Posts Tagged ‘surgery’

Upcoming Doctor Chat: ACL Injuries

ACL Injuries Chat Sign UpDid you know that there are over 150,000 injuries to American athletes each year and female athletes are 2 to 8 times more likely to injure their ACL than their male counterparts?

Surgery is recommended for many ACL (anterior cruiciate ligament) injuries and most athletes are able to get back to their sports within 6 to 12 months. All athletes should know what they can do to prevent ACL injuries or how to take care of an ACL injury if it occurs.  Join Emory Sports Medicine surgeon, Sam Labib on Tuesday, March 26 at 12 noon for an interactive, live, web chat on ACL injuries. Dr. Labib, will be able to answer questions about  the ACL including what the ACL does, how ACL injuries occur, symptoms of an ACL injury, treatment options for ACL injuries, how to get back to your sport after an ACL injury and new research on the horizon.

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

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.

3 Cervical Spine Procedures that Reduce Recovery Times

John G. Heller, MDWhen people think about neck conditions requiring surgery, they usually think about cervical spine injuries. We’ve all seen those tense moments during football or other sports when a player is injured and lies motionless on the field. A dramatic example comes from a Boston Celtics basketball game back in February, when Marquis Daniels bumped into another player and then fell motionless to the floor.

Fortunately, these events are rare. Most cervical spine surgery is needed because of wear and tear that affects your discs over time. In younger adults, this tends to be a herniated disc, which compresses the nerve roots or spinal cord. And, as we age, we all develop bone spurs to varying degrees (the “gray hair of the neck”). These spurs can be a source of nerve root or spinal cord compression, as well.

Cervical spine procedures are typically performed through the front of the neck, or anteriorly. In the United States, the primary surgical technique for the past 50 years has been the anterior cervical discectomy and fusion (ACDF). Since bone spurs form at the margins of the discs as they degenerate, these operations involve a discectomy, or the removal of the entire cervical disc, plus any bone spurs that border the discs.

Over the last two decades, spine surgeons at Emory have been leading the way in performing several innovative cervical spine procedures: laminoforaminotomy, artificial cervical disc, and laminoplasty. These procedures are performed from the back, or posteriorly, and don’t require a spinal fusion, thereby allowing patients to retain range of motion in the neck and also get back to their normal activities more quickly.

How do surgeons at Emory determine if one of these procedures might be right for you?

The first, laminoforaminotomy, is reserved for disc herniations that sit far enough to the side of the spinal canal that they do not compress the spinal cord. This procedure has been performed for many years, but new technology is allowing it to now be done using a minimally invasive microsurgical technique.

The second, for patients who meet the right selection criteria, is an artificial cervical disc, which may be inserted in place of the traditional bone graft with a plate and screws. This artificial disc is a moving part that’s ready for use when the patient wakes from anesthesia. Essentially, this procedure is a “get up and go” operation that avoids most of the limitations we traditionally impose on fusion patients while they heal. The artificial cervical disc is a ground-breaking option that has been very successful in clinical trials, many of which took place at Emory. Like any novel technology, longer term follow-up is needed to fully assess the risks and benefits of artificial cervical discs. But the data thus far are quite promising.

The third procedure, laminoplasty, is most often used in patients who are older and have three or more levels of spinal cord compression that would usually take three or four fusions. During this procedure, which is performed from the back of the neck, the roof of the spinal canal is re-shaped to provide more room for the spinal cord without the need for fusion. A mini-plate device, developed by surgeons at Emory Spine Center, is used during this procedure – allowing patients to move their necks right away after surgery, speeding up rehabilitation.

If you have been told you need cervical spine surgery, I would encourage you to contact the Emory Spine Center for an appointment to learn more about these innovative procedures.

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

About John G. Heller, MD:
John G. Heller, MD, Baur Professor of Orthopedic Surgery and spine fellowship director, specializes in the research and development of instrumentation in cervical spine surgery, including disc arthroplasty and laminoplasty plates. He is the past-president of the Cervical Spine Research Society. Dr. Heller started practicing at Emory in 1989.

