Tucson Orthopaedic Institute 2019

SPECIAL REPORT 2019

THE REGION’S BUSINESS MAGAZINE

TUCSON ORTHOPAEDIC INSTITUTE

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PHOTO: BRENT G. MATHIS

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Paula Register Hecht

CEO Tucson Orthopaedic Institute

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34 PHYSICIANS, 8 LOCATIONS

Tucson Orthopaedic Institute 25 Years Strong

PHOTOS: BRENT G. MATHIS

By Mary Minor Davis When Tucson Orthopaedic Institute was established in May 1994 with 14 general orthopaedic surgeons on the Tucson Medical Center campus, no one could have foreseen the meteoric rise that would launch the institute into a leading orthopaedic care center that serves patients from all over the world.

One key driver for creating TOI still remains a key driver today – the focus on developing sub-specialty care, tapping into expertise across all orthopaedic areas. Today, TOI has 34 physicians and surgeons on staff, ranging from general orthopaedics to specialists in total joint replacement, hand and upper extremities, foot and ankle, spine and pain care, pediatric surgery, sports medicine and non-surgical medical treatment.

TOI also has grown from one location to eight between Oro Valley and Green Valley, plus the Douglas-Bisbee area. From pediatric to geriatric care, TOI has developed its orthopaedic bandwidth to ensure each patient receives the right treatment customized to his or her needs, in a location convenient to home.

“We came from strong surgeons, strong roots and for all the right reasons,” said Paula Register Hecht, CEO of TOI. “Our physicians, therapists

and staff work collaboratively together in the care of our patients.”

Dr. Joel Goode is a specialist in hand and upper extremities. He said, “The best thing that TOI has done is focus on offering sub-specialties. If you come here for a problem with your shoulder, you’re going to see a specialist who works only with shoulders – not someone who does a hip replacement one day and shoulders the next. Their focus is your problem.”

The same is true for all areas within TOI. In sports medicine, you’re most likely to be treated by a physician who once was an athlete as well, providing you with a specialist who has been in your place.

To stay ahead of trends in orthopaedics, TOI launched its own research center in 2002, headed by Dr. Nebojsa Skrepnik. The in-house resource allows TOI specialists to track the latest trends in joint replacement, nonsurgical treatments in the regenerative medicine arena, and what is working in new and innovative treatment options around the world.

For example, Dr. Jeffrey Baron, a spine and pain specialist, said the more traditional spine surgery techniques still seem to be the standard, although there is research out there to try to do spine

replacement.

“We hope to be able to have the replacement technology that we have in joints,” he said. “The problem is the architecture of the spine is very complex.” He said for disc replacement there has been some replacement procedure done in cervical joints – but research is finding that the efficacy of outcomes is about the same as traditional fusion procedures.

TOI has also added physical therapy services to its menu. Now with five locations throughout Tucson – and plans for growth in 2019, Hecht said – patients can have care from diagnosis through recovery in convenient locations.

TOI also launched an after-hours orthopaedic care center that operates six days a week and may expand to seven days in 2019.

“From where we started, we’ve only grown and enhanced what we can offer patients. Our growth focuses on the needs of our community – and that is what matters the most,” Hecht said.

Growth is not without its financial challenges, and TOI is constantly seeking ways to manage its costs.

“TOI is not unlike any other large employer and we struggle to meet the demands of affordable healthcare, not just internally with employees, but also continued on page 136 >>>

1. Founders, Dr. Scott Slagis, Dr. John Wild, Jr., Dr. Lawrence Housman 2. Front row – Dr. Natalie Hua, Dr. Russell Cohen, Dr. Nebojsa Skrepnik; Back row – Dr. Jeffrey Baron, Dr. Scott Goorman, Dr. Todd Tucker 3. Dr. Stephen Curtin, Dr. Brian Nielsen 4. Dr. Joel Goode, Dr. John “Jesse” Wild, III

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Joint Replacement & Revisions By the Numbers Hip & Knee The number of total hip and knee joint replacements and revisions is projected to increase by 150 percent or more by 2030 – and more than 300 percent by 2060.

By 2030 total hip replacements (THA) will increase 171 percent to 635,000 and primary total knee replacements (TKA) up to 189 percent to 1.3 million. Similar gains are expected for hip and knee revisions – up to 142 percent (72,000 procedures) and 190 percent (120,000 procedures).

