Core Ink - Spring 2022

A PUBLICATION OF THE CORE INSTITUTE

®

SPRING 2022

Making a splash Senior Olympic swimmer is back in the water thanks to The CORE Institute Team

Precision Driven Robotic-assisted joint replacement is cutting edge technology

Returning to life before her injury!

The CORE Institute helps restore patient’s passion for living

Your destination for Your destination for surgery. orthopedic & spine orthopedic & spine surgery.

The CORE Institute Specialty Hospital is an orthopedic and spine specialty is a destination for patients The COREhospital Institutethat Specialty Hospital iscenter an orthopedic andacross spine Arizona, the U.S and internationally.

The state of the art facility specialty hospital that is a destination center for patients acrossis nationally recognized for superior orthopedic spine surgicalis Arizona, the U.S and internationally.

The state and of the art facility outcomes outstanding patientorthopedic experience.and Thespine entiresurgical center nationally and recognized for superior is dedicated to outstanding orthopedic and spine care and utilizes the latest outcomes and patient experience.

The entire center ™ surgical technologies, including the Mako robotic-arm assisted is dedicated to orthopedic and spine care and utilizes the latest surgery system and theincluding Xenex LightStrike Robot. surgical technologies, the Mako™Germ-Zapping robotic-arm assisted surgery system Xenex LightStrike Germ-Zapping Robot.

Everything fromand thethe personalized approach to nursing care, who are only focused on musculoskeletal care, to the in-house Everything from the personalized approach to nursing care, chef and bistro menu has been designed to provide the best who are only focused on musculoskeletal care, to the in-house surgical anywhere Arizona. to provide the best chef andexperience bistro menu has beenindesigned surgical experience anywhere in Arizona.

Find out more at TheCOREInstituteHospital.com 19th Ave, Phoenix, AZ 85015 | 602.795.6020 Find6501 outNmore at TheCOREInstituteHospital.com 6501 N 19th Ave, Phoenix, AZ 85015 | 602.795.6020

The Power of One is Here.

Pain Relief in a Single Injection

DUROLANE is a single-injection hyaluronic acid (HA) treatment that has proven: • Greater reduction in knee pain vs. Synvisc-One® (hylan G-F 20)1* • Longer-lasting knee pain relief vs. steroid2 • Clinically equivalent performance to five-injection HA therapy3,4

*Some patients were treated with a three-injection Synvisc® regimen. A three-injection Synvisc regimen is equivalent to one injection of Synvisc-One. Summary of Indications for Use: DUROLANE is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacological therapy or simple analgesics, e.g. acetaminophen.

Do not inject DUROLANE in patients with knee joint infections, skin diseases, or other infections in the area of the injection site. Do not administer to patients with known hypersensitivity or allergy to sodium hyaluronate preparations. Risks can include transient pain or swelling at the injection site.

DUROLANE has not been tested in pregnant or lactating women, or children. Full prescribing information can be found in product labeling, at www.DUROLANE.com, or by contacting Bioventus Customer Service at 1-800-836-4080.

Active Healing Through Orthobiologics

References: 1. McGrath AF, McGrath AM, Jessop ZM, et al. A comparison of intra-articular hyaluronic acid competitors in the treatment of mild to moderate knee osteoarthritis. J Arthritis. 2013;2(1):108. doi:10.4172/21677921.1000108. 2. Leighton R, Åkermark C, Therrien R, et. al. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis Cartilage.

2014;22(1):17-25. 3. Zhang H, Zhang K, Zhang X, et al. Comparison of two hyaluronic acid formulations for safety and efficacy (CHASE) study in knee osteoarthritis: a multicenter, randomized, double-blind, 26-week non-inferiority trial comparing Durolane to Artz. Arthritis Res Ther. 2015;17:51. doi: 10.1186/s13075-015-0557-x. 4. DUROLANE [package insert]. Durham, NC: Bioventus LLC; 2017.

Bioventus, the Bioventus logo and DUROLANE are registered trademarks of Bioventus LLC. Synvisc and Synvisc-One are registered trademarks of Genzyme Corporation. ©2019 Bioventus LLC SMK-002435

10/19

3

WELCOME VOLUME 13, ISSUE 1 – SPRING 2022

FROM THE CHAIRMAN

Spring is the Time of Plans and Projects

S

pring is the season where the weather, flowers and sun are reborn; after a cooler winter, it brings light and color back into our world.

At The CORE Institute, we take this season of change to thoughtfully curate plans and projects to ensure that our treasured patients receive a terrific experience each time they visit one of our clinics. In this issue of CORE Ink, we have highlighted patients who emulate the successful outcomes of our dedication toward a positive patient experience. The two patients we have included not only shared with us their joy from successful surgeries, but also the caring relationships they formed with the physicians and staff at The CORE Institute.

