Page 1

InsideOI

TM

Q u a rt e r ly P u b l i c at i o n

In This Issue Feature Article

Rave Review: Dr. Huler straightens young girl’s spine

Volume 4: Issue 3

2009

Also in this issue Doc Talk:

Dr. Justice discusses what’s new in hip and knee replacements

Work Comp Doc:

Dr. Lavery discusses hip injuries

IOH Ratings:

IOH receives new healthcare ratings


Editor’s Note: Everyone in the OrthoIndy and Indiana Orthopaedic Hospital (IOH ) community is dedicated to providing the highest quality care for patients and their families. We hope to continue to offer our services to those who matter most in your practice: the patients. TM

TM

In this issue you will have the opportunity to meet our new physicians and get a sneak peek of our new facility. You will also learn what’s new in hip and knee replacements. As a member of our team, please let us know if you have any suggestions on how we can improve our relationship by contacting us at suggestions@orthoindy.com. We appreciate your feedback in advance. Thank you for choosing OrthoIndy and IOH for all of your orthopaedic needs. Sincerely,

ON THE COVER Dr. Huler straightens young girl’s spine. Read more about her experience on page 12.

Kasey Peterson Editor Public Relations and Communications Manager

Taking care of your orthopaedic needs....

from pediatrics to geriatrics! TM


New Docs

TM

[Inside OI Staff]

5

Breaking Ground

Referring Physician Representatives North/East Territories Jennifer Nair jnair@orthoindy.com (317) 802-2074 South/West Territories Amy Klesk aklesk@orthoindy.com (317) 884-5228

OI/IOH breaks ground on new facility in Greenwood

8

New Ratings

IOH receives ratings from HealthGrades

Work Comp Representative John Orr jorr@orthoindy.com (317) 802-2131

Dr. Lavery discusses hip injuries

Doc Talk

Editor Kasey Peterson

OrthoIndy

8450 Northwest Boulevard Indianapolis, IN 46278

Indiana Orthopaedic Hospital (IOH)

8400 Northwest Boulevard Indianapolis, IN 46278

4th Quarter 2009

Dr. Justice discusses what’s new in hip and knee replacements

]

Marketing Director Jennifer Fox

9 12

Work Comp Doc

Contributing Writers Kasey Peterson Dr. Matthew Lavery Dr. Benjamin Justice

Graphic Design Kim Connett

3

Meet our newest physicians

Learn more about OrthoIndy chat with us at:

]

(800) 223-3381 or (317) 802-2000 or visit us on:

email us at suggestions@orthoindy.com

2


New OrthoIndy Docs OrthoIndy continues to strive to provide better access to care for all it’s patients. OrthoIndy and IOH have added Drs. Benjamin Justice, Matthew Lavery and Joshua Salyer to the practice. Call today to schedule

an appointment or call your referring physician liaisons Jennifer Nair and Amy Klesk at (877) OICARE1. For worker’s compensation, please contact John Orr at (317) 802-2401.

Dr. Joshua Salyer

Locations: OrthoIndy Downtown, OrthoIndy Northwest Specialties: Physiatry Schedule an Appointment: (317) 802-2842

Dr. Benjamin Justice Location: OrthoIndy South Specialties: Total Joint, General Orthopaedics Schedule an Appointment: (317) 884-5169

4

Dr. Matthew Lavery Location: OrthoIndy South Specialties: Sports Medicine, General Orthopaedics Schedule an Appointment: (317) 884-5170

Inside OI


IOH Receives National Recognition Top 5 Percent in the Nation for Joint Replacement

IOH received national acclaim according to a comprehensive study released by HealthGrades, the nation’s leading healthcare ratings company. IOH received the following ratings:

• • • • • • • • •

Ranked among the Top 5 percent in the Nation for Joint Replacement – 3 years in a row 5-Star rated for Joint Replacement – 4 years in a row 5-Star Rated for Total Knee Replacement – 4 years in a row Ranked among the Top 5 in Indiana for Spine Surgery – 3 years in a row 5-Star Rated for Spine Surgery – 3 years in a row 5-Star Rated for Total Hip Replacement – 3 years in a row 5-Star Rated for Back and Neck Surgery (Spinal Surgery) – 3 years in a row Recipient of the HealthGrades Joint Replacement Excellence Award – 3 years in a row Ranked among the Top 5 in Indiana for Joint Replacement – 2 years in a row

