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Orthopedic surgeon-researchers at St. Joseph’s Healthcare Hamilton, led by Dr. Moin Khan, will be working with orthopedic company, Zimmer Biomet, to evaluate a novel treatment for knee pain. Researchers will take part in a multi-centre, 201-participant randomized controlled trial, in which St. Joseph’s Healthcare Hamilton looks to include 20 participants, to study the effectiveness of an emerging technique known as Subchondroplasty®.

Subchondral bone sits just below the joint cartilage, acting as a shock absorber in weight-bearing bones and a critical support for the joint cartilage. Defects in this region are often referred to as bone marrow lesions.

“Not all knee pain comes from wear or trauma to the joint cartilage,” said Dr. Khan, an assistant professor of orthopedic surgery at McMaster University. “Some patients experience pain that originates from within the bone itself. The source of this pain – bone marrow lesions – can be seen on an MRI scan.”

Dr. Moin Khan, Orthopedic Surgeon at St. Joseph's Healthcare Hamilton

Bone marrow lesions are tiny irregularities of the inner bone that can be caused by fibrosis, medullary fat necrosis, micro-fractures of the trabecular (spongy) bone, vascular insufficiency, and poor mineralization. When bone marrow lesions form in subchondral bone, they can cause severe joint pain.

The Subchondroplasty procedure involves the use of a specialized needle, called a cannula, to penetrate the injured area of the affected bone. With the aid of radiographic imaging, a calcium phosphate based bone substitute is injected into the affected areas, where it solidifies and stabilizes the bone.

As a novel technique, researchers hope that Subchondroplasty will be an effective treatment for knee pain in individuals with subchondral bone marrow lesions. Not only is it less expensive than a partial or total knee replacement surgery, it is much less invasive and allows for quicker recovery.

“In certain circumstances, patients with bone marrow lesions can progress rapidly towards further knee degeneration and total joint replacement,” noted Dr. Khan. “Treating these lesions may provide joint preservation through a minimally invasive treatment for patients with knee pain.”

Traditionally, bone marrow lesions have not been treated surgically, but rather treated non-operatively with a period of non-weight bearing and activity modification. Only recently has research suggested that such lesions may be associated with pain and further joint deterioration.

“Innovative, high quality trials such as this one are required to establish the role of the Subchondroplasty procedure in treating bone marrow lesions,” said Dr. Anthony Adili, an orthopedic surgeon at St. Joseph’s Healthcare Hamilton. “If this procedure and the treatment of these lesions actually results in improvements in patients’ pain and function, Subchondroplasty has the potential to become standard of care.”

Participants for this randomized clinical trial will be recruited from St. Joseph’s Healthcare Hamilton. Patients with knee pain who are found to have bone marrow lesions on MRI scan may be candidates for this procedure. Researchers estimate the first procedure to begin within the next two to three months.

Funding for this trial is being provided by Zimmer Biomet, an American company that specializes in medical devices. Researchers will be evaluating the company’s bone substitute material for its efficacy in the Subchondroplasty procedure and long-term outcomes. Subchondroplasty is a trademark of Zimmer Biomet.


About the Research Institute of St. Joe’s Hamilton

The Research Institute of St. Joe’s Hamilton oversees the work of over 200 researchers and their teams as they carry out clinical, translational, evaluative, and fundamental research to improve diagnostics, care, and treatment. Our researchers have transformed the way medicine is practiced, helping to improve patient quality of life and the quality of care in our community and across the globe.

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