In this Spring issue, our cover story features Donna, a 61-year-old patient from Michigan who, after years of debilitating knee pain, sought the expertise of Dr. William Kesto for a total knee replacement. Within the last month, Donna went back to Dr. Kesto to treat her other knee, proving her confidence in The CORE Institute and our team. Within months of healing from her first surgery, Donna was hiking the Great Smokey Mountains, performed a choreographed dance with her son at his wedding, and even hiked the Grand Canyon! She is currently in physical therapy from her second surgery but is excited to live her life free from knee pain.

We also share the inspiring story of Kathleen, a resident of Sun City, Arizona who has a life of bucket

4

list worthy adventures. However, her exotic travels and life experiences quickly came to a halt when she was in a car accident that left her with significant challenges. She quickly became a proud advocate of The CORE Institute and she talks of her physicians as though they are family and raves about her triumphs after her successful surgeries. Kathleen’s experience epitomizes the outcomes that The CORE Institute aims to provide for each of our treasured patients.

One of The CORE Institute’s renowned physicians, Dr. Melissa Galli, shares insightful advice in an article explaining how to stay active while dealing a foot or ankle injury. You will also find an article highlighting the success of robotic-assisted surgeries. Dr. Sousa of The CORE Institute explains the incredible precision and benefits of robotics being implemented during joint replacement procedures.

Finally, we share how The CORE Institute and MORE Foundation have partnered to investigate an innovative procedure called InSpace. This procedure is revolutionary for rotator cuff injuries and how it can treat rotator cuff tears that were once considered repairable Please enjoy our first issue of CORE Ink in 2022. We wish you a happy and healthy Spring filled with plans and projects that will Keep Life in Motion!

David J. Jacofsky, MD Chairman & CEO

TheCOREInstitute.com

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: DesignIQ

CONTENTS

12 COVER STORY

Life-changing conversation Donna Reynolds found an orthopedic surgeon to help resolve a lifelong knee issue 8

8

DE PA RT ME NTS Patient Feature

12 The CORE Institute helps swimmer continue to reach new milestones despite setbacks

20

Research

15 Clinical trial evaluates unique treatment option for advanced rotator cuff tears

CONNECT WITH US 866.974.2673 TheCOREInstitute.com

Ask the Expert

16 Staying active with foot and ankle injuries

Specialty Spotlight

18 Specialty hospital expands award-winning facility

Trends

19 Robotic-assisted joint replacement becoming more popular

Nutrition

20 Eat healthy this spring

5

to everyone who helped us achieve these awards last year.

VOTED #1 ORTHOPEDIC PRACTICE FOR

2022

Help keep us #1 | Voting ends at midnight on July 31, 2022

scan me

to vote The CORE Institute as #1 in Orthopedics

scan me

to vote The CORE Institute as #1 in Spine

COVER STORY

Life-changing

CONVERSATION

By Elise Riley

8

TheCOREInstitute.com

Donna Reynolds found an orthopedic surgeon to help resolve a lifelong knee issue

D

onna Reynolds knew something was wrong with her knee. She could feel it.

This wasn’t a grinding, bone-on-bone arthritis pain.

It wasn’t wear and tear from an active life. She kept trying to explain that something was seriously wrong with her left knee. The joint was completely collapsing, it was frightening and it needed to be fixed.

But the orthopedic surgeon Donna had originally seen said she wouldn’t order an MRI. Instead, the solution was more cortisone shots.

Maybe try some ice, they suggested.

“I thought, ‘I don’t think that’s going to help,’” Reynolds said. “I asked if I could get an MRI because I wanted to see it. They didn’t think it Dr. William Kesto was worthy of an MRI. I took the injection and went on my way. It didn’t get better.”

SEEKING HELP

Now 61, Reynolds always had problems with her knees, ever since a horrible car accident when she was 16 years old. Minor surgical repairs to her meniscus helped a bit, but the collapsing joint was becoming a repeated, painful problem. An avid hiker, Reynolds didn’t feel comfortable taking the group fitness classes she was so devoted to. Walking her dog was no longer

9

10

TheCOREInstitute.com

enjoyable. Simple tasks like kneeling in her basement to retrieve something could render her leg useless.

She thought that a Sports Medicine Specialist might be more open to helping her. That’s when she found Dr. William Kesto, a Board Certified and Fellowship Trained Orthopedic Sports Medicine Surgeon at The CORE Institute.

