There are many resources available for those wanting to investigate and better understand the musculoskeletal system or any diseases or conditions that might affect the bones and joints of the body. For those who are considering joint replacement in particular, cyberspace allows a full and complete understanding of the joint anatomy as well as how arthritis progresses and the range of treatment options. Our Blog is limited in size and space hence the absence at times of full explanation and graphic representation of each possibility. Yet we at the Neurologic & Orthopedic Hospital of Chicago encourage our patients to inquire and be fully knowledgeable so let us give you some reliable resources on the net which will provide you with written information and graphics pertaining to hip and knee anatomy, basic hip and knee conditions, and the common treatment modalities.
Start with the several web sites of the orthopedic manufacturers including:
Once on line you will find a menu choice for you, the patient and the opportunity to understand the joint anatomy, a condition of ill being and a treatment alternative is limitless. On these corporate web sites you also will find product in formation concerning hip and knee implants. While the anatomic representations and descriptions of treatment options are without bias, when it comes to the prosthetic hype, “shop and compare”. Be a critical consumer and discuss the prosthetic options with your orthopedic surgeon as part of the decision making process. Equally important to the size of your incision and the length of a hospital stay is the documentation of the performance of an implant over time. Before you search cyberspace though, take a good look at our NOHC web site as we continually update information with word, picture and video.
The human hip is vulnerable to damage by arthritis from many causes.
This damage can cause pain that limits everyday activities, vocational undertakings and recreational demands. The first course of action recommended against hip pain includes medication, changes in daily activities and appropriate fitness pursuits. When these interventions aren’t enough, total hip replacement is the next option. First performed in 1960, the procedure usually results in a dramatic reduction of pain and increased mobility for patients with return to an active lifestyle. According to the American Academy of Orthopaedic Surgeons, 193,000 hip replacement surgeries are performed every year in the United States.
Traditional hip replacement surgery has been performed through a 10 to 12 inch incision in the side of the hip. Damaged cartilage and bone is removed from the hip joint and replaced with new, man-made parts. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, patients historically spend three to five days in the hospital following surgery and about three to six months recovering.
Over the past seven years, my clinical research has resulted in new developments in technology and techniques as practiced at the Neurologic & Orthopedic Hospital of Chicago including minimally invasive hip replacement surgery. This type of procedure requires smaller incisions, less hospitalization and a shorter recovery time than with traditional hip replacement.
Surgery at NOHC is performed through a three to four inch incision without detaching muscle from the pelvis or femur minimizing postoperative pain. We are finding our patients are going home in one to two days, and then up and walking and back to work within one to two weeks. For those who have special requests, the surgery can be done in the morning and discharged home in the evening.
I know from experience about misleading information on the internet concerning orthopedics. One problem is that content isn’t always peer reviewed so that marketing may carry more influence than science. Misleading statements may be posted and the potential patient believes that the information is accurate
At issue are the disclaimers that appear on hospital, orthopedic industry, and surgeon web sites concerning potential conflicts of interest (kickbacks to surgeons). In 2007, the five major orthopedic manufacturers negotiated a Delayed Prosecution Agreement with the General Accounting Office for basically the absence of contemporary Corporate Compliance self regulation. In four out of five settings, major fines were assigned to the Orthopedic prosthetic manufacturers and Federal monitors assigned while the industry changed practices. In many cases indeed, the companies had broken the laws and orthopedic surgeons had violated ethical practices for financial reward. To learn more, one need only look at the web sites of Zimmer, Biomet, Smith-nephew, Wright and Stryker. Posted therein is the explanation from the General Accounting Office and the amount of money paid to individual orthopedic surgeons by the company for various reasons. You need to decide if the amount of monies paid out by these companies to your surgeon makes sense or can be justified. You the patient must ask your surgeon about his or her recommendation for use of a particular product. And don’t be satisfied with a disclaimer in a doctor’s office or on a web site, Make sure that the doctor’s opinion is based on science and that a product endorsement is not based on a hidden agenda.
It must be fact that is in evidence and that is what should guide you the patient’s verdict
The Neurologic & Orthopedic Hospital of Chicago is thrilled to announce it is the first Hospital in the Midwest to offer the Zimmer High Flex Mobile Bearing Knee. The MBK was approved yesterday by the FDA according to Zimmer and made immediately available for clinical use to Dr Mitchell Sheinkop of NOHC, one of the panel of clinical investigators whose research with the Mobile bearing High Flex Knee Prosthesis over the past five years led to the FDA’s approval. The main difference between a traditional knee replacement design and a mobile bearing knee is that the polyethylene articulating surface is free to rotate slightly along with the patient’s natural movement. When used with the LPS-Flex femoral component, the knee replacement is designed to safely accommodate active deep flexion of up to 155 degrees for patients who are otherwise capable of that level of flexion. Many activities of daily living require this range of motion, such as climbing stairs (75-140 degrees), sitting in a chair and standing up again (90-130 degrees), and squatting (130-150 degrees). Generally, knee implants were designed to accommodate flexion of only 120 degrees.
