/Inside_OI_Volume_6_Issue_1 by Bennett Dilly

InsideOI Feature Story: Doc to Doc

Dr. Shea Discusses Plantar Faciitis Also: IOH Imaging Meet Our Work Comp Representitives

Volume 6: Issue 1

2011

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Quarterly Publication

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 will continue to offer our services to those who matter most in our practice: the patients. ®

Each quarter, we will focus on three of our sub-specialties. This issue features the latest information in the foot/ankle, trauma and total joint sub-specialties. Also in this issue, meet our Work Comp Representitives. 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 or by contacting one of our staff directly. We appreciate your feedback.

ON THE COVER OrthoIndy has six surgeons specializing in foot and ankle care. Dr. Shea provides information to referring physicians on plantar fasciitis (page 7).

Thank you for choosing OrthoIndy and IOH for all of your orthopaedic needs. Sincerely,

Kasey Prickel Editor Public Relations and Marketing Manager

Injuries aren’t always so bad...

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3 7 9

IOH Imaging

Imaging options for your patients

Ask the Doc

Dr. Shea discusses plantar fasciitis

Rave Review

Patient raves about Dr. Fisher

Joint Replacement

Dr. Kolisek provides an update on the latest in joint replacement

Learn more about OrthoIndy chat with us at: (317) 802-2000 or (800) 223-3381 or follow us on:

[Inside OI Staff] Referring Physician Representatives North/East Territories Kelly Keirns kkeirns@orthoindy.com (317) 268-3197

South Territory Amy Klesk aklesk@orthoindy.com (317) 884-5228 West Territory Adron Scott ascott@orthoindy.com (317) 802-2074 Work Comp Representatives John Orr jorr@orthoindy.com (317) 802-2131 Sarah Shackle sshackle@orthoindy.com (317) 802-2061 Contributing Writers Kasey Prickel Frank Kolisek, MD Michael Shea, MD Editor Kasey Prickel Graphic Design Kim Connett Marketing Director Jennifer Fox OrthoIndy

8450 Northwest Boulevard Indianapolis, IN 46278

email us at suggestions@orthoindy.com

1st Quarter 2011

Indiana Orthopaedic Hospital (IOH) 8400 Northwest Boulevard Indianapolis, IN 46278

IOH Imaging for your Patient’s Needs The IOH Imaging centers provide your patients with state-of-the-art imaging options. Our centers are equipped with the latest technology and are conveniently located to meet your patient’s imaging needs close to their home.

At our IOH Imaging centers, we offer:

• Advanced image testing at three locations for your convenience • Satellite radio is available to listen to during your MRI scan at all locations • Our south location offers a new technology in MRI scanning where earplugs are not needed • Our CT and MRI scanners have a larger opening than most • Advanced 3D post processing • CT and MRI contrast and non-contrast studies offered • Experience 5-Star patient care • Extended hours until 8 pm (locations and days vary, please call ahead) Imaging centers are located in our Northwest, South and West facilities. Each center features different types of equipment.

Northwest

At this location: • MRI (Siemen’s Symphony 1.5T) • Short bore magnet • CT (Toshiba Aquilian 16 slice) • Fast precision scanning • Dual head injector • Ultra Sound • Vascular and musculoskeletal exams

South

At this location: • MRI (Toshiba Vantage Atlas 1.5T) • Extra short bore magnet • Quiet scanning

West

At this location: • MRI (Siemen’s Symphony 1.5T) • Short bore magnet To schedule an appointment with one of our locations, please call: (317) 956-1050

OrthoIndy’s Newest Location in

North Vernon

Two OrthoIndy physicians are now practicing at St.Vincent Jennings to provide orthopaedic care to the residents of North Vernon.

Marsh’s practice focus is foot and ankle, general orthopaedics and sports medicine. Both physicians are fellowship-trained.

Drs. Brian Ludwig and Robert Marsh are now accepting patients four days a week on the third floor of St.Vincent Jennings, located at 301 Henry Street, North Vernon.

To schedule an appointment for a bone, joint or muscle condition at St.Vincent Jennings, please call (812) 352-4300.

