In New Albany, Dr. Johnny Mitias is working with new techniques to help patients regrow torn cartilage in their knees.
In Tupelo, physical therapists are putting high-tech analysis tools that used to be reserved for elite professional athletes to work for weekend warriors and other patients.
Around the region, orthopedic surgeons like Dr. Jay White of Tupelo are using computer-assisted navigation tools to more accurately line up joint replacements.
Without cartilage – a thin layer of tissue that covers the ends of bones where they come together – joints can’t do their job and movement becomes painful, if not impossible.
New Albany orthopedic surgeon Dr. Johnny Mitias is working with the allograft that gives surgeons an early intervention for people with damaged articular cartilage allowing them to regrow cartilage and hopefully avoid debilitating arthritis later in life.
“This is really unique technology,” Mitias, who was the seventh orthopedic surgeon in the country to perform the technique using the Denovo NT graft and has become a clinical investigator for the procedure.
Brad Harris, 30, of Pontotoc, who was a defensive lineman with the New York Giants and New England Patriots, tore a piece of cartilage in his knee after playing all night softball last summer.
In September 2008, Mitias placed the graft material – made from tiny pieces of cartilage harvested from donated juvenile bones – where the cartilage was torn. With physical therapy, Harris was able to walk on the knee without a brace after six weeks and was cleared for normal activity after four months.
“I haven’t had any issues since,” said Harris, who is active in weight lifting competitions and volunteers as a football coach at North Pontotoc High School while he finishes a degree at Blue Mountain College.
Mitias has also used the Denovo graft to help Katie Aderholt, 17, of New Albany, who had a rare condition called osteochondritis dissecans. The condition, where a piece of bone loses its blood supply and sometimes separates from the rest of the bone, can occur in anyone, but most often affects athletic teens.
“It was very painful,” said Katie, a ballet dancer who started having problems as she began to dance en pointe.
The first line of treatment, using a screw to hold the bone together, failed for Katie.
“She had a crater in her knee,” Mitias said, roughly the size of half of a boiled egg.
Her next option was a bone graft, that would replace a large piece of the bone, but that would have effectively ended her dance career.
In May 2009, Mitias used multiple layers of the DeNovo graft to fill in missing bone and cartilage.
Rehab was tough, Katie said, in part because she didn’t trust the knee after two years of trouble, but she was able to go back to dancing in the fall and performed en pointe as the Spanish soloist in the New Albany School of Ballet production of “The Nutcracker.”
“It didn’t hurt once I got back up en pointe,” Katie said.
Mitias sent a photo of Katie from the production to the scientists who are working to improve the graft.
“She’s still the only one treated with this technique,” for her condition, Mitias said.
Right now, surgeons have two and a half years of data on how the grafted cartilage fares. Not everyone is a candidate for the surgery.
“It works for older people as long as the arthritis hasn’t progress through the entire knee,” Mitias said.
About 1,500 cases have been performed across the country. Mitias has done more than 20 of those cases. New Albany is the third biggest center for the procedure behind Denver and Indianapolis.
“The supply is still really tight,” Mitias said, and the procedure is expensive, but it is FDA-approved and covered by insurance in many cases.
Zimmer, the company that makes the graft, is working on an engineered version of the product that would make it more widely available.
North Mississippi Medical Center Outpatient Rehabilitation Center used a high-resolution digital video recorder and computer software to pinpoint the source of Tonya Dunlap’s knee problem and get her back in the race.
The 36-year-old New Albany nurse, who runs half-marathons, developed tendonitis in her left knee. She treated herself for about a year before deciding she needed more help from her doctor, who sent her for physical therapy.
“It went from hurting some time to hurting all of the time,” Dunlap said, but she wasn’t ready to give up on running.
The natural place to start with knee pain, typically, is to focus on strengthening the quadriceps and hamstring muscles, said David Washington NMMC Outpatient Rehab physical therapist.
However, Washington analyzed Dunlap using a high-speed digital camera linked with computer software. It revealed Dunlap’s knee problem was in her hip – it was dipping as she ran and pulling the knee out of alignment.
The problem was the glut muscles on the inside of her hip were weak, coasting along on the work her bigger muscle groups were doing as she ran, Washington said. The prescription was specific exercises to strengthen those muscles and ice on her knee after she ran.
Dunlap went through three weeks of formal physical therapy in September 2009, and was able to run the St. Jude half-marathon in December.
“Now I go to the gym and do strengthening exercises three times a week,” in addition to running eight miles most days, Dunlap said.
The gait analysis tools let physical therapists be more efficient as they work to pinpoint solutions for their patients.
Washington has used the camera to help runners, pitchers and power lifters.
It can also be used to check the gait patterns of amputees and stroke patients.
“It’s used mostly in sports medicine, but we’re hoping to use it in a number of other things,” Washington said.
Special computer technology is working in the operating room to help orthopedic surgeons get just the right fit for total knee replacements, which become necessary when arthritis has so deteriorated the cartilage in the knee that movement is extremely painful, if not impossible.
Using traditional methods, surgeons used guides and exterior points to align the components of a knee replacement, said Tupelo orthopedic surgeon Dr. James “Jay” White. A computer navigation system – developed from technology used by neurologists to map the brain – pinpoints the alignment and angles using specific markers on the bones.
“It just makes things more exact,” White said. “Theoretically, it will be a longer time before it wears out.”
Looking at X-rays, the computer-navigated replacements are correct between 95 and 96 percent of the time; manually aligned joint replacements are correct 76 to 84 percent of the time.
The computer is particularly helpful when there’s a deformity of the leg, like a poorly healed fracture, White said. It also can be helpful with positioning knee replacements in people who are obese.
However, the computer navigation requires a healthy hip joint. Surgeons are not able to use the computer navigation techniques on those with arthritis of the hip or a fused hip.
“You have to be able to find the hip ball within 3 or 3 1/2 mm,” White said. “If you can’t, it’s no better.”
The computer navigation system for knees was developed over the past four or five years. White has been using the system for knee replacements for about a year and a half. Across the country, surgeons are beginning to incorporate the systems in trauma cases and other joints such as hips.
All the technology in the world doesn’t replace the need for dedicated rehab after orthopedic surgery, especially joint surgery, White said.
“The key to this operation is still rehab,” White said of total knee replacement.