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Keep The Joint You Were Born With

Explore Advanced Minimally Invasive
Surgical Options for Joint Preservation

Explore Advanced Minimally Invasive Surgical Options for Joint Preservation

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Benefits of Joint
Preservation vs. Total
Joint Replacement

Benefits of Joint Preservation vs. Total Joint Replacement

Joint preservation is a great option for many people who don’t qualify for total joint replacement. OSI offers surgeons new devices that can improve the way many bone and joint surgeries are performed.

A joint replacement is performed to restore form and function. 

An IA Saucerization is performed to restore the biology of the bone before its form and function are lost. 

Joint
Preservation

Total Joint
Replacement

Preserved Motion and
Native Anatomy of the Joint

Less Painful Recovery

Quicker Recovery Time

Can Be Performed on
Patients of All Ages and Sizes

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Our devices and procedures provide a safe and effective way to preserve the joint you were born with.  

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We help you help patients keep the joint they were born with.

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OSI Has Been Helping
Surgeons Perform Successful
Surgeries for Over 20 Years

OSI Has Been Helping Surgeons Perform Successful Surgeries for Over 20 Years

Minimally Invasive Procedures, Better Wound Healing
Effective Treatment for Avascular Necrosis
Decreased Postoperative Pain and Blood Loss
Effective Endoscopic Evaluation of Bone In-Situ
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What Doctors Are Saying

Patient Stories

  • A 68-year-old female, 2 years on the right and 1 year on the left following Intraarticular Saucerizations with Irrigation Osteoplasties of the knees for OA using the OSI Q Arthroscopy System with Clear Cannula and the Beacon Biomass Bone Graft Harvester and Delivery System. The Biomass Harvester auto-concentrates the bone and bone marrow. The knees are pain-free with normal range of motion. Bone and bone marrow are delivered into the femur to replace the excess fat and oxLDL. This is not the simple injection of a bone marrow aspirate into the joint space. The biology of the bone is restored, and any intraarticular pathology is addressed as well.

  • A 58-year-old female, 7.5 years following an Intraarticular Saucerization of the right knee. The knee is pain-free with normal range of motion.

  • A 46-year-old female, 4 years following an Intraarticular Saucerization and Intraosseous Saucerization of the right hip using the Hip Tool. The procedure combines arthroscopy and endoscopically guided core decompression and debridement of the femoral head for Atypical AVN and AVN. The hip is pain-free with normal range of motion.

A 58-year-old female, 7.5 years following an Intraarticular Saucerization of the right knee. The knee is pain-free with normal range of motion.

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Frequently Asked Questions

What is an Intraarticular (IA) Saucerization of the Knee?

An IA Saucerization of the knee is an advanced arthroscopy procedure that removes bone spurs and excess fat from the knee to eliminate pain and abnormal function of the knee joint while walking. A collection of bone and bone marrow, not a simple bone marrow aspiration, collected through a stab incision at the hip is converted into a bone graft slurry and then injected into the bone at the site of the excess fat, thus restoring the bone's health. The procedure also smooths over the cartilage and repairs the menisci and ensures their proper function. The surgeon must use unique entry portals into the knee; thus, the procedure requires the use of specialized arthroscopes and products designed by Orthopedic Sciences. The patient can go home on the day of surgery, and no incision is larger than 3mm. See our Patient Stories and note that our products have been used for over 20 years. 

The more popularly known knee arthroscopy for osteoarthritis with a meniscus tear does not thoroughly clean and reshape the knee bones to as near normal as possible, nor does the procedure aim to ensure proper meniscus function. Currently available arthroscopic equipment is NOT designed to achieve this objective. Further, orthopaedic surgeons performing arthroscopy for osteoarthritis with a meniscus tear do not do so with an understanding of how fat under pressure within the bone causes the osteophytes to form. See Figures 9A and 9B on our Knee FAQs page. Explore our web pages and carefully read through the information presented. Search the internet for information on saturated and trans fats and how they affect the health of your bones, watch our patient testimonials, be engaged with your healthcare, share our website (www.orthopedicsciences.com) with your doctor to ask the pertinent questions, and join our efforts to help you keep the joint you were born with. 

