Orthopaedics: Innovative Pain Relief for Patients with Knee Osteoarthritis
Dr. Vinod Dasa is at the forefront of some of the latest advancements in orthopaedic pain relief and orthopaedic surgery. As associate professor of clinical orthopaedics and director of research at the LSU Health Sciences Center for the past 11 years, he has incorporated the latest developments into his clinical practice and is excited about what the future holds.
Often referred to as the knee doctor, Dr. Dasa specializes in non-surgical pain relief and outpatient joint replacement surgery. He explains that the most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is a result of osteoarthritis (usually age-related caused by wear and tear), rheumatoid arthritis (caused by chronic inflammation) and post-traumatic arthritis (that follows a serious knee injury).
PAIN RELIEF WITH IOVERA
Dr. Dasa has been instrumental in introducing iovera to patients with knee osteoarthritis. LSU Health Sciences Center was the first medical facility in the United States to offer his new nonsurgical treatment to reduce pain related to knee surgery.
The iovera treatment works by applying targeted cold to a peripheral nerve, which immediately prevents the nerve from sending pain signals. The effect of the cold on the nerve is temporary and does not cause permanent damage because it leaves the structural components of the nerve intact. “Basically, iovera creates an ice cube under the skin,” Dr. Dasa says. “When the nerve touches the cold, it shuts off. At that temperature, the nerve sheath is not damaged and it can still grow back.”
As Dr. Dasa explains, the iovera treatment differs from alternative treatments that use radio frequency ablation (RFA) to lesion (burn) nervous tissue. The temperature in RFA remains constant for 80 to 90 seconds — long enough to burn nerves around the knee and cause permanent nerve damage. “With the iovera treatment, the temperature remains safe,” he says. “It also offers immediate and long-lasting pain relief without the use of narcotics.”
Dr. Dasa, along with his physician’s assistant, Heather Wills, PA-C, have treated many patients successfully with the iovera treatment. The hand-held device is equipped with a nitrous oxide cartridge with three closely spaced 27-gauge closed-end needle tips. The nitrous oxide flows from the cartridge to the needle tips, creating a highly localized cold zone. The effect is transient and provides pain relief until the nerve regenerates and its sensory function is restored.
With iovera treatment, pain relief can last for three to six months, depending on the severity of the osteoarthritis. Patients experience reduced joint stiffness and improved physical function. “We have had great feedback on the iovera treatments,” Wills says. “It is gratifying to be able to witness the benefits of pain relief immediately and to be able to solve patients’ problems with visible results often within a single visit. We have had several patients come to see us in wheelchairs and leave on foot.”
Wills graduated from LSU with a degree in kinesiology and attended physician assistant school at the University of South Alabama in Mobile. She first worked in an urgent care facility and then at an orthopaedic clinic in New Orleans before joining Dr. Dasa in 2017. She explains her work alongside Dr. Dasa involves treating patients of all ages and types of injuries, and conditions regarding the shoulder, hip, knee, foot and ankle.
“For patients with various severities of arthritis pain, we will first start with conservative treatments, such as physical therapy and pain relief through medication or pain relief injections,” she says.
“Not all patients are immediate candidates for knee replacement surgery, and, if they choose to delay, it is good to know that with iovera, we can help them ease their chronic pain and get back to their normal lives faster,” Dr. Dasa adds.
KNEE REPLACEMENT SURGERY
Knee replacement or arthroplasty is a surgical procedure to resurface a knee damaged by arthritis or a severe knee injury. Through knee replacement surgery, the parts of the knee that have been damaged are resurfaced. “In a knee replacement, we trim away just the end of the bone, so we make a small cut, in some cases less than 10 millimeters thick, and basically replace the end of the bone with a metal and plastic cap that fits on the end of the bone so [the patient] can move the joint freely again,” Dr. Dasa says.
If a patient is a candidate for knee surgery, Dr. Dasa will use the iovera treatments one week prior to surgery to help reduce post-op pain. “In the context of the opioid epidemic, we are always looking for innovative solutions to deal with pain issues,” he says. “Through our research, we found that by using cryo-neurolysis, patients experienced significant decreased knee pain and improved symptoms.” Cyro-neurolysis is a medical procedure that temporarily blocks nerve conduction along peripheral nerve pathways by freezing the target nerve. The study revealed that there was a 45 percent reduction in the amount of pain medications for those patients who had knee replacement with the cyro-neurolysis. “There’s no drug; there’s no toxin; there’s [nothing] that’s put in the body. It’s just simply the needles become cold.,” Dr. Dasa adds.
After completing medical school at Albany Medical College, Dr. Dasa trained at the State University at New York (SUNY) at Buffalo orthopaedic surgery residency program. In 2006, he furthered his training in sports medicine and joint replacement surgery at the Insall Scott Kelly Institute in Manhattan — considered a pioneer in knee replacement surgery.
“We now have more precise and accurate control over surgical techniques,” Dr. Dasa says. “This has reduced recovery time from joint replacement surgery from two to three months to only four to six weeks. Generally, patients are able to go home the day of their surgery or the day after surgery.”
The LSU Healthcare Network Orthopaedic and Sports Medicine Practice is now conveniently located at 671 W. Esplanade Ave., Kenner, LA 70056.
LSU Healthcare Network
VINOD DASA, M.D.
Assistant Professor of Clinical Orthopaedics
671 W. Esplanade Ave., Ste. 100
Kenner, LA 70056
Medical School: Albany Medical College
Residency: SUNY at Buffalo, N.Y., Orthopaedic Surgery
Fellowships: Insall Scott Kelly Institute, Adult Reconstruction and Sports