Orthopedic Surgery

Knee Arthroscopy and Knee Arthroscopy Recovery

knee surgeryKnee arthroscopy is surgery that uses a tiny camera (arthroscope) to look inside your knee. Small cuts are made to insert the camera and small surgical tools into your knee for the procedure.

Your surgeon can use arthroscopy to feel, repair or remove damaged tissue. To do this, small surgical instruments are inserted through other incisions around your knee.

Preparation for Knee Arthroscopy:

Usually no significant pre operative testing is needed. Depending on your heath, your orthopaedic surgeon may order pre-operative tests. These may include blood counts, an EKG (electrocardiogram), and even a complete physical examination to assess your health and identify any problems that could interfere with your surgery.

Surgery for Knee Arthroscopy:

During the procedure, the orthopedic surgeon inserts the arthroscope (a small camera instrument about the size of a pencil) into your knee joint through a small incision in the knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your surgeon see your knee clearly so that he may diagnose the problem and determine what treatment is needed.

Arthroscopy for the knee is most commonly used for:

  • Removal or repair of torn meniscal or articular cartilage
  • Reconstruction of a torn anterior cruciate ligament (ACL)
  • Removal of loose fragments of bone or cartilage
  • Removal of inflamed synovial tissue

After your procedure has concluded, a doctor will remove the instruments and close the incisions with a stitch.

Recovery from Knee Arthroscopy

Recovery from knee arthroscopy is much faster than traditional open knee surgery. You may have some slight swelling in the knee after surgery. Keep your leg elevated as much as possible for the first few days following surgery and ice your knee following the instructions given by your doctor. You may or may not be placed on crutches. Your surgeon will make that decision and discuss with you. Your surgeon will most likely prescribe physical therapy for 6-12 weeks, as well.

About Dr. John Xerogeanes

John Xerogeanes MD

John W. Xerogeanes, MD, Chief of Sports Medicine at Emory University, is known as Dr. “X” by his staff and patients. He is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. X has been the Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA since 2001. He specializes in ACL and ACL revision surgery performing over 200 of these operations each year. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

Dr. Xerogeanes has been recognized as one of US News & World Report’s Top Doctors with a special distinction listing him among the top 1% in the nation in his specialty.

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Knee Replacement Surgery

Knee SurgeryThe knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. Your knee can become damaged by osteoarthritis resulting from wear and tear over time, by rheumatoid arthritis, psoriatic arthritis, or by injury/trauma to the knee. Rest, medication, and therapy are the first lines of treatment, but knee replacement surgery — also known as knee arthroplasty — can help relieve pain and restore knee function for those whose cartilage is too damaged to respond to conservative measures. Although surgery always comes with risks, knee replacement surgery continues to be one of the most predictably successful of all major operations done for any problem. It is however a major surgery and should only be considered when other nonsurgical options are not adequate.

Knee Replacement Procedure

In general, knee replacement surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. Knee replacement would be more accurately called knee resurfacing in that only the surface of the femur and tibia are removed and then capped by metal. The ends of the bone are precisely shaped to exactly match the shape of the artificial components. These artificial components mimic the shape of the normal bone. A highly wear resistant plastic insert is placed as the cushion between the two metal components. Usually a total knee replacement also involves capping the surface of your knee cap (patella) with polyethylene. A good result from the operation is very dependent on the accuracy of contouring of bone and placement of components.

What to Expect From Knee Surgery

Recent improvements in materials and techniques have made total knee replacement a common and highly successful surgery, with around 300,000 being performed every year in the U.S alone. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement in pain and range of motion. Approximately 95% of patients after recovering from knee replacement report enough improvement that they would repeat the decision to have surgery. In addition to routing life activities, such activities as walking, cycling, dancing, golf and tennis are comfortable for the majority of patients.

Knee Surgery Rehabilitation

Post-operative hospitalization averages 1 to 3 nights, depending on the health status of the patient. Most people require crutches or a walker for 1 to 3 weeks and a cane for 1 to 3 weeks after that. The average need to see a physical therapist is for 4 to 6 weeks and the time to a better knee overall than before surgery for most patients is about 4 to 6 weeks. Time to safely driving a car is typically 2 to 4 weeks and average time off work is also approximately 4 weeks.

