Hip Arthroscopy - - Joint-preserving surgery for younger patients

April 22, 2008

Many young adults with hip pain have subtle problems that, if corrected, can delay or prevent the need for a hip replacement. These problems can be diagnosed with an MRI-Arthrogram of the hip, which should be considered in patients less than 50 years of age with persistent hip pain that is unresponsive to conservative treatment. Recent advances in hip arthroscopy allow minimally-invasive treatment of the majority of these problems.

Two Bundles Better Than One?

The Anatomic Double-Bundle ACL Reconstruction Technique

April 28, 2008

Anterior cruciate ligament (ACL) injuries are common among athletes young and old, and most require surgical treatment. Although the ACL normally has two distinct “bundles” of fibers, with each performing a specific function, the traditional surgery replaces only a single bundle.

This works well for the vast majority of patients, returning most to their previous level of function. Some surgeons have expressed concern about very high-demand athletes and patients with a previous failed ACL surgery, because of lower rates of success in these groups.

Their concerns have led to advances in technology that allow for replacement of both bundles of the ACL during surgery. This technique is not applicable to everyone, due to individual anatomic variation, and differences between each type of injury.

Your sports orthopedic surgeon can help you decide if this “double-bundle” technique for ACL reconstruction is right for you.

Computer Assisted Knee Replacement - - A new technology for precision

April 25, 2008

By Robert Tennant, MD Orthopedic Surgeon

For the patient who suffers from knee arthritis, there is a new technology for performing knee replacement surgery. Computer-assisted knee replacement surgery guides the surgeon through the case, resulting in more precise cuts and alignment of the knee implants. This will lessen the chance of “loosening” of the joint implant and provide a more predictably successful outcome. Previous methods of knee replacement surgery could create “outliers” of patients whose mal-alignment (poor leg alignment) would result in increased wear of the replaced joint. Patients with only half the knee affected by arthritis may be a candidate for a unicondylar (half) knee replacement. <<More >>

Aching Thumb Pain - - It might be basilar joint arthritis

May 14, 2008

By Rolf Sohlberg, MD Orthopedic Hand Specialist

Do you have aching pain at the base of your thumb?  One of the most common hand problems is arthritis at the joint that connects the thumb to the wrist, also know as the "basilar joint" of the thumb.  

Many people mistakenly assume that they have "carpal tunnel syndrome", which is characterized as a numb/tingly feeling in the fingers and a tendency to wake up in the middle of the night with a "dead" hand or arm. If your thumbs seem to be the problem, there are several treatments available.

Occupational therapists can make splints to help immobilize the painful joint. Stretching and strengthening exercises may also prove helpful.

If this fails, a cortisone injection into the joint can provide relief for up to one year.  There is a limit to how many injections can be put in one area, and the success of the injection depends partly upon the severity of the arthritis.

Ultimately, if the above fail, then surgery to replace the joint can be considered. Although there are many described techniques to accomplish this, a few "standards" have withstood the test of time and are generally recommended by most hand surgeons.  

Your orthopedic hand specialist is the one who can best determine which of the above treatments is best in any given situation.

Treating Shoulder Arthritis

The Reverse Total Shoulder Replacement

May 8, 2008

By Jason Kurian, MD Sport Orthopedic Surgeon

Patients who suffer from chronic unrepairable rotator cuff tears in their shoulder are at risk for developing painful osteoarthritis. Over time, the pain can increase, the shoulder can become more stiff and lose function. Because of the chronic nature of this problem, the rotator cuff tear is beyond repair, rendering the patient’s shoulder mechanics unsuitable for a traditional shoulder replacement.

There is hope for this difficult situation. The Reverse Total Shoulder replacement works to substitute the function of the deltoid muscle for the torn rotator cuff. This is accomplished by 'reversing' the traditional shoulder replacement. Placing the cup (socket) on the humeral (arm) side, and placing the metal head (ball) on the glenoid (shoulder) side converts the function of the deltoid from purely raising the arm up, to allowing the arm to “swing” up as in the normal situation.

This surgery has been gaining popularity in the U.S. for the last 5 to 7 years, though has been used in Europe for 15 years. Early results did show a number of complications. However, these complications commonly occurred in patients with pre-existing risk factors like older patients with fractures, or previous failed total shoulder replacements. As patient selection has improved and surgery modifications have been made, complications have decreased in the hands of experienced or fellowship trained shoulder surgeons.