“I am extremely proud of the physicians and staff at IOH,” said Jane Keller, CEO. “The ratings we have received in the last four years of operation prove that our hospital model provides patients with the highest quality outcomes and patient satisfaction.” Owned by OrthoIndy physicians, IOH’s physicianowned hospital model provides patients with proven quality outcomes because the physician is involved in every aspect of the patient’s treatment. In physicianowned hospitals like IOH, the physicians play the role of the advocate. They personally decide what type of treatment is most appropriate and beneficial, putting the care of their patient’s first. The healthcare industry has become a consumer driven market. Healthcare ratings, such as HealthGrades have

become extremely important in aiding consumers in choosing a healthcare facility. Millions of consumers and hundreds of the nation’s largest employers, health plans and hospitals rely on HealthGrades’ independent ratings to make healthcare decisions based on quality care. “It is an honor to receive these ratings from a nationally recognized company,” said Keller. “Ratings like these allow consumers to make informed decisions when choosing a healthcare provider.” HealthGrades independently and objectively rates the quality of care for nearly every hospital in the country, for each of twenty-eight procedures and diagnoses. Five stars indicate that the hospital has below-average mortality or complication rates for that particular procedure. Low mortality and complication rates are a trend among physician-owned hospitals like IOH. Three stars indicate the care is “as expected,” and one star indicates that the care is among the poorest in the nation, with aboveaverage mortality and complication rates. The star ratings are based on an analysis of tens of millions of patient records over a three-year period that hospitals themselves submit to the Centers for Medicare and Medicaid Services as well as state governments. The records are “risk adjusted,” meaning that hospitals taking sicker patients are compared on equal footing with other hospitals. HealthGrades’ ratings are purely objective, based on information that hospitals report to federal and state governments. There are no subjective elements, such as reputation, that are factored into HealthGrades’ star ratings.

2008/ 2009 / 2010


Breaking Ground:

OrthoIndy and IOH Build in Greenwood

On September 22, 2009, OrthoIndy and IOH officially broke ground on a new facility, located in the city of Greenwood. Spanning 75,000 square feet, the state-ofthe-art facility will provide 5-Star orthopaedic care to the expanding Southside of Indianapolis. The facility is scheduled to open winter of 2010.

“We are excited to offer more services to our patients on the Southside by building a new state-of-the-art facility,” said John Martin, CEO at OrthoIndy. “As a member of the community of Greenwood, our new facility will provide residents with orthopaedic care that is nationally ranked.”

The new facility, OrthoIndy/IOH South, will include:

BSA LifeStructures designed the facility and Meyer Najem will provide construction management expertise. Hokanson Companies, Inc. and McCormack Development will oversee the process to completion.

• • • • •

42 exam rooms 4 operating rooms physical therapy MRI 21 OrthoIndy physicians

“Meyer Najem is excited to have been selected as the Construction Manager for the OrthoIndy/IOH

Left to right: Stephen Hokanson, President, CEO, Hokanson Companies, Inc; John Martin, CEO, OrthoIndy; Dr. John Dietz, Chairman of the Board, IOH; Mayor Charles Henderson, Greenwood; Dr. Frank Kolisek, President, OrthoIndy; Jane Keller, CEO, IOH.


project,” said Tim Russell, President of Meyer Najem. “We are honored to be a part of the growing presence of OrthoIndy as they expand to meet the increasing demand for orthopaedic services in the greater Greenwood area.” The groundbreaking ceremony featured keynote speakers, including: John Martin, CEO, OrthoIndy; Dr. Frank Kolisek, President, OrthoIndy; Jane Keller, CEO, IOH; Dr. John Dietz, Chairman of the Board of Directors, IOH and OrthoIndy patient, Mayor Charles Henderson of Greenwood.

Our new facility will provide residents with orthopaedic care that is nationally ranked.