By 2060, primary THA is expected to reach 1.23 million (330 percent increase) and primary TKA is expected to reach 2.60 million (382 percent increase). Hip revision surgeries are expected to reach 110,000 (219 percent increase) and knee revision surgeries 253,000 (400 percent increase).

Source: American Academy of Orthopaedic Surgeons, March 2018 Foot & Ankle A report by the Agency for Healthcare Research and Quality, an arm of the Department of Health and Human Services, cited 4,435 “hospital encounters” or discharges involving total ankle replacements in 2014.

Shoulder Joint Every year approximately 53,000 people in the United States have shoulder replacement surgery.

Source: Agency for Healthcare Research and Quality

continued from page 135 in keeping costs affordable for patients,” she said. “Costs are up, alongside decreased healthcare revenue. We are constantly working to offer better care and outcomes at a lower cost. Our focus is on value-based healthcare.”

Goode said this is contingent upon the physicians being prudent in making decisions with patient care.

“We as doctors have to do what’s right and necessary and not be conservative at the expense of our patients – while at the same time understand if we send a patient for an MRI, it may cost that patient $500 so we need to be prudent when making those decisions,” he said.

Dr. Christopher Stephens, another TOI hand and upper extremity specialist, also sees managing healthcare costs as one of the greatest challenges in healthcare going forward. He is one of the few surgeons who does carpal tunnel procedures in the office, when appropriate, as opposed to the traditional hospital or surgery center setting. He said that reduces the overall cost of care.

“Think about all that you have to go through and all of the people involved with this procedure when it’s done in a hospital,” he said. “Schedulers, lab staff, nurses and doctors, IVs, the cost of the hospital or surgery center – it’s expensive.

In a clinic, it’s the cost of the procedure and nothing else. We are saving hundreds of thousands of dollars – and I’m just one physician doing it.”

Across the board, the greatest challenge faced in orthopaedic care today is that the need for treatment far outweighs the number of specialists available to treat those needs. According to the Arthritis Foundation, osteoarthritis disease is the most common disease in adults – affecting 30.8 million people. It is fifth among all diseases in the world. It is the most prevalent of all musculo-skeletal pathologies in the world, affecting approximately 10 percent of the world’s population over the age of 60. It is the leading cause of degenerative breakdown in the joints.

Given the aging population, the demand for orthopaedic care will outweigh the supply of specialists. According to a recent report by the American Academy of Orthopaedic Surgeons up to 2016, more orthopaedic surgeons are likely to specialize than they were in 2011 with 58 percent reporting specialization. This will help meet the growing demand, but other challenges remain in the shortage of “physician extenders,” said Dr. Lawrence Housman, one of TOI’s founders.

“The use of physician extenders – physicians’ assistants, nurse practitioners and registered nurses – is growing. These are well-trained medical professionals that can serve patient expectations by seeing them faster, ordering tests and even making diagnoses,” he said.

However, Hecht, who serves on the Pima Community College Foundation Board, said Arizona is one of the leading states facing a shortage of medical professionals in all areas of their operation. In addition to working with Pima Community College, she is also representing TOI on the board of directors for the Tucson Metro Chamber in an effort to address these recruitment challenges “It’s definitely a community-wide challenge,” she said. “I believe things work best when everyone stands together.”

Along with these challenges moving forward, Hecht said there is also great opportunity as TOI continues to build its subspecialty roster and focus on the quality of care they provide. More non-invasive procedures – including arthroscopy, robotics and regenerative medicine – continue to introduce new and innovative ways to treat patients, providing lower cost impact to the national healthcare system and excellent patient outcomes.

“I believe in our group and in the excellent care we provide,” she said. “We all enjoy seeing our patients leave and return to the life they love – healthy and active.

We’re so grateful for our patients who entrust their care to us.”