Dr. Ludwig’s orthopaedic specialties include sports medicine, shoulder and general orthopaedics. Dr.

Gary Portage

La Porte

South Bend

Valparaiso

Auburn

Angola

Goshen

Plymouth

e ano pec p i T

Elkhart

Michigan City

Warsaw

Fort Wayne

Rochester

Huntington

Logansport

Decatur

Wabash

Peru

Marion West Lafayette

Kokomo

Lafayette

Elwood

Noblesville

Crawfordsville

Carmel

Richmond Greenfield Lawrence

Franklin

Greensburg

W hi t e

Columbus

Monroe Lake

Seymour

Ri ver Wab ash

Madison

Shoals

Washington

Jasper

Evansville

io Oh

Bloomington

Bedford

1st Quarter 2011

Shelbyville

Martinsville

Vincennes

Princeton

Anderson

Greenwood

Greencastle 70

Terre Haute

Muncie

Fishers

Indianapolis

Linton

Ri ve r

Frankfort

Patoka Lake

New Albany

Jeffersonville

er Ri v

Drs. Marsh and Ludwig

Receives National Recognition The Indiana Orthopaedic Hospital (IOH) is proud to announce that Press Ganey Associates, Inc. has named it a 2010 Summit Award Winner. IOH has received this award for the second year in a row for patient satisfaction.

“Our physicians and staff operate under the corporate vision of providing 5-Star superior service and I am so pleased to see that they are nationally recognized for their efforts.”

continues to maintain a high level of patient satisfaction over the past three years. Their efforts benefit the Indianapolis community and lead to improved delivery of health care.”

“IOH is honored to be awarded this honor for Jane Keller, chief executive officer at IOH the second year in a Press Ganey currently row,” said Jane Keller, partners with more than 10,000 health care facilities—including 50 percent of U.S. chief executive officer at IOH. “Since our opening in 2005, our hospital has been committed to providing the hospitals—to measure and improve the quality of their best outcomes, safety and high quality customer service care. The company’s databases are the largest in the industry, and allow facilities nationwide to benchmark their to each patient and their family members. Our physicians results against peer organizations. The Summit Award rec- and staff operate under the corporate vision of providing 5-Star superior service and I am so pleased to see that they ognizes top performing facilities that sustain the highest are nationally recognized for their efforts.” level of customer satisfaction for three or more consecutive years. IOH is one of 80 Press Ganey client facilities in the United States to receive this honor in 2010. For more information on the Summit Award and Press Ganey, please visit www.pressganey.com. Richard B. Siegrist, Jr., president and CEO of Press Ganey, noted, “We are proud partners of IOH, which

Meet OrthoIndy’s...

Work Comp Reps

The OrthoIndy Worker’s Compensation department has two individuals ready to assist employers, nurse case managers and adjusters to ensure the quickest and most efficient process when taking care of an injured worker.

Meet our Work Comp Representitives John Orr John’s primary responsibility is to act as a liaison between the OrthoIndy Work Comp (WC) department and the Worker’s Compensation Community, i.e. WC adjusters, Nurse Case Managers and Employers. He provides current information to these customers and gathers their input, sharing that information with the OI physicians and WC department. This information allows OrthoIndy to provide a smoother WC process for the patients, the insurance company, nurse case managers and the employer, as well as for the OrthoIndy staff. He is active in organizing speaking engagements for the OI physicians. These events are beneficial to the entire WC community, as OI physicians can share new surgery and treatment techniques with the WC community. It is also an opportunity for the WC community to use these talks for continuing education and to stay abreast of what new treatments are available. John uses his background of handling WC claims to provide input to the OI WC department, as well as assist in understanding the concerns of the WC community. Customer service is number one and he tries to make certain the WC process is as adjuster and nurse case manager friendly as it can be. John is a graduate of Noblesville High School and Ball State University. He worked as an insurance To speak with either Sarah or John, please contact them at:

