Newsroom/2009_NewsWed, 16 Dec 2009 17:53:47 GMTCopyright 2010. All rights reserved.Pyron Technologies SuiteFin CMSWed, 16 Dec 2009 17:53:47 GMTYour Joint Pain is Personal and So is its Treatment   Editor: Annlouise Ferguson Are you one of the 43 million Americans suffering from arthritis?  Maybe you know one of the 600,000 Americans who had either a knee or a hip replacement this year.  Hip and knee replacement surgeon, Dr. Steven Myerthall, MD spoke to the Ahwatukee Foothills Rotary Club on Dec 1st about the causes, symptoms and treatment of joint pain.  Dr. Myerthall drew laughter when he told the club about a patient complaining his leg hurt after running 23 miles.  His advice  was to  run 22 miles and stop.  There are cases where joint pain is caused by overuse and medical intervention can be prevented. Joint pain is generally the result of osteo, rheumatoid  or post traumatic arthritis or avascular necrosis.  The most common cause is osteoarthritis. Wear and tear on a joint causes osteoarthritis.  Dr. Myerthall explained while using slides of actual diagnostic cases to show the club what damage to a joint looks like at various stages.   Cartilage pitting causes roughness and irritation, leading to loss of cartilage and narrowing of the joint space.  With loss of cartilage, the patient experiences bone on bone.  The alignment of the bones at the joint is askew, not good.  Cysts can develop in the bone and spurs can grow on the edge of the bone.  The ends of the bones in the joint bleed and deteriorate.  Pain with osteoarthritis is more common in the evening after use.  Rheumatoid arthritis is a chronic autoimmune disorder where the joint becomes damaged as well as the surrounding tissues.  Morning stiffness is most common with rheumatoid arthritis. Post Traumatic Arthritis occurs after a joint has been injured but the bone and cartilage did not heal properly, leaving the joint rough.  Avascular necrosis is a disease where the bone lacks blood supply so the bone deteriorates and dies. When other medical intervention does not provide the needed relief, surgery may.  Possible surgical treatments, depending upon the joint involved, include arthroscopy, partial or total joint replacement, or resurfacing, Early intervention with knee pain is best.  It allows for the use of a less invasive arthroscopic treatment.  The treatment is outpatient using 2-3 small incisions.  When only one of the three regions of the knee, medial, lateral or patella, is damaged, a partial knee replacement, PKR, can be performed.  One in five knee replacements is a PKR.  Dr. Myerthall says his most satisfied patients are those who have undergone PKR. Usually because they have experienced less post operative pain, smaller incisions due to smaller implants used, and a shorter recovery time.  When more than one area of the knee joint is compromised, a total knee replacement is recommended.  Dr. Myerthall reports his patients complain their knee does not feel the same afterward but the total replacement allows them to return to their previous activity level. Dr. Myerthall noted that the major improvements to his practice have been minimally invasive surgery, computer assisted surgery and the Cormet Hip Resurfacing procedure. Minimally invasive surgery, laparoscopic surgery, is done through small incisions. Using specialized techniques, miniature cameras with microscopes, tiny fiber-optic flashlights and high definition monitors, allows the surgeon to perform surgery through an incision that requires only a few stitches to close.  One example of minimally invasive hip surgery is the direct anterior hip replacement. The direct anterior approach to hip replacement surgery allows the surgeon to reach the hip joint from the front of the hip as opposed to the side or back approach. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery. The surgeon can simply work through the natural interval between the muscles.  Dr Myerthall says the use of this approach can lead to a shorter hospital stay, smaller incision, less blood loss, less collateral damage to muscles, tendons and ligaments, less post operative restrictions and a quicker rehabilitation than a traditional hip replacement. Dr Myerthall's use of a computer to map the patient's anatomy, properly size the implant and see the surgical site without having to use a ten or eleven inch  incision as in the past is a huge improvement.  Computer assisted surgery is a discipline where computer technology is applied to improve the outcome of orthopedic surgical procedures.  