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

Watch Mario’s Commercial

 

Travel Medicine Update for Anterior Hip Replacement

 

Travel Medicine Update for Anterior Hip Replacement:

Winter is coming ! Travel medicine for anterior hip replacement is alive and well in Arizona. We have many winter visitors to Scottsdale Arizona and some decide to “kill two birds with one stone” while they are here by having an anterior hip replacement.  It works out very well actually, in that the anterior hip procedure is very amenable to enjoying your stay here as the recovery is so fast. The anterior  hip replacement procedure is not easy to come by in many states and other countries.  This is because it is somewhat new, and many surgeons have not yet been trained on it.

Our visitors from Canada get VIP care. Stuart (Dr. Turner) had both hips replaced and is back to heavy biking!

Our visitors from Canada get VIP care. Stuart (Dr. Turner) had both hips replaced and is back to heavy biking!

 

Many of our visitors come from Canada and Mexico.  Both of these neighboring countries have “nationalized” health systems, that make it more difficult to get elective surgeries done in a timely fashion. Even if you can get a hip replacement scheduled in these countries, it is likely not going to be an anterior approach hip.  Special equipment and training is needed to do this operation. A special very expensive traction table (HANA) is used to do the anterior total hips.

Super specialized anterior tota lhip table allows hip replacement without cutting any muscles

Super specialized anterior tota lhip table allows hip replacement without cutting any muscles

 

Most of our patients who come to visit for a joint replacement stay in town about a week.  The anterior hips and total shoulders could go in 4 days if necessary, but the total knees should stay at least a week. The knees require a bit more therapy and wound care before leaving town. I will give visiting patients my personal cell phone number for live real time texting as needed. Little questions often pop up, like, “I forgot when I am supposed to change the dressing”?, ( Once a day after the first dressing change),  and “When can I take a shower?” ( As soon as the wound is dry).  We are now getting many travelers from other states.  They have the advantage in that their American insurance will usually pay for their procedures even though they are in another state. (Some Local HMOs will not!).

 

 

Robert Whicker brought me some Halibut and Salmon from Alaska after his anterior total hip replacement!

Robert Whicker brought me some Halibut and Salmon from Alaska after his anterior total hip replacement!

 

So, if you would like to visit Scottsdale, Az, (and get out of the snow!), please call Gerry McCann in my office and she will fill you in on all the details.   While Gerry is not a travel agent, she is getting very good at this!

Gerry McCann is the office manager and VIP arranger of surgery for all of our patients.

Gerry McCann is the office manager and VIP arranger of surgery for all of our patients.

 

Hope to see you soon here in Scottsdale! Visit our Scottsdale Joint Center Facebook page at www.Facebook.com/ScottsdaleJointCenter to see how great patients are doing!

Anterior Hip Replacement is done under Xray guidance to make sure the implants are in the best position.

Anterior Hip Replacement is done under Xray guidance to make sure the implants are in the best position.

 

 

Obamacare ?

It has been over six months since new Obamacare rules have affected private practices in Medicine.  From my standpoint, this as not been a good thing for patients. Sure, it is laudible and appropriate that every American should have affordable access to health care. But at what price? Patients are already being herded into groups that will have to answer to “ACO’s”, accountable care organizations.  Just a new word for HMO’s that require layers upon layers of administrative permission to get the care that is needed accomplished.  Who benefits? Corporate America, and Insurance companies, which profit acting as  “the middle man”.  This happens whenever administration and regulations become more complicated, and too difficult to follow.   Soon, it will all be about corporate profits and bonuses paid for with-holding necessary care.  While I do see the potential for abuse in a “fee for service” world, at least in that system, patients do get the care they need. In the post Obamacare world,  patients will be convinced that surgery is a bad thing ( because momentarily is seems more expensive to payors), and physical therapy and pain medication will be a better option. The truth is, well performed joint replacement surgery is extremely cost efficient when measured in the years of increased economic productivity the recipients enjoy. Imagine the “cost savings” of taking a 50 year old “disabled” man or woman, who has bilateral knee replacement, and who then rejoins the workforce.

After hip replacement and most revision hip replacement surgeries patients can get back to normal activities.

After hip replacement and most revision hip replacement surgeries patients can get back to normal activities.

Think also of the mental health gains! Already insurance company stock prices are at all time highs. Do you think that is because more premium dollars are going to the care of patients? No, its because they can keep more of it as bonuses for executives. Pharmaceutical companies are at all time highs as well, because Obamacare did nothing to help decrease the ridiculous cost of medications.  The exact same drugs used here in the USA cost much more than they do around the world.  How does that make sense? This new system is not better, and soon patients will realize that their “access to care”, and their ability to get procedures done will be made more difficult.  I do have patients from Canada and Mexico who travel to Scottsdale to get joint replacements done on a timely basis, because the national health services in their countries make them wait in pain for years! Medicare has come out with so many new requirements and administrative paperwork, that most smaller private practices will need to close or fold into a large corporate backed ACO. This is why I have chosen to opt out of some plans, so I can continue to take the very best care of my patients.  I will likely see less numbers of patients in the future, but those who can stick with the Scottsdale Joint Center will benefit from the best orthopedic surgical care available in the world!

