Our Services

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Emergency Services

The team at Orthopedics Associates is proud to provide Emergency Orthopedic Services to our community through the Emergency Departments at United Health Services Hospitals and Our Lady of Lourdes Hospital.

Lourdes
UHS

If you have an emergency, we ask that you DO NOT come directly to our office. As appropriate, dial 911 for an ambulance and/or proceed to the Hospital's Emergency Department.

Following evaluation by the Emergency Department's attending physician, we will be notified of your needs and provide appropriate care as required.

Emergency Services

General Orthopedics

All of our physicians perform general orthopedic services. Each physician also specializes in their individual areas of interest and have obtained additional education, training and/or certifications.

We make every effort to make appointments for our patients with the specialist most appropriate for their condition. It is not unusual to have several physicians collaborating on complex conditions to further facilitate the effective treatment of our patients.

Non-Surgical Services:

  • Fracture Care
  • Closed Reductions
  • Arthritis Treatment
  • Joint Injections
  • Spinal Injections
  • Osteoporosis treatment and care
  • Sports Injuries treatment and care

Surgical Services:

  • Shoulder Arthroscopy
  • Knee Arthroscopy
  • Total Joint Replacement – Hip / Knee / Shoulder
  • Foot and Ankle surgery
  • Upper Extremity surgery
  • Hand surgeries including Carpal Tunnel Release and Trigger Finger
  • Spine Surgery – Cervical / Thoracic / Lumba
  • Orthopedic Associates
  • Orthopedic Associates
  • Orthopedic Associates
  • Orthopedic Associates
  • Orthopedic Associates
  • Orthopedic Associates
  • Orthopedic Associates

The Hip

The hip, a ball-and-socket joint, is the largest weight-bearing joint in the body. When the joint is healthy, the head of the femur (thighbone) forms a round ball that fits into the acetabulum, a cavity at the base of the pelvis that forms the socket.

Ligaments connect the ball to the socket and keep them both firmly supported. The surfaces of the femoral head and the acetabulum are covered by a smooth, tough material known as articular cartilage, which cushions the bones and allows them to move easily. Around the rim of the acetabulum is a layer of fibrous cartilage called the labrum, which deepens the socket and provides a suction seal to hold the head of the femur firmly in place.

The other surfaces of the hip joint are covered by a thin, smooth tissue liner called the synovial membrane. This tissue produces a small amount of synovial fluid that acts as a lubricant and reduces the amount of friction that occurs when the bones move against each other.

Hip Anatomy

What is Hip Replacement Surgery?

Is Total Hip Replacement Surgery for You?

Hip PainThe good news is that if you are considering total hip replacement surgery, you're not alone. According to the hospital billing data, each year more than 340,000 such procedures are performed in the US.1 Even better news is that the US Department of Health and Human services considers total hip replacement to be one of the most successful and cost effective interventions in medicine.1 In fact, the success rate for hip replacements 10 years after surgery is 90-95%.1

Of course, the decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your primary care doctor to an orthopaedic surgeon for an initial evaluation.

Important Safety Notes:

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

1 American Academy of Orthopaedic Surgeon website, http://orthoinfo.aaos.org/topic.cfm?topic=A00377

When is Hip Surgery Recommended?

How Do I Know When It's Time to Consider Surgery?

Hip SurgeryThere are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports.

Important Safety Notes:

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

How is Hip Surgery Performed?

During hip replacement surgery, the surgeon surgically removes the damaged bone and cartilage of the joint and replaces it with smooth, artificial implants - thereby eliminating painful bone-on-bone contact.

Almost all hip replacement implants consist of a four-part system:

  • A hip stem, usually made from a biocompatible metal such as titanium, which is implanted down the shaft of the thigh bone (femur);
  • A femoral head which sits on top of the hip stem and replaces the "ball" portion of the hip's "ball and socket" design; and
  • A two-part hemispherical or "cup-like" component made up of a metal shell and a plastic liner that replaces the "socket" in which the femoral head sits.
  • Once implanted, the new femoral head rotates inside the plastic liner to recreate the ball and socket movement of the original joint.

Important Safety Notes:

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

BIRMINGHAM HIP Resurfacing

BIRMINGHAM HIP (BHR◊) Resurfacing System

A high-performance alternative to total hip replacement

Patients who suffer from hip pain due to arthritis, dysplasia or avascular necrosis may benefit from the bone-conserving approach of the BIRMINGHAM HIP Resurfacing System (BHR Hip), the world's leading hip resurfacing system.