Doctor Sheinkop, director of Joint Replacement at NOHC and Professor of Orthopedic Surgery at Rush, began his work with the MBK when he first visited the United Arab Emirates as a visiting Professor in 2003. Between 2003 and 2006, Dr. Sheinkop has performed over 300 Mobile Bearing Knee surgeries as a visiting Professor introducing the MBK in Morocco, Egypt, Bahrain, Qatar, Saudi Arabia, Algeria,Turkey, Russia, Central and Eastern Europe and Israel. Sheinkop is one of the eight clinical investigators from around the United States whose research led to the approval. His unique contribution to the U.S. FDA clinical research program has been the incorporation of minimally invasive incisions when performing a Mobile Bearing procedure. “ Our research findings suggest the most physiologically normal function when compared to any other knee prosthesis now available” says Dr. Sheinkop.
Many patients with back pain ask me to explain the role of physical therapy (PT) in the course of their treatment. Since they may already be in good physical shape, many believe they do not need a therapist or that PT would be a waste of time. While there are some exceptions to this, physical conditioning alone is not the barometer a spine surgeon uses to determine if a patient may benefit from physical therapy.
One of the important concepts in treating back pain with PT is core muscle strengthening. By developing the “core” and truncal muscles in the front of the body, pressure and strain is taken off the back. Additionally, therapists use various modalities such as massage, ultrasound, heat, ice, stretching, electrical stimulation and TENS units to relieve pain. While patients do not always get complete relief, my patients often tell me the therapy I prescribed did help alleviate some of their pain.
Back pain is the second most common reason patients seek medical attention from their doctor. While many patients ultimately need surgery, physical therapy is a great initial treatment and may help some avoid an unnecessary surgical procedure. A custom tailored regimen including physical therapy is integrated in many of my patient’s treatment plans.
The Neurologic & Orthopedic Hospital of Chicago is thrilled to have added Harmony Health to its menu of services. Harmony Health is a holistic adjunct to our orthopedic surgical approach, which offers prevention, pain control and the Traditional Chinese Medical holistic concept of care. Recently, a patient of mine who underwent a total knee replacement had her post-operative pain control based on acupuncture rather than morphine. While not the first time performed in the United States, to the best of our knowledge, NOHC is the only facility of its kind in the Midwest that is capable of managing the post operative experience with acupuncture and thereby eliminating the side effects of narcotics. The plan is to soon offer the acupuncture alternative to all of our joint replacement candidates for post-operative pain control.
Harmony Health is a well-recognized holistic approach to health care that established its presence at NOHC in the late spring of 2008. For the care and treatment of arthritis, Holistic orthopedic care in addition to acupuncture, combines deep tissue massage and herbal remedy as well as yoga. Our observation over the duration of my practice has been that those individuals who maintain a minimum of weight and a maximum of well being best tolerate arthritic changes. In addition, those who maintain flexibility are able to postpone joint replacement surgery. The reasons that patients ultimately undergo hip and knee replacement include pain, limited motion, deformity and altered functional capacity. The Traditional Chinese Medical (TCM) approach to health care may help you postpone a surgical procedure or better deal with post-operative joint replacement pain. While traditional pharmacologic treatment before or after surgery may be used, acupuncture and TCM have the potential to minimize pain and maximize benefits.
Last night while listening to Daniel Shorr’s commentary on NPR, I was reminded that I have seen very little if any coverage in the Chicago media concerning the Deferred Prosecution Agreement (DPA) between the US Department of Justice and the major orthopedic prosthetic manufacturers. For those unfamiliar, several years ago the Justice Department began investigating kick backs and financial incentives for orthopedic surgeons and hospitals to use a particular corporate product. What was exposed was a total absence of corporate compliance standards within the industry and major abuses wherein the orthopedic corporations would develop contracts with a physician and pay him large sums of money to use a certain type of hip or knee. This egregious violation of ethics and the letter of the law even exposed pay offs to orthopedic surgeons for “research” and for administering large volume joint replacement programs. In October of 2007, the combined investigation of the Office of Inspector General, the Security and Exchange Commission, and the Attorney General resulted in a Deferred Prosecution Agreement whereby large monetary fines were paid ( the largest being Zimmer Corp at greater than $150 million) and the mandatory oversight of Corporate Compliance by U.S. appointed Federal Monitors. Smith-Nephew, Biomet, Johnson and Johnson, Stryker and now Wright joined in the DPA.. Explanation from the recipient orthopedic surgeons include intellectual property and compensation for work done. How much work though justifies millions in payouts?
Daniel Shorr’s editorial questioned what he described as the all too comfortable relation between the Department of Justice and Corporate America. We may never have answers. To see what’s in these surgeons’ wallets access the Orthopedic Corporation web sites where you will find menu choices: Deferred Prosecution Agreement and Company Consultants-Identification and payments. At the Neurologic & Orthopedic Hospital of Chicago there are no hidden agendas.