Best Total Hip Replacement

 

BEST TOTAL HIP REPLACEMENT

The best total hip replacement procedure I have ever seen is the new anterior total hip procedure. There are many reasons I feel  the direct anterior approach yields the best total hip replacement. After 27 years of doing over 200 total hips a year,  I have seen and done all of the different hip approaches and I have years of results to base my opinion.  My anterior hip patients are up walking within one hour of surgery, and many have gone home on the same day as surgery. This was not possible with the older posterior and lateral hip approaches.  There is MUCH LESS PAIN with the anterior hip procedure, because no muscles are cut.

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!

The best total hip replacement that I can offer to patients right now is the anterior total hip.  There have been less complications in my 1000 patient anterior hip group, when I compare them to the last 1000 posterior approach hips. Also the anterior hips heal faster and get back to their chosen activities with less restrictions much faster.  Watch our video on the home page of this website to learn more about the anterior total hip.

Cementless Anterior Total Hip Replacements are better for all sports and earlier return to all daily activities.

Cementless Anterior Total Hip Replacements are better for all sports and earlier return to all daily activities.

Total Knee Arthroplasty

Total Knee Arthroplasty is the same as Total Knee Replacment.  The word arthroplasty comes from the latin –”arthro” meaning “joint”,  and “plasty” meaning to” form or make” (so..to make a new joint).

Before and After a Total Knee Arthroplasty

Before and After a Total Knee Arthroplasty

Any joint in the body can have an arthroplasty, it is a very general term.   Partial knee replacement ( also called unicompartmental replacement) is another form of knee arthroplasty.  Dr. Kozinn performs both types of lnee arthroplasty at the Scottsdale Joint Center.

Partial versus Total Knee arthroplasty - both excellent pain eliminators.

Partial versus Total Knee arthroplasty – both excellent pain eliminators.

We have been in practice for 27 years, and have exceptional experience in complicated cases. If you have been suffering with knee pain, you should come in for an appointment, get a standing X-ray ( so we can see the joint space narrowing), and discuss your options for care. Total knee arthroplasty results are getting better and better. While it is impossible to predict in any specific case how long a given total knee will last, a fair average with modern techniques at this time is 25 years or more, in my opinion.

Excellent Range of Motion demonstrated by our happy patient Jay Buchtel.

Excellent Range of Motion demonstrated by our happy patient Jay Buchtel.

Waiting until you are older in the hopes that you will outlive your joint, does not seem to be the best strategy to getting back as soon as possible to a more productive life. Please visit out additional website at www.TotalKnee.org for more information of Total Knee arthroplasty.

Before and After Total Knee Arthroplasty - the left knee has been replaced ( and straightened) !

Before and After Total Knee Arthroplasty – the left knee has been replaced ( and straightened) !

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. We have many travelers coming to Scottsdale to have their anterior hips done here. It is difficult to get this procedure done in Canada and Mexico. The national health services in those countries does not incentivize their physicians to learn and adapt new techniques. I  visited with Dr. Matta in Los Angeles to learn his technique for anterior total hip replacement, and I have now done over 1000 cases.

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 replacemnt. 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.

Traditional shoulder replacement with a humerus and glenoid (socket) component

Traditional shoulder replacement with a humerus and glenoid (socket) component

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 pain is usually very annoying, and can interfere with sleep and sports activities.. but some people can live with it if they choose to modify their activities.  More and more, the right decision is NOT to live in pain.  Our total shoulder patients have a 95 percent success rate. The small percentage with persistent pain can usually be helped with a second surgery.  A few patients will re-tear their rotator cuffs because they feel so good after surgery that they overuse their arms too soon before full healing.  Some patients who do not push their own rehab and physical therapy can end up with stiffness in the joint – they may face a manipulation after surgery to regain motion.  Sometimes smaller procedures are done to help, for example to remove an arthritic AC joint, or to release a degenerated biceps tendon.

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.

Reverse Total Shoulder Replacement performed by Dr. Kozinn at The Scottsdale Joint Center.

Reverse Total Shoulder Replacement performed by Dr. Kozinn at The Scottsdale Joint Center.

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.  Check out this link to learn more about shoulder replacements: https://www.facebook.com/shoulderreplacement

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 Sports (Info for Our Athletes)

More and more of my joint replacement sports patients want to participate in high level activities - because they feel so good!  In the past we were very cautious about this, because we didn’t know how the artificial joints would stand up to the increased pressures of running and jumping.  While common sense is still the most important guideline, it is becoming clear to me that many patients can participate in active sports activities with their joint replacements.

Cementless Anterior Total Hip Replacements are better for sports.

Cementless Anterior Total Hip Replacements are better for sports.

The cementless hips in particular seem to function quite normally under the stress of increased load.  Older cemented hips may be at increased risk due the possibility of cracks forming in the cement.

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.

Get Back into your Sport with a pain free joint replacement.

Get Back into your Sport with a pain free joint replacement.

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. Most recently I have allowed my partial knee replacement patients to begin running and jogging again. It turns out they are doing very well.   I believe this is another advantage to the rotating platform type joints ( also called mobile bearing joint replacement). The movable plastic insert acts like a shock absorber, and I believe will allow more active sports activities in appropriate individuals.

Mobile Bearing partial and total knee replacements

Call us at the Scottsdale Joint Center for more info 480 994 1149. Mobile Bearing partial and total knee replacements

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.

 

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