The procedure also recontours the cartilage where it is torn and ensures proper function of the meniscus during walking by cleaning or repairing the meniscus and removing any osteophytes that block the meniscus from gliding backward and forward while walking. The function of the meniscus is assessed while in surgery, and it is never assumed that the primary problem with the meniscus is the tear observed on a preoperative MRI.

Osteophytes form when excess fat attempts to escape the bone. These osteophytes are easily seen on x-ray and have a characteristic shape resulting from knee motion. During an IA Saucerization, the surgeon also decompresses the thigh bone by releasing this excess fat from the bone using percutaneous intraosseous irrigation. Cancellous bone and bone marrow are taken from the hip above the knee and then injected into the bone to replace the excess fat. The cancellous bone and bone marrow injected into the bone improve the bone’s health and strength. An IA Saucerization should not be performed using traditional arthroscopes.1 Traditional arthroscopes lack the properties of OSI’s Q Arthroscopes designed to save joints. The skilled surgeon performs the IA Saucerization through two to three small incisions while repeatedly motioning the knee as if the patient were walking. Fluoroscopy should be used during surgery as well. On the morning of surgery, the patient is asked to mark the most painful areas of the knee. This helps the surgeon focus immediately on the most painful parts of the knee during surgery. The blood pressure and heart rate are monitored for abrupt changes indicating that the areas being cleaned/reshaped contribute to the pain experienced by the patient. These painful areas are matched to the ink markings placed on the skin by the patient. The surgeon correlates the arthroscopic findings with the patient’s history, physical examination, x-rays, and MRI and ensures that the anatomy of the knee is restored to as near normal as possible and that the menisci are moving backward and forward smoothly after their cleaning or repair. The surgery can be performed with or without a tourniquet.

Additionally, OSI’s specialized bone grafting system for joint preservation allows the surgeon to collect autologous cancellous bone and bone marrow through a two to three mm incision at the hip. Your doctor may require you to use crutches for two to four weeks after surgery, and home exercises may be equally as effective as outpatient physical therapy. A continuous passive motion machine (CPM) or any other apparatus is usually not required. Given the very small incisions, significant scarring after surgery is unlikely. Most patients can go home the day of surgery.

The following steps comprise an IA Saucerization of the knee:

