November 12, 2021
Avoiding total knee surgery? I have for 25 years and counting. My latest discovery is a conversion of a sports sleeve to further unload my arthritic knee and video evidence of improving my gait. The product is seen at https://topicalgear.com/products/t-25-knee-pair. Read on!
There is an ancient proverb, “Physician heal thyself”. The following is my story and success at healing myself and avoiding total knee surgery.
In 1996, with a single golf swing out of heavy rough I torn both medial meniscus and sheared of the cartilage of both medial femoral condyles. Both massively swollen knees underwent arthroscopic surgery to remove hundreds or cartilage fragment while confirming the major loss of cartilage covering the thigh bone. The prognosis was bad. I was already a candidate for total knee surgery.
I started to look into ways to preserve what cartilage remained, minimize progression, have less pain, stay active and avoid a total knee replacement. Why?
Under publicized is that 25% of patients having a total knee operation are not satisfied with the results. The risk of infection is reported as much as 2%. That percentage is low, but the event is tragic. Underreported is that the 5-year mortality of an infected total joint is worse than cancer of the breast or prostate; 25%. Wow! If the patient lives they have years of pain, loss of life style, multiple courses of antibiotics, repeated operations the final reconstructive results are compromised at best, if they live.
My case, like most knee arthritic cases was initially on the inner side of the knee, not the entire knee joint to which it later will spread.
Wedged Insoles: It is known that pressure forces on an arthritic joint lead to onset and or progression of the condition. Therefore, I set out to study how to reduce the forces across the inner knee joint of my knee. A study at independent contract laboratory in La Jolla, California was performed on four patients who had already had a total knee in place, but all with load sensors for scientific study.
It was learned that a wedged insole would unload the inner aspect of those with the sensor total knees. https://drlannysinsoles.com/independent-testing/
Wedged insoles have been controversial, but because the appliance was applied but without identifying if the potential user was biomechanically qualified to benefit. I discovered a simple test to learn if the patient would benefit from wedged insoles. https://drlannysinsoles.com/wedged-insoles-for-the-arthritic-knee/
I started wearing such wedges and found them an immediate benefit in reduction of pain. Because of my interest in golf and having credentials as instructor on PGA Tour, I got these insoles USGA approved as legal for tournament golf. I have offered them for sale to others at a nominal charge. www.drlannysinsoles.com
An Arthritis Pill? Joint swelling and inflammation accompany arthritis as the joint deteriorates and sheds of fragments of cartilage. I have a long interest in cartilage healing, pre-dating my injury. I have published on the treatment of such not thinking at the time, I would be a patient.
About 15 years ago I was saw an article in the local Lansing, Michigan newspaper reporting Michigan State scientists discovered that that dyes that make cherries red, when applied to rodent pancreatic islet cells caused increase insulin expression. I reasoned that these dyes might cause other cells or tissues to produce an insulin like hormone; IGF-1. IGF-1 is long known in the scientific community to heal cartilage, but no clinical application has emerged.
I returned to the La Jolla laboratory and demonstrated that these dyes called cyanidin-3-glycoside when applied to human joint lining explants in the laboratory resulted in increased IGF-1 production. I was granted US patents concerning such.
8, 263,069 September 11, 2012. This patent showed that the dyes of plants (anthocyanins and anthocyanins) the precursor of the metabolite protocatechuic acid turned on the gene for growth hormone IGF-1 in human synovium.
9,486,468: November 8, 2016. This patent secured the intra articular injection route not previously included in the granted patent claims.
However, it was learned that the bioactive reagent was not cyanidin-3-glucoside, but the primary metabolite of such; protocatechuic acid (PCA). PCA is a food supplement and classified as a nutraceutical. A patent application was made for such and remains under review.
After further study and research, I secured capsules for my use to decrease the inflammation associated with arthritis. They were successful, so I made them available to others. Presently they are commercially available at https://drjsnatural.com/Total-Wellness-PCA.
Time Marches On: It now was 2021 and I had no pain or swelling for daily activities. I could walk more than a mile with no problem, but not often. I could stand on PGA Tour, teaching for 8-10 hours without a problem, given occasional chance to sit down. I golfed in a car, hit practice balls and no problem.
Cosmetically my knees became more bowed but I was not anticipating a beauty contest. I have minimal loss of extension but retained full flexion.
However, stair climbing and decent remain a major problem. I also lose my balance walking on rocky or uneven surfaces. Muscular control or responsiveness is not there.
The Dynamic Total Knee: I knew of this technology for sports. https://topicalgear.com/products/t-25-knee-pair. A reintroduction with the inventor, Bill Bue alerted me to applicable for knee arthritis; mine. Following a re-introduction, I was willing to explore its potential for further non-operative treatment of my bone-on-bone knee problem. I doubted its benefit, but I do not have a closed mind to technology. My approach is always a willing to explore until proven otherwise.
To my surprise, the application to both lower extremities provided immediate improvement in stair climbing. Yes, immediately. I was suspicious of some biomechanical trick. I subsequently learned I could ascend 2 flight of stairs somewhat hesitantly, heretofore not possible. Descending steps was better, but I still lacked confidence.
I then tested on stationary bicycle. I normally do 25 minutes at minimal resistance setting of 2. I do not want to load the arthritic knee. With the Dynamic Total Knee on, I found the #2 setting too easy. I cautiously elevated to #3 and did the 25-minute routine. It was minimally more resistant than #2, but did not hurt. My heart rate before climbed from 60 the 70’s. This time it when into the mid 80’s and caused perspiration not observed before. There was no subsequent knee pain or swelling.
Video-taping provided documentation of my gait. First was barefoot, then barefoot with DTK sleeve on both thighs which showed improvement. Finally, DTK with my shoes with wedged insoles. Amazing video evidence of improved dynamics of my gait; no lessons and no surgery. Way better symptomatically and dynamically.
The wedged insoles provide a passive correction of the malalignment of the knee and the DTK provides the dynamic muscular forces to restore more normal gait pattern.
I am in the process of further pushing the boundaries beyond the activities of daily living.
Lanny L. Johnson, M.D.