“I’m not an athlete, but I’m an active person and I like to be active,” Reynolds said. “I thought he would address my situation differently. As soon as I walked in, his whole attitude was different. It was ‘What is it you’d like to do?’ as opposed to ‘This is what we do.’ I asked him what my options were.”

MAKING A PLAN

After going over her MRI, talking about her lifestyle and determining her goals, Reynolds and Dr. Kesto came up with a plan: they would replace the joint because other minor fixes wouldn’t resolve the issue. They successfully performed the surgery in December of 2020.

By March of 2021, Reynolds and her husband went hiking in the Great Smoky Mountains. That summer, she and her son performed a choreographed dance during his wedding reception. And in October, she hiked the Grand Canyon.

“I’m not going to say the Grand Canyon was easy, but we did it,” Reynolds said. “I didn’t really want surgery; I wanted the outcome. And I got the outcome.”

TAKING TIME TO LISTEN

Donna Reynolds now finds simple pleasures such as dancing with her son are now possible thanks to The CORE Institute.

Reynolds said that Dr. Kesto took the time to listen to her and find out what she was feeling. Together, they determined the best solution.

“It’s flattering to hear that from a patient,” Dr. Kesto said.

“I’m always going to listen to their story. What do they do?

What job do they have? I ask that of almost everyone, then I can go through their diagnosis and their goals. How can we get you there? It takes time to do all that. It’s important for them to understand it so we can form a plan. Everyone’s needs are different.”

Lately, Reynolds has started to experience more difficulty with her other knee – not much of a surprise, given the car accident. But this time, she knows she has an ally who can help her achieve her goals.

“Dr. Kesto looked me in the eye,” Reynolds said. “He was waiting for me to tell him my story. I fully expect this right knee to be fine. I’m looking forward to finding out what he sees when he gets in there.”

In early March of 2022, Reynolds had her other knee operated on by Dr. Kesto. She is currently going through physical therapy and looks forward to living a life free of knee pain.

11

PATIENT FEATURE

Making a splash

K

By Brian Sodoma athleen O’Brien-Lawrence celebrated her 77th birthday in February of 2021 by swimming alongside massive whale sharks in the Sea of Cortez. It was a bucket list experience among an already lengthy list of impressive accomplishments for the active Sun City, Arizona resident. She has competed and won U.S. Masters and Senior Olympic swimming events, was a scuba diving partner with astronaut Buzz Aldrin, spent years as a runner placing in the top 10 among women in numerous marathons, and competed in triathlons.

Today, she continues to stay active and is considering the 1.5-mile swim across the San Francisco Bay to Alcatraz Island for her 80th birthday, which she has completed once already on her 65th birthday.

12

TheCOREInstitute.com

Her life, however, is not short on setbacks either. In 2019, a car accident left her with numerous injuries. The incident also took the life of her husband, Alex, who was also a gold-medal-winning Senior Olympics athlete into his 80s. In losing her partner, she leaned on others. Her biggest “cheering section,” she says, became The CORE Institute’s team of physicians.

“If it wasn’t for all the wonderful care I had received from The CORE Institute over the years, I would have never been able to accomplish this,” she said of her swim with the whale sharks. “I can’t praise them enough.”

GROWING UP IN THE OUTDOORS

As one of 14 children, she grew up in Minnesota and described days full of outdoor activity and few luxuries. “I didn’t grow up with dolls. I grew up with a fishing rod, and I swam and hunted with my brothers,” she said. “I think I became a bit of a survivalist, and that shaped me into someone who is not afraid of a challenge.”

With careers as a flight attendant, model, businessperson, writer, hospice nurse, the mother of four turned to running at 32 when she unexpectedly lost a previous husband. “I needed a place to put my grief and running did that for me,” O’Brien-Lawrence recalled. She would place in the top 10 for women in the Pikes Peak Marathon in 1979, her first of more than a dozen marathons. She eventually remarried, and when the couple retired to Sun City, the active retiree was invited to swim with the Sun City Starrs, a U.S. Masters team, and Dr. John Thompson competed in Senior Olympic swim events, winning her share of medals, from 2002 until her accident in 2019.

THE CORE INSTITUTE’S HAND IN MANY RECOVERIES

The CORE Institute Helps Swimmer Continue to Reach New Milestones Despite Setbacks

After the 2019 tragedy, she faced eight months of intense rehabilitation. A group of physicians at The CORE Institute, led by Dr. John Thompson, a Board Certified and Fellowship Trained Orthopedic Surgeon specializing in joint replacement, performed both knee and hip replacements on her.

She began swimming only six weeks after her hip procedure.