Hip ResurfacingUnlike total hip replacement, the BHR hip resurfaces just a few centimeters of bone, preserving your original joint. The BHR hip is not unlike a cap for a tooth.

Because this technologically advanced surgical procedure resurfaces, rather than replaces, the end of your femur (thighbone), you may participate in physical activity with an implant that is potentially longer-lasting and more stable than total hip replacements.

Candidates for Hip Resurfacing

Hip resurfacing is intended for male patients who are under 65 years of age and in need of a hip replacement. As with all treatments, please discuss with your options with your doctor to find out if hip resurfacing is appropriate for you.

The Implant

The BHR Hip was approved for use in the United States by the Food and Drug Administration in 2006, but has been implanted around the world more than 170,000 times since 1997. Surgeons who offer this implant to patients have undergone specialized training.

The benefits to patients of the BHR Hip technique and implant are significant. The implant's head size, its bearing surfaces and its bone-sparing technique make it a preferred choice for active patients.

While the implant's rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

Head Size

While the implant closely matches the size of your natural femoral head (hip ball), it is substantially larger than the femoral head of most total hip replacements. This increased size translates to smaller chance of dislocation of your implant after surgery.

The Bone Conservation

The BHR Hip implant conserves substantially more bone than a total hip replacement. Since it preserves your natural femoral neck and most of your femoral head, concerns about leg length discrepancy are dramatically reduced. Also, should you need the implant replaced at some point in the future, you are a candidate for regular total hip replacement surgery as opposed to needing a more traumatic and complex revision surgery as is often the case when a traditional hip replacement needs to be replaced.

The Procedure

Total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing preserves the femoral head and the femoral neck. During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BHR Hip implant.

Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the acetabular component is pressed into place much like a total hip replacement component would be.

Important Notes

There are potential risks with hip resurfacing surgery such as fracture, infection, loosening, dislocation and wear that may result in the need for additional surgery. The results and physical activities of this patient may not be representative of the results and physical activities that you may experience following surgery. BHR is contraindicated for all female patients. Do not perform high impact activities such as running and jumping during the first post operative year while the bone is healing. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Hip resurfacing surgery is intended to relieve hip pain and improve hip function. Talk to your doctor to determine what treatment may be best for you.

Hip Oxinium◊ Oxidized Zirconium

Hip Oxinium◊ Oxidized Zirconium

What is OXINIUM◊ Oxidized Zirconium?

If it is determined that an implant made with VERILAST? technology is right for you, the femoral head or ball of your implant will be made from OXINIUM Oxidized Zirconium - a patented ceramicised metal alloy that Smith & Nephew spent more than a decade developing.

Hip ReplacementDuring manufacture, OXINIUM implants undergo a process that transforms the zirconium surface into a hard, ceramicised metal - while still retaining all of the durability of the underlying metal. This means that it won't fracture like a true ceramic, yet its ceramicised surface is more than twice as hard and therefore twice as resistant to the kind of scratching that can cause a cobalt chrome implant to wear out before its time.1

Also, unlike cobalt chrome, the OXINIUM material contains almost no nickel (< 0.0035% vs. ? than 0.5%) and is therefore biocompatible for patients with metal allergy or metal sensitivity.

Important Safety Notes:

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

1 Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005

The Knee

The knee joint is the point at which the femur bone of the thigh meets the tibia bone of the lower leg. All the components of the knee - bones, cartilage, synovial membrane, ligaments, tendons and muscles - must work together properly for the knee to move smoothly.

Cartilage is a protective cushioning that keeps the bones from rubbing against one another.

In a healthy knee, a thin, smooth tissue liner called the synovial membrane releases a fluid that lubricates the knee, reducing friction as the bones move.

Anatomy of the knee

Anatomy of the Knee

Knee Arthritis

Arthritis of the Knee

What is Arthritis of the Knee?

Arthritis of the knee is a disease which wears away the cartilage between the femur (thigh bone) and the tibia (shin bone) causing the two bones to scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded and uneven. The result is pain, stiffness and instability. In some cases, motion of the leg may be greatly restricted.

Osteoarthritis

Osteoarthritis, which is the most common form of arthritis in the United States, is degenerative and, although it most often occurs in patients over the age of 50, it can occur at any age, especially if the joint is in some way damaged.

