Orthopedic News & Events

Prioritizing Patient Care in Orthopedics

Meridian - Caldwell - Fruitland


Dr. George Nicola introduces a new treatment to the Treasure Valley that gets at the heart of knee pain and may prevent the need for joint replacement surgery.

When your knee hurts or aches for an extended amount of time, it’s easy to point the finger at osteoarthritis, a common cause of joint pain. But bone marrow lesions, or flaws in the bone near the joint, are an important underlying cause of joint pain. A new procedure offered in the Treasure Valley by Dr. Nicola, called Subchondroplasty, treats bone marrow lesions, thus decreasing pain levels and delaying or preventing the need for knee replacement surgery.

Joint Preservation

subchondroplasty knee procedure

With time, the body’s processes for repair are sometimes outpaced by the damage the knee is accruing. Bone contusions, fractures, cysts, overuse can lead to bone marrow lesions, or defects in the bone. As cartilage levels decrease and other damages occur, other joint tissues can compensate by becoming stronger, but this isn’t always sufficient to keep pain at bay. The bone is influenced by damaged cartilage and other tissues, and the soft bone underneath the joint’s surface can swell, called bone marrow edema. Small fractures can occur in the bone in cases of chronic bone marrow lesions. These defects will not heal on their own.

The Procedure

Research suggests that the presence of bone marrow lesions is a key indicator that a patient will have joint pain. These lesions are detected by an MRI. Subchondroplasty is a procedure that fills the damaged area of bone (lesions) with a hard-setting, biomimetic filler, through image-guided injection. One or two micro-incisions are made. Over time, the body replaces this bone substitute with new, healthy bone, thus repairing the bone defects. This procedure, which takes less than an hour, is often coupled with arthroscopic techniques to inspect cartilage damage and meniscus damage, and do repairs on these tissues. Loose tissue of chondral debris is removed as well. This is an outpatient procedure, and the patient goes home the same day. Some pain may be experienced for one or two days post surgery. Putting weight on the knee may be difficult for some patients for 1-2 weeks, and crutches may be needed. Physical therapy post surgery is usually recommended. Significant pain reduction may not come for weeks after the surgery. “Let’s face it,” says Dr. Nicola, “We put a lot of strain on our knee joints. This procedure is extremely effective for active people with knee pain, which is often from early arthritis.” In many cases, Subchondroplasty can eliminate the need the need for knee replacement surgery–or at least delay the need for several years. “It’s just another example of doing what’s best for the patient,” says Dr. Nicola. “If you are a solid candidate, you no longer have to rush into surgery.” Dr. Nicola is the only Orthopedic Surgeon in the Treasure Valley performing Subchondroplasty. Recovery time is considerably less and the cost to the patient and insurer is but a fraction of the cost of a total knee replacement surgery. If you’ve been dealing with knee pain for more than three months, and the discomfort increases with walking or standing, it may be time to see Dr. Nicola about Subchondroplasty.

Who Is It For?

Not all patients are the right candidate for Subchondroplasty. The right patient would be an active individual who has good knee function, but has pain related to early arthritis, or has MRI findings consistent with Bone Marrow Edema (BME). Does this describe your pain: • I have experienced symptomatic knee pain for 3+ months • I have increasing discomfort when walking or standing • I have seen limited benefits from NSAIDs, bracing, injections or physical therapy • My symptoms returned after an arthroscopy The SCP Subchondroplasty procedure has been shown to resolve subchondral bone defects as well as the associated edema, which is a known source of chronic knee pain. Less invasive treatments should be tried first, such as painkillers, bracing and physical therapy. But these measures don’t always prove to be effective, and Subchondroplasty is an exciting new option for dealing with your particular joint issues in a safe way, with quick recovery time. George A. Nicola, MD Dr. Nicola is the Treasure Valley’s Knee Expert. He is specially trained in knee replacement and knee resurfacing surgery. He is the only surgeon in the Treasure Valley performing the Subchondroplasty procedure.

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