“She is so positive. Her recoveries were shorter than expected because of her mindset,” Dr. Thompson said.

O’Brien-Lawrence’s knee and hip replacements also benefitted from Dr. Thompson’s advanced techniques and the technology used by The CORE Institute. For her knee replacements, the orthopedic surgeon uses a “midvastus approach”, which results in a smaller incision that doesn’t disrupt the extensor mechanism in the knee. It allows for less pain and a quicker recovery. For hips, he uses a minimally-invasive, tissue-sparing approach with only a 4-inch incision. Both procedures are guided by robotic-assisted technology.

“For hips, the technology helps me to maximize the position of components for the best stability and range of motion,” he added. For knee surgeries, the technology helps

13

him to properly realign the knee and create equal spacing within the joint for better ligament function. “Not only are we able to maximize stability and range of motion, but the prosthesis also lasts longer, too.”

RENEWED SENSE OF HOPE

Lawrence says her support from The CORE Institute goes well beyond her hip and knee replacements and accident rehabilitation. Dr. Kelly Krohn, a bone health specialist with The CORE Institute, still monitors and maintains her bone density to keep osteoporosis effects at bay. At the same time, fellowship trained Orthopedic Shoulder Surgeons, Dr. Bryan Wall and Dr. Jason Scalise, were also instrumental in keeping her life in motion. Without surgery, the physicians were able to rehabilitate an unrepairable broken arm and left shoulder, which was also injured in an accident.

“They believed in my body’s ability to heal and encouraged me to trust it. By not having surgery, I was able to develop strong muscles around what used to be my rotator cuff and in my broken arm,” she said. “That’s why I can still swim.”

Today, with new joints and a renewed sense of hope, she commits to one or two miles a day of “maintenance swimming,” along with other low-impact exercises.

“For anyone who may feel uncertainty about a joint surgery, you shouldn’t fear putting your trust in the hands of the incredible team at The CORE Institute,” she added. “I promise it will be as life-changing for you as it has been for me.”

For anyone who may feel uncertainty about a joint surgery, you shouldn’t fear putting your trust in the hands of the incredible team at The CORE Institute. I promise it will be as life-changing for you as it has been for me.

– Kathleen O’Brien-Lawrence

14

TheCOREInstitute.com

RESEARCH

INSPACE IS A GAME CHANGER

Clinical Trial Evaluates Unique, Less Invasive, Treatment Option for Advanced Rotator Cuff Tears

By Brian Sodoma

R

otator cuff tears are ly together on their own to a common shoulder offer improved comfort and problem, but they motion again. also present to phy“When we heard this was sicians with a wide range coming to the U.S., we wantof severity. Rotator cuff ed to be an early adopter. Inrepair enjoys a high success Space has the potential to fill rate for younger adults a gap in care, and it’s withDr. Marc Jacofsky with smaller tears. On the out a doubt the least invasive other hand, due to poorer option with a shorter path to tissue quality and slower healing, older recovery,” Dr. Amini added. patients with larger tears may not enjoy The procedure has been performed the same benefits. A shoulder replacemore than 30,000 times in Europe over ment has typically been the alternative the last decade, Dr. Amini noted. It has if a repair is unlikely to succeed. been used in the United States since the But that could all change soon for summer of 2021, and surgeons at The many active older adults. The CORE CORE Institute were the first in Arizona, Institute and MORE Foundation have and among the first few in the country, partnered to investigate an innovative to use it. procedure called InSpace, which could bring promise as a new option for many who need it.

EVALUATING REHABILITATION

Accelerating recovery is indeed the greatest potential benefit of InSpace.

The shoulder can be used within two weeks, whereas traditional replacement or repair usually requires the arm to stay in a sling for six to 12 weeks, Dr. Amini emphasized.

With the help of the MORE Foundation, the study will monitor data from 150 patients 65 years or older enrolled across eight sites around the U.S., one of them being The CORE Institute. Two rapid rehabilitation programs will be analyzed for quality of outcomes: one is guided by a physical therapist, the second is a homebased protocol, both with the same exercises and recovery timeline.

RESTORING ROTATOR CUFF FUNCTION

A massive rotator cuff tear, which involves at least two or more of the four tendons in the region, is the most severe tear, and a particular problem for a wide range of older adults, explained Dr. Michael Amini, The CORE Institute’s chief surgeon in its Shoulder & Sports Division and Principal Investigator for the study.

Developed by Stryker Sports Medicine, InSpace places a saline-filled balloon above the shoulder bone to serve much like a “pillow” in place of the rotator cuff.

It reduces pain and improves function by limiting unwanted movement of the shoulder and preventing impingement.

