Posts Tagged ‘Orthopedic Surgery’

Minimally Invasive Hip Surgery Gets Patients Active Faster – A Patient Story

June 10th, 2011 By Dr. Bradbury

Thomas Bradbury, MDWhen I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.

Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.

Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.

While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.

“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”

I encourage you to read up on the details of Mark’s total hip arthroplasty, and watch a video on Mark’s journey. Have you had anterior total hip arthroplasty? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Thomas Bradbury, MD

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

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Orthop(a)edics 101

April 6th, 2011 By Emory Orthopaedics & Spine Center

Orthopedics 101Is it “orthopaedic” or “orthopedic”? What does “musculoskeletal” really mean? What’s the difference between a ligament and a tendon? Today we’re going to answer some of the more pressing questions people have about this fascinating area of medicine.

First off, let’s discuss the use of orthopaedic v. orthopedic. Orthopaedic is derived from the Greek orthos, for correct or straight, and paideion, for child. Today, orthop(a)edics refers to the correction of spinal and bony deformities in both children and adults. In the U.S., we like to keep things simple, so “orthopedics” has become the standard spelling. In Great Britain and its other former (non-U.S.) colonies, orthopaedics is preferred. The academic world, like the Brits, enjoys fancying things up, so in most universities and other academic settings, orthpaedics stands. Microsoft Word prefers it without the “a.” Take your pick.

Simply put, orthopaedic (or orthopedic) surgery is the branch of surgery concerned with conditions of the musculoskeletal system. What’s the musculoskeletal system? Clearly, it’s a system that involves the muscles and the skeleton. Also called the “locomotor system,” the musculoskeletal system includes the parts of your body that help you move. And help you stay in one place. The bones provide stability, while the muscles help the bones stay in place and move. Joints allow motion, and cartilage keeps the bone ends from rubbing against one another. It’s all about how bones are connected to other bones and joints and muscles by connective tissues called tendons and ligaments.

What’s the difference between a tendon and a ligament, you ask? A tendon (or sinew) is a tough band of tissue that connects the muscle to the bone. A ligament connects bones to other bones. But wait—let’s not forget the fascia. The fascia is a layer of fibrous tissue that surrounds muscles and groups of muscles, as well as blood vessels and nerves, and binds all of these together. The layers of fascia include a superficial fascia (connected to the dermis, or skin), a deep fascia (surrounding the bones and muscles), and a subserous, or visceral, fascia (supporting the organs).

The surgeons and physiatrists at the Emory Orthpaedics & Spine Center are intimately familiar with every aspect of the musculoskeletal system and can diagnose and treat myriad ailments, both surgically and nonsurgically. So if you’re hurting, whether from a broken bone or a stretched or torn ligament or tendon, come see us. With or without the “a,” we know our orthop(a)edics.

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Got Hip Pain? Get Back in the Game Quickly with Hip Resurfacing

March 10th, 2011 By Dr. Greg Erens

hip resurfacing procedureIn my practice at the Emory Orthopaedics & Spine Center, I see a lot of patients who suffer from hip pain as a result of osteoarthritis, or degenerative joint disease. In the past, when surgery was called for, hip replacement was often the best option—and in many cases, it still is. However, in 2006 the FDA approved the first total hip resurfacing implant in the United States, allowing patients suffering from serious hip pain another highly effective option.

Unlike total hip replacement, in which the diseased head ball of the hip (femoral head) is completely removed, total hip resurfacing preserves the femoral head and removes only the damaged surface of the bone.

Only a small number of surgeons in the Atlanta area have the training and expertise to perform this procedure properly. I have been performing total hip resurfacing procedures at Emory since 2007, with excellent patient outcomes. This specialized operation has a number of potential advantages for the right patient. Total hip resurfacing can:

  1. Preserve bone
  2. Restore the natural anatomy of the hip
  3. Provide the largest possible head size to improve hip stability
  4. Enable restoration of hip function to allow a multitude of activities
  5. Allow for an easier revision (re-do) in the future, if needed

So who’s the perfect hip resurfacing patient? Hip resurfacing is best suited for the young, active male (<55 years of age) with osteoarthritis of the hip and normal hip anatomy. Healthy and active at 45, Mark Gabriel was the ideal candidate. I met Mark last year, after he’d been suffering from pinching and pain in his hip for a year and was referred to me for surgery. Mark, a director for an Atlanta IT solutions and staffing company, was in great shape, save for his hip. His hip pain had resulted in large part from 40 years of playing tennis on hard-surface courts. As he put it, his hip was like a brake pad that had been used too much. Eventually it wore out. Resurfacing his hip was a great way to preserve the hip bone and allow Mark to get back to the active lifestyle he enjoyed.

In July of 2009, I performed Mark’s hip resurfacing surgery at Emory University Orthopedic & Spine Hospital (EUOSH), our state-of-the-art inpatient facility. Mark was put under general anesthesia for the procedure, which went smoothly and took about two hours. Because Mark is young and had stayed active by cycling up to his surgery date, he recovered from the surgery quickly. He stayed in the hospital just two nights and was off pain medication completely three days after surgery. After six days, he was down to one crutch and was back to walking around his neighborhood.

Mark says that he is 100% satisfied with the results of his hip resurfacing. In the year since the procedure, he’s played tennis five days a week, enjoyed golf, and gone skiing. He chooses clay courts over hard surface when he has the option, but Mark is back in the game and loving life after hip surgery.

