Osteoarthritis is the most common forms of arthritis. It occurs over time as the cartilage on the ends of bones wears down resulting with bone on bone grinding. Osteoarthritis worsens with time and patients often experience pain, stiffness, loss of flexibility, grinding sensation and formation of bone spurs. Currently there is no cure, and maintaining a healthy weight and healthy lifestyle can help slow the progression.

Knee and ankle implants have a lifespan of 10 years and is often reserved as a treatment option for later in life. An alternative treatment option is the use of hyaluronate injections. Hyaluronate sodium is a derivative of hyaluronic acid a natural substance that surrounds joints. The fluid acts as a lubricant and shock absorbent protecting joints. Over a course of four to eight weeks the use of hyaluronate injections may reduce the need for a joint replacement and help promote production of synovial fluid. In a diseased arthritic joint the production of hyaluronate decreases leading to mechanical destruction of the joint and pain. At the moment hyaluronate products are considered as off-labeled use in the ankle joint, but FDA approved for the knee joint. There are six major trade name products: Euflexxa, Gel-one, Hyalgan, Supartz, Synvisc, Orthovisc. Most of these products are injected into the ankle joint 3 times a week. Patients can return to normal daily activities but should postpone strenuous activities for 48 hours after the injection. For more information about viscosupplementiation come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Dardashti

Septic arthritis is a painful infection of a joint cavity, most commonly caused by bacteria. The knee and ankle are common joints in the lower extremity to be infected. The joint cavity is a sterile environment containing synovial fluid. Infection of the joint can occur from either:

1. Direct penetration into the joint (ie. an injection)
2. Hematogenously from bacteria in the blood
3. Other routes such as trauma or surgery

Septic arthritis can cause rapid destruction leading to permanent damage of a joint, thus requires immediate attention. A septic joint typically presents with a fever and a red, hot, swollen joint that is extremely painful to move. Diagnosis is performed via synovial fluid aspiration. The fluid is analyzed for the following tests: clarity, color, presence or absence of crystals, cultures, glucose levels, mucin clot, white blood cell count and viscosity.

Acute joint sepsis requires admission to the hospital for prompt IV antibiotics. An arthrocenteses should be performed every other day to monitor response to therapy and to help remove the infection.

If you think you have a septic joint, go to the emergency department immediately. For more information contact us at Foot& Ankle Doctors, Inc.

Dr. Nejad

Skin grafts are commonly used for ulcers, burns, wound dehiscence, amputation, and surgical excision. The best types of skin graft are those that come directly from the patient. These grafts are known as autografts, auto meaning self. These grafts are safest to use and heal faster than other types of grafts. The only pitfall with using an autograft is that a second wound is created when harvesting the graft from a different site.

There are split thickness grafts and full thickness grafts. Split thickness grafts contains the epidermis and dermis where as a full thickness graft contains more layers of the skin. Split thickness grafts are more commonly used because they are less likely to form a contracture over time. The thickness of a skin graft depends on what area of the body is harvested. For example the skin of the outside of the thigh is thicker than the inside of the thigh.

Types of Split Thickness Grafts

Thin:                             0.008-0.011 inches
Intermediate:                0.012-0.014 inches
Thick:                           0.015-0.024 inches

Graft healing occurs in 4 phases:

1. Plasmatic Stage (24-48hrs): the graft adheres to the bed
2. Inosculation (end of 48hrs): vascular network forms connecting the vessels to the new graft to restore blood flow. The graft will turn a pink hue color
3. Capillary Ingrowth: capillary network penetrates into the graft
4. Maturation: lymphatic channels and nerves develop

Most grafts fail within the first 72 hours as a result of inadequate adherence that disrupts the blood supply from establishing. A hematoma and seroma can separate the graft from the bed and disrupt ingrowing vessels. It is important to have a compression dressing applied and to leave it intact for a week and limit motion to the area. Infection can also result in graft failure.

For more information on grafts and how they are harvested come see us at Foot & Ankle Doctors, Inc

Dr. Dardashti