Replace or rebuild? Orthopedic practice founder on options for joint patients

Athletes and sports enthusiasts alike dread knee injuries. But where before there were few options, today there is an array of ways to treat knees and other joint injuries.

Kevin Stone, MD, founder and surgeon at the Stone Clinic in San Francisco, joined "Becker's ASC Review Podcast" to talk about how he sees different treatments working together.

Note: This is an edited excerpt. Listen to the full podcast episode here.

Question: What would you tell someone who's in need of interventional joint treatment?

Dr. Kevin Stone: I would tell a patient to always know the bias of your surgeon. I'm particularly biased at rebuilding tissues biologically. Another surgeon might be more biased toward always doing a joint replacement.

With biologics, we've learned that cortisone damages the tissues that we're trying to save. It  shuts down tissue healing and inhibits cell metabolism, so everywhere we used to give cortisone shots, we now give anabolic shots. We want to stimulate the tissues to heal. 

The field went through a phase of trying to figure out which cells should be injected into damaged tissues and joints in order to regenerate missing and torn tissue. Today, our most popular injection therapy is actually taking your own blood, getting the platelets out of it and adding hyaluronic acid to it, because it's a natural lubricant of the joint. 

On the arthroscopy side, a classic arthroscopic cleanup is where surgeons would go in and take out the damaged tissues. We would prefer that surgeons use arthroscopy, which is a great tool, but to go in and repair and replace the damaged tissues rather than just take them away. 

On the joint replacement side, it's really changed a lot. By using robotics, we now can place those joints like a resurfacing rather than removing the entire joint. The implant can be designed so the bone can grow into it, and so we've gotten rid of bone cement.

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