Practice News

Anterior Total Hip Replacement Update

I continue to be amazed at our results with the Anterior Total Hip Replacement procedure.

The anterior hip replacement procedure is more accurate because it is checked under real time Xray

The anterior hip replacement procedure is more accurate because it is checked under real time Xray

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. We have many patients flying in from Canada and Mexico to have their joint replacements here in sunny Scottsdale.  We hope to see you in our office soon if you have hip, knee, or shoulder arthritis.  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!

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

New Technologies to Replace Worn Out Joints

Living with chronic pain is stressful and debilitating. Joint pain, stiffness, and chronic swelling that leads to limited mobility and function affects more than 70 million Americans with arthritis. Along with chronic pain comes depression, anger, and anxiety that affects not only the sufferer but also family members and friends.

Although most people associate arthritis with the elderly, according to the center for Disease Control, three out of every five adults younger than 65 suffer with joint arthritis. Increased participation in sports and very active lifestyles has lead to an increase in people of all ages with hip and knee arthritis. According to the CDC, as the population ages that number will increase, making joint disease one of the most prevalent health conditions in America and a leading cause of disability. Because arthritis is treatable, experts at the CDC advise people not to ignore their pain and stiffness, and to seek medical attention.

While there is no known cure for osteoarthritis, there are effective treatments that will reduce joint pain and increase mobility and function. For a thorough evaluation of your hip or knee joint condition, your doctor will refer you to a specialist – an orthopedic doctor. After diagnosis, your doctor may recommend exercise, weight loss, and anti-inflammatory medications, which all help in alleviating joint pain. Sometimes, however, these treatments don’t effectively reduce the pain; and in those cases, your doctor may recommend surgery.

Today’s surgical treatments for osteoarthritis, such as total joint replacement, include innovative, more minimally invasive procedures, says Stuart Kozinn, MD, Medical Director of the Scottsdale Total Joint Center and a specialist in minimally invasive joint replacement. A graduate of UCLA medical school, with training at Cornell’s Hospital for Special Surgery in New York and Harvard Medical School’s Department of Orthopedic Surgery, Kozinn also recently served as Chief of Surgery at Scottsdale Healthcare-Osborn and is director of its new Center for Joint Replacement.

According to Kozinn, there are several causes of chronic hip and knee pain, but the most common diagnosis leading to joint replacement is osteoarthritis. “As active people age, the smooth cartilage which acts as a shock absorber in joints, may wear out and cause paiful bone rubbing directly against bone. Playing sports, such as jogging and tennis, can accelerate the disease,” says Kozinn. Eventually the arthritic hip or knee will hurt even at rest, and at that point, surgery may be the only viable option.

The knee and hip joints concentrate the body’s weight on a relatively small area, and they are therefore the most commonly affected by osteoarthritis. Orthopedic surgeons can successfully replace arthritic joints with artificial ones that will greatly improve mobility and function.

Recent technological advances in joint replacement surgery include more durable biomaterials that won’t wear out easily over time. Metal on metal bearing surfaces, hard ceramic materials, and highly crosslinked polyethylene liners have  improved the lifespan of modern joint replacements. Titanium and Cobalt-chrome metal alloys have proven to be very durable and compatible with human bone. New knee replacement designs that provide increased bending and rotation may improve the activity levels of recipients.

“Minimally invasive surgical techniques have been developed that allow less disturbance of the surrounding muscle and soft tissues, leading to more rapid recovery times and less pain”, says Kozinn. “Patients have been enthusiastic about the smaller incisions that result in shorter hospital stays and less noticeable scars.”

Patients are encouraged to walk the same day as surgery, and to leave the hospital in two or three days. Kozinn also specializes in partial knee replacement surgery, which may be preferable in earlier cases of knee arthritis. “A motivated patient can be out of the hospital the following day after minimally invasive unicompartmental knee replacement, and back to light work in one week”, according to Kozinn.

New techniques in hip replacement surgery are also available. Minimally invasive incisions allow younger patients who have trouble taking time off from work to recover more rapidly. Many patients refuse to give up their active lifestyles, and most hip replacement patients can return to tennis, golf, and skiing.

The new “Direct Anterior Approach” to total hip replacement is resulting in incredibly rapid recoveries, never before thought possible.  Specialized cementless implants and modified instruments have made these adjustments possible. “My routine patients are walking in the halls weight bearing as tolerated on the day of surgery”, says Kozinn.

Today’s technology has resulted in more rapid recoveries, but as with any surgery, complications can occur. “Your surgeon will discuss these risks with you before any surgery is done.” It is important for the surgeon and the primary care medical physician to work as a team to determine the best treatment plan for the patient. Not all patients are candidates for minimally invasive procedures. “Large, very muscular, or heavy patients, as well as those with complex deformities are better treated with more traditional approaches”, notes Kozinn.

With today’s advances in medical technology, more patients are interested in joint replacement surgery to obtain relief from crippling arthritis. For more information about minimally invasive joint replacement surgery, us at (480) 994-1149, or schedule an appointment.

Total Knee Replacement

I have noticed that my patients are getting better and better results from their knee replacements. I have been doing total knees in private practice for 26 years, so I have a good experience to look back on. i will give some credit to the rotating platform total knee, which I think has many advantages over fixed bearing knees. Besides being able to rotate more from side to side, I believe it has a “self-centering” function that helps balance the knee, particularly when the implants rotate going from full extension to full flexion. I see much less evidence of instability and excellent range of motion. The recovery also seems to be faster to me.  The good news is, Total Knee Replacement is getting better – you should have yours done by a qualified joint replacement expert- one that does over 100 total knees a year, and has done a joint replacement fellowship.

Getting the best Total Joint Replacement

Most people will spend more time shopping for a new watch or car than they will picking out their joint replacement surgeon. WHY?! Medicine may seem mysterious to the public, but like ANY other field there are sub-specialists and recognized experts in each field of surgery, It just makes common sense to find the BEST surgeon you can find. Look at credentials. Any doctor should be willing to publish their CV on their website, or ask the receptionist for a copy in their office.

Dr. Kozinn has done a Total Joint fellowship at Harvard Medical School, and has been teaching joint replacement techniques to other orthopedic surgeons for 26 years. He does over 300 total hips and over 300 total knees EACH year! He is the Medical Director of a 5 Star Total Joint Center at Scottsdale Osborn. Research has shown that high volume institutions get better results that facilities who only do a few joint replacements a year. Dr. Kozinn is the kind of surgeon that you want to do your total joint!  He works right here in Scottsdale, Arizona. Why would you want to go anywhere else for your total hip or total knee?

Total Shoulder Replacement

In the last few years, better technology and implants have greatly improved the results of shoulder replacement. Previously many patients suffered with chronic shoulder pain, because of fear of surgical failures. Newer implants in the hands of very skilled specially trained surgeons can now give great results! In additon to the classic full shoulder replacement consisting of a metal ball on the humerus, and a plastic socket on the glenoid (scapula); we now have the reverse shoulder replacement. the reverse is a remarkable advance that now will compensate for a deficient or chronicly torn rotator cuff. in the past, patients with long standing cuff tears had no good options, as the muscular cuff is what controls and stabilizes the shoulder joint. The Reverse TSR uses an anatomical trick to move the center of rotation of the shoulder distally, thereby tensioning the Deltoid muscle, which can no lift and rotate the shoulder without an intact cuff. Amazing! Please read more about the amazing shoulder replacement results at our Facebook page – www.Facebook.com/ShoulderReplacement. Or come in for an evaluation!

Was this helpful to you? If so, give it a +1