- John Martin, OrthoIndy

4th Quarter 2009

6


Orthopaedic Research Foundation OI Seeks Patients for Research Studies

The Orthopaedic Research Foundation, Inc. (ORF) functions as the research and education arm for the physicians of OrthoIndy. Founded in 1986, its mission is “to advance the scientific body of knowledge associated with musculoskeletal disorders, for the scientific and public communities, through research and education.�

Study Title

Participating Physicians

Brief Description Criteria

Enrollment Contact Deadline or Person Enrollment Goal

Contact

A Multicenter, Randomized, Pivotal Study to Evaluate the Safety and Efficacy of the Cartilage Autograft Implantation System (CAIS) for the Surgical Treatment of Articular Cartilage Lesion of the Knee

Dr. J. Farr

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

Open

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

Evaluation of the Composit of Cancellous and Demineralized Bone Plug(CR PLUG) for Repair of Focal Cartilage Lesions of the Femoral Condyle

Dr. J. Farr

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

After 10 paVicki tients enrolled Snodgrass CCRC

vsnodgrass@ orthoindy. com

A Post Market Study of the ABS OrthoGlide Arthroplasty Device for OsteoArthritis of the Knee

Dr. J. Farr

Osteoarthritis of the knee

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

A Post Market Study of Articular Cartilage Defects of the Knee Treated with Denovo NT, Natural Tissue Graft

Dr. J. Farr

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

After 10 paVicki tients enrolled Snodgrass CCRC

vsnodgrass@ orthoindy. com

Rgeneration Technologies, Inc. Registry of Biocleanse Meniscus Transplants

Dr. J. Farr

Meniscal Transplantation Candidates Visit www.clincialtrials.gov for inclusion and exclusion criteria

After 10 paVicki tients enrolled Snodgrass CCRC

vsnodgrass@ orthoindy. com

Collection of Specimens from Joint Replacement Surgery for In-Vitro Osteoarthritis Research

Drs. J. Farr, Kolisek, and Monesmith

Total Knee Replacement Candidates

Vicki Snodgrass CCRC or Nenette Jessup

vsnodgrass@ orthoindy. com or Njessup@ orthoindy. com

Trial to Evaluate Ultrasound in the Treat- Dr. Maar ment of Tibial Fractures (TRUST)

Study of low-intensity pulsed ultrasound treatment vs. placebo treatment in IM nailed tibial fracture healing.

After 15 paDana tients enrolled Musapatika

(317) 9174117

Reamed Irrigation Aspirator (RIA) for Bone Graft Harvest for Segmental Defect

A study focused on the use of reamed irrigation of the tibia or femur as a technique for bone graft harvesting.

After 15 paDana tients enrolled Musapatika

(317) 9174117

Musculoskeletal Injuries Associated with Dr. Jelen Moped and Motorized Scooter Accidents

A study of the factors involved in moped and After 15 paDana motorized scooter accidents and the treattients enrolled Musapatika ment methods utilized.

(317) 9174117

Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH)

Dr. Baele

A trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures.

After 15 paDana tients enrolled Musapatika

(317) 9174117

Post-operative Knee Rehabilitation: Comparing the Conventional Approach to the Use of a Music Rehab Video

Drs. Fisher, Hellman, Kunkel, Randolph,

This is a randomized controlled blind study to determine whether patients who use a music exercise video for their physical therapy after knee replacement surgery have outcomes and satisfaction scores equivalent to patients who undergo a conventional physical therapy protocol.

April, 2010

drobinson@ orthoindy. com

7

Dr. Weber

Deborah Robinson, PA-C

Inside OI


Study Title

Participating Physicians

Brief Description Criteria

Enrollment Contact Deadline or Person Enrollment Goal

Contact

5 – Year Prospective,Post-Market Pilot Study of Biolox Delta 36 mm and Larger Femoral Heads with Trident X3 Polyethylene Inserts

Dr. Kolisek

A single center study evaluating patients with Biolox delta femoral head with an X3 polyethylene insert hip implants for wear rate, clinical results, radiographic stability and quality of life.

18-month period

Nenette Jessup

(317) 8845232 njessup@ orthoindy. com

10 - Year Retrospective/Prospective Radiographic Analysis of Secur-Fit Hip Stem

Dr. Kolisek

A single center study comparing radiographic remodeling of the Secur-Fit stem to the Omnifit HA stem through 10 years and evaluating the group for quality of life and clinical results.