Have you had hip surgery, or are you considering hip resurfacing? We welcome your questions and feedback in the comments section below.

About Greg Erens, MD:
Greg Erens, MD,  is assistant professor of orthopedic surgery and director of the Emory Adult Reconstruction Fellowship. Board certified in orthopedic surgery, he specializes in both uncomplicated and complex problems of the hip and knee. Dr. Erens started practicing at Emory in 2003.

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Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

February 22nd, 2011 By James R. Roberson, MD

James Roberson, MDDislocation of the ball from the joint has always been a possible complication following hip replacement surgery. However, at Emory Orthopaedics, a couple of developments have significantly reduced, if not eliminated, those concerns.

One of these developments is the use of alternative bearing surfaces such as highly cross-linked polyethylene—a super-wear-resistant plastic—which enables surgeons to use larger-diameter balls (femoral heads) in the hip joint. The new, thinner bearing surfaces allow for larger-diameter femoral heads, making the hip intrinsically more stable.

Another development that has significantly increased hip stability is recognition of the importance of reconstructing the ligamentous capsule of the hip joint to its appropriate anatomic position at the completion of the hip replacement. The hip is held in place by the soft tissue around the hip—the capsule, the ligaments, and the tendons. If these are not put back in an anatomic position (i.e., where they came from), the hip will have a greater chance of dislocation.

At Emory Orthopaedics, what these developments mean is that we have become more comfortable allowing our patients to resume natural activities earlier after surgery. Traditionally, patients were told they shouldn’t bend their hip more than 90 degrees, shouldn’t cross their legs, should use an elevated toilet seat, etc. for up to three months following surgery. Patients were apprehensive about dislocating their hip. But with these new materials and improved methods, for most patients we’ve stopped using those restrictions in the early post-op period. Now we feel confident telling patients that they can sit however they’d like to, bend their hips, and so on. They can go straight to enjoying their new and improved hip.

Have you had or are you going to have joint capsule reconstruction surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Dr. Roberson

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

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Getting In Shape For Surgery

July 27th, 2010 By Dr. Bradbury

In this post, I’ll discuss the importance of “getting in shape” for surgery. When conservative nonsurgical measures fail, and we’re considering joint replacement surgery for the treatment of end stage arthritis of the hip or knee, it’s important to take measures to increase your chance of success and reduce the risk of complications. Ideally, these steps should take place well before the actual procedure, and can be compared to “training for a marathon”. Generally, we look at three things in particular: Are you close to your ideal body weight? Are you aerobically conditioned? Are you a nonsmoker? If the answer to each of these questions is yes, you’re probably an excellent candidate for surgery. If not, we suggest that you take the following steps prior to scheduling surgery:

Lose weight

Being at or close to your ideal weight enhances your chances of surgical success. (You can calculate your BMI here.) If your BMI is 30–39, you have a higher risk of complication from surgery. If your BMI is 40 or above, you may not be a candidate for surgery right now, but we have resources at Emory to support you in your weight-loss efforts. Emory Family Medicine offers weight-loss counseling services, and the Emory Bariatric Center provides both surgical and nonsurgical weight-loss options. Weight loss is among the most important steps toward improving overall health and quality of life. In most cases, weight loss will improve the pain and loss of function associated with arthritis of the hip and knee. This improvement can be significant enough to obviate the need for surgery.  If surgery is necessary, appropriate weight loss prior to surgery will dramatically reduce the risk of complications including infection and dangerous blood clots. In addition, it will speed the recovery process and help prevent future orthopedic problems.

Get active

Patients who exercise regularly tend to recover from surgery more quickly than patients who don’t. If you’re preparing for orthopedic surgery such as knee or hip replacement, weight training and cardiovascular exercise can smooth the recovery process. When your muscles and soft tissues are strong and well conditioned, they help stabilize the knee and protect the joints, helping you get moving again more quickly.

Further, if you‘ve been diagnosed with hip or knee arthritis, don’t discontinue exercise and aerobic conditioning. Exercise has been scientifically proven to improve the pain and loss of function associated with arthritis of the knee. If you aren’t currently active, you can start now by slowly introducing exercise into your schedule—even just three times a week is helpful. Choose an exercise that does not cause pain. In general, lower impact exercises such as swimming, cycling, and the elliptical machine will allow elevation of heart rate while minimizing pain associated with hip or knee arthritis. There’s no evidence that increasing activity level will cause worsening of knee arthritis.

If you need help creating an exercise plan, the physical therapists at the Emory Orthopedics & Spine Center can work with you. Having professional support and/or a partner to exercise with can make it easier to begin and stick with an exercise program.

Stop smoking

Smoking cigarettes increases the risk of complication after orthopedic surgery. If you’re a smoker, cessation from smoking for at least one month before and one month after surgery can significantly reduce the risk of complications after surgery. Smoking can inhibit bone’s ability to heal itself, slow surgical wound healing, and increase the risk of infection following surgery. Smokers also have an increased chance of having lung problems, such as pneumonia, after surgery. One study demonstrated that smoking cessation prior to and after surgery could reduce the risk of complication by more than 50%.

If you need help quitting, Emory Family Medicine offers smoking cessation counseling services.

Are you getting in shape for orthopedic surgery? We welcome your questions and feedback in the comments section below.

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

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