I have enjoyed my years as full-time faculty at Baylor College of Medicine having helped start the Baylor Sports Medicine Institute in the mid-90′s. However, I think that my priorities and those of Baylor have drifted apart recently, and I strongly feel I can better care for my patients going forward at Methodist. I will retain a voluntary faculty appointment at Baylor.

My office staff is committed to making this transition as seamless as possible for my patients. New office address and phone numbers will be posted here soon. The present appointment and office numbers will continue to forward patients to me.

Numerous, well- controlled studies still support non-operative treatment of most patients with a first time dislocation.  Over the age of 27, about 2 out of 3 will not have another dislocation or symptoms of instability.  The rate of recurrence, however, can be much higher in the younger, active patient.  In some studies, this recurrence rate was found to be as high as 90%.  The military academies for many years have surgically fixed these first time dislocations.  In this setting there is often an important reason a recurrence could be a serious problem.

As surgical treatment has become less invasive with arthroscopic techniques becoming just as successful as open techniques, an increased interest has arisen in perhaps fixing the younger, active athlete after a traumatic, anterior, first time dislocation.  It is my typical recommendation, though, to treat the first time dislocation conservatively with a temporary sling and shoulder rehab exercises as soon as discomfort allows.  I then allow a return to sports as tolerated.  However, if the shoulder comes out a second time, it will inevitably come out again.  Recurrence or any persistent symptoms of instability despite appropriate rehab are indications for surgical repair.

1.   Activity modification – Certain changes in lifestyle may be necessary to accommodate degenerative changes in the knee. Sometimes if more stressful impact activities stop, then other types of activities are possible without symptoms. Typically, activities like jogging, tennis, basketball, etc. are not a good idea, and these limitations may be permanent. Think of substituting biking, stationary bike, elliptical machine, and swimming instead.

2.   Non-steroidal anti-inflammatory medicines (Naprosyn, Mobic, Celebrex) – These medicines can decrease pain and inflammation in the knee. They work best if taken in blocks of time; that is, 10 days, 2 or 3 weeks at a time. Once symptoms have improved they can be stopped. Reuse again if symptoms recur.

3.   Non-narcotic pain medicine – Good for long term relief of pain due to chronic degenerative changes in the knee.

4.   Visco-supplementation (Supartz, Synvisc) – Series of injections lasting 3 to 5 weeks given into the knee. These colloid substances can coat the end of the arthritic knee and relieve symptoms. Usually helps in about 50% of patients. Variable length of improvement.

5.   Steroid shots – Intra-articular steroid shots can be used for acute flare-ups of knee inflammation and swelling.

6.   Arthroscopy – Unresponsive knee swelling and / or mechanical symptoms such as locking and catching may be amenable to operative arthroscopy. The scope doesn’t replace articular surface that has been lost, but can address loose bodies, and meniscal tears.

7.   Cartilage restoration procedures – Newer procedures to replace lost articular cartilage. Usually for strictly focal lesions. I’ll let you know if you are a candidate for one of these new procedures.

8.   Partial knee replacement (Oxford Knee) – Good procedure for arthritis limited to the medial compartment of the knee. Ligaments have to be intact too. For patients who are candidates and have significant pain despite appropriate conservative management. There is a smaller incision and shorter recovery time compared to a total knee.

10.    Total knee replacement ( Otis Med / Biomet knee) – For patients with worsening arthritis who have failed conservative treatment. Today, we are using a new Custom Fit technique where custom cutting jigs are designed by a computer based on patient anatomy. This requires a preoperative MRI.

If you’re currently suffering from knee arthritis, why not contact us today to discuss your options? We’ll help you get mobile once again.