John Orr: (317) 519-6722 or jorr@orthoindy.com Sarah Shackle: (317) 965-3284 or sshackle@orthoindy.com

adjuster for 18 years and has his Associate-In-Claims designation. He lives in Noblesville. Sarah Shackle Sarah is the newest member to the OrthoIndy Work Comp department. Sarah’s job responsibilities also include working closely with the OrthoIndy Work Comp department; however her focus outside OrthoIndy is building strong relationships with employers around the state. She works closely with HR representatives, Safety Coordinators, onsite nurses, onsite physicians, and work comp representatives. She is directly responsible for increasing work comp referrals while providing the link in the work comp community to answer questions, provide information, and to assist in anyway possible. Sarah’s customer service is unmatched and she is quickly becoming a go to person in the work comp community. Sarah has lived in Indianapolis her entire life and is very familiar with the area. She worked at MicroMed as a territory manager selling medical equipment for almost two years. No stranger to a team environment, she also served as a Women’s Basketball Coach at Indiana State University for one year, as well as a coach for the University of Indianapolis for three years. During her three years at the University of Indianapolis she also served as the head Strength and Conditioning Coach for the team. Sarah received her MBA, as well as her bachelor’s degree from the University of Indianapolis. As an undergrad, she was a member of the women’s basketball team from 2000 to 2004.

Doc

Doc We are proud to introduce our new section of Inside OI, “Doc to Doc”. Each quarter we will feature different sub-specialties and common injuries or conditions, providing a treatment plan.We hope the referring physician community will find this information helpful. This quarter Dr. Michael Shea, orthopaedic surgeon, specializing in foot and ankle conditions discusses plantar fasciitis. Plantar Fasciitis Plantar fasciitis is the inflammation of the plantar fascia at its attachment to the calcaneus. Individuals may have a spur (enthesapatly), but it is not related to pain. Plantar fasciitis is associated with calf tightness, obesity, flat feet and inflammatory disorders. Symptoms Include: • Plantar heel pain • Fatigue pain during the day • Start up pain in the morning Exam • Limited dorsiflexion of ankle • Pain at origin of planta fascia • No pain to medial-lateral compression as this rules out stress fracture • Imaging is usually not needed • Negative tinels at tarsal tunnel, this rules out neurogenic origin Treatment Protocol Each phase of treatment is four to six weeks before progressing on to the next phase. Phase 1 1. Calf and plantar fascia stretching three times daily for ten minutes 2. Over the counter orthotics 3. NSAID 4. Ice and massage 5. Reassurance this is self limited disorder Inside OI

Phase 2 1. Encourage continuation of stretching and phase 1 2. If flat foot – add custom arch support 3. If morning start up pain is present, add night splint 4. If fatigue pain is present without flat foot, physical therapy can be prescribed Phase 3 1. Custom arch and therapy if not tried in the first two phases

OrthoIndy Foot and Ankle Specialists:

David Brokaw, MD

Daniel Lehman, MD

Robert Marsh, DO

Mihir Patel, MD

Phase 4 1. Immobilization in fracture boot 2. Injections may be used if the patient is older or wanting a “quick fix”, but often temporary Phase 5 1. Rule out neuropaty with EMG 2. Rule out inflammatory arthritis with labs 3. Consider MRI if all are negative Dr. Shea is located at the OrthoIndy Northwest and West offices. Specializing in foot and ankle conditions, his practice focus includes: • Foot and ankle disorders • Treatment of disorders using surgical and non-surgical methods • Complex foot deformity • Reconstruction of deformities from trauma, arthritis, neuromuscular and congenital etiology

Timothy Weber, MD

At OrthoIndy, we have six orthopaedic surgeons who specialize in foot and ankle care. For more information, please call (317) 802-2000.

Michael Shea, MD Practice Focus

Locations

Foot and Ankle Disorders Treatment of Disorders Using Surgical and Non-Surgical Methods Complex Foot Deformity Reconstruction of Deformities from: • Trauma • Arthritis • Neuromuscular • Congenital Etiology

OrthoIndy Northwest 8450 Northwest Blvd. Indianapolis, IN 46278 OrthoIndy West 7950 Ortho Lane Brownsburg, IN 46112

To schedule an appointment with Dr. Shea, please call: (317) 802-2821

1st Quarter 2011

Rave Review OrthoIndy provides such great care, our patients can’t help but rave about it.

