients who go through the trial have enough to success to make the decision to move forward with a permanent stimulator (Diabetes Care, 2021).
Once this decision has been made, a permanent spinal cord stimulator can be implanted with a quick outpatient surgery. With any outpatient surgery, the patient is able to go home and recover the same day as surgery. The permanent implant procedure is done through two small incisions. After the incisions are made, a paddle with metal contacts is placed against the spinal cord and a rechargeable battery is placed below the skin.
What is the Average Recovery Time from Spinal Cord Stimulator Surgery?
Moderate activity is limited, and strenuous activity is restricted for approximately six weeks post-surgery. This recovery time ensures that the device is received well, and the body has time to heal. However, despite this dedicated recovery time, many patients can feel pain relief in as little as a few days after their operation.
Recovery is quick with approximately eighty six percent (86%) of patients with Painful Diabetic Neuropathy experiencing substantial, long-term relief after 12-months (JDST, 2021). Additional details of the study can be found here.
Stay tuned, ongoing studies are showing great success using Spinal Cord Stimulation (SCS) to help treat additional types of Neuropathy such as Peripheral Neuropathy.
Click Here for additional Data on Nevro’s HFX™ for PDN or visit https://www.hfxforpdn.com/
Roger D. Sung, MD
Dr. Sung is a Fellowship-Trained and Board-Certified Orthopedic Surgeon who specializes in Cervical, Thoracic, Lumbar, and Sacroiliac surgery, Microsurgery, and Minimally Invasive Spine Surgery techniques. He also performs complex spine reconstruction using minimally invasive techniques.
Cartilage Restoration: Innovative Treatment for Knee Pain in Active Individuals
Cartilage Restoration: Innovative Treatment for Knee Pain in Active Individuals
What is Cartilage?
Articular (or hyaline) cartilage is a tissue in the body that lines the ends of the bones, providing a smooth surface for movement of the joint. It also serves as a shock absorber during activities. When there is an injury to the cartilage in a joint, it does not heal on its own as there is no direct blood supply to aid in this process. Instead, cartilage continues to deteriorate over time, especially with continued activity. This leads to a disease called Osteoarthritis. Fortunately, there are now procedures available to restore the cartilage in a joint without having to go through a joint replacement. The most common joint for a Cartilage Restoration procedure is the knee.
Treatment Options for Cartilage Disorders
There is a spectrum of treatment options for treating cartilage disorders including palliative, reparative, resurfacing, and reconstruction. Palliative treatment is known as Chondral Debridement, where the uneven surface of damaged cartilage is smoothed out during arthroscopic surgery. This does not replace injured cartilage but may relieve pain as there is no longer a loose flap of tissue moving abnormally in the joint. This may be an option for a patient with only a partial thickness cartilage injury or an older patient who does not participate in demanding activities. The recovery time for this procedure is minimal. The patient can be full weight bearing and does not have any range of motion restrictions after surgery.
When there is a very small, focal lesion of missing cartilage, the patient may be a candidate for a reparative procedure known as Marrow Stimulation. This procedure is sometimes referred to as Microfracture. With this procedure, holes are made directly into the lesion allowing bone marrow to escape into the defect. This allows for healing of the lesion with a substance known as Fibrocartilage, which acts similarly to innate articular cartilage when in a small area. This is a simple arthroscopic procedure but does require some restrictions during subsequent rehabilitation to allow the Fibrocartilage to develop and heal.
Cartilage Restoration for Active Individuals
When we think of true “Cartilage Restoration” procedures, there are really two different types – Resurfacing and Reconstruction.
Resurfacing: “Repaving the Street”
When the lesion is too large for microfracture but still only involves the surface of the bone, then a resurfacing procedure is warranted. There are several ways to resurface the end of the bone with new cartilage. One technique is to take the patient’s own unused cells out during an arthroscopic procedure and send them to a lab to be grown into new cartilage cells, which would then be placed over the lesion that is missing cartilage. This process is known as Autologous Chondrocyte Implantation and requires two surgical procedures – one to harvest the cells and another to put them into the defect. The benefits of this procedure are that it uses the patient’s own cells and is able to resurface a large area of damage. The recovery depends on where in the knee these cells are placed, but generally range of motion is encouraged early as cells adhere to the bone and proliferate right away. Patients are able to ride a bike within weeks and even start running after just a few months.
Another resurfacing technique is done by Allograft Implantation. Rather than two separate surgeries, this can be done in one arthroscopic or minimally invasive procedure. The defect is debrided, and the donor cells are pasted into place and fixated with a type of biologic glue. Similarly, patients progressively return to their normal activities within several weeks as the cells grow into real articulating cartilage.