The balloon dissolves in about a year, but with less stress on the muscles, they become stronger and operate efficient-

15

ASK THE EXPERT

Staying active with foot and ankle injuries

By Julie Maurer

Slowly working on low impact movements builds joint strength

16

W

hile there may be the temptation to enjoy more time on the couch after a foot or ankle injury, sometimes a little movement can go a long way when it comes to healing.

According to Melissa Galli, DPM, MHA, a Board Certified, Fellowship Trained Reconstructive Foot and Ankle Surgeon at The CORE Institute, not utilizing the joints and muscles in the areas around the primary injury can lead to further difficulties.

“After an injury, people will often use a special boot for two or three months, but

if they haven’t maintained their legs, by the time they heal, they have secondary spine, hip, knee or leg pain,” Dr. Galli said.

She recommends that patients keep moving the areas of the leg that are still functional.

“You may not be able to move up to a third of your leg, but the parts that aren’t affected, keep those parts moving,” Dr. Galli said. “Do a few simple things to make sure you can maintain your independence, adequately heal and move on with your life without additional issues to your gait.”

The first step after a foot or ankle injury is to immobilize it and the nearest joint without causing further damage.

TheCOREInstitute.com

You may not be able to move up to a third of your leg, but the parts that aren’t affected, keep those parts moving. Do a few simple things to make sure you can maintain your independence, adequately heal and move on with your life without additional issues to your gait.

Dr. Galli “This is an easy thing you can attempt on your own, especially if it’s taking you a while to get a referral,” Dr. Galli said.

But not all immobilization tools are right for every kind of injury. The goal is to keep as much of the leg moving as possible. Dr. Galli advises the following measures, depending on the location of the injury: · Toes/forefoot – post-operative shoe or hiking boot · Arch or bridge – short cam/fracture boot · Hindfoot or ankle – tall cam/fracture boot · For all injuries, in addition, use compression socks (15-20 mm Hg knee high)

to help control pain, reduce swelling and prevent blood clots.

Don’t ignore the other limb; weight should be evenly distributed between both legs.

“If you have to go into a boot or device that causes Dr. Melissa Galli you to not have them in the same height, affix something to the opposite foot to even you out,” Dr. Galli said.

She recommends finding a thick shoe or hiking boot to compensate or purchasing a plastic device for the non-injured side’s shoe.

Once the injured joint is stabilized, it is

important to work activities gradually. Activities to avoid should include anything that is high impact, such as running or contact sports. However, things like tai chi, yoga, and stretching can be beneficial and prevent post-injury contractures.

“Slowly put more and more weight back into the joint after you’ve had a problem,” Dr. Galli said. “It’s an opportunity to listen to your body to make sure you are doing the right thing and it gives you confidence as you’re going to keep adding a little more without setting yourself back.”

17

SPECIALTY SPOTLIGHT

Specialty hospital expands award-winning facility CORE’s best surgical practices yield results

By Julie Maurer

to patients than ever, with 18 patient reThe specialty hospital has a high percovery suites completely remodeled in centage of same-day patients and these 2021. renovations not only increase capacity he CORE Institute Specialty Hos“We are very focused on outstanding and efficiencies but provide for an easier pital in Phoenix has received recpatient outcomes utilizing transition to mobility after surgery. For ognition for its excelbest practices,” Curphy said. some patients, Physical Therapists can lence in patient care This mindset has yielded now visit them right after surgery and as well as its many upgrades great results. The CORE Instiget them up and walking in the recovery and improvements throughroom. out the past year. The hospitute Specialty Hospital has These efforts will only build upon The one of the lowest infection tal has expanded its ability CORE Institute Specialty Hospital’s conrates in the state, with their to provide the latest techrate being much lower than nology and treatment for ortinued success and multiple awards. In the national average. These 2021 and 2022, the facility received the thopedic cases in the Valley.

Rona Curphy, MBA, BSN, FACHE infection-prevention methPatient Safety Excellence Award from In a typical hospital preHealthgrades and was named to their op area, an orthopedic patient might be ods made The CORE Institute Specialty America’s 100 Best Joint Replacement in the bay next to someone coming in Hospital the go-to facility for orthopedic list. for heart surgery or a tonsillectomy. The and spine surgeries for not only patients Put simply, the CORE Institute Specialpost-op team is stretched thin as they in Arizona but from across the country provide care for patients recovering from and abroad. ty Hospital is now better than ever. The a wide variety of procedures.