Nenette Jessup

(317) 8845232 njessup@ orthoindy. com

Osteocel® Plus in Anterior Lumbar Fusion (ALIF): Evaluation fo Radiographic and Patient Outcomes

Drs. Schwartz, One or two level lumbar fusion using OsteoRiina, Tramcel® Plus as a bone graft substitute. mell, Dietz, Huler

July 2010

Kim Fitzpatrick

(317) 8022851

A Prospective, Randomized, Controlled Pivotal Clinical Investigation of DIAM™ Spinal Stabilization System in Patients with Lumbar Degenerative Disc Disease

Drs. Riina, Schwartz, Trammell, Dietz

Mild to moderate degenerative disc disease from L1-L5. Randomized study into either DIAM (surgical) or conservative care group.

September 2009

Kim Fitzpatrick

(317) 8022851

A Multi-center, prospective, parallel group, randomized, pilot study evaluating safety and preliminary effectiveness of Prefix compared to iliac crest bone in subjects with degenerative disc disease undergoing transforaminal lumbar interbody fusion.

Drs. Riina, Huler

Moderate to severe degenerative disc disease. Randomized to Prefix or ICBG. One level TLIF.

September 2009

Kim Fitzpatrick

(317) 8022851

A comparison of INSORB™ staples and traditional wound closure in posterior spinal surgery.

Dr. Trammell

Randomized study comparing use of staples versus sutures on surgical incision.

July 2010

Kathy Flint

(317) 8022496

Linkage analysis and gene mapping of familial spinal disorders (scoliosis, Scheuermann’s kyphosis, spondylolisthesis, lumbar disc disease, osteoporosis).

Drs. Schwartz, DNA (saliva) testing of patients with scoRiina, Tramliosis. mell, Dietz, Huler, Coscia

N/A

Kathy Flint

(317) 8022496

Epidemiology, Process, and Outcomes of Drs. Schwartz, Any spinal cord trauma patients Spine Trauma Riina, Dietz, Coscia, Huler, Trammell

N/A

Kathy Flint

(317) 8022496

Surgical Treatment for Acute Spinal Cord Injury Study

Drs. Schwartz, Riina, Dietz, Coscia, Huler, Trammell

N/A

Kathy Flint

(317) 8022496

Management of Type II Odontoid Fractures

Drs. Schwartz, Cervical spine trauma patients Riina, Dietz, Coscia, Huler, Trammell

N/A

Kathy Flint

(317) 8022496

Magnetic Resonance Imaging and the Posterior Ligamentous Complex

Drs. Riina, Dr. Schwartz, Dietz, Huler

N/A

Kathy Flint

(317) 8022496

4th Quarter 2009

Any spinal cord trauma patients

Spine trauma patients

8


Work Comp Doc:

Hip Inuries By: Matthew R. Lavery, MD

Job-related injuries continue to be a major cause of missed work days for employees. The economic toll on both the injured individual and the employer can be significant. Nationwide, some sources estimate that the direct and indirect costs of work-related injuries total well in excess of $100 billion. Injuries to the lower extremity account for approximately one fourth of all workplace accidents. While the knee is the most commonly injured joint in the lower extremity, there are also a large number of people sustaining hip injuries. Injuries to the hip tend to fall into several broad categories: 1) muscular strains, 2) tendonitis/bursitis, 3) referred pain, 4) cartilage injuries and 5) fractures. In younger people, the majority of injuries to the hip region fall into one of the first three categories. Fortunately, injuries of these types often do not result in the need for surgical treatment.

9

Muscular strains around the hip and thigh are relatively common. These injuries are often seen in workers engaged in activities that involve particularly heavy lifting. Similar to an athlete performing a deadlift, workers who lift heavy objects from ground level must generate large forces in the gluteal and quadriceps muscles. Because most workers are not performing warm-up or stretching activities routinely before work, they may put themselves at some increased risk of muscular strain when performing heavy lifting maneuvers. Improper lifting technique may also contribute to injury of these muscle groups. Maintaining a solid base of physical fitness through regular exercise outside of the workplace combined with the use of proper lifting technique can lessen the risk of these muscular injuries. While muscular strains may be related directly to Inside OI


an injury episode, tendonitis and bursitis type injuries are more often due to repetitive stress. Pain over the lateral aspect (outside) of the hip may be the result of trochanteric bursitis. This relatively common condition occurs due to inflammation and swelling in a bursa that is located near the greater trochanter, a bony prominence that serves as an attachment for several