Patient and gymnast, Allison Saylor

Today, more than 193,000 total hip replacements are performed each year in the United States, according to the American Academy of Orthopaedic Surgeons. A majority of patients who undergo hip replacement surgery are 60 to 80 years old; however, some candidates for a hip replacement are much younger. According to Dr. David Fisher, an orthopaedic hip and knee replacement specialist at OrthoIndy and the Indiana Orthopaedic Hospital (IOH), a hip replacement is a wonderful procedure for people with disabling hip disease; however, there are other treatment options that should be tried before hand. “The average age of a hip replacement patient today is 67,” he said. “Younger patients are a particular concern because of 9

the longevity they have and the demand that will be placed on that artificial bearing. We continue to do research to find the optimum solution for these challenging clinical problems.” In younger individuals, it is extremely rare to undergo a hip replacement; however, there are some circumstances where the hip has been destroyed, there are secondary arthritic changes, pain and loss of function that require the surgery. When 13 year old, Allison Saylor came to OrthoIndy complaining of pain in her hip, she didn’t realize that she would be a candidate for a hip replacement at such a young age. “It is extremely rare for a patient that is Allison’s age to have a hip replacement, said Dr. Fisher. “In my 22 Inside OI

year career as a total joint specialist, I have treated less than 12 patients under the age of 18 with a total hip replacement.”

I would never get to do gymnastics again,” she said. “I also realized at that moment that I would never get to compete in college. I wasn’t scared of having the surgery, I was more relieved because I would be pain free.”

Allison Saylor started gymnastics when she was six years old because her mother thought it would be a good thing to Allison’s experience with “wear her out”. She Dr. Fisher and his staff “We knew he was the right immediately fell was extremely positive. in love with gym“My family and I loved doctor when he took the nastics. “I love the him from the moment time to research the best he walked in,” she said. individual competitiveness and team “He was very personable, type of hip competitiveness,” friendly and reassuring. said Allison. “I love His staff was also kind (picutred: cermaic hip similar to Allison’s) the bars. They were throughout the entire proalways the biggest cess. We knew he was the challenge for me right doctor when he took because of the release moves required and because I the time to research the best type of hip for me.” loved my coach and that is his specialty.” After surgery, Allison is completely pain free. HowIn December 2008, Allison started having some disever, because of her condition, she isn’t able to comcomfort in her hip. Her coach believed it was a pulled pete in gymnastics. According to Dr. Fisher, Allison muscle and she continued to compete; however, the physically may be able to perform gymnastic activipain persisted. In March of 2009, Allison had an MRI, ties; however, he has discouraged her from doing so to which indicated that she had a late developing condiprotect her artificial hip. “She will need regular follow tion known as Perthes disease and part of the ball in up throughout her life to monitor the function of her her hip was cracked. hip prosthesis, and may need additional surgery in the future,” said Dr. Fisher. Perthes is a term for Legg-Calve-Perthes disease, which is a disorder of the blood flow to the femoral While Allison has had to readjust to normal everyday head in children between the ages of two and 13. activities and give up a sport she loves, a year later, The exact cause of the disease remains unknown and she now lives pain free and has a job teaching younger therefore, physicians don’t know how to prevent the children at the gym she used to practice. She has also disease from affecting the hip. Symptoms include the found new sports to love, such as diving and possibly gradual onset of a painless limp that progresses over cheerleading. She is living pain free because of her several weeks. Hip pain is usually felt in the groin, in- hip replacement and she is very appreciative for all the ner thigh or knee. Reduced range of motion in the hip support during her treatment. “I just want my family to may be seen from inflammation of the hip. know how much I appreciated their support and care throughout the whole process. They were awesome, Allison’s condition created many challenges for her especially my Acros Gymnastics family.” sport and every day life. She was not able to run, making it difficult to compete in vault and a tumble pass for her floor routines. Running wasn’t the only challenge; she started walking with a limp and was in constant pain.

for me.”