  1. The treating surgeon has determined that the patient is a good candidate for the procedure. The physician is committed to performing all essential steps and using the proper equipment. Attempting the procedure with “routine equipment” because the surgeon is a skilled arthroscopist and thinks that an IA Saucerization is nothing more than “arthroscopy and a meniscus tear with a different name” is not advised. An IA Saucerization is more extensive arthroscopy and the proper equipment must be used. Additionally, using the proper equipment but not committing to the full procedure is not recommended. The surgeon must understand and acknowledge the underlying issues causing pain, osteophyte formation, and meniscus pathology. The overall alignment of the knee must be considered as well.
  2. On the morning of surgery, the surgeon marks the affected knee.
  3. The patient uses the marker to identify the areas causing the most pain.  The surgeon may ask the patient to be specific and avoid drawing large circles as areas of global pain or commenting, “the whole knee hurts.” The patient must be engaged.
  4. While in surgery, spongy bone and bone marrow are obtained from the hip through a 2 mm incision. The surgeon uses the OSI Bone Saver to auto concentrate this bone graft and bone marrow (biomass). The collected biomass is placed on the back table in anticipation of its later use. “Spinning down” of the graft and bone marrow is unnecessary. OSI’s system auto concentrates the biomass.
  5. After collecting the biomass, the surgeon uses OSI’s Q Arthroscope and Clear Cannula to enter the knee joint through portals at the top of the knee, allowing an IA Saucerization to be performed safely and effectively. A tourniquet may not be required. Conventional apparatuses for knee arthroscopy are NOT required, and only a single scrub technician is needed.
  6. The surgeon explores the knee while the scrub technician takes the knee through its range of motion. The surgeon depresses the areas marked by the patient and matches these locations with the findings inside the knee. The menisci are identified, and the surgeon determines the presence of a tear and if osteophytes are blocking their motion. The surgeon contemplates that if the meniscus is trapped by an osteophyte or cartilage flap, was such trapping identified on the preoperative MRI? The surgeon considers that normal knee motion causes constant stretching of a blocked meniscus, which may cause the tear of the meniscus that led to the surgery being performed in the first cause. This constant stretching may lead to a meniscus root tear as well. Are the osteophytes and cartilage flaps shredding the menisci, causing a so-called degenerative tear? The debridement begins, and a repair of the meniscus is performed as needed. Is the meniscus now moving freely after removing the blocking osteophyte and cartilage?
  7. Fluoroscopy is brought over the knee, if necessary, to ensure that the obvious osteophytes seen on x-ray are removed. Before surgery, It is helpful to determine if osteophytes are impairing the overall motion of the knee, the menisci and causing pain.
  8. The surgeon remains aware of changes in the patient’s heart rate, and blood pressure as the painful areas marked by the patient are debrided. The anesthesiologist or CRNA provides this hemodynamic (heart rate and blood pressure) feedback, and often after the diseased area has been debrided, the heart rate and blood pressure no longer change. The surgeon observes the excess fat entering the joint through the debrided osteophytes and is assured the excess fat is being removed as the arthroscope irrigates the joint while the debridement tools remove the excess fat and debris.
  9. The surgeon now uses fluoroscopy to percutaneously (through the skin) insert OSI’s Beacon Biomass Delivery Trephine into the bone. The surgeon directs this small 3 mm trephine toward the area of excess fat, osteopenia, bone marrow edema, or osteophyte formation. This patented tool allows the surgeon to irrigate the inside of the bone to remove excess fat, oxLDL (Bad Cholesterol), and proteins that cause inflammation, pain, and cartilage destruction. OSI’s system does NOT simply move the fat and cholesterol out of the way by pushing them into circulation. This would be the case when one attempts to inject a bone marrow concentrate without first irrigating the bone. The oxLDL  and pro-inflammatory proteins are removed from the bone through OSI’s patented technology, the Beacon Biomass Delivery Trephine. The surgeon recognizes that the patient is NOT only irrigating the inside of the joint but also irrigating the diseased areas inside of the bone, truly advancing arthroscopy for osteoarthritis with a meniscus tear. This part of the procedure is called an Irrigation Osteoplasty vs. a simple osteoplasty or other commercially recognized names. A basic osteoplasty attempts to inject spun down bone marrow, or perhaps PRP, combined with an off-the-shelf bone graft substitute without first ensuring the host bed (the site where the bone graft and bone marrow are injected) is ideal for new bone formation. The Irrigation Osteoplasty ensures the host bed is ideally suited for new bone formation.
  10. With the Beacon Biomass Delivery Trephine, BBDT, in its optimal position, the biomass is delivered to the bone. The BBDT need not be removed from the position obtained for irrigating the diseased area of bone. Simply remove the irrigation needle and begin the grafting process. OSI’s system does NOT require excessive pressure to deliver the biomass. Excessive pressure is characteristic of competitive systems designed to deliver a biomaterial to a diseased area of bone.
  11. The surgeon uses the Q Arthroscope to observe additional excess fat exit the bone, further ensuring its removal.
  12. All incisions are closed with a single stitch.

Is an IA Saucerization of the knee for osteoarthritis a substitute for a total knee replacement?