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1. Dr. Scott Evans, Dr. Eric Anctil 2. Front – Dr. Stephen Hanks, Dr. Steven Shapiro; Back – Dr. John Maltry, Dr. William Prickett 3. Front – Dr. Troy Taduran, Dr. Geoffrey Landis; Back – Dr. Christopher Stevens, Dr. Kevin Bowers 4. Dr. Steven Zeiller, Dr. Edward Petrow, Jr. 5. Dr. Tad DeWald, Dr. Gerard Jeong 6. Dr. Jose Alicea, Dr. Suezie Kim, Dr. Bradley Norris 136 BizTucson

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GETTING PATIENTS BACK IN THE GAME

Sports Medicine

From youth sports enthusiasts to professional athletes on the field, the specialists in sports medicine at Tucson Orthopaedic Institute are poised to provide the most comprehensive care to make sure their patients get back in the game.

TOI’s sports medicine team works with patients from injury through physical therapy and return to activity, said Dr. William Prickett. With the evolution of surgical techniques and rehabilitative efforts, patients are getting moving even faster.

“Many surgical procedures are able to be done arthroscopically with minimal invasion to the patient,” Prickett said. “This helps with faster recovery and reduces risks associated with surgery. They have also made repairing and reconstructing older athletes more practical.”

In addition, Prickett said, more preventative measures are being taken today to prohibit injuries before they occur. “Through exam and analysis of history, we can put patients who present the possibility of injury through a training program in advance of competition. If we find they have a propensity for an injury, we can offer physical therapy to strengthen the area or joint.”

One of the more common things Prickett sees in youth sports is overuse injuries from specializing in a single sport. “Kids used to participate in different sports throughout the year and now they are tending to focus on one sport” and often one activity within that sport, he said. “Pitching in baseball is one example.”

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“weekend warrior” who only engages in an activity or sports a couple of times a year.

While sports injuries can occur to any part of the body, orthopaedic sports medicine physicians most commonly repair ankles, knees and shoulders.

They also provide guidance regarding injury prevention, heading off overuse syndromes or ACL injuries, suggesting helpful nutrition tips and making sure that beginning players understand their own anatomy which are all part of the “game plan” in sports medicine.

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Patients are seeing less pain and risk, less medications, reduced down time and just overall faster recovery.

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Dr. William Prickett Surgeon Tucson Orthopaedic Institute –

“The best treatment of sports injuries is prevention,” said Dr. Todd Tucker, a sports medicine surgeon at TOI. “The best ACL surgery is the one that never has to happen. There are proven ways to identify athletes at risk for injury and then to modify their risks, commonly with physical therapy and simple training to lower their risk of injury.”

Prickett said many physicians prac-

ticing sports medicine have been athletes themselves. He was a quarterback for the University of Arizona in the early 1990s. Tucker was a college volleyball player.

TOI physicians work with athletic trainers and coaches for youth sports, college and professional sports teams throughout the nation. They are also a partner in the STOP Sports Injuries campaign developed by the American Orthopaedic Society for Sports Medicine to prevent overuse and trauma injuries among young athletes.

“Unfortunately, sometimes injuries do happen and when they do, it is important to have the right team to get back in the game,” Tucker said. “The best way to optimize recovery is a team approach coordinating care with the patient, trainers, therapists, and surgeon. Building a team with excellent communication and a common goal gives people a head start on the road to recovery.”

While surgical techniques and rehabilitative efforts have made repairing and reconstructing injuries more practical, other improvements including advances in imaging and less invasive surgical procedures have improved patient outcomes significantly.

“Patients are seeing less pain and risk, less medications, reduced down time and just overall faster recovery,” Prickett said.

Looking forward, the next generation of care will be from regenerative medicine, he said, including platelet-rich plasma and regenerative biologics.

“We’ve only touched the tip of the iceberg in these treatments,” he said.

“The benefits of a multidisciplinaryapproach in athletes provides benefits across the board.”

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PHOTOS: COURTESY TUCSON ORTHOPAEDIC INSTITUTE

By Mary Minor Davis

Dr. Todd Tucker

Dr. A. Mark Braunstein

PHOTO: BRENT G. MATHIS

Dr. Domingo Cheleuitte

Dr. John Wild, Jr.

Dr.www.BizTucson.com Tad DeWald

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ALTERNATIVE THERAPY AND TREATMENTS CAN HELP

Non-Surgical Care

By Rodney Campbell

Physical therapy

Physical therapy is often the first step toward a patient’s recovery. Medical studies are showing that physical therapy can sometimes be as effective as surgery and a much safer option.

Bodies are designed to heal themselves of certain conditions, given the proper treatment options and nutrition.

