A good friend of mine emailed me today for advice.  He’s a doctor of chiropractic who’s developed severe pain in his hip joint. He saw an orthopaedist, who got an MRI, but it was inconclusive–could be edema, or it could be a more serious disease that could result in surgery. 
 
Trouble is, the picture doesn’t look like what you’d expect if he had the more serious disease. Typical of the problems one sees in clinical practice–cases often don’t follow the textbook presentation. So it makes it tough to know exactly what to do.
 
Seems the guy has asthma and he’s been taking steroids (prednisone) for some time to try to control the symptoms. But one of the potential and most dreaded side effects of longer term systemic steroid use, typically seen in asthmatics, rheumatics, or people with chronic allergies or skin diseases, is a bone disease called avascular necrosis.
 
Avascular necrosis is a kind of weird disease that no one’s ever heard of, until they get it, or know someone who did. It refers to the death of bone cells inside a bone. It’s variously called aseptic necrosis (meaning it is NOT caused by an infection), ischemic (meaning it’s due to oxygen deprivation) necrosis, or avascular (lack of blood supply) necrosis, or just plain old osteonecrosis (or “dead bone”) where “necrosis” means cell death. It commonly affects the hip, knee, shoulder, or ankle, in roughly that order.
 
For any number of reasons, this happens because there is a blockage of the blood supply to the bone of the affected joint. Think of it like a dam in a river. So everything “downstream” that is normally fed by the blood supply is suddenly cut off. The cells, deprived of oxygen, begin to die. The surrounding bone then begins to deteriorate. In the case of the hip, this area is recognized as “dead” by the body and special cells go to the site and begin eating away the dead bone area, so that new healing bone can be laid down.
 
The problem is that as that dead bone is removed, support for the overlying joint surface is is removed, too. The pressure across the joint surface causes the joint surface to collapse under the pressure. Think of a house that has its foundation eroded by an underground river, or a sink hole. What happens to the roof? Caves in, right? 
 
Same thing.
 
When the “roof” caves in, that segment collapses, the hip suddenly hurts like Hell and the resulting irregularity rapidly chews up the rest of the joint, causing rapid onset of arthritis. Very bad news, indeed.  Once that happens, nothing short of a hip replacement can relieve pain and restore function.
 
If you recognize the disease early enough, you can do a small surgery that can often save the joint from collapse. Through a tiny stab wound incision and under fluoroscopic control, a surgeon can drill a hole from the side of the hip bone into the femoral head, just like coring an apple. This relieves pressure inside the femoral head, which is believed to be responsible for cutting off the blood supply to the femoral head. Not as big a deal as total hip replacement, but, hey, it’s still surgery, right? You want to avoid it, if you can.
 
So the doctor’s dilemma is to get an accurate diagnosis quickly enough to do a lesser surgery and head off joint collapse, but not to do an unnecessary surgery, if it isn’t needed. And he has to try to relieve the hip pain, while all this is going on. Not always an easy thing to do. And made much more difficult when the picture isn’t typical. Tough to know what the right thing is to do…
 
Same thing occurs in the knee, but there, because the knee is a larger joint (in fact, the largest joint), it’s a lot more forgiving and less likely to collapse than the hip. So there, conservative non-surgical treatments make the most sense, like those I teach in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Meanwhile, I recommended my friend reduce the forces across his hip joint by using a cane. Same thing for a painful knee. Sometimes, the simplest things are the most effective. That, combined with a number of the alternative and conventional non-surgical treatments  to relieve pain, that I describe in detail at http://drbillsclinic.com/avoid_knee_surgery.html  may be very helpful to him. Even though the program was written for the knee, the methods I use are systemic, that is, they work for the whole body, hip included. And that program comes with a FREE Special Report on HOW TO RELIEVE HIP PAIN, too.
 
So, I wished him luck. Hopefully, he’ll recover soon, and avoid all those problems. We’ll just have to wait and see…
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow, 
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

It’s hard to believe how fast time is flying. Here it is October 2nd, and the last quarter of 2008 has already begun. You know, it was a year ago yesterday that I sent my very first email to a small group of friends–my first subscribers. Well, everyone has to start somewhere, right? Things have changed quite a bit during this last year, too. I started with my LITTLE GREEN BOOK   http://drbillsclinic.com/eliminate_knee_pain.html
 