About Dr. Roberson

James Roberson, MDJames Roberson, MD is professor and chairman of the Department of Orthopaedics at Emory. He specializes in total joint replacement of the hip and knee. Dr. Roberson completed his residency training at Emory University followed by a fellowship at Mayo Clinic. He has been practicing at Emory since 1982.

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Total Knee Replacement
Revision of Total Knee Replacement
Unicompartmental Knee Replacement

Do You Think You Have a Ruptured Disc? Check Out These Signs and Symptoms of a Herniated or Ruptured Disc

Herniated DiscA herniated disc, also commonly referred to as a ruptured disc or slipped disc, occurs when a cartilage disc in the spine becomes damaged and moves out of place resulting in a pinched nerve. You can have a herniated or ruptured disc in any area of your spine but most often it affects the lumbar spine (lower back area). There are many causes of a herniated or ruptured disc including:

  • Degeneration due to aging
  • Wear and tear
  • Injury to the vertebrae
  • Sudden strain or sprain in lower back
  • Sports injuries or accidents

Symptoms of a herniated or ruptured Disc

Symptoms of a ruptured disc will vary from person to person but the most common symptoms of a herniated or ruptured disc include:

  • Severe pain in the back around the ruptured area
  • Muscle weakness, numbness, shooting pain or tingling in the legs
  • Muscle spasms
  • Pain in shoulders, arms, chest, ribs or thighs (depending on where the rupture has taken place)

Treatment for a herniated or ruptured Disc

Most often herniated discs can be treated without surgical intervention. We typically recommend starting a patient on anti-inflammatory medications, ice and heat to reduce the severity of the pain. In some cases a steroid injection may be helpful, and in others physical therapy with back exercises can be added to the treatment plan. If all other options are exhausted and radiating arm/leg pain persists after 6 – 12 weeks of treatment, surgery may be recommended.

If a herniated or ruptured disc is identified quickly, treatments are more likely to be successful. Any one with a ruptured disc should modify their activity level to avoid lifting heavy objects as well as avoid bending or any activities which worsens the radiation of arm/leg pain. Sports activities should also be reduced while healing.

Some surgery options for herniated or ruptured discs are:

At Emory, our nationally renowned spine specialists work together to diagnose and treat cervical spine and lumbar conditions. Emory physiatrists (non-operative physicians) and surgeons use innovative approaches to spine care and have extensive experience that allows us to boast high success rates. Emory is one of the largest University – based Spine Centers in the United States. Our physicians typically exhaust non-surgical options first, but if surgery is recommended, most surgeries for herniated or ruptured discs are performed at Emory University Orthopaedics & Spine Hospital in Tucker. Emory University Orthopaedics & Spine Hospital is a dedicated orthopedic and spine hospital and it leverages the pioneering vision, latest research and medical advances to provide high quality patient and family centered care.

About Scott Boden, MD

Scott Boden, MDScott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics & Spine Hospital (EUOSH).

Dr. Boden’s Clinical Interests:
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

The Road to Emory: Education
• Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
• Internship: George Washington University Medical Center, Washington, D.C. 1987
• Residency: George Washington University Medical Center, Washington, D.C. 1991
• Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Personal
Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

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Types of Knee Replacements

Knee ReplacementThe knee is the largest and most complex joint in the human body. It is also one of the most important joints, playing an essential role in carrying the weight of the body in a given direction. It is formed by the lower part of the femur, the tibial plateau and the knee cap, and enables hinge and rotating movements as the connection between the upper and lower leg.

When the knee joint is damaged, people can experience pain, swelling and decreased range of motion. This can make it difficult to perform daily tasks like standing, climbing stairs or walking. If the knee doesn’t respond to activity modification, anti-inflammatory medications and injections, knee replacement surgery may be a viable option. Your doctor may recommend knee replacement surgery if you have severe knee pain and disability from rheumatoid arthritis, osteoarthritis, or traumatic injury, and will make a determination based on the damage to your knee, bone strength, age, lifestyle and other medical conditions you have.

There are two types of replacement surgeries: total knee replacement and partial knee replacement, with total knee replacement surgeries comprising more than 90 percent of today’s procedures. During both surgeries an orthopedic surgeon will replace the damaged knee with an artificial device (implant). Although replacing the total knee joint is the most common procedure, some people can benefit from just a partial knee replacement.

Partial Knee Replacement
The knee is made up of three areas or compartments: medial and lateral (the sides of your knee) and patella-femoral (the knee cap). When fewer than three of these areas need to be replaced, it is called a unicompartmental or partial knee replacement.

