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Orthopedic News and Physician Articles
The orthopedic doctors and spine specialists at Centura Orthopedics & Spine offer advanced surgical and non-surgical care for a range of orthopedic conditions and spine pain. In addition to offering the latest treatments, our physicians strive to provide patients with up-to-date information to make educated health care decisions.
Partial Knee Replacement May be a Better Option for Knee Pain Treatment
If you’re facing knee surgery, you may not realize there are knee pain treatment options beyond a total knee replacement. But a partial knee replacement can be a much better choice. With help from Ed Szuszczewicz, MD, a fellowship-trained orthopedic doctor with Centura Orthopedics & Spine – Castle Rock and Lone Tree who specializes in joint replacement, we’ll show you why — and the potential benefits of partial knee replacement.
Partial knee replacement: Replacing only what’s broken
Your knee is divided into three basic compartments: the inside (medial), the outside (lateral), and the kneecap (patella). So, if you have arthritis in only one of those three parts, you may be a candidate for one of the two types of partial replacement: unicompartmental knee arthroplasty (or “uni”) for the inside or outside of the knee, or patellofemoral arthroplasty to replace the kneecap. Here are a few reasons worth considering partial knee replacement:
Hospital stay: Patients with kneecap replacements typically spend one night in the hospital; uni patients typically go home the same day, versus three or four days for a total knee replacement.
Recovery time: Partial knee replacement generally results in less pain and less intensive physical therapy and faster recovery than total knee. That’s because patients regain their range of motion and can go straight to outpatient therapy versus home therapy first with total replacement, he says.
Joint feel: “Both types of partial knee replacements feel more like your own knee than with a total knee replacement, which many patients say feels more artificial,” he says.
Revisions: If a partial knee replacement eventually fails, converting to a complete knee replacement is akin to having a total knee replacement for the first time, Szuszczewicz says.
Outcomes: Ten years out, the success rates for partial and total knee replacements are virtually identical — 90 to 95 percent. “The partial knee replacements of 20 to 30 years ago didn’t do as well, and they got a bad rap. But the reality is, the 10-year results are now the same — so they’ve come a long way.”
Patients Going Home Faster with Anterior Hip Replacement Surgery
As strange as it sounds, 65-year-old Michael Gorin of Aurora says if he had a third hip, he wouldn’t hesitate to have Derek Johnson, MD, replace it. Of course, it’s hyperbole. But it’s also his way of saying, Johnson, an orthopedic doctor with Centura Orthopedics & Spine — Meridian and medical director of joint replacement at Parker Adventist Hospital, is batting a perfect two for two in replacing his hurting, arthritic hips using an anterior hip replacement surgical approach.
Gorin, formerly part of the U.S. Coast Guard Search and Rescue, always prioritized his physical health. But as eventually happens with all of us, Gorin felt his age catching up to him. At 60, his family members noticed him walking with a limp. And then the excruciating nerve pain began shooting down his leg.
To put him back together again, Gorin had back surgery in 2015 to relieve pain from a herniated disk, followed by two hip replacements by Johnson in April and August 2017.
Anterior hip replacement offers same-day discharge
A technique called anterior hip replacement is making rapid recovery — including same-day discharge for some patients — possible. Like many of Johnson’s patients, Gorin went home the day of his hip surgeries.
Anterior hip surgery, performed through a 3- to 5-inch incision through the front of the hip, works between muscles. The traditional posterior approach requires 8- to 10-inch incisions through gluteal muscles at the back of the hip. “We’re not cutting or detaching muscles. That’s the key,” Johnson says. This means:
- Less pain
- Faster healing
- Fewer restrictions after surgery
- Quicker return to activities
Anterior hip replacement surgery seems to be catching on. “Anterior went from about 2 to 3 percent of hip replacements in 2010 to now accounting for about one in five replacements,” says Johnson, who has performed nearly 1,000 of the procedures. He believes in the approach — and in the ability of his patients to get up, get moving, and get home sooner.
“Most patients with arthritis are not sick. They just have a bad joint,” he says. Still, many are surprised to learn they may be able to go home the same day. “They don’t have to stay in the hospital. Some can go home and sleep in their own bed the day of surgery,” Johnson says.
Who is a candidate for anterior hip replacement?
Hip joint replacement involves removing damaged bone and cartilage and replacing it with prosthetic components. Ideal candidates for hip replacement have:
- X-ray evidence of arthritis
- Hip pain or stiffness that limits everyday activities
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
Johnson says that anyone who is a candidate for hip replacement is a candidate for the anterior approach. “The surgery is more technically demanding in an obese patient or very muscular males, but that is also true of the posterior approach. The most important thing is to have a surgeon who is experienced in the anterior approach.”