I have a number of products, including CD’s for the LGB and for my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at http://drbillsclinic.com/avoid_knee_surgery.html And, there’s also my magnum opus, HOW TO ELIMINATEKNEE PAIN–ONCE AND FOR ALL! THE ADVANCED MASTERS’ COURSE http://drbillsclinic.com/advanced_masters.html  for the last word in the entire spectrum of methods of treatment for knee pain of all kinds. This can be obtained in a single, BIG volume, or in 12 monthly installments, or Lessons–your choice. Or, if you’re just interested in the specially modified exercises that I used myself after my own knee surgery, and those I prescribed for my patients during my nearly quarter century of private practice in orthopaedic surgery, you could benefit from my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html

These exercises can help get rid of knee pain, FAST, but can also PREVENT knee pain, when done as instructed. And, I’ve made some other great products available to you as well, like the human growth hormone releasing hormone analog, that when rubbed on the skin, helps to reduce inflammation, speed healing, and has anti-aging properties, as well. You can get it here: http://drbillsclinic.com/trans_d_tropin.html 

I’m grateful for all the subscribers who have joined our ranks and for the support of all those who have purchased one or more of my programs. I’ve gotten some great feedback from those who have followed my advice–none better than those who have come back to buy again. All in all, it’s been an exciting and pretty gratifying time. Just think–even though I can’t operate any more, I can still help people all over the world, through my programs, CD’s, tips and general advice. 

Let’s face it. The internet is a gusher of information: some good, some bad, some irrelevant. So much, in fact, that the average person is just swamped–people have NO frame of reference, no filter to determine what information is correct and what isn’t. What you really need is ADVICE, from someone who KNOWS. And that’s what I’ve tried to provide. 
 
So, what’s next for Dr. Bill’s Clinic? Well, I’m now working on a program for ARTHRITIS–what it is, and more important, what you can do about it: how to slow its effects, relieve pain and prevent joint damage, with my usual approach of giving you the latest measures from across the entire medical spectrum, conventional, alternative and complimentary. 

I’m also going to produce some DVD’s and digital videos, and I may provide some teleseminars, as well. So, it should be fun. I’m looking forward to it. And it starts right now….Talk to you soon, my friend. Til then, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html 

P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to http://drbillsclinic.com/advanced_masters.html

FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

For the past week or so, I’ve been trying to relieve your fears about surgery. Hey, you never know. One day you might NEED one of these procedures, and it would be a shame if you were terrified, due to misperceptions, misinformation, distortions and urban myths. It’s also a good idea to know just what your options are, so you can make an informed decision, should that day ever come.
 
So, I’ve attempted to give you the straight dope, tell you exactly what’s done, in each of the most common surgical procedures for the knee. As I’ve said before, when you KNOW the finite dimensions and the finite duration of an experience you fear, it helps a lot to put it in perspective, help you face it and help you handle it. 

Today, to round this all out, is the ultimate option: ARTHROPLASTY, more commonly called joint replacement. Though the term actually means “creation of a joint,” it’s come to be identified with joint replacment, and is now virtually synonymous. This was initially TOTAL knee replacement, but today, through many technical advancements, it encompasses PARTIAL or UNICOMPARTMENTAL joint replacement, as well. These options are explained in great detail, though in layman’s language, in my LITTLE GREEN BOOK at http://drbillsclinic.com/eliminate_knee_pain.html
 
This is really a misnomer, though. Unlike a total hip replacement, a total knee DOES NOT replace the entire joint, nor does it remove the bony segments of the joint. Instead, only the SURFACES are replaced with man-made shells of polished metal, articulating on very tough plastic. Technically, the operation is a joint resurfacing arthroplasty. If there’s severe arthritis on only one side of the joint, then only that side has its surfaces replaced. The so-called UNI (unicondylar knee replacement) can be done through a very small incision, sometimes even on an outpatient basis. The trick is for the surgeon to balance the ligaments and align the knee properly, so the kneecap tracks properly.
 
Small power saws are used, with special saw guides and alignment tools, to cut thin slivers off the ends of the bones, the femur and the tibia. This removes the arthritic surfaces and “opens up” the spongy (cancellous) bone, for acrylic cement intrusion, which holds the implants in place on the respective bones. The properly sized implants are then selected and implanted. 
 
A total knee replacement, like the name implies, resurfaces all three compartments, medial lateral and patellofemoral. It’s done for more extensive, or end stage disease, in two or all three compartments. It needs a larger incision, generally involves somewhat more pain, swelling and potential bleeding. It has a greater potential to develop adhesions, and limited motion, after surgery.
 