Treatment can be customized for patient needs and challenges.

“I start with getting patients in with a physical therapist,” Dr. Tad DeWald said. “They are tremendous. It’s my goto with almost any problem.”

Sometimes, physical therapy is prescribed to prepare a patient for surgery.

Surgeons want people to be in the best possible condition before they enter the operating room.

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“My mentor said surgery outcomes are 50 percent the surgical technique and 50 percent physical therapy,” DeWald said.

Regenerative medicine

TOI offers dextrose prolotherapy, platelet-rich plasma and stem cells to treat some conditions. All are injections and include natural substances or material from the patient’s body.

DeWald has a special focus and training in regenerative medicine. The majority of his work is done with patients who have arthritis or tendonitis, conditions that respond well to his care.

“I go over the benefits, risks and alternatives for every type of procedure or suggested surgery,” said DeWald, who also serves as team physician for two local high schools and the Tucson Roadrunners hockey team. “The field of orthobiologics has grown rapidly with safe alternatives to surgery when appropriate.”

When patients require surgery, injections can serve as a bridge between relentless pain and the operating room.

“We hope to avoid surgery or push it back,” DeWald said. “The field is really expanding. Five or 10 years ago, patients didn’t have this option.”

Osteopathic manipulative treatment (OMT)

There are times when a doctor of osteopathic medicine has to get in touch with where a patient’s pain is originating. Using osteopathic manipulative treatment, the doctor moves a patient’s muscles and joints using innovative techniques.

Dr. Troy Taduran is TOI’s go-to guy for OMT. He sees patients going through issues from head to toe.

“The majority of patients I see do well,” said Taduran, who’s a team physician for two local high schools and an orthopaedic consultant for the University of Arizona. “I’ve had a lot of patients who go through traditional treatment unsuccessfully and I’m still able to help them. These are patients who often have lost hope. I really enjoy that challenge.”

Ultimately, what every physician wants to do is improve the patient’s quality of life. Some get there through injections or physical therapy. Taduran practices the hands-on approach.

“One of the most gratifying things is being able to effect someone’s pain successfully,” Taduran said. “Manipulation is a powerful but safe tool. I’ve been lucky to find this niche.”

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PHOTO: COURTESY TUCSON ORTHOPAEDIC INSTITUTE

People who go to Tucson Orthopaedic Institute are looking for the best way to control their pain – which often requires surgery and significant downtime.

Fortunately, TOI also has many nonsurgical options that reduce risks, avoid opioids and allow patients to resume active lifestyles with minimal or no interruptions. Most often, these types of treatment involve injections, hands-on treatment or physical therapy.

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TOI CENTER WORKS TO DISCOVER OPTIONS

Research for Better Treatments

Medical research is critical to improving the quality of life for patients suffering through musculoskeletal issues. In Southern Arizona, Tucson Orthopaedic Institute is an organization that makes research an integral part of its mission.

Led by Dr. Nebojsa Skrepnik, director of the TOI Research Center, the center participates in studies to advance developments in orthopaedics, new devices, procedures and tools, pain management and research with disease-modifying agents and stem cell stimulation.

Skrepnik has been director of research since 2002. In that time, the center has conducted almost 300 clinical research studies with pharmaceutical and device companies. That’s an average of about 18 per year and new advancements are constantly cropping up.

“It’s evolving as we speak,” Skrepnik said. “I’m reviewing a protocol about stem-cell injection in the shoulder. It’s going to be one of the first prospective clinical trials for stem cells in the shoulder to repair tendons and ligaments. We also have studies with new molecules able to stimulate stem cells already present in the cartilage or below in bone marrow of the knee.”

The center has come a long way in the past two decades. When Skrepnik took over, its main purpose was to conduct follow-up calls with patients at set intervals – three months, six months, a year. The questions often revolved around whether patients had to return for further medical care after surgery – what Skrepnik calls “typical outcome studies.”

Skrepnik saw untapped potential for TOI to play a role in advancing procedures that do not involve an operating room.

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“My interest in joining TOI was the size of the group and the kind of research we could implement,” Skrepnik said. “From an orthopaedic standpoint, it was fantastic. I just needed to figure out their goal. Mine was simple – to create the best orthopaedic research group in the country. If you don’t strive to be the best, you’ll never accomplish anything.”