Partial knee replacement isn’t suitable for everyone because you need to have strong, healthy ligaments within your knee. However, if only one side of your knee is affected, then partial replacement may be a possibility. Partial knee replacements can often be carried out through a smaller cut (incision) than a total knee replacement, and are typically less complicated than total knee replacements. This almost always means a quicker recovery and better function while giving the same level of pain relief as a total knee replacement.

Total Knee Replacement
Most total knee replacement surgeries resurface the bones at the top of your shin bone (tibia) and the bottom of your thigh bone (femur) with an implant made of metal and plastic parts. The end of the femur and top of the tibia are resurfaced and capped with a metal implants. There is a plastic or polyethelene spacer between the two metal components so the articulating surface is metal on plastic. A total knee replacement may also involve replacing the surface of your knee cap (patella) with polyethelene, although many surgeons prefer to leave it in its natural state because it will be less likely to fracture. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

After Knee Replacement Surgery
The average hospital stay after knee joint replacement is usually two to four days, and the vast majority of people who undergo knee joint replacement surgery have dramatic improvement in pain and range of motion. Once muscle strength is restored with physical therapy, people who have had knee joint replacement surgery can enjoy most activities although running for exercise not recommended. . The duration of physical therapy can vary, but typically outpatient therapy lasts from one to two months.

About Dr. Reimer

Nickolas Reimer, MDDr. Nickolas Reimer is an assistant professor of Orthopaedic Surgery at Emory University. He specializes in the treatment of musculoskeletal tumors, total hip and total knee replacements and revision surgeries.

Achilles Tendon Ruptures and Repair

achilles tendonThe Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries: Achilles tendonitis, and a complete tear. It’s important to know whether the Achilles is torn or not, because the treatment is very different: a torn Achilles may require surgery; Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly.

Because an Achilles tendon rupture can impair your ability to walk, it’s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.

Tests and Diagnosis

During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. Achilles tendon rupture can be diagnosed reliably with clinical examination, but if there’s a question about the extent of your Achilles tendon injury then your doctor may order a magnetic resonance imaging (MRI) scan.

Repair

The best treatment for a ruptured Achilles tendon in an active individual is typically surgery. While an Achilles rupture can sometimes be treated with a cast, splint, brace, or other device that will keep your lower leg from moving, surgery provides less chance that the tendon will rupture again and offers more strength and a shorter recovery period. Surgery may be delayed for a period of a week after the rupture, to let the swelling go down.

There are two types of surgery to repair a ruptured Achilles tendon and both involve the surgeon sewing the tendon back together through the incision(s):

  • Open surgery – the surgeon makes a single large incision in the back of the leg.
  • Percutaneous surgery – the surgeon makes a number of small incisions rather than one large incision.

Depending on the condition of the torn tissue, the repair may be reinforced with other tendons.

Rehabilitation

After treatment, whether surgical or nonsurgical, you’ll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to daily activity within four to six months, though high-impact athletes may take up to a year to return to sport.

About Dr. Labib

Sam Labib, MDSam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com. Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University and Spelman College, and an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

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Torn Meniscus and Torn Meniscus Surgery

Torn MeniscusWhen people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The meniscus is a rubbery, C-shaped disc that cushions your knee and acts as a shock absorber between your thighbone and shinbone. Each knee has two menisci, which help to keep your knee steady by balancing your weight across the knee.

Any person at any time can tear their meniscus, but athletes—particularly those who play contact sports—tend to be at a higher risk, the reason being that a meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. Players may squat and twist the knee, causing a tear.

As you get older, your meniscus gets worn which can make it tear more easily. Cartilage weakens and wears thin over time, increasing the likelihood of degenerative meniscal tears. One awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Torn Meniscus Symptoms
Depending on the severity of the tear, symptoms will vary. Typically meniscal tears are categorized into three groups: minor, moderate and major tears. Generally, most people can still walk on their injured knee after a meniscal tear, but you may feel a “pop” when you tear a meniscus. Often athletes will keep playing with a tear, but over the course of two to three days the knee will likely become stiff and swollen.

Common symptoms of meniscal tears include the following:

  • Feeling a “pop” in the knee
  • Pain
  • Stiffness and swelling
  • Inability to move knee through full range of motion (such as not being able to straighten the knee)
  • Catching or locking of the knee
  • The sensation of the knee feeling “wobbly” or giving way without warning

In severe tears and those without proper treatment, a piece of meniscus may come loose and drift into the joint, causing your knee to slip, pop, or catch.