The Cormet Hip Resurfacing procedure is an innovative process where the end of the thigh bone, femur, is capped with a metal covering using a strong cobalt chromium metal. This fits neatly into a metal cup that sits in the hip socket. The head swivels within the cup, gliding together to replicate the hip joint. The capping of the femur is comparable to capping a tooth.  The procedure conserves bone and allows for natural movement.  Dr. Myerthall is waiting for further action by the FDA as the procedure is approved in limited situations, usually for a young, healthy boned, active person.   Despite the high and rising numbers of joints being replaced, Dr. Myerthall's policy is to schedule a joint replacement only when a patient asks to be scheduled.  This is when their pain is severe, interfering with daily activities and not responding to nonsurgical treatments.  A patient undergoing a joint replacement can expect to return to the activities they enjoyed prior to replacement sans sky diving and downhill skiing.  Evidence of this expectation is Floyd Landis, the disqualified 2006 Tour de France winner, who returned to professional bicycling after having hip resurfacing surgery. Steven Myerthall, MD is an internationally fellowship-trained specialist in minimally-invasive hip and knee reconstruction and arthroscopy, and is dedicated to exceptional patient care.  Recently he partnered with the Center for Orthopedic Research and Education in Arizona.  The CORE Institute offers comprehensive care for musculoskeletal health and wellness.  The doctor is the father of two young boys.  The Cormet Hip Resurfacing System is manufactured by Corin and distributed exclusively by Stryker Orthopedics in the USA. More information at:  Stryker.  http://thecoreinstitute.com/Newsroom/2009_News?id=44Tue, 17 Nov 2009 17:45:03 GMTDoctors Use New Treatment For Rotator Cuff Injuries Rotator cuff injuries don't just happen to major league baseball players -- they send 5 million people to the doctor every year, and the risk of injury increases as we age. There's a new procedure that aims to relieve pain and restore movement by changing the way the shoulder works. A bike accident left Jim Smith with a shoulder injury so painful he couldn't ride … or even raise his right arm. "I was down to practically doing nothing," Smith told Ivanhoe. "I couldn't even trim bushes in the yard because I didn't have any control of my right arm." A traditional shoulder replacement failed. Then, his doctor suggested something new -- reverse shoulder replacement. The normal ball and socket joint is replaced with implants that reverse the anatomy of the shoulder. "The reverse shoulder replacement allows us to not only replace the joint that has become arthritic, but it puts the shoulder in a better mechanical position and changes the mechanics of the shoulder to allow people to elevate their arm," Bryan Wall, M.D., an orthopedic surgeon at the Core Institute in Phoenix, Ariz., told Ivanhoe. The surgery works best for older patients who have chronic shoulder pain, longstanding rotator cuff tears and arthritis. It doesn't work for everyone -- there's a risk of patients dislocating the shoulder joint after surgery or loosening parts. "The best thing is, whatever I do during the day, no matter what I do, I don't have any pain in my right arm," Smith said. The surgery fixed his shoulder so he could get back to doing his own fixing. "I've worked pretty hard all my life," Smith added. "Now it's time to play!" Hitting the road to a pain-free and active retirement. The reverse shoulder replacement surgery generally requires a two-day hospital stay and a four- to six-week recovery, plus post-surgical therapy to restore full range of motion. Dr. Wall says younger patients are generally not good candidates for the procedure because they tend to put extreme stress on the shoulder joint. http://www.kptv.com/health/21271618/detail.html http://thecoreinstitute.com/Newsroom/2009_News?id=43Tue, 17 Nov 2009 17:43:37 GMTReverse Shoulder Repair, In-Depth Doctor's Interview Bryan Wall, M.D., an orthopedic surgeon at The Core Institute in Phoenix, Ariz., explains how a new surgery that reverses the anatomy of the shoulder is easing pain for patients with rotator cuff tears with arthritis. Are there limits to the types of patients who can have shoulder replacement surgery? Dr. Bryan Wall: The problem that we have in shoulder replacement surgery is that there is a certain segment of the population that has problems that are just too great to deal with traditional shoulder replacements. We have a certain subset of the population