“

connective tissue that surrounds the socket portion of the hip. The labrum can be torn in a manner similar to the way meniscal tears occur in the knee. For example, a baggage handler who is involved in repetitive twisting with heavyweights in each hand may be at some increased risk of labral injury. Labral tears can be difficult to diagnose and often require the treatment

Because most workers are not performing warm-up or stretching activities routinely before work, they may put themselves at some increased risk of muscular strain when performing heavy lifting maneuvers.

muscles that move the hip. Symptoms may be more pronounced at night, particularly when lying directly on the affected side. Exacerbating factors can include repetitive stair climbing, rising from a chair, a direct blow to the lateral hip and underlying leg length inequalities or spinal curvatures. Trochanteric bursitis can often be treated with anti-inflammatory medications and exercises that help strengthen a specific group of muscles around the pelvis. Physicians may elect to perform injections of steroid and an anesthetic directly into the bursa if pain is severe. Very rarely, recalcitrant cases may benefit from surgical intervention. Injuries to the cartilage of the hip are relatively uncommon, but may result from falls and twisting injuries. These injuries generally involve fairly significant amounts of force being transmitted through the hip joint. Two main components of cartilage are at risk from these types of injuries: the articular cartilage and the acetabular labrum. The labrum is a thick ring of 4th Quarter 2009

�

of a specialist. These injuries are often best treated with arthroscopic hip surgery to alleviate the patient’s symptoms. Similarly, injuries to the articular cartilage can result from direct trauma to the hip joint. The treatment of articular injuries is variable depending upon the severity of injury. Fortunately, hip fractures are somewhat uncommon in the workplace. However, as people are living longer, the US workforce is aging. People who were previously sustaining hip fractures in the community, may now still be members of the working population. The risk of hip fracture starts to slowly increase after the age of 45, though the vast majority of fractures, over 90 percent, occur after the age of 65. There are several things that can be done to help minimize the risk of hip fracture. Eliminating fall hazards by clearly marking uneven surfaces in the workplace and removing obstacles from common walkways can help minimize the risk of worker falls. Additionally, adequate dietary intake of calcium and vitamin D combined with regu-

10


lar weight-bearing activity have been shown to result in higher bone density later in life, thereby reducing fracture risk. Employers and healthcare providers should encourage such healthy active lifestyle choices. While there are many causes of hip pain directly attributable to the structures immediately surrounding the hip joint, some hip discomfort is actually the result of referred pain. The most common site of referred pain to the hip is the low back. Low-back injuries are the most common workplace injury and a major cause of disability. Both muscular strains and conditions that compress spinal nerve roots (e.g. disc herniation) can result in pain that refers to the hip region. A careful history and physical examination from a qualified care provider will often differentiate the etiology of a patient’s hip pain and aid in directing proper treatment. Employers can help prevent work-

related hip injuries by minimizing the need for excessively heavy lifting, minimizing fall hazards, and encouraging worker wellness. Employees can minimize their risk of hip injuries by using proper lifting techniques, avoiding any unnecessary repetitive stress to the hip and maintaining proper dietary and exercise habits outside the workplace. While the primary goal is prevention of work-related injuries, effectively handling these injuries when they occur can minimize their disruption to both the employee and employer. Good communication between the injured worker, the employer, the case manager, and care providers is essential for an expedient recovery.

Matthew R. Lavery, MD Orthopaedic Surgeon, Sports Medicine Board Eligible

Dr. Matthew Lavery graduated magna cum laude from Millikin University, Decatur, Illinois in 1998. He was a three-year letter winner on the varsity football team at Millikin. In 2003, he received his medical degree from Southern Illinois University School of Medicine, Springfield, Illinois. In 2008, Dr. Lavery completed his residency in Orthopaedic Surgery at University of Iowa Hospitals and Clinics in Iowa City, Iowa. He completed a fellowship in Sports Medicine at the Southern California Orthopedic Institute in Van Nuys, California in 2009. Dr. Lavery served as an associate team physician at the University of Iowa for the men’s baseball, football and gymnastics teams, as well as the women’s basketball team. He also provided team coverage for several high schools and the Los Angeles Valley College football team during his fellowship. Dr. Lavery’s work has been published in professional journals, including: Iowa Orthopaedic Journal, and Clinical Orthopaedics & Related Research. Practice Focus:

