59 Year Old Knee & Wrist Pain in Patient with RA
Some patients are more complex than others. This patient was 59 years old and had an autoimmune disorder Rheumatoid Arthritis. She was also complicated by having knee degenerative arthritis pain which began in her early 50’s. She also had a knee arthroscopic surgery 8 years ago, at age 51, in which she underwent knee meniscal debridement. Like many patients, who undergo knee arthroscopic surgery they are led to believe the surgery would fix their problem. Removing portions of the knee meniscal or meniscal debridement leaves a defect in what is supposed to be smooth cartilage when you are young. Removing portions of the meniscus through surgical debridement, cannot make it new or “fix” the problem. It leaves a hole or defect in the worn cartilage.
50-year-old cartilage is never smooth like 18-year-old cartilage, and removing portions just compounds the structural problem or time. In fact, many top orthopedic surgeons, will not perform arthroscopic knee meniscal debridement after the age of 50, as it only accelerates the degenerative progression of knee osteoarthritis. Unfortunately, many patients are not told this. This leaves Dr. Lox the bearer of bad news. Dr. Lox is an expert in Sports and Regenerative Medicine and always looks for the bright side. Some patients are not the easiest, but helping them is gratifying for both the patient and Dr. Lox.
Analyzing Each Patient
Despite her knee surgery after age 50, she still had relatively good joint space. It was diagnosed as moderate-severe, compared to severe. Unfortunately, her other knee was now beginning to hurt, and she had early moderate knee arthritis of the other knee. Humans walk upright, so after 59 years, it is not atypical to have involvement of both knees. A recent MRI showed meniscal fraying from the surgery 8 years ago, and synovial swelling. The synovium lines the joint capsule it functions to allow diffusion of nutrients, as well as can be inflamed in both degenerative arthritis, as well as Rheumatoid arthritis or RA.
In RA the immune system attack your own body and the synovium becomes inflamed. This can be addressed with Regenerative Medicine and Stem Cell Therapy. Her wrist pain was found to be carpal tunnel syndrome, which with RA, this can be due to synovium swelling irritating or compressing the median nerve at the wrist. Her hands showed no signs of deformity from the RA, which was a good prognostic factor. Structurally her biggest orthopedic issue was her degenerative knee arthritis. She was adamant that she did not want a knee replacement surgery, and was very interested in Dr. Lox’s opinion on Regenerative Medicine and Stem Cell Therapy, as her husband had treated with Dr. Lox 3 years ago successfully for his knees.
A final factor of importance to this patient was weight. She had already lost 13 pounds. In the last year with the pandemic most patients gained weight, she didn’t, she lost. This was a positive factor for a good outcome. She was willing to lose 10 more pounds, as she was of short stature 5’3” and 154 pounds.
Good Motivated Patients have Better Outcomes Typically
One of the biggest problems that doctors face is patients not wanting to help in their own care. The same is true with Regenerative Medicine and Stem Cell Therapy. Helping your own body to heal itself with Regenerative Medicine is becoming more appealing to patients, however, patients that listen to their doctor, and take an active role in their care are ideal. Dr. Lox can’t fix everyone, but he spends a great deal of time discussing the science, and the important factors which makes each individual patient different. By knowing the honest truth and facts, it can be possible to formulate a successful approach to helping patients obtain their goals.
This is the practice of medicine and the art of medicine.
It is gratifying to help patients, after all this is what it’s all about.
About Dennis M. Lox, M.D.
Whether you are a professional athlete, weekend warrior, or have arthritis from aging, Dr. Lox can help.
Dennis M. Lox, M.D. is an internationally renown Sports and Regenerative Medicine specialist. Dr. Lox incorporates Regenerative Medicine techniques such as cell science applications, Platelet Rich Plasma (PRP), and Tissue Engineering aspects, to help patients from around the world with a vast array of problems. Dr. Lox is board certified in Physical Medicine and Rehabilitation. Dr. Lox lectures extensively and has edited two PM&R textbooks, the prestigious A State of the Art Review (Star) on Low Back Pain, and Soft Tissue Injuries: Diagnosis and Treatment.
Dennis M. Lox, M.D. maintains an active practice in the Tampa Bay, Florida area, and in Beverly Hills, California.