Torn Meniscus Diagnosis and Treatment
When diagnosing a meniscal tear, doctors will often perform what is known as a McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your doctor may also order imaging tests such as an X-ray or MRI to confirm the meniscal tear.

How your doctor treats your meniscus tear depends on several things, such as the type of tear, where it is, and how serious it is. Your age and how active you are may also affect your treatment choices.

Common treatments include:

  • Rest
  • Ice
  • Physical therapy
  • Non-steroidal anti-inflammatory medicines (such as aspirin or ibuprofen)
  • Surgery

Surgical Treatment
Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee. Knee arthroscopy is a commonly performed surgical procedure in which a miniature camera is inserted through a small incision to better view the knee. Your orthopaedic surgeon will then insert miniature surgical instruments through other small incisions to trim or repair the tear.

Depending on the tear, a variety of procedures can be done:

  • Meniscectomy. In this procedure, the damaged meniscal tissue is trimmed away (partial meniscectomy) or, in extreme cases, the entire meniscus will be removed (total meniscectomy). Total meniscectomy procedures are typically avoided because of the likelihood of causing osteoarthritis in the knee.
  • Meniscus repair. Some meniscal tears can be repaired by suturing (stitching) the torn pieces together.

It is preferable to preserve as much of the meniscus as possible. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total removal.

Recovery / Rehabilitation
How well the knee will heal depends on how bad the tear is. After surgery, your doctor may put your knee in a cast or brace to keep it from moving, and you may need to be on crutches for a period of time to keep weight off the knee. Your doctor will work with you on a rehabilitation program that helps you regain as much strength and flexibility as possible.

About Dr. Pombo

Mathew Pombo, MDMathew Pombo, MD, is a highly regarded orthopaedic surgeon, speaker, author and researcher who specializes in getting patients with injuries back to an active lifestyle. His professional interests include anatomic single and double bundle ACL reconstruction, rotator cuff tears, shoulder instability, meniscal/cartilage injury and repair, joint preservation in the aging athlete, and minimally invasive joint replacement surgery of the knee and shoulder. Dr. Pombo has conducted extensive scientific research, published multiple journal articles, written several book chapters, and has presented both at national and international meetings on topics related to sports medicine, concussions, and orthopaedic surgery. He is a member of several design teams for orthopaedic companies and enjoys participating in the engineering of the next generation of orthopaedic techniques and equipment. He has been instrumental in bringing awareness to Sports Related Concussions and the new Georgia “Return to Play” Act and is one of the top regarded experts in the area for the treatment of Concussions. He currently serves as the Director of the Emory Sports Concussion Program.

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How is Arthroscopic Hip Surgery Different?

ArthroscopyArthroscopy (also called Arthroscopic surgery) is a surgical procedure by which the internal structure of a joint is examined for diagnosis (and possibly treated) using an instrument called an arthroscope. Arthroscopy gives doctors a clear view of the inside of a joint, and helps them diagnose and treat joint problems. Hip arthroscopy has been slower to evolve than arthroscopy of other joints such as the knee or shoulder, mostly because the hip joint is much deeper in the body and therefore harder to access, but can be very effective at treating certain hip conditions.

Arthroscopic hip surgery is radically different than traditional open surgery, and may be considered before one opts for a full hip replacement surgery. Non-operative measures should always be considered first — rest, behavior modification, physical therapy and anti-inflammatories may work to alleviate reversible disorders. If non-operative measures aren’t effective and you do elect for surgery, a procedure may be done arthroscopically instead of by traditional surgical techniques, as it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

Hip Replacement Surgery 101

hip replacementThe hip is one of the body’s largest and most important joints. It allows us to walk, run and jump, and bears our body’s weight and the force of the muscles of the hip and leg. If your hip has been severely damaged—by a fracture, arthritis, osteonecrosis or other conditions–common activities such as walking or getting in and out of a chair may be painful and difficult. You may even feel uncomfortable while resting.

If other alternatives such as medications, the use of walking supports, or changes to daily activities do not effectively help your symptoms, hip replacement may be a viable solution and you should consult with your physician to learn more. Generally, hip replacement surgery is a safe and effective procedure that can help you get back to enjoying everyday activities.

