Mario Gomez – 2 Anterior Hip Replacements

Mario Gomez – 2 Anterior Hip Replacements

Mario-GomezMario Gomez had both hips replaced by Dr. Stuart Kozinn, after traveling the country in search of the best orthopedic surgeon to perform the procedure. Mario’s recovery was so rapid that he returned to Dr. Kozinn to have his other hip replaced, too! “Thanks for the best hip replacement I could get!”

Dr. Kozinn used the anterior approach for both hips, which had Mario walking 2 hours after his surgery. Mario drove home from the hospital the next day!

Watch the Interview with Mario Gomez

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Anterior Total Hip Replacement Update

I continue to be amazed at our results with the Anterior Total Hip Replacement procedure.  We did two anterior hip replacement patients yesterday, and the immediate results (up walking soon after the procedure), is remarkable. I am reminded of this when my medical students see the relatively painless function of the patients so soon after they have seen the actual procedure in the OR. After all, we are cutting the bone ( removing the femoral head), and reaming the pelvic socket (acetabulum). Amazingly, due to the bodies distribution of pain fibers ( mostly in the soft tissues) these bony  procedures do not generate much pain.

Our patients often are up walking in the recovery room. This man went home the same day as his anterior total hip surgery.

Our patients often are up walking in the recovery room. This man went home the same day as his anterior total hip surgery.

I love the look in my patient’s eyes when they put weight on the hip for their first steps. Wow!, it really doesn’t hurt..in many cases the preoperative pain was much worse and is magically gone! Patients actually feel better while they are walking, then when they are immobile waiting in bed to get going.

So many happy anterior hip patients like Ewa, have gone back to their active lives again!

So many happy anterior hip patients like Ewa, have gone back to their active lives again!

I love doing the anterior total hip replacement procedure, and the word is out, Scottsdale joint Center is the place to come for your anterior total hip. Welcome to our practice, and I am happy to have you as our patient!

Shoulder Replacement

Shoulder replacement surgery is becoming much more popular. That is because the results have been much better than in years past. Since there are fewer arthritic shoulders than arthritic knees and hips, less are done.   Also the fact that we do not walk on our hands, allows us to tolerate shoulder arthritis much better than hip and knee arthritis. The heavy weight bearing on our legs, magnifies the pain we feel in our worn out hip and knee joints.

shoulder replacements are more successful now - there are different types for different situations

shoulder replacements are more successful now – there are different types for different situations

In the past, we only had the traditional shoulder replacement device to use on arthritic shoulders. This device depends on a well functioning rotator cuff (see picture) to keep the joint centered and to allow us to lift the arm overhead.  Now with the invention of the “reverse” total shoulder replacement implant, we can replace shoulders that have massive cuff tears, and the patient can still lift the arm by using a “trick” of biomechanics.  By moving the center of rotation of the shoulder joint lower and more towards the center of the body, the large superficial deltoid muscle now comes into play as an elevator of the arm.  Many patients feel stronger after the reverse surgery than they have in years!

small rotator cuff tears  can be repaired, massive tears can be replaced with a Reverse total shoulder replacement

small rotator cuff tears can be repaired, massive tears can be replaced with a Reverse total shoulder replacement

An Xray and an MRI will allow Dr. Kozinn to determine which implant is best for YOUR shoulder. The revovery is easier than for a total knee, but maybe a bit more inconvenient than our anterior hip recovery.  The arm will rest in a sling until the pain is minimal, than you may progressively use the arm as tolerated. We do use post-operative physical therapy for total shoulders and total knees, in contrast to our anterior total hip replacements and partial knee replacements, which rehab just fine without formal PT.

traditional total shoulder replacement

traditional total shoulder replacement

Total Knee Recovery

Total knee recovery can be more arduous than total hip recovery.  There is generally more pain after a knee replacement then with an anterior hip replacement.  I think this is because we push the range of motion of the knee so soon.  We do partially split the quadriceps muscle to some extent, and repair then it.  It often feels tight, like it is pulling on the suture line when we push you to flex your knee.  It has been my observation that the patients who start their Physical Therapy a week later seem to do better than those who start right away. This may simply be due to the recent bleeding and subsequent swelling that occurs immediately after the surgery.

