Stay Injury-Free! TOCA’s Experts Share ACL Injury Prevention Exercises & Tips

Athletes, listen up! That sport you love to play may place you at greater risk for sustaining an ACL injury. Sports that involve sudden deceleration—such as basketball, soccer, football, volleyball, and tennis—pose a higher risk for ACL tears in young athletes. This is due to the repetitive movements of cutting, pivoting and/or landing on a single leg. Research also shows that female athletes are 2-10 times more likely to sustain an ACL injury than males due to gender differences in biomechanics and anatomy.

Recovery from an ACL tear can typically sideline athletes for up to 6-9 months. To help keep athletes of all ages and skill levels in the game, TOCA’s PT experts are here to share with you the following ACL injury prevention tips and exercises:

  • TAKE the “JUMP TEST!”

    Orthopedic doctors and physical therapists often use this simple test to check an athlete’s knee alignment and knee stability when landing from a jump. An athlete who lands with weak or knocked knees is at greater risk for injury. The jump test is also often used post-ACL surgery to help determine if the athlete is ready to return to their sport.

  • TRAIN SMART!

    Neuromuscular and strength training exercises are an effective way to help your body master and improve stability and control without placing as much stress on the ACL. These techniques usually involve a combination of stretching, plyometrics (exercises involving repeated rapid stretching and contracting of muscles) and strengthening.

  • WATCH for the SIGNS.

    Pay attention to your body’s cues. Although the symptoms of an ACL injury are not always the same, it is important to seek medical help if you experience any of the following: a loud “pop” accompanied by knee pain, persistent knee pain/swelling, difficulty supporting your weight or trouble standing/walking.

In addition to these ACL injury prevention facts and tips, TOCA’s PT experts suggest that athletes/parents/coaches check out this step-by-step ACL injury prevention program with exercises from the Interventional Orthopedics Foundation.

To visit one of our orthopedic sports medicine or PT specialists, please contact TOCA at 602-277-6211.

Dr. Blazuk and colleagues study the Validity of Indirect Ultrasound Findings…

Title: Validy of Indirect Ultrasound Findings in Acute Anterior Cruciate Ligament Ruptures

Ken Mautner, MD, Walter I. Sussman, DO, Katie Nanos, MD, Joseph Blazuk, MD, Carmen Brigham, ATC, Emily Sarros, ATC

Objectives: Ultrasound (US) is increasingly being used as an extension of the physical examination on the sidelines, in training rooms, and in clinics. Anterior cruciate ligament (ACL) injury in sport is common, but the literature on US findings after acute ACL rupture is limited. Three indirect US findings of ACL rupture have been described, and this study assessed the validity of these indirect signs.

American Institute of Ultrasound in Medicine /  J Ultrasound Med 2018; 9999:1-8 / 0278-4297

Click here for full article!

 

Congratulations to Dr. Evan Lederman for his recent publication!

Title: The Evolution of the Superior Capsular Reconstruction Technique

Alan M. Hirahara, MD, FRCSC; Evan S. Lederman, MD; Wyatt J. Andersen, ATC; and Kyle Yamashiro, PT, DPT, CSCS

Introduction

Irreparable, massive rotator cuff tears can result in unacceptable functional deficits in patients. When the supraspinatus tears and retracts medially, the superior capsule is also disrupted, and superior constraint is lost. With no superior restraint to the humerus, the humeral head migrates superiorly, causing a decrease in the acromial-humeral distance. [1-4]

Biomechanical analysis has shown that a defect in the superior capsule results in a minimum 200% greater glenohumeral superior translation and subacromial peak contact pressure compared with an intact capsule. [3] The malposition of the humeral head leads to functional abnormalities and pseudoparalysis.

Numerous proposed treatments for massive rotator cuff tears – including debridement and tenotomy, tendon transfers, and reverse total shoulder arthroplasty – have yielded mixed results and high complication rates. [5-12] In particular, reverse shoulder arthroplasty can result in humeral or glenoid fractures, persistent anterior or posterior instabilities, loosening of the glenoid or humeral cemented components, dislocations, and infection. [5-7]

The superior capsular reconstruction (SCR) was described by Hanada et al [13] in 1993 and by Mihata et al [1] in 2013 as an alternative procedure to increase function and decrease pain by restoring the restraint mechanisms in the shoulder. Using a graft to recreate the superior capsule, the humeral head is centered in the glenoid, allowing the larger muscles (ie, deltoid, latissimus dorsi, and pectoralis major) to function appropriately. Mihata et al [3,4] have found that the SCR reduces glenohumeral superior translation and subacromial contact force.

Full article link below.

ICJR.net  March 2018

Congratulations to Dr. Evan Lederman, Top Doc!