The FDA recently approved a custom total hip implant that Johnson predicts could more accurately maintain leg length, a common concern following hip surgery. “I expect to be one of the first surgeons to have access to it, possibly within eight to 10 months,” says Johnson, whose experience with custom knee implants is already well-known in the region.
When is it time for hip replacement surgery?
Johnson says patients will know when it’s time to have hip replacement surgery. “There’s not really an ideal age; it’s more about quality of life. You’ll know when you’re giving up things you enjoy,” he says.
For his part, Gorin knew it was time. “I lived with the pain. Scratch that, I suffered with the pain. I took pain pills. I was limping and compensating,” he says, noting that his mind had to be as ready for the surgery as his hips. “I’ve always been active. It’s difficult to accept that you have to slow down. I had to realize that I can’t expect to run, swim, and skip like a 25-year-old anymore,” he says.
What he didn’t anticipate was a recovery that had him walking a brisk 3 miles and logging more than 30 minutes on his elliptical trainer daily by October, just two months after his second hip replacement
So, that business about having a third hip? He means it. “I’m fantastic. I haven’t walked this way in years. I’ve lost 10 pounds. I feel terrific. In fact, sometimes I have to keep in mind that I’m still healing.”
Life after hip replacement surgery
Today’s hip replacements aren’t your grandma’s hip replacements. “Most people think after hip replacement you can’t do anything. They picture an 85-year-old grandma sitting in her chair. I have patients who are now running 10Ks, skiing, playing basketball, and power lifting,” says Derek Johnson, MD.
So, what’s changed? Plenty.
- Improved implants: Johnson says data shows that 95 percent of today’s joint implants are lasting 20 or more years. This means younger patients now can pursue surgery sooner.
- Improved technique: With an anterior approach to surgery, muscles and tissue are spared, the surgical incision is smaller, and recovery is quicker.
- Fewer restrictions: After about three months of recovery, today’s hip replacement patients can return to active lives.
Biologic Shoulder Resurfacing – An Alternative to Shoulder Replacement
While knees and hips tend to take more of a pounding, the shoulder joint can succumb to pain and arthritis, too. In fact, 53,000 people in the U.S. have shoulder replacement surgery each year.
A select group of these patients may be candidates for an alternative to shoulder replacement called biologic resurfacing that replaces worn, arthritic cartilage of the shoulder joint with donor cartilage. In Colorado, it is performed at Porter Adventist Hospital by Ryan Carr, MD, a fellowship-trained orthopedic doctor and shoulder specialist with Centura Orthopedics & Spine – Porter.
Here’s what you need to know.
Q: What is biologic shoulder resurfacing?
A: In a typical shoulder replacement surgery, the damaged, arthritic parts of the shoulder are replaced with artificial components. “You have metal rotating on a piece of plastic. Over time, the implant can loosen or wear down. If you’re young and have total shoulder replacement, you will likely have a revision surgery in your lifetime,” Carr says.
“Biologic resurfacing is an alternative to total shoulder replacement that preserves the patient’s normal anatomy, essentially replacing worn, arthritic cartilage of the shoulder joint with cartilage from a deceased donor,” says Carr, who completed fellowship training in Cleveland under the nationally recognized surgeon who developed the procedure. “We go in, cut the arthritis out, and replace that area of worn-away cartilage.”
Q: Who is a candidate for biologic shoulder resurfacing?
A: For patients who have debilitating shoulder pain uncontrolled by cortisone shots and other conservative treatments such as physical therapy, surgery is the next step. “For most people, it’s total shoulder replacement. For some, it’s biologic resurfacing,” Carr says.
Younger patients in their 40s and 50s with late-stage arthritis who would like to avoid traditional shoulder implants are optimal candidates for biologic resurfacing.
Patients do better if anatomically their ball and socket line up well and if the shoulder socket is well-preserved. “For a lot of patients, even if biologic resurfacing sounds interesting, their anatomy may not make them a great candidate.”
Q: What’s post-op life like compared to shoulder replacement?
A: Biologic resurfacing is typically a same-day outpatient, or one-day inpatient procedure. Patients wear a sling for about six weeks to help immobilize and protect their shoulder. “When we put cadaver bone in there, we want the body to grow bone and incorporate the graft. If a patient gets too aggressive in terms of motion and activities, there’s a chance it can come loose,” Carr explains.
Q: What are the pros and cons of shoulder resurfacing?
A: Pros: The idea of preserving normal anatomy and avoiding shoulder replacement surgery is an attractive idea to younger patients.
Cons: The procedure is an out-of-pocket expense, not typically covered by insurance. Since it is a newer procedure, there is not a lot of long-term data documenting its effectiveness.