It is usually confined to the large weight-bearing joints of the lower extremities, including the hips and knees, but may affect the spine and upper extremity joints, too. Patients with osteoarthritis often develop large bone spurs, or osteophytes, around the joint, further limiting motion.

Osteoarthritis of the knee is a condition commonly referred to as "wear and tear" arthritis.

Causes

Although the degenerative process may accelerate in persons with a previous knee injury, many cases of osteoarthritis occur when the knee simply wears out. Some experts believe there may be a genetic predisposition in people who develop osteoarthritis of the knee. Osteoarthritis of the knee is the most common cause for total knee replacement surgery.

Symptoms

The primary symptoms of osteoarthritis are pain in the knee, swelling and stiffening of the knee joint. In the early stages of osteoarthritis the pain may be mainly associated with activity. As the cartilage wears away and the bones of the joint rub against each other, pain can become more severe and constant, interfering with regular daily activities and disrupting sleep.

Treatment

In the early stages of osteoarthritis, treatment may involve several techniques. Behavioral and lifestyle changes including losing weight and changing routines to avoid painful situations can be very effective in relieving pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium may also provide relief from pain. Cox-2 inhibitors are also effective in providing knee arthritis pain relief. Physical therapy may improve muscle strength and joint mobility, reducing the symptoms of osteoarthritis in the knee. Joint fluid therapy may lubricate the knee and reduce the pain and swelling of the joint. Partial or total knee replacement surgery may be necessary as the disease progresses and daily functioning becomes more impaired.

Rheumatoid Arthritis

Unlike osteoarthritis, which is a "wear and tear" phenomenon, rheumatoid arthritis is a chronic inflammatory disease that results in joint pain, stiffness and swelling. The disease process leads to severe, and at times rapid, deterioration of multiple joints, resulting in severe pain and loss of function.

Meniscus Tears and Repairs

Meniscus Tears

If you have had knee pain recently, or periodically for months or years, it's possible that you have a meniscus tear, also referred to as "torn cartilage." A meniscus tear often occurs during a twisting or pivoting motion with the foot planted on the ground - for example, when playing tennis or squatting in the garden - and it can also occur from lifting. A tear can occur at any time during life, but it is rarely seen in young children. With age, the menisci become worn and may tear more easily.

Torn MeniscusThe symptoms of a meniscus tear depend on the size and location of the tear. Because the menisci have no nerve endings, pain associated with a tear is actually due to swelling and injury to the surrounding tissue. With a small tear, you may experience minimal pain. Over several days, slight swelling may develop gradually. Often, you may walk with minimal pain, but squatting, lifting, or rising from a seated position may increase the pain. Small tears may possibly heal on their own with a brace and a period of rest.

With a typical meniscus tear, you will feel pain at the side or center of the knee, depending on the tear's location. Often, walking is not impeded, and the knee may swell or feel stiff. You may also experience limited bending of the knee. Over time, symptoms may diminish but could recur with activities that involve twisting or overuse of the knee. Pain may appear and disappear over a period of years, and the tear may become larger if left untreated. Other symptoms include tenderness when pressing on the meniscus, popping or clicking within the knee, and limited motion of the knee joint.

The location of the tear may determine whether or not the knee is able to heal on its own. Tears at the outer edge of the meniscus tend to heal more easily because there is a good blood supply. However, the inner two-thirds of the meniscus does not have a good blood supply, which makes it difficult for tears to heal on their own. In time, this may cause the knee to develop arthritis.

Ice packs and immobilization can be used for immediate treatment of almost any knee injury. Such simple measures will help to decrease swelling and pain in the joint. When a tear begins to interfere with everyday activities, arthroscopic surgery may be necessary to prevent additional damage and to restore the knee's full functional abilities.

Meniscal Repair

Meniscus RepairMost meniscus tears are small, and the torn portion is removed, leaving a smooth, stable surface. Occasionally, other problems are found during arthroscopy, such as cartilage damage or loose fragments, and these may also be treated during surgery.

Certain meniscus tears must be repaired. Historically, during a meniscal repair procedure, stitches were placed from the interior of the knee outward, and incisions were made at the joint line to allow for tying of the knots. In recent years, an instrument was introduced that includes pre-loaded surgical implants that are absorbed in the body over time, as well as a pre-tied knot. With this innovative device, meniscal repair can be performed without the need for additional incisions.

When is Knee Surgery Recommended?

