Subchondroplasty

Subchondroplasty is a minimally invasive surgical procedure that involves the injection of a bone substitute, typically calcium phosphate, into the subchondral bone where bone marrow lesions (BMLs) are present. This technique aims to stabilize the bone, alleviate pain, and prevent further deterioration of the joint.

Ideal candidates for subchondroplasty include patients with persistent knee pain due to osteoarthritis, who exhibit bone marrow lesions on MRI, and have not responded adequately to conservative treatment methods. Patients should not be immediate candidates for total knee replacement.

The procedure is performed under fluoroscopic guidance to ensure accurate placement of the injection. A mixture of a solid and fluid bone substitute is injected through a cannula into the affected area, filling the lesions and supporting the bone’s natural healing process.

As with any surgical procedure, subchondroplasty carries risks such as infection, bleeding, and reaction to anesthesia. Specific to this procedure, there is a risk of the injected material leaking or migrating, and potential for an inflammatory response to the bone substitute.

Recovery varies but typically patients can return to normal activities within a few weeks. Pain and mobility improvement can be noticed as early as a few days post-operation, although full benefits might take several weeks to manifest.

Coverage can vary depending on the patient’s health insurance plan and the specific indications for the procedure. It’s important to consult with the insurance provider prior to the procedure to understand coverage details.

Yes, the procedure can be repeated, but the necessity for this would depend on the individual patient’s response to the initial treatment and progression of underlying conditions such as osteoarthritis.

Success rates vary, but studies generally report significant improvements in pain and function. Many patients experience relief from symptoms and improved quality of life following the procedure.

Alternatives to subchondroplasty include conservative treatments like physical therapy and medications, as well as more invasive procedures like osteotomy or total knee replacement, depending on the severity of the condition.

Bone marrow lesions are areas within the bone that show up on an MRI as regions of increased fluid. They are often associated with pain and are indicative of changes in the bone that could lead to further joint deterioration.

Subchondroplasty does not typically affect the outcomes of future knee surgeries such as total knee replacement. It can serve as a bridge therapy, potentially delaying the need for more invasive surgeries

The procedure can be performed under local anesthesia, regional anesthesia, or general anesthesia, depending on the extent of the procedure and the patient’s needs.

Unlike traditional bone grafting, subchondroplasty specifically targets subchondral bone lesions using a minimally invasive approach and injects a flowable bone substitute rather than solid graft material.

Symptoms such as persistent knee pain, swelling, and decreased mobility, especially in patients with osteoarthritis and visible bone marrow lesions on MRI, may indicate the need for subchondroplasty.

While it is most commonly performed on the knee, subchondroplasty can also be applied to other joints experiencing similar issues, such as the hip or ankle, though these applications are less common.

The long-term efficacy of subchondroplasty appears promising based on current research. Patients often report sustained improvement in pain and function, with effects lasting for several years. However, the long-term success also depends on the progression of the underlying joint condition, like osteoarthritis.

While subchondroplasty can delay the need for knee replacement by alleviating symptoms and stabilizing the joint, it does not cure the underlying osteoarthritis. For some patients, knee replacement may still be necessary in the future.

There are no strict age restrictions, but the procedure is typically recommended for middle-aged and older adults who suffer from bone marrow lesions due to osteoarthritis or other degenerative joint diseases.

Postoperative care typically involves pain management, gradual weight-bearing activities, and physical therapy to restore mobility and strengthen the joint.

Most patients are able to resume light activities within a few days and return to more normal levels of activity within several weeks, depending on the individual’s health status and the specifics of their procedure.

Signs of potential complications include excessive pain, swelling, redness, or drainage at the injection site, and fever. Any of these symptoms should prompt immediate consultation with a healthcare provider.

The calcium phosphate bone substitute gradually integrates with the surrounding bone tissue through a process called osteointegration, helping to restore the strength and structure of the subchondral bone.

Yes, subchondroplasty can be performed in conjunction with other procedures such as arthroscopy to address additional joint issues like cartilage damage.

While there is limited data specifically on younger patients, those without advanced degenerative changes tend to respond well to subchondroplasty, with good improvement in pain and function.

There is no preferred season for undergoing subchondroplasty. The decision should be based on the patient’s clinical needs, lifestyle, and the advice of their orthopedic surgeon.