Where Tech Meets Tech Can Help Your Knee

By: Dr. Barry Kraushaar

Total knee replacement is evolving in ways that will improve outcomes for our patients in the future. While around 95% of knee replacements are good or excellent at five years, there is still room to reduce problems with Total Knee cases in the future. Two areas where technology is guiding surgery outcomes are in the precision for positioning components and in eliminating the need for acrylic bone cement, which sometimes crumbles or loosens.

Component Positioning with Surgical Robot

One advancement over the past few years is the use of a surgical robot as a tool to optimize the precision in the process of putting the implant in the best position possible. We at NEOSM have been using this device with great success since 2017, and our results have been incredible. The surgeon can make real-time adjustments to their preoperative plans during the case, measuring each decision against the robotic feedback that technology gives us. This decreases the likelihood of the knee being too loose or too tight, and allows the surgeon to test stability before the end of the case.

Cementless Knee Replacements with Robotic Guidance

The precision of robotic surgery helps us meet another need for future knee replacement patients. In total knee replacements, acrylic bone cement is applied to the undersurface of the metallic components and acts as a cement to provide stability.  The downside is that bone cement is a brittle substance. It does not flex and deform with motion. Rather, it tends to crack and does not heal itself. Over time pieces can break off and act as particles to create debris in the joint which can be abrasive. If the use of cement can be avoided then there will only be a bone-metal connection with no debris. Robotic surgery provides a predictably precise surface upon which to rest a “press-Fit” total knee replacement, allowing for a cleaner match and better outcome. The immediate stability is achieved by the pegs and surface shapes of the total knee implant components, and, in the long term, the porous inner surfaces of the devices provide a way for bone to grow into the tiny spaces and form a long term bond.

Cementless knee replacements are not new. They have been around for decades, but recently the popularity of this technology has grown when used alongside robotic guidance. Currently only a small number of patients who have ideal circumstances receive cementless total knee replacements, but that number may grow if it becomes apparent in the long run, there are even better outcomes in the future. NEOSM surgeons remain attentive to emerging trends and we are applying these advances to our patients with careful consideration.

Each case is different, so we encourage you to schedule your consultation with one of our orthopedic surgeons today to discuss options available to you.

Arthritis: Defined

By: Dr. Arup Bhadra

What is the second most common health problem after the common cold? Arthritis. About 54 million adults are diagnosed with a type of arthritis*, the inflammation of one or more of your joints.

Arthritis can occur in any joint in the body, but most often, it develops in weight-bearing joints like knee and hip. Because pain, swelling, and stiffness are the primary symptoms, arthritis in these joints can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

There are more than 100 different forms of arthritis, but the most common types of arthritis are osteoarthritis and rheumatoid arthritis. Let’s dive into what an arthritis diagnosis means.

Osteoarthritis

Osteoarthritis is the most common form of arthritis in the knee and or hip. It is a degenerative, “wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too. In osteoarthritis, the cartilage in the knee/hip joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone and produce painful bone spurs. Osteoarthritis develops slowly and the pain it causes worsens over time.

Arthritis can occur in any joint in the body, but most often, it develops in weight-bearing joints like knee and hip. Because pain, swelling, and stiffness are the primary symptoms, arthritis in these joints can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. Don't wait any longer...Contact Northeast Orthopedics and Sports Medicine TODAY!

(Left) Healthy Knee joint and (Right) worn cartilage and arthritic knee joint

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis

Posttraumatic arthritis is a form of arthritis that develops after an injury to the knee or hip. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury.

Treatment for Arthritis

Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active. Non-surgical treatments include adjustment of lifestyle and activities, pain management, cortisone and/or viscous supplement injection. Should a joint replacement be necessary, there are many advances to ensure successful outcomes. Surgical treatment options include traditional and robotic-assisted knee and hip replacement utilizing the latest minimally invasive techniques.

If you are suffering the symptoms of arthritis, contact us today for a consultation with one of our providers to ensure the right diagnosis and treatment to help you.

*Source: Arthritis Foundation

Preventing Gardening Injuries

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year.