However, CISH allows patients to reWe’re not a surgery center; we’re truly a hospital,” said ceive specialized care from those whose expertise is focused solely on orthopeRona Curphy, CEO of The CORE Institute Specialty dics and spine. The facility launched in Hospital. “We don’t have an emergency room, so we 2017 with five operating rooms, all of don’t have new patients coming in throughout the day which handle only orthopedic and spine patients. This year’s exciting expansion that might need emergent surgery. This way, we can stay grew their OR capacity, creating more focused on those cases that are scheduled, minimizing the opportunities to seek the specialized chances of your surgery being delayed. treatment at CISH. “We’re not a surgery center; we’re truRona Curphy, CEO of The CORE Institute Specialty Hospital ly a hospital,” said Rona Curphy, CEO of The CORE Institute Specialty Hospital.

The new expansion also allows for “We don’t have an emergency room, hospital’s expansion provides more pathe hospital to expand the latest surgiso we don’t have new patients coming tients within the community with a prein throughout the day that might need cal and orthopedic care technologies to mier orthopedic experience. Its continuemergent surgery. This way, we can stay every aspect of the hospital. Specialized ous efforts to push the advancements in focused on those cases that are schedand state-of-the art surgical robots as orthopedic & spinal surgery and patient well as infection-fighting technologies recovery have instilled pride among its uled, minimizing the chances of your are throughout the now expanded operstaff, and confidence in the patients who surgery being delayed.” go there.

The hospital provides more comfort ating rooms and treatment areas.

T

18

TheCOREInstitute.com

TRENDS

Precision driven ROBOTIC-ASSISTED JOINT REPLACEMENT BECOMING MORE POPULAR

By Elise Riley

F

ractions of a millimeter or the slightest alteration of a degree can make the difference in the success of a joint replacement.

Achieving that level of precision isn’t science fiction or a special effect. It’s happening every day when orthopedic surgeons perform joint replacements with the help of robotic technology.

“It is very common practice for robotics to be used for total or partial knee replacement,” said Dr. Paul Sousa, a Board Certified and Fellowship Trained Orthopedic Surgeon at The CORE Institute. “There are many robotic systems available for joint replacement. The most commonly used system is the Mako robot, which allows for symmetric alignment and very precise component positioning.”

ROBOTIC TECH

“Robotics for joint replacement, as in any other field, is much more accurate than humans can possibly be on

their own,” Dr. Sousa said.

“The robot is important for surgery when precision matters the most. It’s not doing all the work, but it helps to make things very precise.”

While surgeons like Dr. Sousa still perform the actual surgery, the robotic arm Dr. Paul Sousa assists during the procedure to make perfect cuts and position implants for optimal knee balance. It’s as though the surgeon has an extra – and extremely accurate – pair of eyes and hands.

PRECISE ALIGNMENT

Robots can help not only during the joint replacement procedure, but also during pre-op assessments to take exact measurements of a joint, map it, and calculate exactly where and at what angle the implant should be positioned.

“We’re not talking about millimeters, it’s fractions of a millimeter,” Dr. Sousa said. “They’re accurate to a fraction of

a degree and a fraction of a millimeter.”

Those fractions of a millimeter or degree allow more accurate and precise alignment and positioning, which in turn may have practical impacts on the joint itself – better alignment may mean the joint will perform better and last longer. But more importantly, the patient experiences real, practical benefits from the precision the robot provides. Proper alignment should translate into a better, stronger and more stable gait.

As more people experience the benefits of robotic-assisted joint replacement, Dr. Sousa said it’s not something he has to convince patients to consider.

“It’s the opposite,” he said. “People are coming in and asking for it.”

19

NUTRITION

EAT HEALTHY THIS SPRING

I

t seems the more we try to eat healthy foods, the more confused we get. Much of what’s considered “healthy” changes day to day as scientific studies are revised to mean the opposite of what we thought they meant.

Even avid label readers aren’t always sure what product claims mean. “Sugar-free” isn’t the same as unsweetened, “all-natural” usually isn’t, and don’t even start with low fat.

The list of artificial ingredients added to make up for its removal is usually long. Add to that are growing concerns over GMOs, pesticides, antibiotics and other questionable farming practices, and it can all result in food frustration.

Instead of throwing in the towel, more and more health-conscious eaters are “trimming the fat,” so to speak, and reaping the benefits of springtime’s crop of fresh-grown fruits and vegetables, either harvested at home or purchased at your local farmer’s market.

GROW YOUR OWN

There are a number of reasons that at-home gardens have been on the rise in the past few years. Aside from knowing exactly what you’re eating and how it was grown, there is an

20

economic advantage to growing your own food, as well as a sense of accomplishment.

Perhaps the biggest draw to growing your own fruits and vegetables is the abundant nutritional advantages.