Understanding Rotationplasty – Alternative to Limb Sparing Surgery

Rotationplasty Child Limb Sparing Surgery AlternativeRotationplasty is a surgical option for young children who have been diagnosed with a variety of malignant or benign conditions. Rotationplasty is most commonly used as a treatment option for osteosarcoma or Ewing’s sarcoma in the distal femur or proximal tibia. This procedure can also be used in the proximal femur for rotationplasty in the hip, but this is much less common than the knee.

In rotationplasty, the bone cancer and surrounding tissues are removed and the remaining lower section of the leg is rotated before reattaching to the healthy upper section.  Rotationplasty is typically recommended when a portion of the limb is injured or diseased.

During the leg rotationplasty procedure, the ankle becomes the knee joint.  A prosthesis is built that allows the foot and ankle to function as the patient’s knee.  This prosthesis is different than a typical prosthetic device since it requires consideration of an anatomical ankle to act as the knee.  The ankle (new knee) requires structural support so that the patient does not overextend the ankle.  Prosthetic fit and function are very critical and should only be performed by a skilled prosthetist.

Patients who undergo rotationplasty as a surgical option for treatment require intensive physical therapy to gain motion and strength in the reconstructed limb. A physical therapist and prosthetist who are skilled in this specific design/procedure should work very closely with the patient’s orthopedic surgeon to guide the exercise program and prosthetic fitting.

Other surgical options for young patients with sarcomas such as osteosarcoma or Ewing’s sarcoma are:

When making the decision whether to receive rotationplasty versus the other treatment options, parents should take into consideration the age of the child, the location and size of the cancer, medical diagnosis and prognosis as well as the “functional outcomes” that the parents/child/physician agree on.

Rotationplasty is a good option for young patients who have not finished growing and have a malignant bone tumor around the knee joint.  Because their legs have not grown completely, the leg length difference will not be as great.  Also, the young patient will be able to run and jump and keep up with their friends and classmates.  The patient can participate in most sports even those with jumping and high impact.  Because the ankle joint is a natural joint functioning as the “new knee,” the patient has greater control of the “knee” with sensation of how it is moving as well as the position of the knee as the patient walks and runs.

At Emory Orthopaedics & Spine, we work closely with the resources at Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center, one of the largest childhood cancer programs in the country. Our continuum of care features pediatric experts in orthopedic surgery, radiation oncology, social work, case management, physical therapy and prosthetics.

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About the Experts

Dr. David MonsonAbout Dr. Monson
David K. Monson, MD, assistant professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery at Emory University Hospital Midtown, started practicing at Emory in 1988. Dr. Monson is an expert in the treatment of rare tumors (sarcomas of the bone and soft tissue). Dr. Monson’s specialties are Orthopaedic Surgery (Board certified since 1990) and Orthopaedic Oncology. His areas of clinical interest are orthopaedic tumors, sarcoma, and limb reconstruction.

 

Dr. Shervin OskoueiAbout Dr. Oskouei
Shervin V. Oskouei, MD, assistant professor of Orthopaedic Surgery at Emory University, is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. Dr. Oskouei started practicing at Emory in 2004. Dr. Oskouei is board-certified and fellowship trained in orthopaedic surgery. Combining his experience and interests with the state-of-the-art facilities of Emory University and the Winship Cancer Institute of Emory University allows Dr. Oskouei to treat patients with the latest modalities using a multi-disciplinary approach.

About Emory Orthopaedic Oncology
Dr. Monson and Dr. Oskouei lead the Emory Musculoskeletal Oncology and Limb Reconstruction program at Emory.  The world – class program treats a variety of conditions, including benign and malignant tumors of the extremities and spine, as well as metastatic disease. Together, they offer a combined 34 years of clinical practice experience. They care for both pediatric and adult aged patients.

Both of these physicians belong to the Musculoskeletal Tumor Society which requires fellowship training in orthopaedic oncology.  Physicians belonging to this group must also have a primary clinical focus in orthopaedic oncology.  This is important for patients because it means the specialist you are seeing has had extra training in this area and is viewed by peers as an expert in the care of orthopaedic oncology. Patients should take the time to research physicians in their area to determine if they are seeing an orthopaedic oncology specialist that belongs to this organization.

What is an Osteosarcoma and What is the Best Way to Treat it?