By: Dr. Doron Ilan

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year. Back injuries, hand lacerations/puncture wounds, infections, overuse tendinitis, bug bites, and heat exhaustion are some of the more common medical conditions seen in recreational gardeners. Here are a few tips to keep you safe this spring and summer.

  • Warm up: One of the most common mistakes is to head straight to the shed and start lifting heavy bags of mulch, soil, and equipment. This can lead to back sprains and muscle strains.  Instead, first, take a 5-10 brisk walk to warm up the muscles, loosen the joints and get the heart rate up a bit.
  • Wear gloves: This will prevent most thorn punctures, blisters, lacerations, and bug bites. It will also protect your skin from pesticides, bacteria, and fungus (often live in soil). A small cut can lead to a major infection. A light long sleeve shirt and long socks or pants can’t hurt either.  Don’t forget the sunscreen and a hat.
  • Hydrate: It is very easy to spend hours gardening without drinking. Bring a bottle of water outside with you and sip regularly
  • Rotate your tasks: Avoid overuse repetitive stress injuries by not spending more than 10-15 minutes in a row doing the same motion. Make sure your gardening activities are varied so that the same muscles are not used repetitively.
  • Use proper equipment
  • Check your skin for ticks after you finish gardening for the day. Lyme disease and other tick-borne infections are very common in our area.

Following these tips can help minimize your risk, but of course, if you do sustain an injury make sure to get medical attention as soon as possible.  Have a great spring and summer — and enjoy your gardening!

If you do encounter an orthopedic injury while gardening, contact us today to find out what’s wrong and how we can help.

The Most Common Types of Shoulder Pain, Explained

The shoulder is an efficient combination of joints, muscles and tendons that enable a wide variety of movement and range of motion. However, its utility and versatility make the shoulder prone to a variety of injuries and conditions. In fact, shoulder pain will affect up to 70 percent of the population in their lifetime. It can be disabling and result in a host of unwanted consequences.

Below are some of the most common painful shoulder conditions:

Biceps Tendinitis

The biceps tendon is a structure that connects the biceps muscle to the humerus (upper arm bone) bone near the shoulder joint. Biceps tendinitis, a common cause of shoulder pain, is an irritation or inflammation of the upper part of the tendon.

Causes

Often, biceps tendonitis is due to wear and tear. It can also be connected to other shoulder issues, such as instability, shoulder impingement or a rotator cuff injury. It is particularly associated with damage to the rotator cuff tendon.

Repeated motion in work or sport—particularly those activities that require overhead motion, such as construction work, painting, swimming, tennis and baseball—can also cause biceps tendinitis.

Treatments

  • Rest (from overhead activity)
  • Ice
  • Medication
  • Physical therapy
  • Steroid injections

Surgery-If more conservative measures have been exhausted, surgery may be indicated. This may entail biceps tenodesis, which is detaching the tendon from the shoulder socket and reattaching it to the upper arm bone.

Rotator Cuff Tear

The rotator cuff is involved every time you move your shoulder. It helps to stabilize the shoulder. So, it stands to reason that it is a commonly injured area. Rotator cuff tears can either be partial or incomplete (a tear that is frayed), or complete, which entails a tear that goes completely through the tendon.

Causes

There are two main causes of rotator cuff tears. They can occur from an acute injury (such as a fall or other cause of severe twisting motion of the joint). An acute injury can also be caused by the stress of improperly lifting a heavy object.

However, most rotator cuff tears occur due to progressive degeneration (wear and tear) over time. The incidence of tears increases with aging. It is important to determine the cause of a rotator cuff tear since this impacts what treatment is recommended.

Treatments

  • Rest
  • Modified activity
  • Medications
  • Physical therapy
  • Steroid injections

Surgery: If conservative measures have not offered relief or if the tear is severe, surgery may be indicated. This is particularly the case for athletes or those who engage in repetitive overhead movement, since many tears do not heal on their own.