[vc_row][vc_column][vc_column_text]Congratulations to TOCA Physician and Orthopedic Surgeon Dr. Evan Lederman, who was named as a Top Orthopedic Surgeon 2017 in the Phoenix Magazine Top Doc’s 2018 publication.

The TOCA Physicians and Orthopedic Surgeons have been ranked in Phoenix Magazine’s Top Docs consecutively since 2004!

Dr. Lederman is board certified in orthopedic surgery and subspecialty board certified in orthopedic sports medicine. Dr. Lederman has been practicing in Phoenix, Arizona since 1996. He has years of experience with specialty training in sports medicine, minimally invasive arthroscopic surgery of the shoulder and knee and complex reconstructive surgery. His practice encourages non-operative care when possible and considers surgery only when necessary. Dr. Lederman specializes in all disorders of the shoulder including advanced techniques for rotator cuff repair, shoulder instability repair, acromioclavicular joint repair and primary and revision shoulder replacement including reversed shoulder replacement and also specializes in knee arthroscopy and ACL reconstruction.

Dr. Lederman’s work has earned him acceptance as an associate member of the American Shoulder and Elbow Surgeons (ASES) and is only the second surgeon in Arizona to receive this prestigious honor. He has been awarded the distinction of Phoenix Magazine’s Top Doc and Phoenix SuperDoctors. He has been named one of the “20 of the Top North American Shoulder Surgeons: 2015″ by Orthopedics This Week.

To schedule an appointment with one of TOCA’s physicians call 602-277-6211 today!

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Join Team TOCA with Dr. Feng & the Arthritis Foundation for the Walk to Cure Arthritis!

Enjoy the beautiful Arizona weather by joining Team TOCA, Dr. Earl Feng (Orthopedic Surgeon, Arthritis & Total Joint Reconstruction) and the Arthritis Foundation in the Annual Walk for the Cure, Saturday May 5th, 2018 at the Phoenix Zoo! Dr. Feng is not only a TOCA Physician & Surgeon but also serves as a Board Member for the Arthritis Foundation!

At TOCA, each of us has an important role in helping the more than 1.2 million Arizonans living with arthritis including many our patients, our colleagues, and more than 6,000 children in Arizona alone. TOCA is proud to continue our support the 2018 Arizona Walk to Cure Arthritis on May 5th at the Phoenix Zoo. As a sponsor of the Walk to Cure Arthritis, our goal is to help more people with arthritis.

The Arthritis Foundation is the Champion of Yes for patients with arthritis who are being told “no” a lot. No, there isn’t a cure. No, you cannot play sports. No, you cannot pick-up your grandchild.

Here is how you can help!

• Through funding critical research for osteoarthritis to find better treatments and ultimately a cure.
• Giving kids living with arthritis the opportunity to attend Camp Cruz to meet other kids living with arthritis.
• Supporting programs like the Live Yes network for people in our community struggling with pain, connecting them with others with arthritis.
• Getting a patient get back on their feet so they can walk their dog.
• Helping a grandparent alleviate back pain so they can pick up their grandchild.
• Saying “YES” to a patient today!

The event features a three-mile and one-mile course, with arthritis information and activities for the entire family!

Let’s raise funds to find a cure for arthritis, then come together to support each other and walk! Every step counts, every dollar matters!  The Arthritis Foundation’s Walk to Cure Arthritis to help the more than 50 million Americans and 300,000 children with arthritis live better today and to keep the Arthritis Foundation’s promise of finding a cure for tomorrow. Be a Champion of Yes – join our team and raise funds to fight arthritis and find a cure, all while having A LOT OF FUN! If you aren’t able to join the team, we’d appreciate your donation to help reach our goal.

Click here to learn more about this event, join Team TOCA and/or Donate Today! Team TOCA

Event Location:
The Phoenix Zoo
455 N Galvin Pkwy
Phoenix , AZ 85008
Event Schedule:
Event Registration Starts 5/5/2017 6:30 am
Event Registration Ends 5/5/2017 8:00 am
Event Starts 5/5/2017 7:30 am
Event Ends 5/5/2017 10:00 am
Fees:
Walk to Cure Arthritis Registration: No Fees
Event Registration

To Learn more about Dr. Feng and TOCA visit: www.tocamd.com or call 602-277-6211

#Arthritisfoundation #WalktoCureArthritis #Results #Recovery #Relife#TOCAMD #TOCA #ArthritisPhxWalk #PhoenixZoo

Celebrate National PA (Physician Assistant) Week October 6 – 12th!

Each year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.

This week is also an opportunity to raise awareness and visibility of the profession. Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6th is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD. Now the profession is 50 years strong!

History of the PA Profession

The PA profession was created to improve and expand healthcare.

In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians.

To help remedy this, Eugene A. Stead Jr., MD, of the Duke University Medical Center, put together the first class of PAs in 1965. He selected four Navy Hospital Corpsmen who had received considerable medical training during their military service. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II.

