Apr 1, 2019 | Hip, Knee, Shoulder
I just read an interesting article in a surgical journal. The vast majority of studies in my scientific journals tend to focus on biomechanics, surgical techniques and implant methods. This caught my attention as it instead focused on health. More specifically, the researchers were asking whether Vitamin D deficiency is associated with failure to heal after surgery. They were looking specifically at rotator cuff tears that were surgically reattached. It turns out that more tendon repairs had to have surgery again in the group of people with low Vitamin D. We have known for a while that those over age 70 have less potential to heal repairs, possibly from diminished blood flow to the tendon. This information about Vitamin D may give people another method of maximizing healing potential in advanced age.Read the article
Mar 24, 2019 | Hip
Arthroscopic hip surgery is a minimally invasive method of looking into a hip joint to diagnose and treat certain hip disorders. The most common problem I treat is a so-called labrum tear. The labrum is a ring of cartilage around the hip socket that acts to stabilize and seal the ball and socket joint. When there is a labral tear, there are a number of problems that occur. Some people have dull or sharp pain in the groin with activities. Sometimes people will feel an ache that goes through the groin to the back of the hip like a stabbing sensation going from front to back. I also hear people who describe a popping/catching of the joint with certain positions of the leg or activities.
I will sometimes inject the hip joint under ultrasound guidance in the office with local anesthetic to help confirm that the hip socket is where the pain is coming from. You want to make sure that a separate issue, such as a pinched nerve in the back, is not the main issue. Pinched nerves are notorious for acting like hip problems.
If there has not been an MRI performed, I usually order one to get images of the labrum. The MRI shows the labrum more accurately if there is fluid injected into the hip that helps to reveal the labral tear.Read the article
Sep 5, 2018 | Hip, Knee, Shoulder
PRP stands for ‘Platelet Rich Plasma’. In short, it is taking a sample of your blood and separating out the components of the blood that can stimulate a healing response. That concentrated part of the blood is then injected into the injured part of the body.
The procedure itself involves an outpatient office visit that lasts up to 30 minutes. Just like a regular blood draw, the blood is taken from a vein in the arm. That blood is then placed into a centrifuge and spun down for 5 minutes. This separates the blood into two distinct layers. The lower layer is dark red and where the red blood cells are. The upper layer is yellow and more clear, and that is where the platelets and other healing factors reside.
The upper ‘platelet’ layer is then separated off within a self-contained sterile device. The fluid is then contained in a syringe, allowing it to be injected into the injured joint or tendon. I use ultrasound guidance to accurately target the site of injury and guide the injection.Read the article
May 25, 2018 | Hip
There are a few options when it comes to hip replacement approaches. The approach is the location the surgeon places the incision to gain access to the hip joint. Traditionally, surgeons have used the so-called ‘posterior’ approach. From the patient perspective, there is a hockey-stick shaped incision over the buttock. Surgeons typically restrict bending the hip up and crossing legs when the posterior approach is used, as this may increase the risk of the hip dislocating out of the back of the socket. If you know someone who had to sleep with a foam wedge in between their legs after surgery, that means it was a posterior approach.
There are a few anterior approaches, but the most commonly used is the so-called ‘Smith-Peterson’. This describes the specific muscles that the surgeon goes between. The posterior approach detaches (and then later re-attaches) muscles from the hip that provide stability to the hip joint. The anterior approach aims to improve stability and function by going in between the front muscles and thus preserving the muscles in the back of the joint. Read the article
May 22, 2018 | Hip, Knee, Shoulder
After you have taken care of enough people, you start to notice patterns in how some people bounce back quite quickly after a repair/reconstruction, and others have a very difficult time. As someone who is trying to improve outcomes and happiness among patients, I try to figure out what the differences are among these people, and how those differences may tie into how they recover. If I perform a couple hundred arthroscopic shoulder repairs in a year, there are usually enough people I see with a very similar problem and it becomes easier to then compare amongst them.
One of the factors that has stood out for me is gratitude. Time and again I see patients who are generally appreciative of the world around them and the opportunity to interact with people. These are people who are thankful for what they have, and tend not to rue what they are missing or wanting. They discuss issues in terms of where they are heading, not where they are stuck at. It seems obvious that a “happy” person would feel better, but it seems to be more than just a smile on a face. It is the attitude of really knowing that things will go well; if they don’t go well for a time, then there must be a reason for the bump in the road and it will be bypassed soon enough. It reminds me of actualization. That is to say, visualizing positive outcomes and general appreciation of those around you, and then the realization of that positivity becoming real in future experiences.Read the article
Apr 24, 2018 | Hip, Knee
There are different risks associated with different types of surgery. Each person has an individually different risk profile and many of the risks are worsened by overall medical issues. Hip and knee replacement tend to have a higher risk of blood clot due, in part, to the decrease in activity after the procedure. If the clot stays in the leg, then it is usually treated with anticoagulant medication for 3-6 months. If the clot travels into the lungs, then there are more involved treatments. Most surgeons use some form of blood thinner in the first few weeks after surgery to help reduce the chance of clotting. Read the article