Pre Cartilage Resurfacing Of The Patella
Post Cartilage Resurfacing Of The Patella
Reconstruction: “Filling the Pothole”
When a cartilage defect extends beyond the surface to involve the underlying bone, a structural graft is necessary in a reconstructive procedure to restore the cartilage. The size of the injured cartilage determines whether the cartilage can be obtained from the patient or must come from a donor. If it is a smaller lesion, then a cartilage plug (includes underlying bone) may be taken from a place in the joint that does not need it and placed into the defect. This procedure is called Osteochondral Autograft Transplantation and is typically done with a minimally invasive open incision. However, when the size of the defect is too large to take it from another place, donor tissue is required. In this case, a plug can be made to fit the size of the void after the missing cartilage and damaged underlying bone is removed. Even an oval shaped plug can be fashioned to fill a large, long defect over the weightbearing surface of the knee, which is termed a BioUni. These procedures are called Osteochondral Allograft Transplantations and may be an alternative to partial or total joint replacement for the right patient. Although they do take longer to heal compared to a cartilage resurfacing procedure, the patients generally return to activity within a few months and have excellent outcomes.
Large Cartilage Defect Of The Medial Femoral Condyle
Cartilage Graft Being Placed Into Defect
Cartilage Graft Placed Into Defect
Small Cartilage Defect Of The Medial Femoral Condyle
Large Cartilage Defect Of The Medial Femoral Condyle
Large Cartilage Defect Of The Medial Femoral Condyle
Reconstruction Innovation
There is a very exciting new procedure using the Osteochondral Allograft Transplantation concept to replace the entire undersurface of the patella (kneecap). The patella cartilage is especially vulnerable to injury in athletes, specifically runners. Here in Colorado Springs, we see many patients with this problem who are told that their only options are to stop being active, live with the pain, or get a partial or total knee replacement. This procedure provides an opportunity to restore their cartilage and get them back to activities within a matter of months. We are excited to announce that Dr. Jamie Friedman is the first orthopaedic surgeon to bring this technology to the state of Colorado. The first patient to undergo this procedure here in Colorado Springs is currently doing his physical therapy and has registered to run a marathon this coming June.
Pre Total Biologic Resurfacing Of The Patella
Pre Total Biologic Resurfacing Of The Patella
Donor Patella Ready For Placement
Post Total Biologic Resurfacing Of The Patella
Cartilage Restoration and Joint Deformity: Knocked-Kneed and Bowlegged
Finally, one aspect of Cartilage Restoration that is often overlooked is the alignment of the joint itself. Many people are born either knock-kneed or bowlegged, but if there is too much of this deformity in the joint, it puts additional pressure on one side of the knee. If the underlying problem of leg malalignment isn’t addressed, it can cause continued damage to the existing cartilage and a cartilage restoration procedure may fail. In this case, the patient may be a candidate for realignment surgery to balance out the knee joint in conjunction with restoring the damaged cartilage. If the patient is too knock-kneed (Genu Valgum), then they may need what is called a Distal Femoral Osteotomy. This is when the bottom end of the thigh bone (Femur) is cut and straightened out with an opening wedge. If the patient is too bowlegged (Genu Varum) then they may need what is called a High Tibial Osteotomy. This procedure involves cutting the top end of the shin bone (Tibia) to straighten out the joint with an opening wedge. Although these deformity correction procedures require the longest recovery (several months), they save the patient from a joint replacement and have great long-term outcomes.
Valgus Malalignment Pre Distal Femoral Osteotomy Surgery For Knocked Knee
Valgus Malalignment Post Distal Femoral Osteotomy Surgery For Knocked Knee
Varus Malalignment Pre High Tibial Osteotomy Surgery For Bow Legged Knee
Varus Malalignment Post High Tibial Osteotomy Surgery For Bow Legged Knee
Is Cartilage Restoration right for you?
So, who is the right candidate for a Cartilage Restoration procedure? The ideal patient is young, active, and motivated. These patients are typically considered too young for a partial or total knee replacement (18-45 years old) and are still involved in an active lifestyle such as team sports, running, hiking, biking, skiing, etc. Patients who currently have pain in their knee with these activities are first assessed in the clinic and with x-ray images. Typically, advanced imaging with an MRI is necessary to fully characterize the cartilage and the underlying bone. If the surgery does not require a donor graft, then the surgical procedure can be scheduled right away. If a donor graft is necessary, then this graft must be ordered, and surgery is not scheduled until a match is found, which usually takes 4-8 weeks.
Cartilage Restoration Recovery
Cartilage Restoration procedures do take some time to recover from – weeks to months – but the patients who are determined to follow the rehabilitation protocols have great outcomes. The goal of Cartilage Restoration is to get patients back to the activities that they love to do without having a joint replacement.
Developed by the Colorado Springs Orthopaedic Group Sports Medicine Team