In both cases, weight bearing is initially limited by pain, and the use of crutches or a walker. Motion is started right away. Pain is controlled with medications, and physical therapy and rehabilitation are essential. Many of the exercises used are those I teach in my PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html
 
But here’s the thing. Although the success rate, in the right hands, is very good with joint replacement, you NEVER do this without the right indications. The truth is, nothing made by man is as good as what God gave you. Man-made parts can wear out, can get loose, even get infected…and there’s always the chance of a technical problem or human error, even in the best of hands. 
 
So you need to be SURE that if TKR or a UNI is recommended, it’s NECESSARY. And if you can get relief from ANY more conservative methods, conventional, alternative, or complementary, provided you don’t have a lot of bone loss in the joint or severe deformity, then it’s an UNNECESSARY SURGERY and should be delayed, or avoided. And it was to help you do just that, that I wrote my new healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
Well, I hope that this series on knee surgeries has been informative for you and that I accomplished my goal: to tell you exactly what goes on in the O.R., give you some perspective and relieve your anxiety and fears about surgery. If you NEED surgery, by all means, accept the risks and get the benefits.  Odds are, you’ll do great. But if you’re not sure, or if all non-surgical measures have NOT been exhausted, then there’s at least the possibility that you may be headed for an UNNECESSARY SURGERY.
 
In that case, get my program and be prepared. Don’t guess, when you can KNOW. Click on the link and get HOW TO AVOID KNEE SURGERY today, right NOW, at   http://drbillsclinic.com/avoid_knee_surgery.html   to relieve your pain, restore your function and do it WITHOUT SURGERY.
 
Til next time, my friend, be well and have a great weekend.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

As you know, before the last few days, I’d been giving you the “Readers’s Digest” version of a number of different types of knee surgery. The purpose is to alleviate your fears, based as they are on misinformation, exaggeration, outright distortion and your own imagination, by telling you exactly what’s done. This gives the fears limits, as reality limits imagination, and helps you to cope, if you actually DO need one of these procedures at some time.
 
We’ve already covered basic arthroscopy, as well as patella debridement and realignment, partial meniscectomy for a torn meniscus, and, most recently, arthroscopically assisted ACL reconstruction. Today, I will finish up the description of other miscellaneous arthroscopic procedures, that are often done simultaneously. 

Bear in mind that once you’ve entered the joint through those tiny arthroscopic portals (mini-incisions), there’s almost no limit to what you can do in there. And the postop morbidity (pain, swelling, stiffness, disablity, etc.) is pretty much the same, regardless of how much you do inside the knee, UNLESS you cut, drill, abrade, puncture, or otherwise violate the bones. 
 
If you DO get into the bones, you automatically increase postop bleeding, pain and swelling–which makes sense, right? Otherwise, however much you do, the postop limitations are a function of those tiny portal incisions. That’s the great advantage of arthroscopy and why it’s been a transformative concept in modern surgery, that’s made outpatient surgery possible.
 
All these procedures are described in much greater detail, including the conditions that require them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now as a book and an audio CD, too, at  http://drbillsclinic.com/eliminate_knee_pain.html
But for now, let’s look at a few other conditions for which arthroscopic surgery is often recommended, how they are treated surgically and whether other options and NON-surgical treatments are available.
 
First up is SYNOVITIS, an inflammation of the lining of the joint (any joint that has freely moving parts, not just the knee). I alluded to this with a brief remark, last Wednesday. When the lining of the joint gets irritated, it gets bigger, actually grows, often in an irregular way, resulting in flaps, shelves, clumps and masses, that can flop around inside the joint, occasionally getting trapped between the moving parts. This entrapment causes pain, and further swelling and inflammation. The irritated membrane produces lots of joint fluid, resulting in “water on the knee,” as well as pain.
 
The arthrocopic removal, or resection, of this diseased membrane is executed with an electronic motorized shaver. This is a stainless steel tube, with a small window at its end. The window encloses a rotating (or reciprocating) blade, that nips off small morsels of synovium, which are then sucked out by a vacuum pump and collected in a trap, for pathological study. Using this technique, you can systematically resect almost ALL the lining, as in cases of Rheumatoid Arthritis, or Bacterial Infection, where you want to rapidly “debulk” the mass of diseased membrane. But guess what? A new membrane grows back very rapidly, hopefully in an uninflamed, relatively normal state.
 
DEBRIDEMENT is a French term, meaning “house cleaning,” and it’s pronounced “De-BREED-mont,” not de-BRIDE-mont. I had an Australian professor once, who use to say “Da BRIDE is whut walk down de aisle wit’ de groom. Gentlemen, it’s deBREEDmont.” This refers to shaving off loose shreds of degenerative cartilage from the articular surfaces, to smooth them out. It’s important to remember that you can only REMOVE tissue; you can’t put anything back. 
 