that has arthritis, but they also have large tears of their rotator cuff mechanism. What we’ve found in those patients is that a traditional shoulder replacement does not work particularly well because the mechanics of the shoulder are dramatically altered, and that the shoulder replacement fails at a fairly rapid rate. What has happened to these patients’ shoulders that they aren’t working correctly? Dr. Wall: Typically, the entity is referred to as a cuff tear arthropathy. That’s a massive rotator cuff tear, and then they eventually develop arthritis of the shoulder joint on top of that. When a patient has arthritis, what happens to their range of motion? Dr. Wall: Typically, what happens when a patient develops pain because of the arthritis and also because of the failure of the rotator cuff, they lose their ability to raise their arm above the level of their head. In fact, most patients can only raise their arm approximately 30 degrees or 40 degrees, typically. Is an injury to the rotator cuff common? Dr. Wall: The rotator cuff, I think, is a very misunderstood structure, as far as the general public goes. I think there are high profile injuries, baseball pitchers, for example, who have problems with their rotator cuff. However, the vast majority of patients that have problems with the rotator cuff are actually in their 50’s or 60’s or 70’s, so it’s actually a problem with the older population. It’s a very common injury. What is the traditional method of treating a rotator cuff injury? Dr. Wall: In the past, we had very, very limited options. We would actually replace part of the shoulders and tell patients that, ‘Well, we’re going to just have a limited goals rehabilitation for you,’ meaning that we’ll replace your shoulder, we’ll try to take care of the pain from the arthritis, but your arm is just not going to work very well, you’re just going to not be able to elevate it. Obviously, that’s not an ideal solution. The reverse shoulder replacement that we use now allows us to not only replace the joint that’s become arthritic, but it puts the shoulder in a better mechanical position and changes the mechanics of the shoulder to allow people to elevate their arm. How does the procedure work? Dr. Wall: What we do is we reverse the joint. Everybody knows that the shoulder is a ball and socket joint, with the socket being on the shoulder blade side, and the ball being on the arm bone side. By reversing the joint and putting the ball on the shoulder blade side and the socket on the arm bone side, we’re actually able to create a captured joint. What that does is it puts the deltoid muscle, which is the largest muscle in the shoulder, in a better mechanical position, in order to allow the arm to elevate. Is an implant used in the procedure? Dr. Wall: Yes. The implant is typically made out of metal and plastic. There’s a metallic ball that goes on the shoulder blade that’s fixed in usually with screws, and then there’s a stemmed implant that goes into the center of the arm bone that has a plastic cup on it that can be just fit into the arm bone, or sometimes just fixed with cement. How does the reverse shoulder replacement affect patients’ lives? Dr. Wall: It can be fairly life-altering, particularly in patients who are older and patients who have bilateral problems. You don’t think about the ability to raise your arms very much. However, say you’re in your 70’s living by yourself. If you can’t raise your arms above the level of your waist, you can’t use half the cabinets in your kitchen, you can’t wash your hair, you can’t fix your hair, you have a difficult time brushing your teeth and feeding yourself, so it can be very, very dramatic, as far as the effect on these people’s ability to live independently, and function. Who’s a good candidate for this procedure? Dr. Wall: Typically, I would say that a good candidate is an older patient who’s less active. While I’d love to say that all patients would be a great candidate for this, what we think is that patients who are younger put a tremendous amount of wear and tear and stresses and strain on the shoulders, just because they’re more active and they do more aggressive activities. The shoulder implant isn’t great at dealing with those types of problems, and the concern is that over time, the shoulder implant will loosen and fail. The older patient, who is say in their 60’s or 70’s, typically isn’t going to have that same level of activity, so we don’t worry about that quite as much, so we think that’s probably a better candidate for the procedure. That being said, we do use