Arthroscopic Repair or Reconstruction
Dr. Grotz performs minimally invasive, arthroscopic repair and reconstruction on numerous areas of the body. Repair consists of reattaching torn or damaged tissues to bone. Reconstruction includes the placement of tissues from your own body (autograft), from carefully selected cadaver donors (allograft), or from other species (xenograft) to fix locations where simple repair is not possible. The implanted tissues become a substitute for your injured ligament, tendon, cartilage and/or bone. Examples of xenografts include the DePuy Restore Orthobiologic Implant or the Wright Graft Jacket as used to strengthen badly torn rotator cuffs.
Arthroscopic procedures are intended to be minimally invasive, using the fewest number of arthroscopic wounds needed. For example, whereas shoulder and knee arthroscopies typically performed by other surgeons require three incisions, when
performed by Dr. Grotz these surgeries only require two small incisions. The location of incisions is typically precise, intending to minimize blood loss and down-time following surgery.
Arthroplasty (Joint Replacement) & Hemi Arthroplasty
Joint replacement arthroplasties are intended to improve function and reduce pain in patients whose joints are worn out. Arthroplasty includes the replacement of natural bone and tissue with "plastic and metal" (high molecular weight polyethylene and titanium alloy) components. Dr. Grotz performs arthroplasties for
numerous joints, including the shoulder, elbow, wrist (total joint or carpal bone), thumb-base (trapezium), finger (MCP and PIP), hip, knee, and ankle (pictured below).
Top-Left: AP (Anterior-Posterior) x-ray showing pathological ankle, with severely diminished tibiotalar joint space.
Top-Right: AP x-ray one-month post-operatively shows good alignment of the prosthesis, as well as plate and screws used in tibial-fibular fusion
Bottom-Left: Lateral x-ray showing diminished joint space
Bottom-Right: Lateral view with proper alignment (anteriorly/posteriorly) and plate and screw placement
Hemi arthroplasty - partial joint replacement - is an appealing alternative to a full joint replacement, when feasible. Hemi arthroplasties of the knee joint include the replacement of only one of the three knee joint-compartments, allowing the patient to maintain a more natural state, including the maintenance of the other compartments as well as the anterior and posterior cruciate ligaments.
Carticel
In an effort to preserve patient's natural knee joint, the Carticel surgery series is a restorative effort, wherein a cartilage biopsy is taken (termed Carticel I), and shipped to the Genzyme corporation in Boston where cartilage cells are cloned. At a later date, these cells can then be implanted (termed Carticel II) to the area where cartilage lesions are present, including the FDA cleared trochlear groove and/or femoral condyles, and/or the "off-label" retropatellar and tibial plateau surfaces.
In the world-to-date there have been approximately 25,000 Carticel II surgeries. Of these cases, one in six-or-seven still go on to a traditional total joint replacement arthroplasty. When only the femoral condyle is treated, 92% of patients report a good-to-excellent result, and when other or multiple regions are treated, good-to-excellent results are realized in 75% or more cases. These are patients who otherwise would have gone on to a knee replacement.
Since being trained in Carticel in 1996, and beginning to perform the technique in 1999, Dr. Grotz has performed over 200 Carticel I biopsies, in patients whose cells are now being stored for later use, and 90 Carticel II implantations. Of these, four have gone on to a traditional knee replacement and one to a hemi arthroplasty. The largest lesion treated in the world is 31 square centimeters; Dr. Grotz has successfully treated lesions up to 30 square centimeters in size. This means that even in patients wherein extensive cartilage loss is present, the knee can often be saved. The implications are substantial, as those who realize cartilage regrowth have joints more approaching normal, and often allow full return to work and sports. In contrast, patients with knee joint replacement arthroplasties are not able to run, kneel, and perform many sports. Further, joint replacements often fail at the hip in 10-20 years and in the knee at 10 or fewer years, due to either loosening or infection. When Carticel results are maximally favorable, further surgery may never be required in the treated areas.