Welcome
Specialties
Anatomical
Shoulder, Hip, Knee
Treatment
Arthritis, Arthroscopic Surgery, Joint Replacement, Sports Medicine, Trauma/Fractures
My approach to treating patients
The primary scope of our practice is to focus on shoulder, hip and knee surgery. We also do sports related injuries, trauma and some hand surgery, including endoscopic carpal tunnel release.
In the shoulder this includes arthroscopy and open surgery for repairs of rotator cuff injuries, dislocations or instability and other ligament or tendon damage.
Hip surgery involves primarily total hip replacement. I've had the opportunity to participate in this surgery since it's introduction into this country in the late 60's, so I have a lengthy experience with it's development and use. It has a high degree of success and they last for many years. I am a member of the American Association of Hip and Knee Surgeons. Membership has volume requirements and peer quality endorsements.
Hip pain in younger patients has sometimes been a mystery. We have recently become more aware of an entity called femoral-acetabular impingement. We can work with you to diagnose and treat this problem.
Our knee operations are more diverse. They include arthroscopy for routine and sports related cartilage injuries and ligament reconstructions. Arthritis management includes medications, injections, arthroscopy, leg realignment and both partial and total knee replacement. I am a member of the Arthroscopy Association of North America. This also has surgical volume requirements and peer endorsements.
Our approach to patients is to treat each one like friends and family. Each individual is one of God's creatures and should be treated with respect, encouragement, compassion, and honesty. We will strive for excellence and quality integrated care. If we don't have the answers, we will assist you in the best referral. Our staff has long term experience and we all desire your complete restoration. I've practiced Orthopaedic Surgery for thirty-five years and do not have a specific retirement time set. We appreciate the opportunity to serve each one.
TOTAL JOINT REPLACEMENT
One of the primary concerns of joint replacement patients is the life or longevity of the implant. How long will it last and can it be revised if necessary? Utilizing standard implants, we expect that the hip or knee implant will last fifteen years or more in ninety percent of cases.
This is a general statement meaning that most will go longer, but some will fail earlier. We now are using in younger patients a new material called Oxinium. It is a metal, but it performs like ceramic. Testing indicates that it wears much less than the metal used by other implant manufacturers. We therefore expect it to last longer in the body before needing revision. Oxinium also has no detectable nickel so is much less likely to cause allergic reactions. We are very encouraged by this material and the benefits it holds for joint replacement patients. You can read more about Oxinium in the links section of this site.
HIP SURFACE REPLACEMENT
You may have seen advertised a "new" more conservative or bone sparing hip replacement option called Surface Replacement. It is actually a concept many years old and I have done them in the past. Previous versions had both material and design flaws that have now been successfully addressed. We have available the Birmingham Hip Replacement (BHR). It was designed by a British surgeon and has an excellent 10 year global track record. Less bone is removed from the upper femur so that revision is easier in the future if necessary. Both the ball and socket are metal alleviating some of the disadvantages of plastic and ceramic. The BHR, however is not for everyone. It is best for younger active patients who have good bone quality. As with every procedure, there are advantages and potential complications. We are ready to answer your questions and explain your options. See the Birmingham Hip Replacement link on this web site.
ANTERIOR APPROACH
There are several incisions that can be used to perform a hip replacement. The most common is a posterior incision in back of the hip. It is a relatively easy approach which cuts a few small tendons, but has an occasional post-op dislocation. We still use that in some patients, but now most often use an anterior (front of the hip) incision. This has a lower dislocation rate and cuts no muscles or tendons. It goes between muscles. In my mind, that is the goal of minimally invasive surgery and is more important than the length of a skin incision.
MINIMALLY INVASIVE SURGERY
I'd like to comment about Minimally Invasive Surgery (MIS) and Less Invasive Surgery (LIS). Much has been presented in the press, media and internet about MIS and it is a popular topic especially among people considering hip or knee replacement surgery. Let me first comment about the terms and trends in joint replacement surgery.
Less Invasive Surgery is a term that signifies a general trend toward smaller incisions and on the inside trying to cut fewer ligaments and muscles, making it less traumatic for the patient with a quicker and easier recovery. This is a very desirable goal and one we actively pursue. Associated with LIS are continuously progressive improvements in pain control, more rapid rehabilitation, shorter hospital stays, and sooner return to a normal life.