it in younger patients at times as a salvage procedure, such as patients who have advanced tumor reconstruction or sometimes patients who have significant problems after a regular shoulder replacement and we have to revise it. Is the procedure widely available? Dr. Wall: It’s becoming much more common in the United States. It’s been done in Europe since 1986 – that’s when the first type of this implant was done. It was actually done in the United States back in the 60’s and 70’s, but what we found is we have problems with those implants, so a gentleman named Paul Grammont, who is a French surgeon in Lyon, France, redesigned the implant in 1986, and started placing them in France. They came out with their second generation in 1991, which is fairly similar to the implant that we’re using today, so it’s been used in Europe in this form since 1991. In the United States, it’s been available since about 2004. Is this a procedure patients with cuff tear arthropathy must have? Dr. Wall: This is sort of an elective procedure in every sense of the word. What I tell every patient who comes to me asking when they need to have this done, is that they never need to have this done. Nobody’s ever died from cuff tear arthropathy. You may have shoulder pain, you may have inability to raise your arm, but it’s not that you need to have this done. The time to have this done is the time when the patient decides that they’d rather have this surgery, they have some potential consequences that go along with surgery, being in the hospital, outpatient rehab, those sorts of things. When they decide that it’s time to do that rather than continue to live their life the way they are, that’s the time for them to have the surgery. How long is the actual surgery time, hospital time, and recovery time? Dr. Wall: It’s an inpatient surgery, so you’re going to be, on average, about two days in the hospital. Most patients will be in a sling anywhere from about two to six weeks. Outpatient rehab is usually anywhere from six weeks up to three to six months. Most patients are going to feel a lot better than they did before surgery at about six weeks, and I tell most patients that they’re going to get about 100 percent of their function wherever they’re going to be, at about a six month post operative time. What type of patients typically wants to have this procedure? Dr. Wall: If you look at the larger series that’s in the scientific literature that we published out of France, the average age was 72, so it is a little bit older than the average age for the population for joint replacement in general. It’s patients who are older and active who are the ideal candidates for this procedure. Those are typically patients with the cuff tear arthropathy. Anybody who is in their 60’s or above really who has this problem and wants to maintain their activity level, I think they’re a great candidate for it, and particularly patients who have pain, too, because it’s a very, very effective operation in relieving pain. I think there’s a second set of patients who are good candidates for it, and those are patients who had previous shoulder replacements, either because they’ve had fractures or arthritis surgeries that have failed. It’s a very, very good option for revision of failed previous shoulder replacement surgery. http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=22500 http://thecoreinstitute.com/Newsroom/2009_News?id=42Tue, 17 Nov 2009 17:43:00 GMTBy: Wanda Robert Becoming a Marine is a transformation that cannot be undone.”  (www.marines.com)   In 2007, a meeting between doctor and patient proved to be the first step on a journey of transformation.  The CORE Institute’s Jason J. Scalise, MD is proud to have played a part in the future of one of our nation’s heroes. The patient, Anthony (Toni) Brewer sat with us to share his inspiring story of determination.  Anthony (Toni) Brewer is a young man who understands the importance of hard work and reaching out to his community.  Growing up in Paradise Valley, Arizona, Brewer followed in the footsteps of his father, an officer with the Phoenix Police Department.  He began volunteering with the department at the age of 12.  It seemed obvious to everyone that after his graduation from Phoenix Christian High School he would enter a career in public safety.  The surprise came when rather than becoming a police officer; Brewer decided that he wanted to become a United States Marine.   As a football and basketball player in high school, the athletic Brewer prepared to pass the medical evaluation portion of the Marine’s processing.  