The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages. The medical community helped support the new profession and spurred the setting of accreditation standards, establishment of a national certification process and standardized examination, and development of continuing medical education requirements.

What is a PA? (American Academy of PAs)

What is a PA?

A physician assistant (or PA) is a nationally certified and state-licensed medical professional. There are currently more than 100,000 clinically practicing PA’s in the United States! PA’s practice medicine on health care teams with physicians and other providers. They also prescribe medication in all 50 states.

 

What does a PA do? Well, at the most basic level, a PA is a medical practitioner who works under the supervision of a physician.

Physician assistants (PAs) work closely with doctors and handle duties that range from taking medical histories to setting simple fractures. They are allowed to prescribe medications in some states. Many PAs specialize in a particular area of medicine, such as pediatrics. A master’s degree is required, and all states require that PAs be licensed. Licensing requires passing a multiple-choice exam and completing continuing education courses to keep knowledge current.

Beyond the basic definition, however, the PA profession represents an essential part of the health care infrastructure in a number of important ways.

Physician assistants examine, diagnose and treat patients under the supervision of licensed physician. PAs can prepare casts or splints, suture small wounds and interpret medical tests. According to the American Academy of Physician Assistants (AAPA), these medically-trained professionals can also prescribe medications (www.aapa.org).

Some PAs specialize in a particular area of medicine, such as emergency care or geriatrics, and can assist doctors in advanced medical techniques and procedures. Physician assistants are often the first line of medical care in rural and underserved areas. In some cases, a physician assistant will refer the patient to a medical doctor or make arrangements for transferring the patient to a hospital or clinic.

During this week, TOCA is excited to honor our amazing PAs and to say a big thank you. We appreciate your dedication to patient care, and we recognize the impact that you make in the lives of those patients every day.

To read more about the dedicated Physician Assistant staff at TOCA Click Here

To learn more about TOCA or to schedule an appointment call 602-277-6211

 

#Recovery #Results #Relief #TOCA #TOCAMD #PA #PAWeek #ThankAPA #Patientcare #PhysicianAssistant #PADay #MyOrthoDoc

NUsurface Meniscus Surgery: Are You a Candidate?

NUsurface Meniscus Surgery: Are You a Candidate?

Your Life Arizona talks with orthopedic surgeon Dr. Tom Carter and NUsurface Meniscus Implant recipient Robert Nowlan about a clinical trial for knee pain after meniscus surgery. For more information on the trial, please call (844) 680-8951.

Have you had surgery to repair a torn meniscus but are still living with knee pain? Have you been told that you’re too young for knee replacement surgery and thought you were out of options? If you answered yes to these questions, you may be a candidate for the NUsurface Meniscus Implant – a medial meniscus replacement to treat persistent knee pain caused by injured or deteriorating meniscus cartilage.

The implant, which is made of medical grade plastic and inserted in to the knee through a small incision, has been used in Europe since 2008 and Israel since 2011. A clinical trial called SUN (Safety Using NUsurface®) is taking place at TOCA (The Orthopedic Clinic Association) to determine the effectiveness of the NUsurface Meniscus Implant for individuals with knee pain. More information about this study can be found here.

While it’s not meant to take the place of a total knee replacement, the NUsurface Meniscus Implant can serve as an opportunity to treat knee pain and keep you active until knee replacement surgery, if needed, is a viable option. The unique materials and composite structure are designed to mimic the function of a natural meniscus and redistribute loads transmitted across the knee joint. To date, the implant has given nearly 100 patients a second chance at a pain-free, active life.

About the Procedure

The meniscus implant is inserted into the knee through a small incision, and patients are allowed to go home the same day or the day after the operation. After surgery, they undergo a six-week rehabilitation program and a physician will explain recommended activities during this period.

Who is Eligible?

If you’re interested in the NUsurface Meniscus Implant, ask yourself the following questions to determine if you might be eligible to participate in this clinical trial:

  • Have you had a previous medial partial meniscectomy that was performed at least six months ago?
  • Do you have persistent knee pain?
  • Has your physician recommended non-surgical therapies to deal with the pain?
  • Are you between the ages of 30 and 75?

Please note patients who are candidates for partial or total knee arthroplasty are not eligible.

How Can I Find Out if I Qualify?

Visit sun-trial.com, call (844) 680-8951 or contact the dedicated TOCA Team at 602-277-6211

Learn more about Dr. Carter Here

TOCA (The Orthopedic Clinic Association) performs the first meniscus replacement in Arizona read more Here

 

#MyOrthoDoc #TOCAMD #TOCA #YourLifeAtoZ #ActiveImplants #MeniscusReplacement

What is Spinal Stenosis & How do I treat it?

What Is Spinal Stenosis?