No. The IA Saucerization should be performed when the knee can be saved. This period of time is called the “run-up to a total knee.” Specifically, if a patient is undergoing arthroscopy for osteoarthritis with mechanical symptoms or a meniscus tear, the IA Saucerization goes further by removing all osteophytes that block the normal function of the meniscus, releasing the fat in the bone that causes the osteophyte to form, injects the patient’s spongy bone and bone marrow obtained from the hip into the bones of the knee, and restores normal anatomy to the knee to the extent possible. The procedure is performed using non-traditional arthroscopic portals and can be considered for obese patients who may have been denied traditional arthroscopy because of their weight. Special positioning equipment is not required; therefore, the assistant can freely move the knee as if the patient were walking, verifying a return of normal function of the meniscus. As noted above, the IA Saucerization also includes the release of the excess fat and elevated pressure within the bone that causes the osteophytes to form. Furthermore, autologous bone and bone marrow (bone and marrow taken from the hip) are injected into the femur to replace the excess fat. This is done to strengthen the bone and improve its health. One may read the above and then decide to inject PRP (PRP only requires a peripheral blood draw) into the bone or draw a bone marrow aspirate and concentrate it by spinning it down and injecting it into the bone. OSI believes these techniques are considered because competitive devices do not exist for minimally invasive bone harvesting from the hip and many companies manufacture devices that concentrate aspirates. The bone of the osteoarthritic knee needs living bone (not a demineralized bone matrix) and bone-forming cells in a volume sufficient to improve the bone’s health. OSI’s harvesting devices were designed with the above in mind. Substantially all of the bone and bone marrow obtained from the patient’s hip can be injected into the bone during an IA Saucerization, and there is little waste. With PRP and bone marrow aspirate injections, there is always considerable waste. PRP injections would assume plenty of bone-forming cells in the diseased bone, and a concentrated bone marrow aspirate has no bone in it. The so-called bone graft substitutes require the area in which the substitute is injected to act on the substitute biologically. However, the area of bone where this biological act is required is diseased; thus, the need for medical intervention performed. This understanding makes the importance of the Irrigation Osteoplasty (preparation of the host bed) clear. OSI’s products deliver autologous biomass (concentrated cancellous bone and bone marrow) so that such grafts can act on the diseased bone and not the other way around. A total knee is indicated when joint destruction is advanced and the patient has lost significant knee function. Joint preservation aims to recognize and treat disease before the only treatment option remaining is replacing the knee. Physical therapy and oral medication have shown to be helpful during the run-up to a total knee replacement. However, OSI has designed and developed products that allow the surgeons to address this disease more thoroughly using arthroscopic techniques in those patients undergoing arthroscopy. Patients with more advanced osteoarthritis who benefit from total knee replacement often have:
  • Advanced osteophyte formation
  • Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs.  It may be hard to walk more than a few blocks without significant pain, and it may be necessary to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of the knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

How does an IA Saucerization of the knee for osteoarthritis differ from basic arthroscopy for osteoarthritis with a meniscus tear?

An IA Saucerization cleans and reshapes the inside of the knee and restores the biology to the bone. Basic arthroscopy for osteoarthritis is often performed as a procedure to correct mechanical problems in the knee that cause pain and locking of the knee. The underlying problems within the knee are not addressed, namely, the excess intraosseous fat and oxLDL. Additionally, the procedure is NOT performed to prevent a total knee, but rather to delay the total knee. The IA Saucerization is performed with the view that the excess fat and oxLDL must be released, the menisci must be repaired or debrided, the contours of the bone must be returned to near normal as possible, and bone graft and bone marrow must be injected into the bone where the excess fat and oxLDL have been removed. The IA Saucerization of the knee views the knee joint as the end-organ of the femur, as Fremont Chandler considered the femoral head as an end-organ, albeit related to its blood supply. Using OSI’s system, all of the harvested cancellous bone and bone marrow can be percutaneously injected into the knee bones after it has been irrigated, and there is no waste. See our patient testimonials. After this reading, we are certain that others will begin to recommend or promote their bone marrow concentrating products for injecting bone marrow concentrate into the bone after arthroscopy. But here again, the oxLDL and excess fat should be removed along with the removal of all osteophytes to the extent possible. The indications to perform an IA Saucerization of the knee for osteoarthritis may be the same as those for performing basic arthroscopy of the knee for osteoarthritis with a meniscus tear. Basic arthroscopy for osteoarthritis with a meniscus tear addresses the torn meniscus and may also include a degree of debridement of other structures. Even if the surgeon intends to perform extensive debridement of the knee and does so, traditional arthroscopic equipment and techniques, having been developed in the 1970s, do not fully allow this to be accomplished. Peer-reviewed publications on such debridement do not describe the quality of the debridement performed but conclude that debridement is not effective.1,2 Additionally, when performing basic arthroscopy, no efforts are made to address the health of the bone or the process that led to the formation of the offending osteophytes. In the case of an IA Saucerization of the knee, the surgeon inserts the arthroscope at the top of the knee beneath the patella through OSI’s patented Clear Cannula. The inside front, sides, and back of the knee can be observed. The OSI Clear Cannula elevates the patella to improve visibility without damaging it. See Figures 1 and 2.