It was through this medical evaluation, however, that his past shoulder injuries were brought to the forefront once again.  By speaking with Toni, the medical examiner discovered that for the past five years, his left shoulder would occasionally dislocate.  Following the evaluation at the Marine Entrance Processing Station, medical staff suggested that Brewer join a branch of the military that was not as “physically demanding” as the Marine Corps.  The Marines dismissed Toni and stopped him from enlisting, stating medical reasons. Undeterred, Brewer was not ready to give up on his dream.  The Marines understood his determination to join this elite group of men and women who serve the United States. Toni added, “The Marines said if I really wanted to pursue a career in the military, I needed to have surgery on my shoulder.”  Enter Jason J. Scalise, MD, an orthopedic surgeon with The Center for Orthopedic Research and Education in Phoenix, Arizona.  Dr. Scalise specializes in shoulder injuries and complex shoulder issues, having trained and worked at the renowned Cleveland Clinic before joining The CORE Institute.  Dr. Scalise evaluated Brewer in November 2007 for his chronic shoulder instability.  After a physical exam and MRI, Brewer was diagnosed with recurrent shoulder instability and a Bankart lesion.  A Bankart lesion is a tear of the labrum the lining of the socket of the shoulder.  This occurs when the shoulder is dislocated and can cause instability, pain, acatching sensation and an increased likelihood of future dislocations.    Dr. Scalise noted that this “recurrent instability will prohibit” the high level of activity Brewer would need to maintain as a Marine.  After considering many possible treatments and the possible risks of surgery, for Brewer the solution was obvious -- the arthroscopic Bankart repair procedure. He wanted his shoulder fixed and believed that Dr. Scalise was the surgeon to do it.  At Paradise Valley Hospital on December 17, 2007, Dr. Scalise performed an arthroscopic Bankart repair on Brewer’s left shoulder.  The procedure took one hour and included an evaluation of his shoulder through the arthroscopic camera.  Through the small incisions, both camera and instruments were able to repair the torn labrum back to its anatomic location on the front edge of the shoulder socket and thereby restoring stability to Brewer’s shoulder.   “Mr. Brewer’s surgery went extremely well.  He had a classic tear of the labrum which the arthroscopic camera showed well.  We were able to obtain a very robust labral repair.  It is interesting that a seemingly small disruption in the normal anatomy can have such profound consequences on an individual’s shoulder function; and in this case, his aspirations.”  After Dr. Scalise did his part repairing the tear and customizing Brewer’s rehabilitation program, the job fell to Brewer to do the hard work of recovery.  A large part of this process involved physical therapy to help improve the shoulder’s range of motion, improve strength and restore function.  Six weeks after surgery, Brewer began his physical therapy regimen.  Before the procedure, Dr. Scalise explained that recovery could take as long as six to seven months and there was always a chance that the shoulder may not heal properly, preventing complete recovery and function.  However, with the same energy and commitment he uses to face all challenges, Brewer tackled his rehabilitation head on – completing his rehab in ¾ the time prescribed by Dr. Scalise.  While admitting that recovery was one of the “hardest times in my life”, Brewer was able to pass his physical and join the Marines on schedule.  On June 6, 2008 Brewer graduated from boot camp at M.C.R.D. Camp Pendelton, San Diego, as his platoon’s second squad leader.  This earned him a meritorious promotion to private first class.  Shortly after his graduation, PFC Brewer paid a visit The CORE Institute.  Dr. Scalise told Brewer, “Good to hear your shoulder has kept up with the rest of you.”  From the successful completion of boot camp, Brewer’s next step was Iwakuni, Japan on a two year tour.  