MDNews - Cleveland-Akron-Canton

PHOTO COURTESY OF DR. MICHAEL SALATA, UHCMC In addition to joint replacement and preservation procedures, several cartilage restoration treatments are offered at UHCMC. In this photo, a particulate juvenile chondrocyte implantation was performed to replace damaged knee cartilage. and an entire floor of nurses and physical therapists in our new center who are dedicated solely to caring for patients who have undergone these procedures,��� says Dr. Petersilge, ���So our staff, as well as our surgeons, are subspecialized. And that���s beneficial in providing our patients with a consistent hospital experience and excellent outcomes.��� As a tertiary care academic medical center, many patients are referred to UHCMC for surgery because of their complicated medical problems or comorbidities that are difficult to manage in a community hospital setting. One innovative approach to optimize the perioperative care of these complex patients has been the addition of a specially trained perioperative hospitalist to the Center���s staff. ���Having a full-time dedicated hospitalist who is uniquely trained in the perioperative management of our joint replacement patients provides our patients with superior perioperative medical care and has the potential to dramatically reduce perioperative medical complications, ICU admissions and hospital readmissions,��� states Dr. Fitzgerald. In selected younger, more active 20 | Cleveland/Akron/Canton MD News patients, the joint replacement team may recommend joint-preserving procedures such as a realignment osteotomy to help shift weight to a normal or nondiseased part of the joint. For patients 55 years of age and under who have arthritis or pre-arthritic hip and knee conditions, joint preservation procedures ��� such as pelvic osteotomies for hip dysplasia and arthroscopic surgery for femoral acetabular impingement (FAI) ��� delay or may even eliminate joint replacement down the road. FAI is a condition where the anatomy of the pelvis, either on the ball joint side or the socket side, is abnormal causing impingement and leading to damage of the labrum, a fibrocartilagenous structure that provides a sort of ���gasket��� for the hip socket. Over time, it also starts to peel the articular cartilage off the top of the socket which progresses to the development of arthritis in the hip. ���Arthroscopically, through three incisions the size of pencil erasers, we can re-shape those bones to eliminate the impingement and repair the labral tearing that occurs,��� says Michael Salata, MD. ���And what we think, and a lot of the preliminary literature has been favorable about this, is that this may slow or eliminate that mechanism as a cause of arthritis.��� According to Dr. Salata, UHCMC is one of the few centers in the state that does hip arthroscopy to that extent. The hospital is also reportedly one of the few where acetabular osteotomies are performed for complex hip joint preservation. Dr. Wilber is considered to be an expert in this procedure. In addition to joint preservation procedures, several cartilage restoration treatments are offered at UHCMC. These include marrow stimulation techniques which are done arthroscopically, an advanced autologous chondrocyte implantation (ACI) procedure in which a patient���s cartilage is grown in the lab and reimplanted, and particulate juvenile chondrocyte implantation to replace damaged knee cartilage and provide surgeons with an early intervention option for articular cartilage injury. ��� MDNEWS.COM ��� JANUARY-FEBRUARY 2013 Dr. Salata explains, ���When we talk about problems with articular cartilage, we talk about it in two terms: 1. global thinning and wear (like a tire going bald) which is better served by having a joint replacement, or 2. an overall good-looking joint with an area that has a focal defect (like a hole popped in a tire). Cartilage restoration treatments can patch that hole.��� For patients with defects of both cartilage and bone in the knee that requires implantation of both to restore the joint to a more normal state, an osteochondral allograft transplant can be done. This involves making a ���plug��� of both bone and cartilage from a sizematched organ donor to fill the defect. According to Dr. Salata, patient selection criteria include intact meniscal cartilage, a ligamentously stable knee and neutral alignment or corrected alignment. The joint must also ���look good��� except for one spot. ���Working with Dr. Salata and the other members of our joint preservation team gives us the expertise to treat young adult and adolescent patients that have joint problems which, if not diagnosed and treated early, would likely require joint replacement,��� says Dr. Kraay. He adds that UHCMC is ���one of only a small number of hospitals in the country with the ability to provide the full spectrum of joint replacement and joint preservation surgical procedures for our patients, regardless of age.��� For more information about the UHCMC Center for Joint Replacement & Preservation visit www.uhhospitals.org/newjoint or to refer a patient, call (216) 844-7200. ���

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