Figure 1
Figure 2

The Q Arthroscope and Clear Cannula allow the surgeon’s assistant to motion the knee during surgery as if the patient were walking or stooping. This motion aids in locating the areas that make the knee snap, lock, or pop and cause pain. In contrast, a traditional arthroscope is inserted below the patella in the front of the knee. The surgeon cannot see behind the tip of the arthroscope (blind spots) nor how the tibia and menisci move along the femur while walking because the arthroscope must move as the doctor moves the tibia. See Figure 3. 

Figure 3

Inserting a traditional arthroscope at the top of the knee may damage the cartilage because these arthroscopes are too short and too large. Even if inserted safely, a traditional arthroscope does not provide the surgeon with the non-digital 3D images required for a successful IA saucerization, as does OSI’s Q Arthroscopy system with Clear Cannula. For many years, the deficiencies of traditional arthroscopes have not been recognized because most arthroscopists consider themselves excellent technicians when performing arthroscopy, and the goal of surgery is frequently to “repair or clean the torn meniscus,” with meniscus tears being considered a sports injury or a “degenerative” tear. As a result, arthroscopy for osteoarthritis with a meniscus tear is commonly performed with much ongoing debate about its effectiveness. The IA Saucerization requires using OSI’s patented arthroscopic equipment and cannulas to create a non-digital 3D view of the inside of the knee joint. OSI developed its arthroscopy system to improve the debridement of the knee joint, not to resolve the debate of the effectiveness of arthroscopy among professionals. Patented specialized burrs and shavers allow access to the back of the knee to reshape the bones and cartilage so the meniscus can glide along the cartilage as it should. See our Safety PX video under Cartilage Surface Products. Standard arthroscopy equipment does NOT allow the surgeon to complete an IA saucerization of the knee successfully and should not be attempted. Doing so will lead to exacerbation of the pain experienced by the patient.

Is knee arthroscopy for osteoarthritis helpful?

Experts differ on whether knee arthroscopy is a worthwhile treatment option for knee osteoarthritis. Many experts comment on clinical studies suggesting knee arthroscopy does NOT benefit patients with knee osteoarthritis.1,2 Some surgeons argue that because knee arthroscopy is less invasive, it is worth trying before moving forward with a more invasive irreversible total knee replacement. It is important to note that the clinical studies that reported no benefit from arthroscopy do NOT describe decompressing the fat within the bone. These clinical studies used traditional equipment and techniques that included lavage (washing the knee out with saline) and removing osteophytes that were immediately visible or free-floating inside of the joint. Many other structures may have been debrided as well. However, these clinical studies make a large assumption about the quality of the surgery performed and remain silent on how osteophytes form and how they may block the motion of the menisci. These studies do NOT comment on how the inaccessibility of various osteophytes represents a limitation of the equipment or the surgeon's skill. Further, these clinical studies do not discuss how the meniscus function may have or may not have improved after its repair or the debridement of any meniscus-blocking osteophytes. More importantly, no mention of how intraosseous (within the bone) fat may cause pain, pressure, or weakening of the bone in any stage of disease. The IA Saucerization reshapes the bones and removes nearly all osteophytes to the extent possible, releases the excess fat that blocks the inflow of blood, improves the quality of the bone with an injection of autologous cancellous bone and bone marrow into the femur and tibia, and restores the function of the meniscus. Well-known knee injections for osteoarthritis call for the chosen medicament to be injected into the joint, assuming the cartilage or its age-related degeneration (senescence) is the sole and primary cause of disease. 

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