No matter which surgery is right for you, Carr urges patients with debilitating shoulder pain to see an orthopedic physician specifically trained in shoulder surgery.
The Right Back Pain Treatment Begins with Understanding Back Pain Cause
Finding a back pain cause, such as a herniated disc, isn’t always easy. Even if you can point to a specific incident that triggered the back pain, a doctor might still have to do some detective work to accurately diagnose the injury.
“As physicians, we ask patients a lot of questions to make sure we understand the type of pain and its exact location,” explains Christopher Gallus, DO, an orthopedic doctor spine surgeon with Centura Orthopedics & Spine – Castle Rock. “Those are critical clues to helping us understand the injury.”
A physical exam and sometimes imaging scans are needed, too. Here’s why that detective work matters: “Only when we understand the injury can we make the best recommendation for back pain treatment,” Gallus says.
Gallus walks through some of the most common back injuries and the best treatments for each to show how the same type of pain could be caused by two wholly different problems requiring different treatments.
Back Pain Cause: Muscle strain
Whether it’s because of overuse or a sudden awkward twist, muscle or ligament strain is the most common cause of acute back pain. People who are overweight and those who are sedentary are at the greatest risk of injury.
“Our bodies are meant to move,” Gallus says. “Being active and staying in shape are key to preventing back pain.”
It’s also helpful to lift with proper form — that is, bending your knees and squatting while keeping your back straight. This way, you’ll use your strong leg muscles and take the load off your back.
Back Pain Treatment: Muscle strains typically just need time to recover. Anti-inflammatory pain relievers like ibuprofen can help in the early days. Topical pain relievers that you rub into your skin as well as ice might help as well. Then, as the pain subsides, carefully ease back into activity. Continuing with activity as your pain allows is much more beneficial than completely resting and stopping activity. If you’re still in pain after a couple weeks, see a doctor to make sure it’s not more than a strain.
Back Pain Cause: Herniated disc
In between the bones in the spine are discs, which act as shock absorbers. A sudden injury to the spine or regular wear and tear can cause a disc to be out of place, or herniated. It’s possible to have a herniated disc and not experience any symptoms, which is actually much more common than having symptoms. But sometimes the disc can press on the nerve roots and cause pain, numbness, or weakness in the arms or legs.
Back Pain Treatment: For most people, a conservative plan that includes anti-inflammatory pain medications, physical therapy, and exercise — or possibly steroid injections — will help. If that doesn’t work, though, surgery is an option, Gallus says.
“I typically like to make sure a patient has tried everything else before we look at surgery,” he adds.
If surgery is used, the protruding part of the disc is typically removed to relieve the pressure on the nerve, which usually gives complete relief of leg pain. In general, spine surgery is very good at relieving symptoms that arise from nerve compression.
Surgery might be needed urgently if there is severe numbness or weakness or if the disc injury has affected bladder or bowel control — indicating nerve damage.
Back Pain Cause: Compressed nerves
A herniated disc is one possible cause of a compressed nerve. But even repetitive motions or holding the body in one position for long periods of time can lead to nerve compression. The type and location of the pain will depend on which nerve is compressed. A compressed nerve in one part of the spine can lead to arm pain, for example, while compression of a different nerve can lead to leg and foot pain.
Back Pain Treatment: Anti-inflammatory medications and steroid injections as well physical therapy can be helpful. For people who don’t see any relief from these conservative back pain treatments, surgery may be needed. The goal of the surgery, Gallus says, is to remove whatever is pressing on the nerve root — that could be a disc, pieces of bone, or scar tissue.
Back Pain Cause: Osteoarthritis of the spine
As we get older, we’re at risk for arthritis in our joints. And while we often think of hips and knees, the spine also can be affected. With osteoarthritis, the cartilage in the joints and discs breaks down — and without that cushion between the bones, pain results. Sometimes, arthritis in the spine can lead to bone spurs, which can cause compressed nerves. Spinal stenosis — the narrowing of the spaces in the spine — also can occur.
Back Pain Treatment: “Maintaining a healthy weight and strong core and back musculature are helpful when it comes to back pain,” Gallus says. “For people who are overweight and suffering with osteoarthritis, I typically want them to start a simple exercise program to lose weight and increase flexibility and strength.”
Massage and acupuncture can be helpful as well. In severe cases where spinal stenosis has caused compression of nerves, surgery may be needed.
Back Pain cause: Osteoporosis
Osteoporosis is a disease that weakens the bones and increases the chances of bones in the spine breaking. A traumatic injury or fall could lead to a broken bone, or something simple like a sneeze could cause a compression fracture. Sometimes these breaks can cause sudden, sharp pain. But other times, people don’t realize they’ve broken one or more bones.