Diana had both knees replaced with partial knee replacements. She is very active when she is not writing #1 Bestselling novels!

Diana had both knees replaced with partial knee replacements. She is very active when she is not writing #1 Bestselling novels!

I think functional rehab, like walking, is much more important early on then range of motion exercises.  The motion should come easier later as the swelling goes down. Ice works well in the knee to control pain and swelling. We use sophisticated pain blocks to minimize pain initially, and our patients get a head start on functioning.  It is rare for patients to not get the motion they need by 6 weeks post op.  97% of the time, the knees loosen up over time on their own. Get outside and hike, walk, climb- use the knee! It will loosen up- it wants to move!

Mobile bearing total knee and partial knee replacements allow patients to be very active.

Mobile bearing total knee and partial knee replacements allow patients to be very active.

Our total knee replacement patients are recovering faster than they did years ago.  We use muscle sparing approaches, and minimize the use of the tourniquet ( used to control bleeding during the surgery).  We now have an injectable medication called Exparel* that is a timed release local anesthetic – it can provide pain relief for up to 72 hours. Many patients are requiring less overall physical therapy visits. What used to be 3 times a week is now two visits a week for many patients. Our knee implants are also getting better. The new rotating platform system we use has many more sizes to fit all knees, and the plastic spacers go up in one millimeter increments for maximum accuracy and stability. It is a good time to have a painful knee replaced!  Read more about total knees at www.Totalknee.org.

Daphne played tennis at Wimbledon in the old days. Her total knee will let her play again!

Daphne played tennis at Wimbledon in the old days. Her total knee will let her play again!

Joint Replacements and Sports

Our patents ski well with their new anterior total hips. Go Jan!

Our patents ski well with their new anterior total hips. Go Jan!

 

Joint Replacements and Sports

Patients always ask me what sports they can play after a total hip or total knee replacement.  After observing joint replacement patients for 27 years in practice, it is my opinion that we may  have been too conservative with our advice to our athletic patients. Of course, depending on the patient and the sport, different people could do different things.  The anterior hip patients truly seem to be able to do all sports. We still advise them to limit the amount of hard running (to lengthen the lifespan of the implant), but I am not seeing ill effects so far in my running patients (and they seem much happier doing what they want to do!).  I think it is fair to see that you can do all sports, with the understanding that we just don’t have enough scientific data to conclude one way or the other about how it will effect the implant over time. (Sports might make the muscles passing over the joint stronger, and therefore improve the joint function over time!).  The total knees are a little more worrisome, in that they are cemented in place, and may possible suffer a loosening injury with constant pounding. I have not seen this in practice, but it has always been the concern. We want your joint to last forever if possible- so we make some moderate risk assessment decisions. Jumping sports (basketball, volleyball) seem to be the most worrisome for a cemented total knee. Snow sprts are OK – more gliding than jumping. Just need to watch out for the “other guy” as it is pssible to get injures even without joint replacements!

Michelle has 2 titianium hips and two titanium knees - she promised she would snowboard again- and she did!

Michelle has 2 titianium hips and two titanium knees – she promised she would snowboard again- and she did!

I do let all my total knee patients play tennis and golf and softball – and they do very well in these sports. Common sense should prevail, and we need to take care of our joints so they will take care of us in years ahead.

Stem Cell Therapy

Stem cell therapy is coming! A future  exciting new treatment option for osteoarthritis of the knee and hip may be stem cell therapy.  This is done by obtaining stem cells from your bone marrow and re-injecting them in an arthritic joint.  Stem Cell therapy is an experimental treatment, and is not FDA approved. However,  some early results have been reported to be positive at relieving symptoms and pain from osteoarthritis. One research scenario will be for the hip patient undergoing anterior hip surgery. We can save the bone marrow usually displaced during the procedure, spin it down in a centrifuge to concentrate the stem cells (along with other blood cells) and re-inject in the opposite arthritic hip under the same anesthetic. We would follow these patients in a research protocol to see if they had significant pain relief allowing them to delay a future total hip on the other side. Another application may be in treatment of avascular necrosis of the femoral head.  After drilling or core decompression of the head, stem cells could be injected to repopulate the femoral head bone with live cells.  There is a lot to learn about the potential for stem cells to heal worn out joints. It will be exciting to be involved in some research projects that could lead to a new treatment for osteoarthritis.

stem cells 1

Any Stem Cell treatment is currently not FDA approved, and no definite results have been proven at this time. We are considering some appropriate research project options with stem cell therapy and will write an update on this topic later.