How Do I Know When It's Time to Consider Surgery?

Knee SurgeryThere are several reasons why your doctor may recommend knee replacement surgery. People who benefit from knee replacement surgery often have:

  • Knee pain that limits everyday activities, such as walking or bending
  • Knee pain that continues while resting, either day or night
  • Stiffness in a knee that limits the ability to move or bend the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

Arthroscopic Knee Surgery

What is Arthroscopic Knee Surgery

In the late 1970s and early 1980s, arthroscopic surgery became popular, especially in the sports world, as fiber-optic technology enabled surgeons to see inside the body using a small telescope, called an "arthroscope," which projects an image to a television monitor. Thanks to ongoing improvements made by technology leaders like Smith & Nephew, arthroscopic surgery is now accessible to more people than just professional athletes. In fact, active patients all over the world have experienced the benefits of minimally invasive surgical procedures.

Arthroscopy may be used for a variety of knee joint conditions, including a torn meniscus, loose pieces of broken cartilage in the joint, a torn or damaged anterior or posterior cruciate ligament (ACL/PCL), an inflamed or damaged synovium (the lining of the joint), or a malalignment of the patella (knee cap).

Arthroscopic Knee SurgeryThrough an incision the width of a straw tip, your surgeon is able to insert a scope, which allows him or her to inspect your joint and locate the source of your pain. The scope can also help identify tears or other damage that may have been missed by an X-ray or MRI. Your surgeon will then make one or more small incisions to accommodate the instruments used to repair the knee. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.

Arthroscopic knee surgery is often performed in an outpatient surgery center, which means no overnight hospital stay is required. Patients report to the surgical center in the morning, undergo the procedure, and - following a recovery period under the care of medical professionals - return home later in the day.

Postoperative Care

After surgery, you will be transported to the recovery room for close observation of your vital signs and circulation. You may remain in the recovery room for a few hours.

When you leave the hospital, your knee will be covered with a bandage, and you may be instructed to walk with the assistance of crutches. You also may be instructed to ice or elevate your knee.

Your surgeon will likely provide further details regarding postoperative care for your specific procedure.

Rehabilitation

Steps for rehabilitation following a meniscus repair or an ACL procedure vary from physician to physician. To learn what activities will be involved in your own rehabilitation, consult your orthopedic specialist.

Reasons For Arthroscopic Knee Surgery

Minimally invasive knee surgery is a positive measure to regain your active lifestyle, which knee damage has negatively affected over a period of weeks, months or even years.

Arthroscopic surgery can:

  • Relieve pain.
  • Improve joint stability.
  • Repair tears and damage.
  • Maximize quality of life.
  • Optimize activities of daily living.

Who Is A Candidate For Arthroscopic Knee Surgery?

Patients with knee pain or limited knee function may be candidates for arthroscopic knee surgery. Most people who suffer from a knee injury or degeneration and who have not found the relief they need through nonoperative treatments can benefit from a minimally invasive procedure.

Preparation For Arthroscopic Knee Surgery

Preparation for your surgery begins weeks and sometimes months before the surgery date. Here are just a few events and considerations you may experience:

Initial Surgical Consultation. Preoperative X-rays, a complete medical history, a complete surgical history, and a complete list of all medications (i.e., prescription, over-the-counter, vitamin supplements) and allergies will be reviewed.

Complete Physical Examination. Your surgeon will perform a physical examination and determine if your internist or family physician should assist with optimization of medical conditions prior to the surgery. This will ensure that you are in the best physical condition possible on surgery day.

Physical Therapy. In some cases, instruction in an exercise program to begin prior to surgery, as well as an overview of the rehabilitation process after surgery, will better prepare you for postoperative care.

Preparation for Surgery. You may want to wear loose-fitting clothes or sweat pants, and also bring crutches. You should bring your insurance information and a list of all your medications and dosages as well as drug allergies. You will need to arrange for someone to drive you home.

Evening Before Surgery. Do not eat or drink after midnight. Your surgeon or anesthesia provider may recommend that you take some of your routine prescription medications with a sip of water.

What is Total Knee Replacement Surgery?

Is Total Knee Replacement Surgery for You?

Knee Surgery

Total Knee ReplacementThe good news is that if you are considering total knee replacement surgery, you're not alone. According to the American Academy of Orthopaedic Surgeons, more than 600,000 such procedures are performed in the US each year.1 Even better news is that the US Department of Health and Human services considers total knee replacement to be one of the most successful and cost effective interventions in medicine. In fact, the success rate for knee replacements 10 years after surgery is 90-95%.