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

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.

Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

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.

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.

New Biomaterials Mean Fewer Hip and Knee Replacement Reoperations

James Roberson, MDIn Emory Orthopaedics, we perform hundreds of hip and knee replacement operations every year. Most of these operations are highly successful, but occasionally, a reoperation is necessary. In these cases, it’s usually because the materials originally used in the knee or hip have worn down over time.

At Emory, we’ve been testing new and improved biomaterials for use in hip and knee replacements for more than a decade, and we’ve found that a new generation of biomaterials is making a significant difference in the longevity of these replacements. This means fewer patients will need reoperations down the road.

The failure rate in a knee replacement operation is directly related to how fast the knee wears, which is affected by how well the knee was put in, the patient’s activity level, the patient’s weight, and the wear resistant properties of the materials used. Think of the tires on a car. The stronger the tire material, the longer it lasts. What if, instead of getting 30,000 miles on a set of tires, you could get 100,000 miles? In essence, that order of magnitude difference is similar to the improved wear resistance of new biomaterials used in hip and knee replacement.

I’ve been using alternative bearing surface materials in hip replacements for about 12 years, starting with metal on metal, then ceramic on ceramic, and now highly cross-linked polyethylene. All three materials have dramatically improved wear resistance and have worked very well for several thousand patients, with no measurable wear on any patient visible through x-rays. But while metal on metal and ceramic on ceramic are useful in hip replacements, they aren’t an option in knee replacements. Until recently, this was also true of cross-linked polyethylene. However, the more recent second generation techniques for cross-linking now make this a viable option for knee replacement also.

Polyethylene, simply put, is a plastic formed from long molecular chains made of carbon and hydrogen atoms linked together. Prior to cross-linking manufacturing techniques, these molecular chains consisted of carbon atoms linked to other carbon atoms in single long chains with the remainder of the molecular bonding sites filled with hydrogen atoms. On a molecular level, cross-linking simply means that the single chains now are cross bonded together to, in essence, create a woven structure. This results in a material that looks identical but is actually a more wear-resistant form of plastic.

Over the past three to five years, we’ve performed approximately 1,000 knee replacement surgeries using cross-linked polyethylene. While all three materials—metal, ceramic, and polyethylene—appear to perform fairly evenly in hip replacement surgery, cross-linked polyethylene is less expensive than ceramic on ceramic. Although the individual patient does not experience a cost difference, this is a benefit to the industry as a whole. Our goal is to develop improved materials that will result in better outcomes and be cost-effective.

If you’re having knee or hip surgery, you can trust your doctor to choose the most effective material for you. Regardless of whether it’s metal on metal, ceramic on ceramic, or cross-linked polyethylene, with all of these new biomaterials, we are cautiously optimistic that wear may no longer be a problem.

Have you had or are you going to have hip or knee replacement surgery? Have you had experience with any of the new biomaterials? We’d like to hear from you. Please take a moment to give us feedback in the comments section below.

About James R. Roberson, MD:

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.

At EUOSH, It’s All About the Patient

The Emory University Orthopaedics & Spine Hospital is known for its strong focus on patients and families, as well as its sharp attention to detail. It’s unlike any other facility in Georgia.

In fact, EUOSH is so focused on patient satisfaction and comfort, we call upon 75 various patient committees and have adopted listening practices to ensure that we fully understand the needs of the patient. Further, we make a point to avoid being married to any sort of protocol; for example, there’s no limit on patient visiting hours, and family members are welcome to sit with patients right up until the time of surgery. Our efforts have not gone unnoticed—I’m proud to say that we have over a 90% satisfaction rate among our patients.

EUOSH is focused on teaching and research, and all of our physicians are highly specialized within their particular areas of focus.

Every room is equipped with everything a patient could possibly need for a comfortable recovery, including an interactive television that offers hospital information, a “my education” feature, the patients’ chart, health notes, and of course, regular TV channels and movie options.

EUOSH truly strives to exceed patient expectations every day. Learn more about the facility in this video:

Getting In Shape For Surgery

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.