Fresh fruits and vegetables provide the most nutrients for fewer calories and have little or no saturated fat, sodium and added sugars. Produce that’s high in fiber helps you feel full, aids in bowel health, and maintains healthy cholesterol levels.

According to the Academy of Nutrition and Dietetics, eating fruits and vegetables is linked to a lower risk of many chronic diseases and it may help protect against certain types of cancer.

MARKET FRESH

If you don’t have a green thumb, your local farmer’s market is a great way to get the fresh pick of the season.

Farmer’s market produce is almost always fresher than produce found in the grocery store, but don’t assume it’s organic or grown with non-GMO seed. Maintaining an organic certification is expensive and many smaller farmers can’t afford it, so some will say their foods are “responsibly grown” (indicating a commitment to human health and the environment)

TheCOREInstitute.com

Foil Packet Cheesy Sausage and Peppers INGREDIENTS Reynolds Wrap® Non-Stick Foil 4 sweet or spicy Italian chicken sausage links (about 2 3/4 oz each) 2 medium onions, sliced into 1/4 inch strips 2 red bell peppers, sliced into 1/4 inch strips 1/2 tablespoon extra virgin olive oil

3/4 cup marinara sauce 1/2 cup shredded part-skim mozzarella 3/4 teaspoon kosher salt fresh black pepper, to taste crusty bread, optional for serving

INSTRUCTIONS 1. Preheat the grill on high heat on one half and medium-low on the other.

2. In a large bowl combine the onions, pepper, olive oil, salt and pepper.

Make foil packets:

By Michelle Jacoby or “natural” (implying the use of non-GMO seeds, pesticides, etc.). This isn’t regulated, however, so if this is important to you, ask the seller about their growing methods.

The variety of foods offered is different than a supermarket because farmer’s markets feature items that are in season in your region. There will still be plenty of produce to choose from, but some of it may be unfamiliar, so be willing to try new things.

TASTE THE RAINBOW

When it comes to choosing what to grow or buy, opt for fruits and vegetables that are in season. They cost less and are likely to be at their peak flavor. Also, consider adding color to your plate.

Different colors typically mean foods have different vitamins and minerals. For instance, red, orange and yellow produce is packed with vitamin A, vitamin C, manganese and fiber. Greens contain lutein, which helps with eyesight, and folate, which helps in cell reproduction. Blues and purples are packed with antioxidants that help transport oxygen to cells, remove waste, protect joints and organs, and promote healthy skin.

1. Tear off 4 12 x 18” sheets of Reynolds Wrap® Non-Stick Foil.

2. Divide the onions and peppers between 4 pieces of foil, with the dull side facing up. Top with 3 tablespoons marinara.

3. Bring up the long sides of the foil, so the ends meet over the food.

4. Double fold the ends, leaving room for heat to circulate inside.

Double fold the two short ends to seal the packet tight, so no steam escapes.

5. Place the foil packets on the side of the grill with the mediumlow heat. Cook until the vegetables are tender, about 25 minutes.

6. When ready, set aside and add the sausage to the medium-low side. At this point you can shut off the high side of the grill.

7. Cook sausage, 6 to 8 minutes turning often until cooked through in the center and place on a cutting board.

8. Open the foil packets, slice the sausage and add to the foil packets, top each with 2 tablespoons cheese and keep open.

9. Cover grill and leave until cheese melts, about 5 minutes.

Serve with bread, if desired.

Source: https://www.skinnytaste.com/foil-packet-cheesy-sausage-and-peppers/

Turn to page 22 for more delicious recipes!

21

Ground Turkey Skillet with Zucchini, Corn, Black Beans and Tomato INGREDIENTS

14 ounces from 2 medium or 1 large zucchini, quartered and sliced 3/4 inch 1 pound 93% lean ground turkey 1/4 cup chopped onion 1 tablespoon tomato paste 3/4 cups canned black beans, rinsed and drained 3/4 cups corn kernels, fresh or frozen 1 large diced tomato

1 jalapeño, diced 1 cloves garlic, minced 2 tbsp chopped cilantro, plus more for garnish 1 1/4 teaspoon cumin 1 1/4 teaspoon kosher salt 1/4 cup water lime wedges, optional

INSTRUCTIONS 1. Spray a large skillet over high heat with oil and brown the turkey, season with 1 teaspoon salt and 1 teaspoon cumin.