To treat Allison’s condition, Dr. Fisher decided she needed a hip replacement. Allison’s initial reaction to the news was hard. “I cried a lot because I was told 1st Quarter 2011

Allison and Dr. Fisher after her surgery 10

Joint Replacement

Moving Forward By: Frank Kolisek, MD

Joint replacement surgery has come a long way in the past 50 years. Initially joint replacement procedures were reserved for the older and less active patients. Nowadays, these procedures are offered and are successful in younger and more active patients. Much of this can be attributed to advances in implant design and in bearing surface technology. Early on, implants would often loosen from the patientâ&#x20AC;&#x2122;s bone, especially in the more active patients, before we saw any signs of wear of the prosthesis. It was after we improved the fixation of these implants that we then noticed that they can actually wear out. Bearing surface technology has now advanced to the point where we expect most of these implants to function 11

well over 20 years, even in the more active patients. Attention was then directed to surgical techniques whereby we tried to implant these prostheses with the least amount of soft tissue disruption possible. The whole idea is to allow patients to return to their normal activities sooner by using soft tissue sparing surgical techniques. It was during this time that advanced anesthetic techniques were introduced, again allowing patients to get up and moving sooner and actually going home one to two days after surgery. Rapid rehabilitation programs were also introduced, allowing patients a quicker return to their usual activities. Personally, now that I have been using these soft tissue sparing surgical techniques for the past ten years, I have seen Inside OI

my patients who play golf, actually playing at four to five weeks after surgery compared to seven to eight weeks ten years ago.

and the current implant designs require us to remove the ACL in order to insert the new knee and the design of the new knee substitutes for the removed ACL. Much design work is being done so we can implant a new knee while leaving a well functioning ACL intact. The hope is that this will allow patients to experience a more normal feeling knee after joint replacement surgery, especially with higher activity levels.

Today, much work is being done in cutting technology, implant sizing and patient specific functional positioning. I have been doing computer assisted surgery for over seven years. This allows me to confirm the position of the patient’s prosthesis in the operating room so I can The field of joint remake fine tuned placement surgery is exadjustments citing and continues to immediately beimprove with time. My fore I finish the hope is that advances in operation. We technology will conare also worktinue as it has in the past ing with robotic so that we can continue technology so to improve surgical we can prepare techniques, implants and the bone more patient outcomes. Hopeaccurately. fully, the healthcare Furthermore, changes in the United we are trying to States will not bring combine robotthis to a screeching halt ics with navias someone has to pay - Frank Kolisek, MD gation so we for these technological can place these advances. Hospitals implants with even less soft tissue disruption and also will not be able to afford, and therefore offer, the latest place the implants more along the patient’s functional advances in technology if the Government and insuraxis rather than an anatomic axis as each patient is ance companies refuse to pay for it. There may come a unique. We hope this will give patients a more natural time where patients may have to pay more for adfeeling joint. vanced technology, as they do in some other countries. Many patients have a functioning anterior cruciate lig- Time will tell. ament (ACL) at the time of joint replacement surgery

“The field of joint replacement surgery is exciting and continues to improve with time. My hope is that advances in technology will continue as it has in the past so that we can continue to improve surgical techniques, implants and patient outcomes.”

Frank Kolisek, MD Practice Focus

Locations

• • • • •

OrthoIndy South 1260 Innovation Pkwy Suite 100 Greenwood, IN 46143

Partial Joint Resurfacing Total Joint Replacement Hip and Knee Arthritis Surgery Computer Assisted Surgery Soft Tissue Sparing Minimally Invasive Surgery • President OrthoIndy 2005-present

OrthoIndy at St.Vincent Indianapolis 8402 North Harcourt Road Indianapolis, IN 46278

To schedule an appoint with Dr. Kolisek, please call: (317) 884-5160 12

STUDIES

Studies Currently Enrolling... The Orthopaedic Research Foundation, Inc. (ORF) supports various research and educational interests of the physicians at 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.” The ORF is enrolling the following studies.