Of course, the decision to have knee replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your primary care doctor to an orthopaedic surgeon for an initial evaluation.

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

VERILAST◊ Knee Technology

VERILAST◊ Knee Technology

Our LEGION◊ CR Knee with VERILAST Technology was lab-tested to simulate the number of steps the average person takes in 30 years. 1-7

OXINIUM◊ + XLPE VERILAST◊ Technology

Verilast Knee ReplacementIf knee replacement is in your future, you've come to the right place to learn about one of the truly significant advancements in joint replacement materials in the past 20 years, VERILAST Knee Technology.

It's important to remember that not every knee implant is the same. VERILAST Knee Technology directly addresses one of the most commonly cited concerns associated with knee replacement implants, implant wear.

Whether or not to undergo knee replacement surgery is a very important decision. No matter how statistically safe and successful knee replacement surgery has proven to be, every surgery has risks. Before making any surgical decision, conversations should take place with your family, your primary care doctor and your orthopaedic surgeon to make sure that knee replacement with VERILAST Technology is the right course of action for your particular situation.

Important Testing Note

VERILAST knee wear testing and results apply only to the VERILAST LEGION CR Primary Knee System only. Extended lab-testing for other VERILAST knee systems have not been performed. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

  1. Goldsmith AA et al., "Comparative study of the activity of the total hip arthroplasty patients and normal subjects". J Arthrop, (16)5:613-619, 2001.
  2. Morbidity and mortality weekly report, 55(40):1089-1092, October 13, 2006.(Accessed on October 30, 2009).
  3. Gioe TJ et al., "Knee Arthroplasty in the young patient - Survival in a community registry". Clin Orthop Relat Res, 464:83-87, 2007.
  4. Wallbridge N and Dowson D. "The walking activity of patients with artificial hip joints". Eng Med 11:95, 1982
  5. Wimmer M A et al., "Joint motion and daily activity profile of total knee patients in comparison with the ISO knee wear simulator". Paper 0159, 48th ORS, 2002.
  6. Huddleston J I et al., "How often do patients with high-flex total knee arthroplasty use high flexion?",Clin Orthop Relat Res, 467:1898-1906, 2009.
  7. Naal F D et al., "How active are patients undergoing total joint arthroplasty? A systematic review", Clin Orthop Relat Res, DOI 10.1007/s11999-009-1135-9, published online: 28 October 2009.

VISIONAIRE◊ Patient Matched Technology

VISIONAIRE◊ Patient Matched Technology

As a patient considering knee replacement surgery, it is important to remember that you have choices.

In our VERILAST◊ Technology section, we discuss how the choice of materials used to make your implant can have a significant impact on both your implant's ability to resist wear, and on your body's ability to accept the implant if you have a metal allergy.

However, as important as your choice of implant materials is, it's only part of the equation.

After all, no matter how much new technology goes into the creation of your implant, if your implant isn't correctly aligned within your body, implant wear and performance will still be concerns.

For this reason, we developed VISIONAIRE Patient Match Technology - a system that uses your own MRI and X-Ray images to design and build surgical instruments customized specifically for your unique knee anatomy.

Visit the "How It's Made" website - http://www.commentcestfait.com

Visionaire Knee Replacement

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

The Shoulder

The shoulder is a ball-and-socket joint and has the greatest range of motion of any joint in the body. Because of this mobility, it is at risk for injury or degenerative problems. The bones of the shoulder are the humerus (upper arm bone), clavicle (collar bone), and scapula (shoulder blade). The head of the humerus bone (the ball) is lined with cartilage that glides over the shoulder socket (also known as the "glenoid cavity"). The clavicle attaches the shoulder to the rib cage and holds the shoulder out from the body. The scapula is a large triangular bone located on the back side of the upper body, and it is connected to the clavicle through the acromioclavicular (AC) joint.

In the shoulder socket, the humerus sits like a golf ball on a tee, supported by a complicated arrangement of muscles, tendons, and ligaments. The rotator cuff is a group of tendons that attaches four shoulder muscles to the upper arm. These tendons help keep the humerus bone in place within its shallow socket and ensure that the arm moves freely within the joint.

