Subchondroplasty Procedure FAQs
What is an insufficiency Fracture?
Insufficiency fractures are often referred to as a "deep bone bruise" or "stress reaction/fracture". They can be traumatic or atraumatic in nature. Most of the time these injuries will not be visible on plain xrays of the knee. Pain is usually localized to one side of the knee and may not respond well to conservative treatment such as NSAIDs, activity modification, or intra-articular injections.
What is a subchondroplasty?
Subchondroplasty is a minimally-invasive, fluoroscopically-assisted intervention that targets and fills subchondral bone defects, often called Bone Marrow Lesions (BML) with AccuFill® Bone Substitute Material. AccuFill BSM is an engineered calcium phosphate mineral compound, a bone graft substitute, that mimics the properties of cancellous bone, resorbs and is replaced with new bone during the healing process.The SCP Procedure is usually performed along with arthroscopy for visualization and treatment of findings inside the joint. In some cases, an open or mini-open procedure is necessary for access to the defect.
How do I know if I need a subchondroplasty?
The recommendation to proceed with surgery is based on a variety of factors including surgeon recommendation, overall health, failure of conservative treatment, as well as future expectations and aspirations. We believe all of your questions and concerns should be addressed before surgery so that you are comfortable with your decision.
What are the risks of subchondroplasty?
Risks of surgery include blood clots (DVT/pulmonary embolism), bleeding, infection which can require reoperation, fracture, damage to nerves or blood vessels. Other risks include chronic knee pain and stiffness as well as potential anesthesia complications such as heart, lung, kidney, and liver damage.
How is my surgery scheduled?
If Dr. Wilson has recommended surgery and you have consented to proceed, you will be contacted by one of our surgery schedulers, and a date for your surgery will be set. The time of day your surgery occurs is based on many factors and if you have a specific need or request please let them know. Our surgery scheduler will coordinate insurance authorizations, specialist referrals, post-operative physical therapy appointments, as well as follow-up office visits. Our surgery scheduler will contact you several days before surgery to inform you what time to arrive for your procedure. You will be provided instructions on bathing/cleansing measures to perform before your surgery. DO NOT shave your leg for one week prior to surgery. If you develop any wounds/sores/cuts/scratches/bites around your surgical site please contact our office 48-72 hours prior to surgery to arrange for evaluation. Failure to do so could result in your surgery being cancelled.
What will I do on the day of surgery?
You may use the free valet parking if desired and signage is marked throughout hospital grounds. You will present to the outpatient surgery desk on the second floor of the hospital where you will check in. The receptionist will verify your identification and update any insurance/billing information if necessary. Following check-in, you will be taken back to a private room where nursing staff will prepare you for surgery. Your designated family member may be allowed to accompany you once deemed ready by the nursing staff. An anesthesiologist will examine you and discuss your medical history. They will also discuss with you options including general or spinal anesthesia, as well as nerve block procedures. Dr. Wilson and/or his Physician Assistant Adam will see you before surgery and answer any final questions you may have. Your family/friends will wait in the outpatient surgery lobby while you are in surgery. Dr. Wilson will call your designated contact upon completion of the surgery to inform them your procedure is complete.
How long will my surgery take and how long will I be in the hospital?
Your procedure will take approximately 30 minutes. Upon leaving the operating suite you will be taken to the PACU(Post Anesthesia Care Unit) for 1-2 hours before being transported back to a prep/recovery room. Subchondroplasty is an outpatient procedure and patients are discharged home on the day of surgery. Overnight stay is uncommon. It is normal for you to have a mildly elevated temperature after surgery. This can sometimes continue for 4-5 days. However, if a fever persists above 101.0 degrees, or is accompanied by chills, sweats, increased pain, or drainage from the incision, please call the office at 270-417-740 or send a message through MyChart.
How much pain will I have?
Pain is a subjective measure of discomfort that each individual experiences differently. Pain control requires a multimodal approach including preoperative nerve blocks, intraoperative local anesthesia, and postoperative oral and/or intravenous medications. If you have an allergy or intolerance to specific medications this should be mentioned before your surgery. You will be prescribed narcotic pain medication as outlined in full detail in our office policy on prescribing narcotics. You will be expected to decrease your narcotic use quickly in the postoperative period. Dr. Wilson will not prescribe any narcotics beyond 8 weeks post-op and if pain control is still an issue a referral to a pain management specialist may be required.
How long is my recovery?
Subchondroplasty can reduce the time it takes to recover from an insufficiency fracture. It can take up to 8 weeks to return to most activities, with most patients requiring 3 months to obtain maximal strength and endurance. Your recovery is affected by many factors including dedication with physical therapy, condition before surgery, additional medical problems, and potential postoperative complications. Return to activities such as driving will depend on which knee is operated on, what type of vehicle you drive, and one’s comfort level and confidence. In general, driving is acceptable when you can ambulate safely without a cane, enter/exit a vehicle safely, and are no longer taking narcotic pain medication. You can anticipate using an ambulatory assistive device such as crutches for 2-4 weeks post-op. The use of assistive devices can help improve gait and balance while regaining your strength, and decrease the risk of falls. Return to work is based upon your profession and workplace demands. Someone with a sedentary or office job can often return after 2-4 weeks. If your job requires frequent walking, standing, lifting, squatting, and/or stairs, 2-3 months recovery may be necessary before you can safely resume working. If your employer offers light duty accommodations we can communicate and coordinate with them to accelerate your return. Traveling is not recommended for at least 2 weeks after surgery, unless it is an emergency. If traveling is necessary due to an emergency, take frequent breaks and get up to walk around.
What else can I do to prepare for surgery?
We ask that you enroll in MyChart prior to surgery in order to provide a more efficient and effective means of communicating with our office. Our staff will be happy to help you enroll. You may be required to obtain medical clearance for surgery based upon your past medical history. This may entail encounters with your primary care provider or other specialists (allergist, cardiologist, pulmonologist, endocrinologist, etc.) to ensure you are optimized for surgery. Several tests such as blood and urine samples, x rays, CT scan, MRI, and EKG may be necessary. Your mobility will be decreased after surgery and preparing your home in advance is helpful to reduce risks of fall or injury. You will need assistance with daily activities including bathing, cooking, shopping, and laundry. Removing obstacles such as rugs, cords, chairs, and additional clutter is beneficial. You will need an assistive device such as crutches and should clear walking paths throughout your home. Purchasing toiletry, food, and wound care items in advance will reduce your or your need for travel outside the home. Please make arrangements for someone to care for your pets if possible. In addition, animals pose a potential contamination threat to healing surgical wounds. Making lifestyle changes prior to your surgery can lessen the chance for complications and improve outcomes. If you smoke, cut down or quit altogether. Smoking affects blood circulation, delays healing, and slows recovery. If you drink alcohol, do not consume alcohol for at least 48 hours prior to your surgery.