Big Surgeries, Big Complications

POSTED ON 6/29/2009 IN Results BY Christopher Centeno

ankle1

Just getting back to blogging after a much needed vacation.  In the last few decades, there has been a big move towards minimally invasive procedures, essentially making smaller and smaller incisions to accomplish the same medical goal.  The reason?  The bigger the surgery, the bigger the potential for complications.  Take the patient I saw this morning for the Regenexx-C procedure on his ankle.  This gentleman had an ankle arthroscopy to remove a bone spur caused by years of running.  However, he contracted MRSA (a super bacteria that is very hard to kill with antibiotics) during the arthroscopy and then underwent 12 additional surgeries over the next two months.  Because the skin on the outside of his ankle was pretty chewed up, they had to take a skin/muscle graft (flap) from another area and bring it down to the lateral ankle (the large "bump" you see on the outside of the ankle in the picture above).  As a result of the MRSA all cartilage in his ankle was also chewed up and the medial talus also partially collapsed.  While MRSA infections are not common with arthroscopy, I use his case this morning to illustrate a point.  We see many patients in our practice where big surgeries have produced big complications.

This patient was treated with the Regenexx-C (cultured stem cell injections).

A second example is also illustrative.  Last week I met with a patient considering the Regenexx-C procedure for a labral tear.  She had started with a frozen shoulder (adhesive capsilitis) due to the original shoulder labrum tear.  The help this, arthroscopy was combined with manipulation under anesthesia.  While this MUA procedure can help free up shoulder movement in patients who have very little shoulder range of motion, in her case it tore up the joint capsule leaving an unstable shoulder.  In particular, the damage was to the superior lateral fibers that the shoulder hangs on when it's at rest at your side.  Without these ligaments, the shoulder becomes grossly unstable, and all of the muscles of the shoulder are in constant "overdrive" spasm, trying to keep the shoulder stable.

The take home message, the advent of regenerative medicine techniques will allow more minimally invasive procedures to be used in more patients.  There will still be a place for bigger surgical procedures and undoubtedly regenerative medicine will be mixed and matched with surgical and non-surgical approaches alike.  However, the ability to perform more procedures through a needle or very small tools, will allow complications rates to fall.  Here's to the future!

  1. surgery
  2. surgical risk

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