Bone and soft tissue sarcomas are rare conditions that affect approximately 13,000 people each year. In the US, 10,000 are diagnosed with soft tissue sarcomas and approximately 3,000 are diagnosed with bone sarcomas, of which 1,000 are osteosarcomas.

The most common type of sarcoma that develops in the bone is called an osteosarcoma while sarcomas that develop in the connective tissue are called soft tissue sarcomas. Soft tissue sarcomas can develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. The rarity of sarcomas means most doctors seldom see one, which explains why patients are often referred to specialty hospitals where experienced surgeons utilize limb-sparing (no amputation) surgery whenever possible.

Understanding Osteosarcomas

Osteosarcomas are aggressive malignant bone tumors and are the most common type of bone cancer in young people. They usually occur between the ages of 10 and 25, but can occur at any age and are more common in males than females. They encompass about 20% of all primary bone cancers and it is estimated that the incidence rate in U.S. patients under 20 years of age is 5 per million. Osteosarcomas most commonly start in the ends of long bones of the arms or legs where new bone tissue rapidly forms.

Symptoms of Osteosarcoma

  • Pain near the affected bone is the most common osteosarcoma symptom
  • Swelling of the bones and joints. Noticeable swelling or protrusion near the location of the tumor
  • Brittleness/weakness of the bone which can lead to fractures
  • Difficulty moving during physical activity
  • Noticeable limp when the osteosarcoma is in the leg

Treatment for Osteosarcoma

Typically chemotherapy is given to shrink the tumor before surgery. Most often, chemotherapy results in a necrosis (or death) of the tumor and allows the physician to treat possible cells in the blood stream. In most cases, surgery is required to remove the section of cancerous bone. Limb sparing surgery (LSS) is a special operative procedure performed by oncology orthopedic surgeons and has become the accepted standard of care for patients with sarcomas of the extremities. Limb sparing surgery can be accomplished in approximately 90% of the cases. During limb sparing surgery, the cancer in the bone is removed surgically and the portion of the bone that was removed is either replaced with special metal prostheses or a bone allograft. An allograft is a bone transplant obtained sterilely from a person that has died and agreed to be an organ donor. Emory Orthopaedic surgeons have mastered the limb-sparing surgery in order to save as much bone as possible without compromising the ability to cure the patient.

Emory offers a unique multi – disciplinary treatment approach to bone sarcoma care. Emory Orthopaedic oncology surgeons collaborate with medical oncologists, radiation oncologists, pathologist, radiologists, thoracic surgeons, plastic surgeons and vascular surgeons to develop a treatment plan catered to each individual patient.


Dr. David MonsonAbout Dr. Monson
David K. Monson, MD, assistant professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery at Emory University Hospital Midtown, started practicing at Emory in 1988. Dr. Monson is an expert in the treatment of rare tumors (sarcomas of the bone and soft tissue). Dr. Monson’s specialties are Orthopaedic Surgery (Board certified since 1990) and Orthopaedic Oncology. His areas of clinical interest are orthopaedic tumors, sarcoma, and limb reconstruction.

 

Dr. Shervin OskoueiAbout Dr. Oskouei
Shervin V. Oskouei, MD, assistant professor of Orthopaedic Surgery at Emory University, is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. Dr. Oskouei started practicing at Emory in 2004. Dr. Oskouei is board-certified and fellowship trained in orthopaedic surgery. Combining his experience and interests with the state-of-the-art facilities of Emory University and the Winship Cancer Institute of Emory University allows Dr. Oskouei to treat patients with the latest modalities using a multi-disciplinary approach.

About Emory Orthopaedic Oncology
Dr. Monson and Dr. Oskouei lead the Emory Musculoskeletal Oncology and Limb Reconstruction program at Emory. The world – class program treats a variety of conditions, including benign and malignant tumors of the extremities and spine, as well as metastatic disease. Together, they offer a combined 34 years of clinical practice experience. They care for both pediatric and adult aged patients.

Both of these physicians belong to the Musculoskeletal Tumor Society which requires fellowship training in orthopaedic oncology. Physicians belonging to this group must also have a primary clinical focus in orthopaedic oncology. This is important for patients because it means the specialist you are seeing has had extra training in this area and is viewed by peers as an expert in the care of orthopaedic oncology. Patients should take the time to research physicians in their area to determine if they are seeing an orthopaedic oncology specialist that belongs to this organization.

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