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Osteoarthritis is a painful disease.

Some physicians want to start prescribing opioids.

Our surgeons are careful about that.

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– Dr. Nebojsa Skrepnik Research Center Director Tucson Orthopaedic Institute

TOI physicians often work with patients who are suffering from osteoarthritis, the most common form of arthritis. It affects millions of people worldwide and happens when the protective cartilage on the end of a bone wears down over time. It most commonly affects joints in the hands, knees, hips and spine.

“Osteoarthritis is a painful disease,” Skrepnik said. “It’s cyclical. It comes and goes. Some physicians want to start prescribing opioids. Our surgeons are careful about that. Opioids can create addictions.”

Instead, research studies conducted at TOI explore the use of nervegrowthfactor (NGF) antibodies that block pain without side effects often caused by opioids.

“We have a couple of great studies with NGF antibodies,” Skrepnik said.

“These antibodies won’t make you nauseated, constipated or addicted. We started working with NGF antibodies in 2008. We enrolled more than 300 patients in Tucson over that period. Controlling pain with one simple under-theskin injection per month without side effects and addiction is priceless.”

Organizations like TOI start clinical studies in the second phase of development, after initial rounds on smaller groups of patients are conducted. Then they follow through with the third phase of clinical trials. Most potential drugs fail during the first round. Skrepnik said only about 3 to 5 percent make it to clinical studies. Phase II usually includes between 150 and 200 patients.

On average, drugs that make it to market spend around a decade in testing before they are approved by the Food and Drug Administration.

Skrepnik and his team work with TOI’s physicians to determine when patients are good candidates for studies.

They meet individually with potential participants before studies begin.

“Many patients who have been coming to TOI for years don’t realize we have a research center,” Skrepnik said.

“I encourage patients to talk to their orthopaedic surgeons. Our strength as a research center comes from our surgeons and their practices. We always have new interesting drugs and procedures.”

To find out about current studies and see if you are eligible to participate, call (520) 784-6482.

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By Rodney Campbell

Medical research is critical to improving the quality of life for patients suffering through musculoskeletal issues

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Dr. Edward Petrow

DEMAND WILL CONTINUE TO RISE EXPONENTIALLY

Total Joint Replacements

Joint replacement – also known as arthroplasty – is one of the most common elective surgeries in the nation and the specialists at Tucson Orthopaedic Institute predict demand will continue to rise as the population ages and technology allows for greater access to procedures.

According to the American Academy of Orthopaedic Surgeons, there were 370,770 total hip replacements and 680,150 total knee replacements in 2014. Nationally, the number of total and partial shoulder replacements increased from about 18,000 in 2000 to more than 45,000 in 2013 and is expected to go as high as 60,000 by 2025.

A new study released in March by the AAOS at its annual meeting estimates that hip and knee joint replacements and revisions will increase by 150 percent or more by 2030 – with increases of more than 300 percent by 2060.

“We are seeing an explosion of people wearing out their knees and hips,” said Dr. Kevin Bowers, a specialist in total joint replacement at Tucson Orthopaedic Institute’s Oro Valley location.

“The demand for what we’re doing just keeps going up.”

Even as the demand increases, the age of patients receiving joint replacements has gone down, he added. Reasons for this include active adults wearing out joints sooner, trauma or birth defects that need to be addressed.

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According to TOI specialists, improvements to the plastics used in manufacturing artificial joints has been one of the greatest improvements, allowing for greater longevity. “On average, artificial joints have lasted 20 to 25 years, but we are seeing patients with replacements that are even 30 years old. Orthopaedics is about longevity – so we won’t know how well the new plastic lasts until another 20 years or more.”

Two areas that are going to set the stage for the future of joint treatment are in the areas of technology and regenerative procedures.

Dr. Russell Cohen is a self-described “avid user” of the robotics technology for knee and hip replacements. Dr. John Maltry, a surgeon at TOI’s Northwest location, has also used robotics as well as other minimally invasive procedures on patients in their 40s. “All of us are aggressively involved in using the latest technologies to try to improve the outcome for our patients,” he said.

Robotics procedures have also made partial knee replacements much more accessible. “About 10 percent of my procedures are partial knees,” Cohen said. “Robotics has allowed us to spare part of the joint.”