Study Title

Participating Investigator

Study Synopsis

Status

Contact Person

Contact

Investigating the use of a cryopneumatic therapy device in primary total knee arthroplasty patients

Joseph Randolph, MD

A randomized, controlled study to determine the effectiveness of the cryopneumatic therapy device vs. the standard ice bag

Enrolling

Darrell Whinnery, PA-C

(317) 8022040

Ascension® PIP Pyrocarbon Total Joint Arthroplasty

Timothy Dicke, MD

Humanitarian Use Device-Used to track safety and effectiveness of the device

Enrolling

Kathy Williams, RN

(317) 8022052

A Prospective, Comparative, Randomized, Double Blind, Multi-Center Study of the Uniglide Mobile Bearing Unicondylar Knee System vs. Uniglide Fixed Bearing Unicondylar Knee System

David Fisher, MD

This a randomized study to compare a mobile bearing to a fixed bearing for uni knee replacement.

Enrolling

Mary Burgess

(317) 8022853

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

Frank Kolisek, MD

Post-market study to track long term effectiveness the larger femoral head with the polyethylene insert

Enrolling

Charles Jaggard

(317) 8845232

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

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

Enrolling

Dana (317) 917Musapatika, 4117 MSc

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

Joseph Baele, MD

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

Enrolling

Dana (317) 917Musapatika, 4117 MSc

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

Joseph Riina, MD

The DIAM™ Implant is a small, soft interEnrolling spinous process spacer inserted between two spinous processes to stabilize the spine at the diseased level between L2 and L5.

Kim Fitzpatrick

(317) 8022851

A Multcenter, 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

Jack Farr, MD

A multicenter study to evaluate how the CAIS treats knee articular cartilage lesions.

Enrolling

Vicki SnodgrassMiller, CCRC

(317) 8845230

Evaluation Outcomes After Standard of care Operative and Non-operative Management of the Knee 20 Year Follow-up

Jack Farr, MD

This study is a long term follow up for the surgical management of the knee.

Enrolling

Vicki SnodgrassMiller, CCRC

(317) 8845230

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

Jack Farr, MD

Collection of discarded surgical specimens that then placed into a tissue bank for use.

Enrolling

Vicki SnodgrassMiller, CCRC

(317) 8845230

Inside OI

Each quarter, OrthoIndy will focus on three sub-specialties, allowing referring physcians and the work comp community to become more familiar with our physicians. This quarter’s sub-specialties include: foot and ankle (for more information, see page 8), total joint and trauma. OrthoIndy’s Total Joint Specialists

Robert Clayton, MD

Daniel Dro, MD

David Fisher, MD

Edward Hellman, MD

Timothy Hupfer

Benjamin Justice, MD

To schedule an appointment, please call:

(317) 569-2511

(317) 569-2512

(317) 802-2828

(317) 802-2844

(317) 802-2839

(317) 884-5169

David Kaehr

Frank Kolisek, MD

Michael Kramer, MD

Dean Maar, MD

Eric Monesmith, MD

D. Kevin Scheid, MD

To schedule an appointment, please call:

(317) 917-4367

(317) 884-5160

(317) 268-3635

(317) 917-4361

(317) 884-5166

(317) 917-4363

OrthoIndy’s Trauma Specialists

Joseph Baele, MD

David Brokaw, MD

Renn Crichlow, MD

Timothy Dicke, MD

Gregory Dikos, MD

Bradley Jelen, DO

To schedule an appointment, please call:

(317) 917-4360

(317) 917-4388

(317) 917-4384

(317) 802-2808

(317) 917-4370

(317) 917-4368

David Kaehr, MD

Dean Maar, MD

Greg Reveal, MD

D. Kevin Scheid, MD

Terry Trammell, MD

Timothy Weber, MD

To schedule an appointment, please call:

(317) 917-4367

(317) 917-4361

(317) 917-4389

(317) 917-4363

(317) 802-2885

(317) 917-4369

1st Quarter 2011

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8450 Northwest Blvd. Indianapolis, IN 46278