Minimally Invasive Surgery is a more specific term related to definite incision lengths. For hips this is usually in the 4 inch range. One technique uses two 2 inch incisions. For knees MIS is about 5-6 inches (two times the length of the knee cap). The actual length of course varies with the height and weight of the individual. It also has some specific implications as to exactly what is cut on the inside and this varies with different surgeons. Because of differing patient's size and joint conditions, not all patients are candidates for MIS. Even in heavier or more muscular patients, the incisions are less invasive than in the past.
MIS may at first glance seem to be the obvious way to go. Everyone wants a joint replacement "without having an operation." Media coverage and some personal testimonies make it all very compelling. By contrast some internationally known joint replacement surgeons advise caution in being sure that even a small increase in complications or a reduction in implant life are not the price we are paying for a smaller incision, two to three fewer hospital days and a quicker return to daily activity. There is pressure by the patient to want MIS and pressure on the surgeon to offer MIS.
It is obvious that doing an operation through a small incision is more difficult. This can increase the chance of less precise component position, fracturing one of the bones, stretching tissues and generally increasing complications. This boils down to a potential trade off between a quicker, easier recovery and the possibility of increased risks and complications. Unknown, in addition to the possibility of increased complications, is the affect on long term results. Will MIS lead to more complications and shorter long-term life of the implant?
Coincident with MIS we are using a much improved multi-modal pain management program. It is well probable that these pain management factors add more to the ease of recovery than smaller incisions.
Presently joint replacement surgery has excellent longevity with 10-15 years of function in the 90-95% range of patients. Many factors affect the long-term survival of a joint implant. Surgeon controlled factors include component position, ligament tension, leg alignment and soft tissue trauma around the wound. Patient controlled influences include weight, attitude, medical conditions and therapy compliance. We know that if any of these are less than ideal the short term and/or long term results may be negatively impacted.
In the appropriate individuals we are now doing MIS and LIS on hips and knees but approach each person as an individual trying to make the very best decision for that person using as minimally invasive techniques as possible which are consistent with patient safety and optimal surgical technique. We do not compromise on implant design, but use implants that have a good long term track record. Our desire is to make the joint replacement experience as smooth as possible consistent with safety and uncompromised short and long term results. Our recommendation for patients is to be as informed as possible and make a calculated objective decision as to how hard to push for MIS or LIS. Our promise is to do our very best for every patient making your joint replacement experience as successful as possible in terms of a complete pre-operative testing and educational experience, a hospital stay with optimum pain control and as short as feasible but long enough to feel comfortable going home, complete follow up care with specific therapy programs for each individual's needs and an excellent long term pain free well functioning joint.
GENDER KNEES
Recently one of the major orthopaedic joint replacement companies has introduced a "Gender Knee" for female patients because of some anatomic differences between women's and men's knees. The main issue is that ladies knees tend to be a little narrower. The potential problem is that the implant may be too wide and overhang the bone and thereby cause pain. In my 25 year plus experience in knee replacement, I have not found this to be a problem. Other differences include smaller size and a slightly different knee cap gliding angle. The basic biomechanics of men's and women's knees are very similar. My personal belief is that this is more about marketing than function. If I chose to, I could put in the Gender Knee, but I firmly believe that what we use is better.
The truth is that for many reasons, the knee we use is excellent for both men and women. 1. The anterior flange where overhang could possible occur is actually narrower or the same on the S/N knee as the Gender knee. 2. The tibial base-plate which covers the top of the tibia in the S/N knee comes in right and left whereas the Gender is one shape fits all. 3. Metal allergy from nickel is a possible cause of knee pain. Women have a higher percentage metal allergy than men. The femoral component of the S/N knee is made of Oxinium and has no detectible nickel. The Gender femur is made of chrome/cobalt which is 1% nickel. 4. The wear of the femoral component on the tibial plastic is 85% less with Oxinium than chrome/cobalt which is used by all other companies.
The Smith & Nephew Journey Knee that we now use, especially in younger patients is made of Oxinium, which is a superior material and also has other design features that have the potential for excellent motion, function and longevity. This material and design more than make up for any potential advantage of a female knee.
We welcome any questions and promise our best efforts for every patient.