Overall, robotics and other minimally invasive procedures allow for lower risk, faster recovery and more exact placement of the joints. “Robotic technology allows us to change the percep-

tion of how we place joints. It allows us to customize the joint placement to each patient,” Cohen added.

Cohen said that they are now able to do joint replacements on an outpatient basis, with patient recovery taking place at home. “More patients than ever before seem to be doing better earlier.”

“The field of arthroplasty is going through a renaissance,” said Dr. Edward Petrow, whose specialty at TOI is hip and knee replacement. “The addition of robotics has given us the ability to place implants within 1 millimeter of our target. Robotics combined with 3-D printed materials and improved bearing surfaces offers patients a very reliable and durable operation that will likely last them their lifetime.”

From its inception 25 years ago, the heart of TOI’s mission is providing state-of-the-art total joint care by offering specialists in all areas. As new technology and treatments become available, this diversity of specialty care will continue so it can meet the rising demand that lies ahead.

“TOI to this point exists so that we can provide relatively cost-effective orthopaedic care to our patients,” Maltry said. “We have general orthopaedic physicians and we have specialists in just about every area of orthopaedics that serve patients throughout Southern Arizona and around the world.”

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By Mary Minor Davis

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We are seeing an explosion of people wearing out their knees and hips. The demand for what we’re doing just keeps going up.

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Dr. Kevin Bowers Total Joint Replacement Specialist Tucson Orthopaedic Institute –

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Dr. Eric Anctil

Dr. Geoffrey Landis

CONSTANT IMPROVEMENT FOR BETTER OUTCOMES

Feet and Ankles

PHOTOS: COURTESY TUCSON ORTHOPAEDIC INSTITUTE

By Mary Minor Davis Dr. Geoffrey Landis specializes in foot and ankle conditions at Tucson Orthopaedic Institute. He and his four colleagues provide care for all areas of the ankle and feet – ranging from fractures to plantar fasciitis. In recent years, Landis says they have added both total ankle arthroplasty (TAA) and big-toe implants.

The global market for foot and ankle implants and devices was expected to reach $4.7 billion by the end of 2018, according to an article in Micro Market Monitor. An aging population, increase in sports injuries and diabetes are some of the major contributing factors to the growth.

Total ankle arthroplasty has been performed since the 1970s but has become more common since 2005.

“In my opinion, a foot and ankle orthopaedic surgeon can give you the very best opinion and options for your care,” said Dr. Eric Anctil, a foot and ankle surgeon with Tucson Orthopaedic Institute.

“We’re in the third generation of www.BizTucson.com

ankle replacements,” Landis said. “The newer generation of materials used in ankle implants finally received FDA approval at that time. There are now improved outcomes and lower failure rates.”

A report published in the National Institutes of Health National Medical Library analyzed the efficacy and failure rate of TAA. The study looked at the total number of procedures performed in the United States between 2005 and 2012 in patients 65 to 85 years of age. The study concluded there was a 20 percent failure rate of the total 7,181 procedures performed, which is consistent with studies done in other countries.

Another area that has seen tremendous improvement in patient outcomes is the adoption of big-toe implants to manage joint pain. According to the Centers for Advanced Orthopaedics, osteoarthritis in the big toe is the No. 1 form of foot arthritis, affecting 2.5 percent of the population. The traditional fix has been to fuse the joint, which of-

ten relieves the pain, but limits the toe’s range of motion. Landis said TOI adopted the procedure following research published out of Canada.

“It’s really evolved quickly,” Landis said. “Previous implant material included silicone and metal, both of which can break down the bone. Today’s implants are made of the same biocompatible material as contact lenses, so they are much safer and produce better outcomes.”

Landis said the foot and ankle team is also looking at regeneration techniques that include amniotic membrane injections. Amniotic membrane, which is rich in stem cells, can help repair worn out, damaged tissues in joint conditions, osteoarthritis, tendinopathies and other inflammatory diseases.

“Between our own research center and following research throughout the world, TOI has done a good job of making sure we have paid attention to the needs of the community and that we’ve got the expertise to address those needs,” Landis said.

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Dr. Steven Zeiller

PRESCRIBING RELIEF FROM PAIN

Getting Patients Back to ‘Normal’

By Lee Allen Over the past quarter of a century Tucson Orthopaedic Institute has become Southern Arizona’s largest multispecialty orthopaedic group urging those in need to “get back in the game with comprehensive care from a team of trusted experts.”