Frequently, patients ask me about the latest technology in disc replacement surgery. My clinical interests in spine surgery include procedures that not only alleviate pain, but also allow my patients to regain their normal motion. There has been a significant breakthrough in the way spine surgeons treat cervical herniated discs and neck pain. While the clinical indications for this procedure are specific, a cervical disc replacement is an excellent option for patients who might have otherwise undergone a fusion operation years ago.
The initial stage of both operations remains the same – a thorough decompression of the involved area to remove pressure from the nerves and spinal canal. However, the main difference between cervical fusion surgery and disc arthroplasty (replacement) is that motion will largely be preserved with the latter. The general benefits of retaining one’s motion in the neck are readily appreciated. However, a key benefit of motion preservation is less “wear and tear” on the adjacent levels - thereby decreasing the chances discs above and below degenerate with time. Also, since we are not “welding” bones together as we do in fusion surgery (the fusion takes a significant portion of time to heal), patients return to activities such as driving, working, and recreational activities much sooner.
Please speak with your spine surgeon to see if this motion preserving procedure is right for you.
Arthroscopic surgery to relieve symptoms from osteoarthritis of the knee, a widely practiced procedure, proves no better than medicine and physical therapy alone at two years, new research shows. This is the second major study to call into question the benefits of the arthroscopic procedure, a study in the Sept. 11 issue of the New England Journal of Medicine showed and that’s why arthroscopic surgery for degenerative knee arthritis is not part of the Neurologic and Orthopedic Hospital approach. Fortunately, there are still considerable options available and that’s what we offer. For severe disease, total joint replacement is a very effective form of therapy. This study de-emphasizes the middle step of arthroscopic surgery.”
Arthroscopic surgery does work well in certain select patients who have loose bodies or meniscal tears with mechanical symptoms. The classic example would be a patient saying their knee was hurting for Five years, but three months ago, they stepped off a curb, and since then, it’s been killing them. It’s a different pain from the arthritis . . .. If we put it all together, there’s a good chance with arthroscopic surgery, but we do need to temper expectations.
If patients have severe arthritis that fails non operative treatment, then they may benefit from a total knee replacement rather than arthroscopic surgery.
The minimally invasive procedure involves inserting small instruments, Including an arthroscopy, into the knee through tiny incisions. Surgeons then “scrape” the joints to remove cartilage and smooth the surfaces of the joints. Since 2001, I have employed minimally invasive incisions and, have been able to complete a Total Knee Replacement through a three-inch incision.
A herniated disc is one of the most common conditions I see in my office. Disc herniations can occur in the neck, the upper back, or lower portion of the spine.
Often my patients can recall a specific event that causes the relentless pain they are experiencing. This past week, I saw a woman in her 30’s who said, “When I bent down to pick up my 2 year old son, I immediately had burning and sharp pains in my back and legs. I stayed on the floor for hours because the pain was so intense.”
Well, she’s certainly not alone. In fact many patients can recall a specific situation that caused them the pain they are having. However, some patients cannot recall any specific event. I recently heard one of my patients say, “I was driving my car and all of a sudden, I couldn’t turn my head without pain shooting down my arm.”
Our discs function as shock absorbers within our spines. They are comprised of an outer firm portion called the annulus fibrosis, and an inner soft portion called the nucleus pulposis. The analogy I frequently use in describing a herniated disc is the following: when you squeeze a jelly doughnut, the soft jelly (the nucleus pulposis) is extruded through a hole in the firmer, outer portion of the doughnut (the annulus fibrosis). When this occurs in the context of an acute herniated disc, the contents of the herniation serve to not only push on the nerve, but also cause inflammation and swelling around the nerve – causing severe pain. Spine specialists diagnose this condition by performing a thorough history & neurological assessment and frequently will obtain x-rays and an MRI of the involved area.
The good news is that most disc herniations can be treated without surgery. A short course of bed rest, physical therapy, medications, and sometimes injections are part of our “armamentarium” in treating patients. However, if a patient has intractable pain that does not improve, worsening weakness, or the inability to control their normal bowel and bladder functions, these “red flags” indicate the patient will need surgical intervention in a timely fashion.
The goal of surgery is to take the pressure off the nerve and decompress the area involved. This is frequently done through a procedure call a micro-discectomy where the surgeon uses either a microscope or high-powered surgical loupes through a minimally invasive incision.
If you or someone you know have the symptoms described above, please consult with a physician trained in dealing with this condition. Between the various medical and surgical interventions I’ve outlined, you should be able to get “back” on your feet in short course.
View some video testimonials of NOHC patients treated for disc herniations:
Frequently, patients ask me about the latest technology in disc replacement surgery. My clinical interests in spine surgery include procedures that not only alleviate pain, but also allow my patients to regain their normal motion. There has been a significant breakthrough in the way spine surgeons treat cervical herniated discs and neck pain. While the clinical indications for this procedure are specific, a cervical disc replacement is an excellent option for patients who might have otherwise undergone a fusion operation years ago.
A herniated disc is one of the most common conditions I see in my office. Disc herniations can occur in the neck, the upper back, or lower portion of the spine.