Finally, Non-Invasive Options for Chronic Knee Pain

Forest Heis, M.D.

OrthoCincy Orthopaedics and Sports Medicine



Doctors love to be able to tell patients they have them. And patients love to hear they have a range of strategies for dealing with an ailment. But when it comes to
micro fractures in a knee joint that create chronic pain with osteoarthritis, the treatment options have been limited. They really only included a conservative or radical choice: treat it with anti-inflammatories and troublesome pain medicine or get a complete knee replacement.

Now there is a middle ground osteopathic surgeons are using that can buy patients valuable time and provide pain relief without drugs. It’s called subchondroplasty (SCP), a procedure that provides support to bone lesions in the knee, giving them a chance to heal.

“SCP will not cure arthritis. But for many people this is a viable option that can put off a higher-risk total knee replacement for years,” says Forest Heis, M.D., an orthopedic surgeon with OrthoCincy Orthopaedics & Sports Medicine, who practices at St. Elizabeth Healthcare.

The SCP procedure is used when some people with arthritic knees develop subchondral bone lesions, or micro fractures. It is often those lesions that are causing the pain. Indeed, those with the micro fractures have a four-times higher rate of needing a knee replacement to relieve the constant pain. The SCP procedure is designed to heal those small fractures with minimally invasive surgery in a less than hour-long outpatient surgery.

“I go in with a scope and clean up any tears and other material, then inject a calcium phosphate compound that squirts into the area of weak bone, filling up nooks and crannies and micro fractures,” Heis explains. “Then it sets and hardens.”

The bone substitute material has a toothpaste-like consistency and acts like a mortar supporting the area while the bone heals.

“It instantly gives this area that was unsupported more support,” Heis says. “Sometimes it helps with the pain very quickly. It is osteo-inductive, so it induces new bone growth. After a couple years, healthy bone grows into the area. Knee replacements last longer the older you get. So, if you are under 65, many patients are happy they have the option to delay the decision.”

Heis, who has performed over 700 SCP procedures in the last five years, says his patients have seen a success rate comparable to the national average. Studies show 80% of people don’t need a knee replacement in the first two years. Five-year studies are showing a 50-60% success rate. And the procedure doesn’t limit future care options, such as knee replacement surgery. In fact, if pain does return, Heis has found conservative therapies, such as anti-inflammatories, will often work where they didn’t before. He also believes, if a knee replacement is still needed, a surgeon has a better bone structure on which to attach the replacement.

Subchondroplasty can be a viable option for some specific groups of people. Heis points to the ex-athlete who has arthritis from knee injuries. “At 45, he is not going to want a knee replacement that will last 10 to 15 years. This can buy some time,” Heis says.

It is also a solid alternative for high-risk knee replacement candidates, such as the obese and diabetics, where doctors are reluctant to operate until patients get those medical issues under control. Again, SCP buys these folks some time to deal with their multiple health issues.

The SCP procedure has come on the medical scene as estimates show knee replacement surgeries will skyrocket over 500%  in the coming decades, largely because of the aging baby boomer population. Heis says patients now have another option to deal with osteoarthritis pain.

“I am not saying this is any kind of miracle cure. But it does give people a chance to get some relief until they feel they are ready for a knee replacement.”

St. Elizabeth Healthcare operates five facilities throughout Northern Kentucky and more than 115 primary care and specialty office locations in Kentucky, Indiana and Ohio. For more information, visit OrthoCincy Orthopaedics & Sports Medicine has 12 locations in Ohio, Kentucky and Indiana. For more information, call 859-301-BONE or visit