Shoulder Anatomy

Nonsurgical Shoulder Treatment Optios

Shoulder Nonsurgical Options

There are some nonoperative, conservative options to consider for the treatment of a rotator cuff tear or shoulder instability:

Ice Packs. Reduce swelling while resting the arm.

Anti-inflammatory Medications. Decrease swelling in the joint and provide temporary pain relief. Please note, however, that all medications have risks and should be taken only in consultation with your pharmacist and physician.

Physical Therapy. Helps shoulder to regain normal motion and strengthens muscles.

Arthroscopic Shoulder Surgery

Arthroscopic Shoulder Surgery

Arthroscopic Shoulder SurgeryIn the late 1970s and early 1980s, arthroscopic surgery became popular, especially in the sports world, as fiber-optic technology enabled surgeons to see inside the body using a small telescope, called an "arthroscope," which projects an image to a television monitor. Thanks to ongoing improvements made by technology leaders like Smith & Nephew, arthroscopic surgery is now accessible to more people than just professional athletes. In fact, active patients all over the world have experienced the benefits of minimally invasive surgical procedures.

Through an incision the width of a straw tip, your surgeon is able to insert an arthroscope that allows him or her to inspect your joint and locate the source of your pain. The arthroscope can also help visualize tears or other damage that may have been missed by an X-ray or MRI. Your surgeon will then make one or more small incisions to accommodate the instruments used to repair the shoulder. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.

Arthroscopic shoulder surgery is often performed in an outpatient surgery center, which means no overnight hospital stay is required. You report to the surgical center in the morning, undergo the procedure, and - following a recovery period under the care of medical professionals - return home later in the day.

Postoperative Care

After surgery, you will be transported to the recovery room for close observation of your vital signs and circulation. You may remain in the recovery room for a few hours.

When you leave the hospital, your arm will be in a sling. The sling should be worn for the amount of time recommended by your physician.

Rehabilitation

Steps for rehabilitation following rotator cuff surgery and instability repair vary from physician to physician. To learn what activities will be involved in your own rehabilitation, consult your doctor.

Reasons For Arthroscopic Shoulder Surgery

Minimally invasive shoulder surgery is a positive measure to regain the active lifestyle that a painful shoulder is preventing.

Arthroscopic shoulder surgery can:

  • Relieve pain.
  • Improve joint stability.
  • Repair tears and damage.
  • Maximize quality of life.
  • Optimize activities of daily living.

Who Is A Candidate For Arthroscopic Shoulder Surgery?

Patients with shoulder pain or limited shoulder function may be candidates for arthroscopic shoulder surgery. Most people who suffer from a shoulder injury and who have not found the relief they need through nonoperative treatments may benefit from a minimally invasive surgical procedure. The information in this brochure will help you better understand the anatomy and function of the shoulder, as well as the effects on the shoulder of a rotator cuff tear or the condition known as "shoulder instability." In addition, it will guide you through the steps of arthroscopic shoulder surgery for the treatment of these conditions.

Shoulder Instability and Repair

Shoulder Instability

Shoulder instability occurs when the structures that surround the shoulder joint loosen and cannot maintain the ball within its shallow socket. If the joint is too loose, it may slide partially out of place, a condition known as "shoulder subluxation."

When the joint comes completely out of place, also called "shoulder dislocation", the ligaments that support the shoulder are torn. Normally, this injury does not heal tightly, making the shoulder prone to repeat dislocation and additional episodes of instability.

With shoulder instability, some activities can create sudden pain, a sense of arm deadness, or the feeling of your shoulder slipping out and back into the joint. If you experience complete dislocation, you may have severe pain along with the inability to "reset" the joint.

Some shoulder instability can be treated with rest followed by rehabilitation. However, in certain instances, the physician may recommend surgery - these include more complicated injuries, cases of recurrent instability, and first-time dislocations in younger patients who have a high risk of recurrence, further damage, or limited activity.

Instability Repair

Shoulder Instability RepairFor years, shoulder instability has been treated with open surgery to repair the torn lip of the glenoid socket, called the "labrum." Many surgeons now believe that instability is associated with more than just labral tears. Using minimally invasive arthroscopic techniques, your surgeon will have access to the entire joint. As a result, he or she can examine all potential tears and will base the method of repair (arthroscopic and sometimes open) on this thorough inspection. The arthroscopic repair is done using small incisions, which typically means your recovery is quicker and less painful.