Shoulder Impingement

Shoulder impingement syndrome, which is also sometimes called “bursitis” or “tendinitis”, occurs with the repetitive compression (“impingement”) of the rotator cuff during movement. A thorough and careful examination is the best approach to a personalized diagnosis.

Causes

Shoulder impingement is also the result of repeated overhead activity involving the shoulder. It can also be caused by a shoulder injury. Finally, in some cases, there is no known cause of the condition.

Treatment

  • Rest (from overhead activity)
  • Ice
  • Medication
  • Physical therapy
  • Steroid injections 

Surgery: If other treatments do not provide results, surgery may be indicated to increase the space around the rotator cuff. The procedure, which can usually be done with minimally invasive arthroscopy, allows free movement without the compression or rubbing on the bone and the resulting pain.

Frozen Shoulder

Frozen shoulder, technically called adhesive capsulitis, is a condition causing stiffness, pain and immobility in the shoulder joint. It is due to a thickening and tightening of the shoulder joint capsule which restricts room for movement.

Causes

While the causes are usually unclear and cannot be identified, some people suffer frozen shoulder following a recent injury or fracture to the area which resulted in a need to immobilize the shoulder. In about 10 to 20 percent of cases, it can be caused by diabetes. Other medical problems may put people at risk for frozen shoulder (hypothyroidism, hyperthyroidism, Parkinson’s and cardiac disease).

Treatments

  • Medications
  • Physical therapy
  • Steroid injections

Surgery is rarely required for frozen shoulder. Although recovery can take a long time (up to a couple of years), in the majority of people it resolves on its own with the use of nonsurgical treatments. In the event of surgery, manipulation under anesthesia and/or arthroscopy are performed to release the scar tissue.

If you’re having shoulder pain, contact us today to find out what’s wrong and how we can help.

5 Simple Stretches for Sciatica

Sciatica can be a real pain in the back, among other things.

Also known as lumbar radiculopathy, sciatica (pronounced sci-at-ick-aa) is a term used to described a series of symptoms—most notably, pain—that occurs when the sciatic nerve is irritated. This large nerve runs from your lower back, past the buttocks and down each leg.

Sciatica is currently estimated to be the cause of low back pain in five to 10 percent of Americans.

What are some stretches to alleviate sciatica symptoms?

The beauty of creating a routine to manage your sciatic pain is that it also serves as a way to prevent sciatic pain and other symptoms from making a reappearance. In fact, though it may seem unlikely (or unpleasant), exercising actually helps to improve symptoms better than bed rest.

One of the forms of exercise to help relieve sciatica is performing stretches that externally rotate the hip. Here are five stretches that do just that:

  1. Reclining Pigeon Pose
    • While lying on your back, bring your right leg up to a right angle. Grip both hands behind the thigh and lock your fingers.
    • Lift your left leg and place your right ankle on top of the left knee.
    • Hold the position for a moment, then repeat with the other leg.
  2. Sitting Pigeon Pose (to be done once the reclining pigeon pose can be performed with ease)
    • Sit on the floor with your legs stretched out straight in front of you.
    • Bend your right leg, putting your right ankle on top of the left knee.
    • Lean forward and allow your upper body to reach toward your thigh.
    • Hold for 15 to 30 seconds.
    • Repeat on the opposite side.
  3. Knee to Opposite Shoulder
    • Lie on your back with your legs extended, and your feet stretched upward.
    • Bend your right leg and fasten your hands around the knee.
    • Lightly pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds.
    • Push your knee so your leg returns to its starting position.
    • Repeat for a total of three reps, and then switch legs.
  4. Sitting Spinal Stretch
    • Sit on the ground with your legs stretched straight out with your feet arched upward.
    • Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
    • Place your left elbow on the outside of your right knee to help you gradually turn your body toward the right.
    • Hold for 30 seconds and repeat three times, then switch sides.
  5. Standing Hamstring Stretch
    • Place your right foot on a raised surface at or below your hip level. Flex your foot so your toes and leg are straight.
    • Bend your body forward slightly toward your foot (without feeling pain).
    • Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot.
    • Hold for at least 30 seconds, and then repeat on the other side.