Normally, the shaver is used to do this and it’s combined with synovectomy and LAVAGE, essentially washing out the joint with irrigation fluid. This is controversial in the treatment of arthritis, but if you’re there for other reasons, you might as well “clean house.” Today, you can also do this with radiofrequency probes and lasers, too.
 
And, as I also mentioned last Wednesday, LOOSE BODIES and FOREIGN BODIES can be grasped by forceps and extracted through the arthroscopic portals.
 
Areas of bare bone, if they’re small enough, can be treated through the scope to restore some kind of cartilage covering, but as I mentioned above, the morbidity and pain is greater once you penetrate the bone surface. Arthroscopic awls are sharp, pointed steel spikes that are used to put multiple shallow punctures into the bone, a procedure called MICROFRACTURE. Another way to do the same thing is to use a high speed burr to “sand” the surface and stimulate bleeding. This is called ABRASION CHONDROPLASTY. Both these techniques result in blood clot, which is changed into fibrocartilage over the bare area.
 
An alternative is to restore actual hyaline cartilage, in one of two ways: CHONDROCYTE TRANSPLANTATION, in
which cells initially harvested from non-articular parts of the knee are cultured, then reimplanted to grow new cartilage; and OATS (Osteochonral Articular Transplanation ) which transposes plugs of bone, with its articular cartilage attached, into drill holes in the bare area. Pretty cool stuff, no?
 
And, really, NOT so scarey, now that you KNOW what’s involved, right? Whatever it is in your life, if you KNOW what you have to deal with, you can DO it, if you have to.
 
But, there are many times that you DON’T need any of these techniques. Those are the times that surgery ISN’T warranted, because conservative methods will work to relieve your pain and restore your function just fine, thank you very much. If you want to AVOID An
UNNECESSARY SURGERY, then you need my newest healing program, HOW TO AVOID KNEE SURGERY. Get it here, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Next up, osteotomies and realignment surgeries. Talk to you tomorrow, my friend. Meanwhile, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Just the other day, I got an email from one of my subscribers, who also happens to be one of my friends from the “old days,” back when I was living in New York and practicing orthopaedics. It seems she was looking for some helpful advice for a friend of hers who apparently has arthritis of her knee. 

The woman had apparently developed gradual onset pain of her knee over the last several years. She had seen a physician and apparently had x-rays. The x-rays reportedly showed “bone-on-bone” in the inner aspect of her knee (the medial compartment). She was told that she needed a total knee replacement. But she clearly didn’t want to have surgery. So she asked my friend to ask me what she should do.
 
Well, I wrote back that once you have an x-ray that demonstrates “bone-on-bone,” you are pretty much committed to having a joint replacement, eventually. However, that procedure can be DELAYED, or postponed.

You see, “bone-on-bone” means that the bones of the knee joint, that you see on the x-ray, are touching each other. And that means that their protective cartilage layer has worn away. Since cartilage is invisible on an x-ray, the normal appearance of an x-ray is one of the bones appearing to “float” apart. In other words, there is a  joint “space” between them. Once the cartilage is gone, there’s nothing to hold them apart anymore–hence, the bones touch, ie., “bone-on-bone.” 

The problem is that once the cartilage has worn away, and the underlying bone is exposed, the cartilage isn’t going to grow back. That’s one of the key factors about cartilage: it lacks a blood supply. And without a blood supply, healing, or regrowth of the tissue CANNOT take place. 

Yes, yes. I know there are methods out there being promoted that CLAIM to regrow cartilage. They even show x-rays, reportedly “un-retouched,” that seem to show a new “joint space” re-formed. I saw one just recently in an in-flight airline magazine and I’ve seen them before on various web sites, which market to the credulous. 

Unfortunately, that is absolute crap! No known non-surgical method can regrow cartilage, once it’s been destroyed. 

What these magazines and websites show is actually a “before” weight bearing x-ray, in which the bones are touching, followed by a NON-weight bearing x-ray,  in which the bones APPEAR to be separated, because there’s no weight on them to press them together. 

So their claim is technically true: the x-rays ARE un-retouched. But the new “space” is  NOT from new growth of cartilage. And they’re even cleverer than that–they never actually SAY that they grow new cartilage. They show the pictures and let YOU make the inference.

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
 
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
 
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s all for today, my friend. Talk to you soon. Meanwhile, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved