Orthopedic Surgery and General Specialties

Arthritis (Osteo and Rheumatoid)

A healthy joint allows a range of comfortable movement. Arthritic joints, however, are painful, stiff and swollen. Arthritis may result from cartilage damage (osteoarthritis), an autoimmune disorder (rheumatoid arthritis), or a joint injury (post-traumatic arthritis).

Nearly one in three adults suffers from arthritis or other chronic joint symptoms. Arthritis is the most common chronic ailment among the elderly, although it can affect people of any age, including children.

There are over 100 different types of arthritic diseases. The most common is osteoarthritis (OA), or "wear and tear" arthritis. This is a degenerative joint disease in which the cartilage cushioning the joint slowly wears away. The bones then rub together whenever the joint moves, and the fluid-filled capsule enclosing the joint (the synovium) becomes inflamed. The bone ends may thicken to compensate for the increased friction, and bone spurs may form at the edges of the joint.

At first, discomfort and stiffness are mild and can be relieved with rest. Then, as OA progresses, the joint becomes increasingly stiff and inflamed, difficult to move, and very painful even when at rest.

OA frequently affects weight-bearing joints such as the hips, knees and spine. Athough it can occur to anyone at any age, OA most often affects the elderly, particularly women. Risk factors include obesity, a family history of the disease, previous injury or infection in the joint, and an injury that puts increased pressure on the joint.

Rheumatoid arthritis (RA), a type of inflammatory arthritis, is a chronic condition in which the body's own immune system attacks the joint lining, causing it to swell. This autoimmune disorder can cause pain even when the joints are not being moved. RA is the most common inflammatory arthritis affecting the hips and knees. Because of the systemic nature of the disease, it tends to affect joints on both sides of the body at the same time; if you have RA in one knee, you are likely to have it in the other.

• RA of the hips often presents as a dull ache in the groin, outer thigh or buttocks. The pain may make walking or other movements difficult, and it is often worst in the mornings.
• RA of the knees may make it difficult to bend or straighten the knee, leading to trouble walking, climbing stairs or kneeling. The knee may feel weak and susceptible to locking or buckling. As with RA of the hips, the pain and swelling are usually worst in the mornings or after resting.

Post-traumatic arthritis is arthritis that develops after an injury to a joint, such as a fracture, dislocation, ligament injury or meniscus tear. It is similar to osteoarthritis and can occur months or years after the original injury.

Arthroscopic Surgery

Arthroscopy is a minimally invasive procedure that allows doctors to diagnose and sometimes treat joint injuries and disease through small incisions in the skin. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.

During an arthroscopic procedure, a thin fiberoptic light, magnifying lens and tiny television camera are inserted into the problem area, allowing the doctor to examine the joint in great detail. For some patients it is then possible to treat the problem using this approach or with a combination of arthroscopic and “open” surgery. Sports injuries are often repairable with arthroscopy. Tendon tears in the knee are frequently repaired in this way. Other potentially treatable injuries include torn cartilage or ligaments, inflamed joint lining, carpal tunnel syndrome, rotator cuff tears, and loose bone or cartilage.

Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery: No cutting of muscles or tendons Less bleeding during surgery Less scarring Smaller incisions Faster recovery and return to regular activities Faster and more comfortable rehabilitation Arthroscopy is not appropriate for every patient. Your doctor will discuss the options that are best for you.

Autoimmune Diseases

Autoimmune diseases are those that occur when the immune system reacts abnormally and attacks its own body.  Proteins called antibodies, produced by white blood cells, are used to identify and destroy foreign bacteria or viruses.  When normal substances are mistaken for foreign, the antibodies end up attacking the body and causing an autoimmune disease. 

The cause of autoimmune diseases is not known, but is believed to be affected by exposure to microorganisms or other environmental causes.  These diseases are more common in women, who account for 75 percent of cases.  Some people may be genetically predisposed to autoimmune diseases.

There are more than 150 different autoimmune diseases.  Some attack certain specific organs while others affect multiple organs or the entire body.  They can be mild or life-threatening, but every disease is rooted in an immune system malfunction.  The common symptoms among these diseases include fatigue, dizziness, malaise and fever.

The most common types of autoimmune diseases are:

• Rheumatoid Arthritis (RA) – RA is a chronic autoimmune disease that causes inflammation of the joints and surrounding tissues.  It most commonly affects the wrists, fingers, knees, feet and ankles and causes muscle aches, stiffness and joint pain.  RA affects over 2.5 million people in US.
• Lupus – Lupus is a chronic autoimmune disease that affects the entire body.  Mild cases of lupus can primarily affect the skin, causing skin rash, mouth sores and hair loss.  Most people also experience joint pain and swelling, fatigue and fever.  There are over 16,000 new cases of lupus each year and it most commonly affects women between the ages of 15 and 45.
• Multiple sclerosis (MS) – MS is an autoimmune disease that affects the nervous system and cause loss of muscle control, vision, balance and sensation.  The immune system attacks the myelin sheath, which is the protective coating that surrounds nerve fibers.  Without the protection, the nerves become inflamed and symptoms form and worsen as the disease progresses.
• Scleroderma – Scleroderma is a chronic autoimmune disease that causes fibrosis, or hardening of the skin and its connective tissues.  Mild cases can cause skin deformities while more severe cases can affect internal organs including the joints, lungs and kidneys.  About 100,000 Americans suffer from scleroderma.

Other types of autoimmune diseases include diabetes, celiac disease, dermatomyositis, Addison’s disease and Grave’s disease.

