`Cooking' Away Joint PainKate Murphy
Melinda Timberlake's shoulder began to bother her two years ago. It hurt when she played racquetball and twinged when she lifted file boxes at the Charlottesville (Va.) Treasurer's office, where she works as a revenue technician. The pain became so severe that Timberlake, 38, had trouble sleeping. "There was a constant tenderness and throbbing that went all the way down my arm," she says. After months of ineffective physical therapy, cortisone shots, and anti-inflammatory medication, Timberlake underwent a new type of arthroscopic surgery that two weeks later had her pain-free and ready to resume an active lifestyle. "I'm pretty impressed," she says.
SLACK CRADLE. So are many orthopedists, who claim the technique--electrothermal arthroscopy--beats other methods of treating joint instability. Joints, such as those in the shoulder and knee, become unstable when supportive tissues surrounding them get stretched or damaged. The causes may be an injury from lifting something the wrong way, overuse from repetitive-motion sports such as racquetball, or both. When the joint's fibrous cradle goes slack, the bone end that connects there is likely to slide in and out of place. "Patients complain of aching and feeling out of joint," says Dr. Gary Poehling, chairman of the department of orthopedics at Wake Forest University's school of medicine in Winston-Salem, N.C.
Doctors began using electrothermal arthroscopy last year after it gained Food & Drug Administration approval. The procedure employs radio waves to shrink loose tissues so they go back to supporting the joint. Collagen, a prime component of connective tissue, contracts when heated--the way a cotton T-shirt shrinks in the dryer. The technique is used most often to treat unstable shoulders. But increasingly, doctors are relying on it to brace knees and ankles and even to fix slipped discs in the back.
Using a small, telescope-like device called an arthroscope to see what they are doing, surgeons guide a probe that emits radio waves into the structures sagging around the joint, heating them to approximately 150F. The tissue recoils or tightens to hold the joint firmly without limiting range of motion. Radio waves allow for a high degree of accuracy because they have a mere 1/5-inch range. "It's pretty hard to mess up," says Dr. Frank McCue III, a professor of orthopedic surgery at the University of Virginia's medical school in Charlottesville, who performed Timberlake's operation. The 20-minute procedure costs $2,000 to $2,500 and is covered by most insurance plans.
Previously, open surgery lasting up to 2 1/2 hours was the standard treatment. In that procedure, surgeons make a 3- to 6-inch incision, then use staples and sutures to cinch up loose tissue around the joint. Recovery can take as long as 12 to 18 months, as opposed to just weeks with electrothermal arthroscopy. And with the standard surgery, "very few people get back in peak condition afterwards" because all the binding ends up limiting range of motion, says McCue.
This surgery can also be performed arthroscopically with a far shorter incision. But the failure rate is higher than open surgery, since doctors have a smaller field in which to accomplish the necessary nips and tucks. Orthopedists have also used lasers to warm and tighten the lax area around unstable joints. But using a laser to heat collagen is like using a flamethrower to dry your clothes. "Lasers penetrate too deeply and damage surrounding structures," Poehling says.
RISK FACTORS. One downside to electrothermal arthroscopy: No one knows the long-term effects, since only two years of data have been collected. "We don't know whether the tissue will stretch back out," says Dr. Walter Lowe, an orthopedic surgeon at Baylor Sports Medicine Institute in Houston.
There is also concern that heating connective tissue will make it more likely to degenerate years down the road. But considering the near-term likelihood of a quick and full recovery, many people--especially athletes--are willing to take the risk "to get back to doing what they want to do," Lowe says.
The leading suppliers of electrothermal probes, Oratec Interventions in Menlo Park, Calif. (888 996-1996), and ArthroCare of Sunnyvale, Calif. (800 797-6520), each report that their equipment is in more than 1,000 medical institutions. The two companies will provide a list of doctors who perform electrothermal arthroscopy upon request.