Several untreated breaks over time can lead to a curve in the spine, which can vary in severity.
Back Pain Treatment: If you’ve had a bone density scan and been diagnosed with osteoporosis, your doctor will likely talk to you about medications and lifestyle factors, such as exercise and getting enough calcium and vitamin D. For people who’ve had several compression fractures that have led to a deformity in the spine, surgery could eventually be an option.
Back Pain Cause: SI joint dysfunction
The sacroiliac (SI) joint is where the sacrum (five vertebrae at the base of the spine) and the iliac bones (two large bones of the pelvis) meet. Symptoms of SI joint dysfunction often include pain on one side of the lower back, hip pain, and discomfort bending over. It can be caused by arthritis, a traumatic injury, pregnancy, or having one leg longer than the other.
Back Pain Treatment: Rest, physical therapy, medications, and joint injections commonly help. It is very important that the physician who examines you is skilled in the art of physical diagnosis so that he or she can differentiate between low back pain, SI joint pain, and other musculoskeletal disorders.
Spinal Fusion Helps Patients Get Back to Pain-Free Lives
Forget the bad rap you’ve heard about spinal fusion surgery. This spine surgery is helping thousands get back to their lives, pain-free.
Nearly 500,000 spinal fusions are performed in the U.S. every year — six times as many as were performed two decades ago. While the increase in spinal fusion rates has caused debate, the reality is that spinal fusions, particularly lower back (lumbar) fusions, which join together one or more vertebrae in the lower back, can greatly benefit patients, says Scott Stanley, MD, an orthopedic doctor and spine surgeon with Centura Orthopedics & Spine -- Meridian.
“Lumbar fusions get a bad reputation, as people have a misconception that you are stiff and can’t move afterward,” Stanley says.
Patients like 75-year-old Nancy Rosenberg, who suffered from lumbar degenerative disc disease for years, prove otherwise.
“I can now move pain-free,” says Rosenberg, a longtime runner and yoga enthusiast who underwent a lumbar fusion and a laminectomy, which removed a portion of her vertebrae, a year ago. “If you played ’50s music, I could do the twist.”
“The prominent reason why we do lumbar fusions is to stabilize the back and, in cases of severe arthritic change, to eliminate pressure on nerve fibers,” Stanley says. “Fusion is not a surgery you seek out to solve back pain. It is used as an adjunct for nerve and instability problems.”
Conditions treated with spinal fusion surgery
Lumbar fusion may be used for the following:
- Spondylolisthesis treatment: spondylolisthesis occurs when one vertebra slips forward over another and causes pressure on the nerves
- Degenerative scoliosis treatment: degenerative scoliosis is caused by slow degeneration of the stabilizing joints between vertebrae
- Spinal stenosis surgery: spinal stenosis is a narrowing of the spinal canal, causing irritation to the spinal cord or nerves, resulting in pain, weakness, or numbness
“If you are 20 with back pain, a fusion is not for you. But if you are older and suffer from one of the conditions above, fusion could positively change your life,” Stanley says.
On the road to recovery with spinal fusion
Rosenberg had tried nearly everything to relieve her pain — injections, rest, medications, and physical therapy — to no avail. After a road trip to New Orleans in March last year, she was at her wit’s end.
“I could not walk from the car to the motel without extreme pain,” Rosenberg says. “I came back home and had another injection, but it didn’t help.”
That’s when Rosenberg went to see Stanley, whom she was referred to by two primary care physicians and a physical therapist. Stanley quickly discovered she had three worn discs in her lower back and spondylolisthesis. Rosenberg had surgery soon after and has never looked back.
“It’s not great to have surgery, period, but the whole process went so well,” Rosenberg says. After her hospital stay, Rosenberg spent three weeks in a rehabilitation facility, which helped her recover and took strain off her husband.
“I can do everything now and can’t wait to head out on the road,” she says.
Lumbar spinal fusion pros and cons
“Not all spine fusion is bad,” Stanley stresses. “Things have changed drastically over the years, and it’s a great surgery for the right candidates.”
Like every surgery, lumbar fusion offers pros and cons to patients.
Patients can often function and move better than before surgery
No bending, lifting, or twisting for up to 3 months
Can provide pain relief for certain conditions when conservative treatments fail
May initially require some pain medications
Once healed, you can go back to normal activities
Recovery requires help from family, physical therapists, and occupational therapists
“Like with any surgery, you have to be patient,” Stanley says.
The fusion is similar to an internal cast; once the body repairs and recovers, the benefits become exponential, he adds.
“Dr. Stanley did wonders for my body, inside and out, repairing my vertebrae and sparing me from a nasty scar,” Rosenberg says. “I couldn’t be happier.”