To repair shoulder instability, your surgeon will attach anchors to the bone, then will pass sutures through the tissue. The anchors hold the suture in place. In many cases, these anchors are bioabsorbable and are gradually absorbed in the body over time (within three to five years following the procedure), rather than permanently residing in the bone. The surgeon may tighten the joint capsule using suture or a radiofrequency (RF) or thermal probe that heats the tissue, causing a molecular change in the collagen that allows the tissue itself to shrink.

Rotator Cuff Tears and Repairs

Rotator Cuff Tear

Shoulder Surgery

Age plays an important role in the development of rotator cuff tears. As we age, so does the rotator cuff, and weakening of the tendons increases the chances of a tear occurring. For this reason, tears are most common in adults over the age of 40. However, repeated use of the arms in the overhead position often accelerates weakening of the cuff. Individuals who perform common overhead activities, such as painters and sheetrock workers, frequently develop tendonitis, and this tendonitis may eventually progress to a complete tear in one of the tendons.

Tears are also common in certain athletes who use repetitive overhead motions, such as baseball pitchers, swimmers, and tennis players. In some cases, a tear can be sustained from a direct blow - a fall from a bicycle, for example.

Rotator Cuff Surgery

With a rotator cuff tear, you may experience pain primarily on top and in the front of your shoulder. Sometimes, pain may occur at the side of your shoulder, and it is usually worse with any activity that forces you to reach above the level of your shoulder. You may also experience weakness and stiffness, and it may be difficult to perform simple overhead activities like placing dishes in the cupboard. Some people with tears can't lift their arm to comb their hair. Stiffness may result from the inability to move your shoulder, and this stiffness may become progressive.

Often with a rotator cuff tear, bursitis (inflammation of the bursa, the small sac of fluid that surrounds the joint) will occur, which may cause a mild popping or crackling sensation in the shoulder. The tear itself may rub and cause this sensation. You may also have difficulty sleeping on the shoulder at night.

Rotator Cuff Repair

When a rotator cuff tear begins to interfere with normal activities, arthroscopic (minimally invasive) shoulder surgery may be necessary to restore your shoulder's full functional abilities. Then you can get back to the activities you love, or simply enjoy a good night's rest.

Rotator Cuff Repair

Rotator Cuff Surgery

In rotator cuff repair, your surgeon will begin by inspecting the shoulder joint. Then he or she will inspect the subacromial bursa, a small cushioning sac of fluid that surrounds the joint, followed by the rotator cuff itself.

Arthroscopic shaver blades are used to clear away scar tissue, to shape the under side of the acromion (the bone at the top of the shoulder), and to smooth the edges of the cuff tear. Once the joint has been prepared, small anchors are attached to the bone. Sutures are passed through the edge of the tissue, and the anchors are used to hold the suture in place.

Radiology Services

We are proud to offer our patients the following diagnostic services:

  • Digital X-Ray
  • Fluoroscopy Services
  • Nerve Conduction Studies
Fuji

Our office utilizes digital X-Ray technology. This digital technology reduces film processing time and permits your provider to view your images promptly.

Osteoporosis is an important concern of ours. Bone densitometry is an important tool used by our providers to assist in diagnosing osteoporosis.

  • Orthopedic Associates Office
  • Orthopedic Associates Office
  • Orthopedic Associates Office
  • Orthopedic Associates Office
  • Orthopedic Associates Office
  • Orthopedic Associates Office
  • Orthopedic Associates Office

Orthopedic Associates is proud to announce we will be offering in office Magnertic Resonance Imaging (MRI) begining Summer of 2015.

Additional information will be posted here in the near future.

PRP Therapy

Orthopedic Associates is the first and only place in the area that offers office based regenerative medicine program offering PRP therapy for both acute and chronic conditions. PRP therapy utilizes your own bodies healing system to promote and accelerate healing for painful conditions. This is already heavily utilized in professional sports and has been used by athletes such as Kobe Bryant, Hines Ward, Tiger Woods and Rafael Nadal to name a few. Call for your own evaluation to see if PRP therapy is right for you.

Click on the links below for further information from other large hospitals already offering PRP and also a clinical paper for your review.


Contact us today to learn more about the services we offer or to request an appointment.

  • Orthopedic Associates, P.C.
  • 65 Pennsylvania Ave • Binghamton, NY 13903
  • (607) 723-5393

The information listed on this site is common guidance and is not meant as medical advice. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. Should you have a medical emergency, phone 911.