Monday, February 20th, 2012
This is a 40s female who presented with progressive and disabling anterior knee pain . Her condition had been getting progressively worse to the extent that she was no longer able to participate in even routine activities without having substantial discomfort followed by swelling. She had undergone prior surgery for the knee and recently had a second procedure done which was a lateral release and micro fracture. She was scheduled to have the same procedure performed for the opposite knee however since she had not gotten acceptable pain relief came to see us for a second opinion.
We made a diagnosis of advanced osteoarthritis of the patellafemoral compartment and based on the advanced nature and pattern of the cartilage loss recommended a resurfacing procedure for effective and durable pain relief. Arthrosurface implants were used for the resurfacing ( image 1,2). Note the implants and how they are surgically implanted to match the complex curved geometry of the knee. She achieved an excellent result from the procedure with no further symptoms of pain or swelling.
The following video is at her most recent visit to schedule the identical procedure for the opposite knee. The video shows the cosmetic incision as well as restoration of full knee motion (video).
Watch Video
Sunday, February 19th, 2012
This is a 50 something male who was a client of ours having undergone a hip replacement. He was extremely satisfied with the results and care he received and asked us to evaluate his shoulder. He complained of severe pain in the shoulder and restricted motion. He was tentative about undergoing treatment for the condition having been told he would need a shoulder replacement and not able to return to playing golf.
After evaluating his problem we recommended a shoulder resurfacing procedure as an effective surgical intervention that would eliminate his pain and still allow a return to sports activity including golf. Based on our reassurances and the confidence we had built as a result of the successful hip surgery he decided to proceed. The following video shows his motion at 4 weeks from the surgery. He is extremely pleased with the results and looking forward to returning to the golf course this spring.
Shoulder resurfacing is a new procedure and is a substitute for shoulder replacement surgery. The procedure is radically less invasive and allows for a much more complete restoration of function and return to sports.
Watch Video (Shoulder Resurfacing)
Read Client’s Testimonial (after hip replacement)
Thursday, February 16th, 2012
This is a female patient over the age of 60 who presented to our office for a second opinion with complaints of severe disabling pain in her lower back. She had been treated at another facility and it was recommended that she undergo surgery on her lower back. In our evaluation we identified disc degeneration and arthritis of her lower back but much more significant degeneration of the right hip (Image 1).
On the basis of our diagnosis we recommended a total hip replacement (Image 2) which almost immediately resolved the pain she was experiencing. At 3 weeks from the procedure she is walking independently and is very satisfied with the results of the procedure (video) She is also extremely grateful that we correctly identified and treated her problem effectively.
Hip arthritis symptoms can manifest as buttocks pain or even knee pain. Also the loss of motion from hip osteoarthritis can transmit substantial stress to the lower back and significantly aggravate a lower back condition. The correct diagnosis of hip osteoarthritis and effective treatment can prevent unnecessary and ineffective surgery on secondary or non- symptom generating conditions. (watch video)
Thursday, February 2nd, 2012
This is a 17 year old female who sustained an injury to her left knee while playing Lacross. Her MRI showed a tear of the ACL. Image 1 torn ACL. Image 2 After torn ACL was derided. Image 3 you can see the new ACL graft now in place.
Tuesday, January 24th, 2012
This patient came to us Iinitially after having a fall and sustaining a displaced fracture of the distal radius (wrist). She had surgical treatment of the fracture with bone grafting and internal fixation using a volar locking plate (image 1). 1 year later she fell and suffered nearly an identical fracture of the right wrist and returned to our care undergoing the identical procedure (image 2). She had a full restoration of motion and strength after recovery (image 3,4,5). The cosmetic result is quite good at 1 year and barely visible compared to the appearance at 6 weeks (image 6).
Tuesday, January 24th, 2012
Image 1 and 2 show a postop knee only 6 days from the surgical procedure. The muscles are not disrupted during the procedure and therefore the patient has achieved active functional range of motion almost immediately after the operation.
Image 3 shows a minimal incision which is barely noticeable after it heals. Image 4 shows that the patient is less then a week from surgery and is able to stand and walk independently. He is taking only occasional pain medication and has already started physical therapy.
Tuesday, January 24th, 2012
This is a 28yo man that sustained a traumatic injury to his knee. He underwent initial arthroscopic surgery in 2001 by another surgeon at which time he was noted to have damaged the cartilage surface of his knee. He continued to have pain and swelling in the knee.
A repeat arthroscopic surgery performed by Dr. Montalbano in 2007 showed 2 full thickness cartilage defects in the femoral condyle.
He underwent Autologous Chondrocyte Implantation. This is a procedure by which a small cartilage biopsy is taken from the joint and is sent to a specialized facility in Mass. where the cartilage cells are proliferated.
As a second stage procedure the cells are transplanted into the defects (Image 1) which are covered with a collagen patch (Image 1) The transplanted cartilage cells (chondrocytes) will eventially produce matrix and the cartilage defects will be filled in with new cartilage tissue. A second look arthroscopic procedure shows the cartilage defects have healed (Image 2,3,4)
Tuesday, January 24th, 2012
This woman came to our office complaining of bilateral knee pain and also complaining of a progressive bow-legged deformity and difficulty waking. She was diagnosed with osteoarthritis and elected to undergo reconstructive joint surgery.
The procedures were done in a staged fashion with the left knee being done first followed by the right knee 1 year after the first surgery. 2 months following her second surgery she has restoration of normal alignment and motion (image 1,2) as well as nice cosmetic result utilizing a small incision and muscle sparing approach (image 3).
Also notice how the appearance of the incision fades with time when comparing the left knee which is 1 year old vs. the right knee which is only 2 months old (image 4). In this video you can see how she walks in the office with no pain, restored alignment of her legs and normal strength and motion at 1 yr postop left knee and 2 months postop right knee. (Video)
Tuesday, January 24th, 2012
Image 1 and 2 demonstrate a reconstruction of the medial compartment of the knee using a mobile bearing. The remaining 2/3rds of the knee remains natural.
Image 3 – 2 weeks postoperative; is full weight bearing and walking with a cane; the procedure is done through a minimally invasive 3 inch incision and discharge was within 23 hours of the procedure.
Image 4 and 5 – 2 weeks postoperative; has regained functional range of motion.
Monday, December 19th, 2011
This is a case of a fifty-something yo female who presented to us after sustaining a knee injury. Her xrays were normal (image 1,2). She underwent an arthroscopic procedure and was found to have a cartilage defect on the medial femoral condyle (image 3). A micro fracture procedure was performed.
1 year after the procedure she continued to have knee pain. A second look arthroscopy showed healing of the cartilage defect with fibrocartilage (image 4), however the quality of the tissue was poor and when stressed using a blunt probe cracked easily (image 5).
The reconstruction that was done was a resurfacing implant (Arthrosurface). This implant was used to reconstruct the medial femoral condyle by filling the cartilage defect as opposed to doing a more traditional procedure – total knee replacement (image 6,7).
One of the many advantages of this procedure is that the surface of the knee can be reconstructed with the removal of very little adjacent tissue during preparation of the bone. Also , the procedure is done through a minimally invasive exposure, is ambulatory and immediately weight bearing. Also, the kinematics of the knee are not changed as a result of the procedure and there are no anticipated limitation in regard to activities – run, jump, twist etc.
This is a wonderful reconstructive option for appropriately selected knees and a much better option then knee replacement for limited cartilage loss.
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