No matter where an injury happened or how, their medical specialists fix banged-up elbows, hands, shoulders, feet and ankles – everything right up to total joint replacement – at eight area locations.

They offer a no-appointment, walkin clinic for acute injuries, and their testimonials are numerous from grateful patients who showed up in pain and found relief.

One of those is competitive distance runner Dan Heston of Marana, who extols the virtues of TOI doctors. During the work day, he shows homeowners how to build outdoor kitchens and fireplaces. When not doing that, he’s running – competitively, frequently and for long distances.

That was until he went on a dimly lit construction zone – an ill-conceived trip for an experienced runner of 30 years – that sent him to the TOI orthopaedic specialists with torn tendons after tripping through an unseen excavation.

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drugs and opted for physical therapy,” he said. “After just a few visits, I was back training and running 50 to 60 miles a week. Physical therapy can do wonders for the human body.”

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Our patient stories provide essential feedback as we work every day to improve our care.

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– Dr. Andrew Mahoney Tucson Orthopaedic Institute

He should know something about the mind over body equation because he pushes his body so hard. “I like to see how hard I can push myself physically and although you break your body down pretty good, I don’t feel I’ve

reached a stopping point yet. In fact, that injury came shortly before one of my best runs – a 26-hour, 106-mile distance run that ended as the national anthem signaled the start of the El Tour de Tucson bike race.”

Dr. William Prickett and colleagues at TOI may have to prepare Heston a frequent-patient card as he recently expended himself a bit too hard in the gym and tore muscles so badly he couldn’t walk. “This time, they put me in a boot, added some meds and exercises, and got me rehabbed and back on the road again so I could finish a marathon run down Mount Lemmon.”

Ronnie Grate, a fitness specialist at Grate Performance Training and a member of the Canyon Ranch Fitness Team for more than 20 years, got to know Dr. Russell Cohen and the concept of robotic hip replacement when several decades of running and jumping workouts brought him more pain than pleasure.

“I love what I do in helping clients achieve their goals – but the initial pain was slowing me down,” he said. “It was getting progressively worse. I’d be walking and out of the blue the pain would be so bad, I’d have to stop before I could take another step.”

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BizMEDICINE continued from page 150 with him. When the hip pain didn’t go away and began to affect his job, he remembered one of his workout sessions was called “No Excuses” and he took his own advice.

X-rays showed a worn-out hip joint that made him a good candidate for Cohen’s specialty of minimally invasive and more accurate robotically assisted hip replacement. And because postrehab physical therapy to strengthen while recovering is one of Grate Performance Training’s specialties, he could take advantage of his own expertise to get himself back up to speed.

Now very familiar with the terms “titanium” and “ceramic” and with a full post-op range of motion, he said: “I’m glad I had it done. Everything is back to where it used to be – maybe even better. After I finished physical therapy, my first day back on the job, I taught a spin class. I’m doing stuff now that I haven’t been able to do in recent years.

Post-op, I’m 110 percent over where I was preop.”

Hannah Edwards was a competitive baton twirler who, her mom thought,

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was slouching too much. As it turned out, Edwards’ twisted back was due to scoliosis or curvature of the spine.

At 14 years old, Edwards went through a seven-hour surgery on her back to correct a double curve. She

Hannah Edwards

was told there was a strong chance she wouldn’t walk again.

“I decided with fortitude that not only would I walk, I would dance and twirl,” she said.

She was being treated by Dr. Brian Nielsen, who she said “documented and followed my rapid spinal changes.”

“As a parent, the stress of having a child needing health care can be intense,” Nielsen said. “The pediatric orthopaedic section at TOI understands, and is well equipped to handle any orthopaedic need, from cutting-edge, 3D patient-specific scoliosis correction, rapid treatment of sports injuries to get your child playing again, and new technologies for deformity correction.”

“Dr. Nielsen went above and beyond to make sure I was able to get back to full health and strength,” Edwards said.

“He helped me plan out what I needed to accomplish, step-by-step, before having surgery. During post-surgery follow up visits, Dr. Nielsen made sure I was able to return to my everyday activities, including playing sports and competing on the national level.”

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