He keeps in touch with Dr. Scalise via email and during a recent trip state-side to get married, Brewer summed up his experience by saying “I had a major obstacle to overcome so I could pursue my dream of being a Marine. I can’t thank Dr. Scalise enough for his efforts. He has changed the course of my career, and more importantly, my life”. http://thecoreinstitute.com/Newsroom/2009_News?id=41Tue, 17 Nov 2009 17:42:11 GMTKnee needs rise with aging population Joy Slagowski Daily News-Sun An aging population is causing "an explosive growth" in knee replacement surgery, according to one local expert. John Thompson, an orthopedic surgeon, will be giving a free community lecture "Joint Replacement: How do you know when it’s time?" at 9 a.m. on Friday, Sept. 11 in Memorial Hall at Banner Boswell, 13180 N. 103rd Drive, Sun City. Reservations are encouraged by calling 602-230-CARE (602-230-2273). Light refreshments will be served. Thompson is medical director of Banner Boswell’s Joint Club, a special unit dedicated to the care of patients undergoing total knee or hip replacements. Thompson specializes in adult reconstruction, and primary and revision hip and knee replacement surgery. "They should try all of the non-operative means first, such as over-the-counter remedies, topical ointments, Tylenol, and non-steroidal anti-inflammatory meidations." Thompson said. "(They should also try) ice, heat, bracing and activity modifications. They should also try physical therapy, injections and also herbal medications." But if those fail, surgery can be a consideration if radiographs confirm degenerative arthritis. The surgery is extremely painful, Thompson said, and recovery takes a full year. "The first 48 hours are when there is the most significant amount of pain," Thompson said. "But we begin physical therapy about three hours after surgery, which at that point is when we get everyone up and walking." A normal hospital stay is three days, with physical therapy taking place twice a day while there. Thompson said about 50 percent of patients recover within about two months, while it will take three months for another 25 percent to recover. "It takes a year to be 100 percent recovered," Thompson said. "Also, we tell patients if they have both knees replaced at the same time, they never heal at the same rate: one hurts and is more stiff than the other." In the long run, though, studies are showing those who have knee replacements are actually saving money. "When they start calculating the pain medication, disability from it, or time off work, it’s one of the few procedures that confirms its cost effectiveness is great," Thompson said. http://thecoreinstitute.com/Newsroom/2009_News?id=40Tue, 17 Nov 2009 17:41:39 GMTA local sports medicine physician will discuss the need for seniors to reverse a trend of "underuse" of muscles by becoming active again, as well as rehabilitative activities for common injuries Wednesday at the Sun City West Foundation. Dr. John Kearney, a specialist in non-operative, rehabilitative and medical aspects of sports medicine, will present his expertise about the importance of staying active in general, the benefits of different types of exercise and the best ways to prevent over-use injuries. "Staying active should be a priority in everyone's life," said the physician, who works with the Center for Orthopedic Research and Education based in Sun City West. "Everybody should be aiming for at least two hours a week of activity that gets you out of breath and makes you sweat." Seniors should look for an activity they enjoy, whether it's bocce or lawn bowling, as long as they stick with it, Kearney said. "Whatever (seniors) enjoy and they can participate in, that's the most important thing," he said. "The goal should be to find something you enjoy doing that you can stick with." Often, seniors face injuries during physical activity, and they become discouraged about continuing to exercise. Kearney said the correct rehabilitative techniques can often ease the pain. "There are usually very simple things (seniors) can do to stack the odds in (their) favor to treat an injury or prevent an injury from occuring," he said. "In general, with seniors we see a lot of shoulder, knee and back problems. Chronic underuse is just a natural, slow decline in the muscles that support the joints. We can usually get those feeling a lot better with the right physical therapy and strengthening. "(It's common for seniors to) think that they need to exercise less whenever they run into a painful problem. They tend to give up very easily, when in reality there's usually an easy way to fix the problem." The presentation, sponsored by the Foundation, Recreation Centers and Property Owners and Residents Association of Sun City West, will be at 1:30 p.m. Wednesday at the Sun City West Foundation Building, 14465 R.H. Johnson Blvd. The talk is open to the public.  http://www.yourwestvalley.com/news/seniors_4912___article.html/city_exercise.html http://thecoreinstitute.com/Newsroom/2009_News?id=39