 

Total Hip and Total Knee in young active people

It seems that everyday younger people are requesting joint replacements for their painful, arthritic joints. Many young people ( 30 to 50 !), want to keep their active lifestyle. They understand that a joint replacement may not last forever, but it is possible to revise them in the future if they do wear out. The orthopedic community has come to accept this philosophy since the short term results have been very good.  I do try to get patients to give up running and jumping sports, but most other activities have been OK to do. Today I talked with another horse trainer patient of mine, and he is anxious to get back onto his horse and start “jumping” them again.  i gave him the go ahead at 5 weeks post-op from an anterior hip. I now have a number of racquetball players with total knees, I use the rotating platform device so they can get more motion. So far I have not seen an increase in problems from my athletic patients. I do ask them to use common sense. If patients take care of their new joints, the joints will take care of them for a long time!

What is your opinion on Hip Resurfacing?

What is your opinion on Hip Resurfacing?

I am a Dentist in the Toronto area. I’m 52 and have moderate osteoarthritis in my right hip. It is limiting my enjoyment of life as it is very painful to golf and I’m limping a lot. I can walk for about 15 mins without pain. I can no longer run. I’m trying to decide between THP and resurfacing.

Submitted by Dr. Steven Millman.

Stuart C. Kozinn, MD Responds:

Hip resurfacing is a dying procedure. I do not recommend it for anyone. Besides the potential long-term problems from wear debris with the large surface area metal on metal articulation, the failure rate is much higher than for standard total hip replacements. Fractures of the femoral neck are common, and loosening of the cemented cap is inevitable.  A well performed total hip is cementless ( potentially leading to permanent bone fixation ). Smaller minimally invasive components actually may be more conservative than surface replacement when you consider that socket bone loss is increased to fit the larger cup sizes needed for the larger head implant.  The anterior hip procedure, which cuts no muscle (muscle sparing), using E-poly or equivalent longer lasting polyethylene is now the preferred procedure in most people.

 

I Can’t Even Comb my Hair!

I can’t even comb my hair!

My shoulder has become so stiff and painful that I can’t comb my own hair! An MRI said the rotator cuff was not torn but I had arthritis in my joint. My general orthopedist said I need a shoulder replacement, but he does not do them. Do you do shoulder replacements? Do they work well?

Submitted by Theresa R.

Stuart C. Kozinn, MD Responds:

Yes and Yes! Shoulder arthritis is actually less common than hip and knee arthritis, so less shoulder replacements are done. Relatively few orthopedic surgeons are trained to do Total Shoulder Replacements, and you should seek a specialist. Both myself and my associate Dr. Evangelista are fellowship trained and we do shoulder replacement surgery on a regular basis.
 The results are very good, but somewhat less predictable than knee and hip replacements which routinely give 95% success rates. This is because the shoulder joint relies so much on muscles and soft tissues for stability, and even a perfectly placed shoulder implant can have soft tissue weakness or stiffness. Most total shoulder patients are better than before surgery, but some still have some limitations. Recovery is rapid and most patient use the arm for simple daily activities immediately. It takes about 3 months for full recovery, and physical therapy is usually needed post-op.

 

Update on the Anterior Hip Replacement procedure

I started doing the anterior hip procedure about 3 years ago after learning it from its inventor Dr. Joel Matta, who practices in Los Angeles. Now, after doing many hundres of anterior hips, I am even more excited about its potential.  I predict it will be the most preferred approach to hip replacement 5 years from now ( it takes a long time for a “new procedure” to prove itself, and have many established surgeons be willing to learn it and change from the way they have already been doing hips.

The biggest update is that wea re now doing larger, more muscular males as well. It is harder in these men, because we do not cut any muscles, therefore things get tighter when bigger muscles are “in the way”. With experience however, even the biggest men can benefit from this technique. My results are nothing short of spectacular when I compare every category of possible complications to the older posterior approach!  If you have hip arthritis, there has never been a better time to get it fixed. Please visit our facebook page deicated to this procedure at www.Facebook.com/AnteriorHipReplacements

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