Since most autoimmune diseases are chronic, treatment focuses on controlling symptoms and preventing flare ups.  Treatment depends on the type of disease but may include medication, hormone replacement therapy, corticosteroids and nutritional supplements.  If the disease affects the blood, transfusions may be needed.  Preserving organ function is important since these diseases will continue to attack the body.  This treatment is just as important as relieving symptoms and will help to prevent future damage.  Radiation or surgery to remove damaged cells can also be effective treatment for autoimmune diseases. 

Living with an autoimmune disease can be manageable through a healthy lifestyle and help from a doctor.  It is important to eat a balanced diet, exercise regularly, get enough rest and see your doctor on a regular basis to continue leading a full and active life.  There are new treatment options being developed all the time so staying up-to-date and informed is the best way to achieve the best treatment for you.  Call us today to talk with a doctor and figure out how to deal with your symptoms.

General Orthopedic

Orthopedists specialize in the diagnosis, treatment, rehabilitation and prevention of injuries to and diseases of the musculoskeletal system – the network of bones, joints, ligaments, tendons, muscles and nerves that gives the body its shape and allows us to move.

Many of the problems orthopedists treat involve the joints, places in the body where two or more bones meet. Humans have three different kinds of joints: fibrous (in the skull), cartilaginous (in the spine) and synovial (the neck, shoulders, elbows, wrists, hands, hips, knees, ankles and feet). This last type is what we usually refer to when we say “joint.” Ligaments connect bones to each other, and tendons connect muscles and bones.

These parts of our bodies can be damaged from a traumatic injury, disease, congenital disorder or the natural aging process. Commonly treated conditions include arthritis, back pain, carpal tunnel syndrome, bone fractures, sprains and strains, knee and shoulder problems, tendon and ligament tears, osteoporosis, sports injuries, and pediatric conditions such as club foot. Patients may be infants, adolescents, middle-aged or elderly. The introduction of minimally invasive techniques has meant that many patients can be examined and treated through tiny incisions, minimizing the trauma of “open” surgery and allowing them to enjoy a faster recovery and return to regular activities.

Osteonecrosis

Osteonecrosis is a disease in which bone tissue dies because blood flow has been cut off. The nutrient-deprived bone breaks down faster than the body can repair it. The bone may collapse after it dies, and if the affected part of the bone is near a joint, the joint surface may collapse in turn, leading to pain and arthritis.

Osteonecrosis most often affects the ends of the femur, the long leg bone running from the hip to the knee; it is responsible for about 10% of hip replacements. It also commonly affects the upper arm (humerus), knees, shoulders and ankles. It can strike one or many bones, at the same time or at different times. Men and women of any age may develop the disease, although most cases occur between the ages of 30 and 60. Women, especially those over 60, are three times more likely than men to develop osteonecrosis of the knee.

As osteonecrosis progresses, usually over several months, symptoms worsen from mild pain when putting weight on the affected joint, to pain and limited motion even when at rest, to disabling arthritis. If you have osteonecrosis of the hip, you may feel a dull or throbbing pain in your groin or buttock. If the disease affects your knee, you may feel sudden pain after an injury or activity, swelling on the front and inside of the knee, sensitivity to touch, an increase in pain at night, and limited motion.

The loss of blood flow that causes osteonecrosis may result from steroid use, excessive alcohol intake, joint injury (e.g. dislocations and fractures), radiation or chemotherapy, obesity, organ transplantation and certain medical conditions (e.g. cancer, lupus, blood disorders, HIV infection, gout, vasculitis, osteoarthritis, rheumatoid arthritis and osteoporosis). However, in many cases, no cause can be found.

Pediatric Orthopedic

There are a variety of orthopedic conditions that specifically impact children and teens, including congenital abnormalities, childhood diseases, broken bones, playground accidents, sports injuries, and aches and pains associated with the growth spurts of puberty. Orthopedists who specialize in pediatric medicine are trained to diagnose and treat problems in young patients, including:

Sports Medicine

Sports medicine is a subspecialty of orthopedics that deals with the prevention, diagnosis, treatment and rehabilitation of injuries suffered during athletic activity. The goal of treatment is to heal and rehabilitate the injury so patients can return to their favorite activities quickly, whether it’s Little League, recreational play or a high school, college or professional sport.

As with a sports team, there are many physicians who work together to help the patient regain maximum use of the injured limb or joint. “Players” on the team are typically the physician, orthopedic surgeon, rehabilitation specialist, athletic trainer and physical therapist – and the patient him/herself.  

Total Joint Replacement

Sometimes the best way to relieve pain and restore function to a joint is to replace all or part of it with a prosthesis (an artificial joint). Prostheses are intended to restore function to the joint and relieve pain associated with arthritis, other chronic conditions, or traumatic injury.

Prostheses are designed to move like a regular joint. They are made of durable plastic and metal parts that fit together snugly but glide smoothly (as opposed to the painful friction associated with the worn cartilage of arthritic joints). The pieces are shaped like the structures they replace – for example, the damaged bones in a ball-and-socket joint of a hip or shoulder are replaced with a metal ball and plastic socket. They are held to the surrounding bone either with a locking mechanism or with a special bone cement.

The length and difficulty of recovery depend on the location of the joint replaced as well as the patient’s age and overall health. Hip or knee surgery typically requires temporary use of a cane or walker. Some pain and stiffness following surgery is normal. Gradually the weakened muscles regain strength and flexibility as the patient becomes accustomed to using the joint. The physician will discuss when it is safe to return to any athletic activities. Once in place, prostheses usually perform well for up to a decade or longer.

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