July 24, 2003

Note to our users: This interactive feature is in no way a substitute for the examination and advice of a physician. You are responsible for all actions you take after reading material on this site. Always seek the advice of a doctor for concerns about your health or a specific condition.

Knee1 : Welcome to today's discussion with Dr. Pavlovich of Hermosillo, Mexico. Dr. Pavlovich is the recipient of national honors from several countries, including Mexico, his homeland, and the U.S. He is the author of many influential articles published in prestigious journals as well as member of the editorial board of several major journals. In addition to his many accomplishments, Dr. Pavlovich speaks five languages and has traveled and practiced in Europe, the Americas, and the Middle East. Dr. Pavlovich, thank you for joining us today. Users, we welcome your questions for Dr. Pavlovich!

lcm2457 : I have had 3 arthroscopic surgeries, and now 10 years later I have been diagnosed with RSD. My doctor wanted me to have a series of Synvisc injections. I had five, but with no relief. Could you explain why this does not work on RSD patients?

Knee1 : Note to our users: "RSD" is Reflex Sympathetic Dystrophy

pavlovich : RSD is a syndrome regarding nervous tissue. The local injections may eventually stop working because the problem may not be in the knee itself. You need to seek advice of a doctor related to a pain clinic; there, you may be offered some epidural blocking in a therapeutic fashion.

David Ing : Dr. Pavlovich: I am 59 years old and in very good health except for my knees. My left knee was scoped in '95 for medial meniscus. Now after walking on a cement floor at work, I find I have patella chondromalacia. Cortisone shots in both knees did not work. My physician will refer me to an orthopod. I have been very active and now find that my knees are deteriorating. Any suggestions will be very helpful. Thank you. David Ing.

pavlovich : Chondromalacia is an arthroscopic diagnosis not a clinical one, because you have to take a look directly in to the cartilage to actually see if it is weak or soft. You are maybe dealing with some hyperplasic sinovitis due to over demand of your knees, secondary to your activity. You must go to your orthopedic surgeon for further evaluation.

Dr. Mitchell : 78 year old female with DJD of both knees wants meniscus replacement vs. total knee replacement. What are you opinions on this matter?

Knee1 : Note to our users: "DJD" is degenerative joint disease

pavlovich : Meniscus replacements are aimed at younger patients who to tend have much less cartilage deterioration. Due to cartilage wasting [due to age], I would rather consider a total knee replacement instead.

awood36 : I worked out hard on my legs yesterday with no signs of overwork, but today I can't fully straighten my right knee. What do I do?

pavlovich : This is a classic over demand episode of your knee. Fluid is being secreted by the irritated synovial tissue, and the capsule is expanded, so your knee cannot fully extend due to pushing the excess of fluid against your capsule, and that causes pain. Rest and anti-inflammatory medication may suffice.

pallen2881 : On July 8th I had arthroscopic surgery for a complex tear of my medial meniscus plus an additional small rend and a lateral tear also. I also had a huge baker's cyst that was drained during the procedure and was given a shot of cortisone. Two days after surgery the baker's cyst came back and has continued to get larger and very hard, its about the size of 1 1/2 golf balls and is inhibiting the straightening and bending my knee. I am going back to my doctor on 7/24 so he can drain the cyst and give it another shot of cortisone. Will this continue to come back? Also, he discussed the option of surgical removal of the cyst. Will this resolve the problem? I thought that once the tears were taken care of, the baker's cyst would resolve itself? Any and all info is appreciated along with web sites to understand what is happening with my knee. Thanks.

pavlovich : Baker's cyst is a herniated communication from the inner joint to a pouch seated in the back of the knee. Sometimes this little pouch becomes symptomatic because it has a little valve which allows fluid only to enter but not to exit. Certainly irritating factors such as synovitis due to meniscal tears or over demand in exercise will worsen the picture. Cortisone shots try to calm the synovial reaction, but sometimes this is not enough and doctors have to perform either partial synovectomy and or baker's cyst removal.

karen slaughter : I am 18mos. post TKR...Will power walking 5miles daily shorten life span of replacement?

pavlovich : If you would like to loose weight by walking with TKR, it would be better to do some stationary cycling instead and dieting. The impact of the normal walk may indeed affect the life span of your prosthesis in long term when you are overweight . Cycling may appear to be less demanding to the joint, and you may go ahead with a cardiovascular plan.

mgb0321 : Can the uni knee be performed on a patient who has very bad arthritis on the knee? (The inner part.) Will he get some relief? Thank you.

pavlovich : You have to assess the bone status. This is very important to think of in uni; they are very good in the right patients, but there are some criteria to be analyzed before going ahead.

HHiwasa : What do you think of the procedures of Dr. Allan Dunn of Miami who uses growth hormone injections with mild exercise to cause regrowth of the meniscus cartilage? Henry Iwasa of Honolulu.

pavlovich : It sounds like a very interesting field. This is a very powerful non-steroidal anabolic, among other properties, and it certainly stimulates the protein synthesis. However, I think that much more research must be done regarding this.

S Nagi : I have pain in both knees on the outside, and there is some minor swelling on the left knee. Is it ITB?

Knee1 : Note to users: "ITB" is illotibial band syndrome.

pavlovich : ITB is an inflammatory status of a large band in the lateral side of the thigh, reaching the lateral side of the knee joint immediately below the joint line. This entity goes along in some runners and some persons with tibial deformity, and it does deal with an irritation of its point of insertion in the knee due to over pulling mechanism. Check you shoes or the routine of exercise you are now performing. Yes these symptoms may call for ITB.

Sue : I'm a 55 yr old female with a torn left medial meniscus. My OS wants to do surgery with 3 needles and scrape or cut the torn area away. How long will the recovery really take? Will I have a leg brace as well as be on crutches? He wants me to start physical therapy the next day. Right now the pain is constant - I limp when I walk. Will the surgery really help? I've read so many negative stories from people who have had this "so called minor procedure" that I'm scared (of even more pain). Thank you for answering! Sue.

pavlovich : Artrhoscopic surgery was one of the breakthroughs of the last century, a very important step in orthopedic surgery. Remember that bad stories go around like ripples in the water; meanwhile successful ones only reach a few centimeters. Medial meniscus tear is an entity that must be treated as soon as possible to avoid further damage to your cartilage. It may be either repaired or partially taken away, depending on the anatomical area of the tear. If this is repaired most surely you will be non weight-bearing for a few weeks, allowing the meniscus to heal. If you sustain a partial menisectomy, you may go ahead with full weight bearing as tolerated, be confident!

wldnsnkchrmr : I was diagnosed with chondromalacia of the knee and internal derangement of the knee and osteoarthritis spurring in all three compartments. My doctor is speaking of resurfacing the knee. Is this something I should consider?

pavlovich : Yes, the term resurfacing the joint is most likely to mean total joint replacement or total knee replacement. Ask your doctor what he means. If it is total joint replacement this is a time honored procedure when properly indicated and usually when the person has the three compartments wasted. You may think of this procedure as the solution of your problem. Please double-check the terms or the words with him.

Knee1 : We're just about ready to end this discussion. Dr. Pavlovich, do you have any closing thoughts you'd like to share with our users regarding knee care?

pavlovich : I am very honored to participate with these distinguished users; I really hope it was of use to all of you. I thank Knee1 for this privilege. Yours, Rafael Inigo Pavlovich,MD,FACS,IOM

Knee1 : Dr. Pavlovich, thank you for joining us and providing us such valuable insight into knee care. Users, thank you for joining us and stay tuned for future discussions!