Sports Medicine Arthroscopic treatment of shoulder, hip, knee, and ankle injuries General Orthopaedics

To schedule an appointment with Dr. Lavery please call (317) 884-5170


Another Rave Review OrthoIndy provides such great service, the patients can’t help but rave about it! During a routine scoliosis screening at her school, twelve year old, Ariel Zhang discovered she had scoliosis. Ariel visited her family doctor who then referred her to orthopaedic spine surgeon, Dr. Robert Huler, who informed Ariel that her spine curved at almost a 90 degree angle.

be taller and need all new clothes! He was supporting and pushing me along the way.” Ariel’s surgery was successful. After her two year follow up appointment, Ariels severe deformity was nearly completely corrected as shown in the before and after x-rays below. She says the surgery has changed her life, teaching her discipline due to the discipline required of her for her

“You usually don’t see something like this in children,” said Dr. Huler. “However, what’s astonishing is that it wasn’t discov“He [Huler] explained to me that I was going to get ered at through it, supporting and pushing me along the way.” an earlier age.” Dr. Huler said with current technology, this type of curvature can be cor- recovery. “It has taught me to see the bright side of things. I still dance and rected. I am a black belt in tae-kwon-do. I Ariel was prepared to have a surgical procedure to corhave limitations now, but I have rect her serious deformity. She donated her own blood found ways to work around them.” for the surgery. She took iron pills to “gear up” her own blood production. She read about scoliosis surgery on the While Ariel was extremely pleased internet. She e-mailed Dr. Huler with questions about her with her physician, Dr. Huler was equally impressed with Ariel. upcoming surgery nearly every week. “Ariel’s amount of intellect is Prior to surgery, Ariel enjoyed tae-kwon-do and dance and beyond her years,” he said, she worried surgery would keep her from participating “she was asking quesin her favorite hobbies. “The idea of surgery was scary, tions at age eleven that especially with rods being placed in my spine,” she said. an adult would ask. “I thought it would be a limitation, but after Dr. Huler It was amazing how explained the surgery, it didn’t worry me too much.” she held her head up high. She is Ariel believes her experience with Dr. Huler put her at ease. “He is really friendly and he calmed me down about an unbelievable young lady.” everything,” she said. “He made the situation lighter by making me laugh and explaining to me that I was going to

If you or someone you know suffers from scoliosis, please call us at (317) 802-2000 to schedule an appointment with an orthopaedic spine surgeon.

X-Rays of Ariel’s spine before and after surgery with Dr. Huler. Dr. Huler and Ariel after her check-up


Doc Talk

this quarter’s Physician:

Benjamin J. Justice, M.d.

What’s New In Hip and Knee Replacements? Total joint arthroplasty has come a long way over the Conservative Treatment last several years. Since modern components were The mainstay of conservative treatment is still nondeveloped in the 1970’s these procedures have had an steroidal antiinflammatories and assistive devices, as excellent success rate, however patient selection has well as corticosteroid injections. Viscosupplementabeen very limited. Patients younger than 55-65, were tion (synvisc, orthovisc, hyalgan, etc.) injections have told “you’re too young for a joint replacement” and been shown to be effective, especially in patients with were left to suffer until many of their active and prominor degenerative changes. Viscosupplementaductive years were passed by. The tion does not have the same risk of osteonecrosis that reason for this was the high likelihood cortisone might have, which is especially appealing in of a revision surgery younger patients with in a young patient, minor arthritis. Many not only because they patients also try chonhad more time for the droitin and glucosamine primary component to and have had anecIn hips, components were fail, but also because dotal success. These of the increased activsubstances have been cemented into place with ity and demand a shown to be effective a grout-like polymer. Now young patient would in multiple journals, put on the prosthesis. in younger patients (that put however the studies use Better materials have pharmaceutical grade higher demands on hip remade implant failure, chondroitin and glucosplacements), in-growth imdislocation and reviamine and the over-thesion surgery a much counter brands are often plants are used. In-growth lower concern; this unregulated and their implants are manufactured has allowed young contents frequently difpatients with debiliferent from pill to pill in with micro-pores that allow tating disease to get the same bottle. Forbone to grow in. appropriate treatment tunately there are little and resume an active side-effects and this is a lifestyle. Technique viable option especially and prophylactic in patients who cannot treatment has imtolerate NSAIDs. proved significantly as well. Surgeries that previously took 4 hours or more are now routine and can be done Better Materials in 90 minutes, which significantly decreases blood loss Significant improvements have been made in the and infection risk. Pain management and less invasive prosthetic materials that are used. In hips, components procedures have made the initial post-op period and were cemented into place with a grout-like polymer. rehabilitation much less onerous for the patients as Now in younger patients (that put higher demands on well. hip replacements), in-growth implants are used. In-