2. Cook breaking the meat up until the turkey is cooked through, about 5 minutes.

3. Push the meat to the side, add the onion and tomato paste and cook 1 minute.

4. Add the black beans, corn, tomato, jalapeño pepper, garlic, cilantro and stir with 1/4 cup water.

5. Add the zucchini remaining 1/4 teaspoon salt and cumin.

6. Mix and cover, cook low 4 to 5 minutes or until the zucchini is tender crisp.

7. Serve with lime wedges and more cilantro if desired.

Source: https://www.skinnytaste.com/ground-turkey-skillet-with-zucchini-corn-black-beans-and-tomato/

Grilled Steak with Tomatoes, Red Onion and Balsamic INGREDIENTS

2 lb. flank or London broil steak 1 1/2 teaspoons kosher salt and fresh black pepper, to taste garlic powder 1 tbsp extra virgin olive oil 2 tbsp balsamic vinegar 1/3 cup red onion, chopped INSTRUCTIONS 1. Pierce steak all over with a fork. Season generously with salt, pepper and garlic powder and set aside about 10 minutes at room temperature.

Failure is Not an Option We’ll help you get back in the swing of things with the right physical therapy plan designed specifically for you. Because with Team Rehab in your corner it isn’t over ‘til you say so.

2. In a large bowl, combine onions, olive oil, balsamic, salt and pepper. Let onions sit a few minutes in the mixture to mellow a bit. Combine with tomatoes and fresh herbs and adjust seasoning if needed.

Find a location near you at

team-rehab.com

22

3 to 4 medium tomatoes, chopped (about 3 1/2 cups) 1 tbsp fresh herbs such as oregano, basil or parsley

3. Heat grill or broiler on high heat. Cook steak about 7 minutes on each side for medium rare or longer to taste. Remove from grill and let it rest on a plate for about 5 minutes before slicing.

4. Slice steak thin on the diagonal; top with tomatoes and serve.

Source: https://www.skinnytaste.com/grilled-flank-steak-with-tomatoes-red

TheCOREInstitute.com

Satisfaction patients deserve.

Assurance you can trust.

Hip fractures affect a substantial proportion of the ageing population1, have a high mortality rate2-5 and are associated with high rates of morbidity, severely impacting patients’ mobility and daily living.1,6

Morbidity

51%

29%

of patients exhibit a decline in activities of daily living1

53%

of patients exhibit a decline in fine motor skills1

of patients exhibit a decline in mobility1

39%

70%

of patients exhibit a decline in self-reported health1

of patients live with reduced ability to walk following fracture union6

Comparison between pre-hip fracture and post-operative scores.

The TRIGEN INTERTAN Hip Fracture System is clinically proven to provide improved clinical outcomes compared with other IM nails to ensure you live Life Unlimited5 TRIGEN INTERTAN significantly reduced the risk of revision/ reoperation by

66%

5

Mean rate was 3.7% and 10.2% for TRIGEN INTERTAN and comparators, respectively (p<0.0001)

TRIGEN INTERTAN significantly reduced the risk of implant failure by

!

71%

5

Mean rate was 4.7% and 21.2% for TRIGEN INTERTAN and comparators, respectively (p<0.0001)

TRIGEN INTERTAN significantly reduced the risk of hip and thigh pain by

52%

5

Mean rate was 5.8% and 11.2% for TRIGEN INTERTAN and comparators, respectively (p=0.0004)

Visit us at www.smith-nephew.com to learn more.

References 1. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009;170:1290-1299. 2. Hossain M, Andrew JG. Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery? Injury 2012;43:2161-2164. 3. Mundi S, Pindiprolu B, Simunovic N, et al. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop 2014;85:54-59.

4. Okike K, Chan PH, Paxton EW. Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Hip Fracture. J Bone Joint Surg Am 2017;99:1547-1553. 5. Smith+Nephew 2021. A systematic literature review and meta-analysis comparing INTERTAN and other intramedullary nails for the treatment of AO OTA 31-A fractures. Internal Report. EA/TRAUMA/ INTERTAN/003/v1 6. Tang VL, Sudore R, Cenzer IS, et al. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med 2017;32:153-158. ◊ Trademark of Smith+Nephew. 30493 V1 05/21.

AR-GCI0858146-01

Together we can transform orthopaedics.

Every day, hospitals across the world are transforming orthopaedics with Mako Robotic-Arm Assisted Surgery.

Isn’t it time you meet Mako?

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery.

The information presented is intended to demonstrate the breadth of Stryker’s product offerings. A surgeon must always refer to the package insert, product label and/or instructions for use before using any of Stryker’s products. The products depicted are CE marked according to the Medical Device Directive 93/42/ EEC. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets.

Please contact your sales representative if you have questions about the availability of products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Mako, Stryker. All other trademarks are trademarks of their respective owners or holders.

MKORIO-AD-8 MKORIO-AD-9 07/16