13

Inside OI


growth implants are manufactured with micro-pores that allow bone to grow in. As micro-trauma occurs around the implant the bone remodels and maintains secure fixation, whereas cement around implants loosens without remodeling after repeated micro-trauma. Polyethylene (the plastic bearing surface in most hips and knees) gives off micro-particles as the joint goes through normal range of motion cycles. The body’s own immune cells can react to these particles with an inflammatory-like response which causes bone loss and loosening of the implants. This process is called osteolysis. Osteolysis has been a major concern since the inception of modern joint replacement, and a major area of materials research. The manufacturing processes of polyethylene have vastly improved. The current “highly cross-linked” generation of plastics create much fewer wear particles, and the risk of osteolysis and loosening is much lower. In addition, metal-onmetal and ceramic-on-ceramic bearing surfaces for hips avoid the polyethylene wear issue altogether.

Improved Techniques

Improvements in surgical and anesthetic techniques have made total joint replacement more successful and less traumatic for the patient as well. Less invasive surgeries for hip and knee replacement have become more refined. A new procedure, anterior approach total hip replacement, goes between two muscles, instead of through the gluteus maximus muscle (a major source of post-operative pain). The short term recovery is much shorter and less painful. With this approach, the posterior capsule is undisturbed, virtually eliminating dislocation risk (a major concern with

total hip replacements) and the need for precautions with certain movements and positions that are necessary with posterior approach hip replacement. Knee replacement can be done with smaller incisions or with a subvastus approach. The subvastus approach leaves the entire tendon and muscle unit intact and undisturbed, allowing the muscle to stay strong for post-operative recovery. Breakthoughs using computer navigation (similar to equipment used for neurosurgery) have allowed for more accurate placement of knee components. Better aligned implants give a better functioning knee and are better able to withstand the stresses a knee undergoes. Anesthetic advances with spinal, epidural, and regional blocks allow for less general anesthesia and much less post-operative pain. Less post-operative pain gives patients the opportunity to more aggressively rehabilitate. Aggressive rehab is often the critical factor in achieving the best outcome possible. With all of the advances in materials and techniques, total joint replacement is an option for patients who were previously relegated to years of pain because they were “too young.” These advances have also made the surgery and rehabilitation period shorter and less painful for the patients that undergo these procedures. Implants last longer and are more functional, rehabilitation is easier and less painful, and outcomes are improved.

Benjamin Justice, M.D.

Orthopaedic Surgery, Spinal Surgery Dr. Justice graduated from Indiana University in Bloomington in 1999 and Indiana University School of Medicine in Indianapolis in 2003. He completed his orthopaedic residency at St. Mary’s Hospital, San Francisco, California in 2008 and a total joint replacement fellowship in 2009 at University of Louisville/Jewish Hospital in Louisville, Kentucky. In 2008, Dr. Justice received the Garnett F. Wynn Award, awarded to the outstanding resident each year at the San Francisco Orthopaedic Residency Program. He has special training in muscle-sparing hip and knee replacement as well as hip resurfacing arthroplasty, an alternative for young, active patients. Practice Focus: • Anterior Approach Hip Replacement • Muscle-sparing Knee Replacement • Revision Surgery • Hip Resurfacing Arthroplasty

• Unicompartmental Knee Replacement • Total Shoulder Replacement • General Orthopaedics (including fractures, ligament and tendon injuries, and infections)

To schedule an appointment with Dr. Justice, please call (317) 884-5169.


TM

8450 Northwest Blvd. Indianapolis, IN 46278

/Inside_OI_Volume_4_Issue_4  

http://www.orthoindy.com/images/uploads/Inside_OI_Volume_4_Issue_4.pdf

Advertisement