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects the brain to the body. The cord rests in the canal formed by your vertebrae.

For most people, the stenosis results from changes because of arthritis. The spinal canal may narrow. The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.

There’s no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay. Most people with spinal stenosis live normal lives.

 

Healthy Spine

The spinal canal has a rounded triangular shape that holds the nerve roots without pinching. Nerve roots leave the spinal canal through openings called nerve root canals which are also free of obstruction.

Affected Spine

New bone growth within the spinal canal causes compression of nerve roots, which leads to the pain of spinal stenosis.

 

Causes

The leading reason for spinal stenosis is arthritis, a condition caused by the breakdown of cartilage — the cushiony material between your bones — and the growth of bone tissue.

Osteoarthritis can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.

Other causes include:

  • Herniated discs. If the cushions are cracked, material can seep out and press on your spinal cord or nerves.
  • Injuries. An accident may fracture or inflame part of your spine.
  • Tumors. If cancerous growths touch the spinal cord, you may get stenosis.
  • Paget’s disease. With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Thickened Ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.

Some people are born with spinal stenosis or diseases that lead to it. For them, the condition usually starts to cause problems between the ages of 30 and 50.

Symptoms

Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.

When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck (cervical spine).Cervical stenosis can cause numbness, weakness or tingling in a leg, foot, arm or hand. Tingling in the hand is the most common symptom, and many people also report problems with walking and balance. Nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back (lumbar spine).Compressed nerves in your lumbar spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.

 

More specific symptoms include:

  • Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks.
  • Foot drop. Painful leg weakness may cause you to “slap” your foot on the ground.
  • A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain.
  • Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel.

If you’re having symptoms, you might want to talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Diagnosis and Tests

When you visit your doctor, she’s likely to ask you questions about your medical history. After that, she might order at least one of the following tests to figure out whether you have the condition:

  • X-rays. These can show how the shape of your vertebrae has changed.
  • Magnetic resonance imaging (MRI). By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
  • Computerized tomography (CT scan). A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Treatment

Your doctor may start off with nonsurgical treatments. These might include:

Medication: Common pain remedies such as aspirinacetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenosis, such as muscle spasms and damaged nerves.

Corticosteroid injections: Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.

Anesthetics: Used with precision, an injection of a “nerve block” can stop pain for a time.

Exercise: You can improve your flexibility, strength, and balance with regular activity. Your doctor may recommend a physical therapist to help you.

Assistive devices: You might get braces, a corset, or a walker to help you move about.

Surgery

Some people have severe cases. They struggle to walk or have issues with their bladder and bowel. Doctors may recommend surgery for these people. Procedures such as laminectomy and laminoplasty create space between the bones so inflammation can go down.

Surgery carries its own risks. You should have a talk with your doctor about how much it can help, recovery time, and more before taking that step.

Many patients also try nontraditional therapies, including chiropractic and acupuncture. Again, be sure your doctor knows if you’re trying a nontraditional approach.

What You Can Do at Home

Some things you can do to help ease symptoms of spinal stenosis include:

  • Exercise. Think about moderation — not 100 push-ups. Just take a 30-minute walk every other day. Talk over any new exercise plan with your doctor.
  • Apply heat and cold. Heat loosens up your muscles. Cold helps heal inflammation. Use one or the other on your neck or lower back. Hot showers are also good.
  • Practice good posture. Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
  • Lose weight. When you are heavier, there will be more pressure on your back.

 

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD

Knee Re-Alignment (OSTEOTOMY) What you need to know!

Osteotomy literally means “cutting of the bone.” In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint.

Knee osteotomy is commonly used to realign your knee structure if you have arthritic damage on only one side of your knee. The goal is to shift your body weight off the damaged area to the other side of your knee, where the cartilage is still healthy. When surgeons remove a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can bend away from the damaged cartilage.

Imagine the hinges on a door. When the door is shut, the hinges are flush against the wall. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Removing just a small wedge of bone can “swing” your knee open, pressing the healthy tissue together as space opens up between the thighbone and shinbone on the damaged side so that the arthritic surfaces do not rub against each other.

Knee osteotomy is most commonly performed on people who may be considered too young for a total knee replacement. Total knee replacements wear out much more quickly in people younger than 55 than in people older than 70. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The procedure can delay the need for a total knee replacement for up to ten years.

 

Why it’s done

Slick cartilage allows the ends of the bones in a healthy knee to move smoothly against each other. Osteoarthritis damages and wears away the cartilage — creating a rough surface.

When the cartilage wears away unevenly, it narrows the space between the femur and tibia, resulting in a bow inward or outward depending on which side of the knee is affected. Removing or adding a wedge of bone in your upper shinbone or lower thighbone can help straighten this bowing, shift your weight to the undamaged part of your knee joint and prolong the life span of the knee joint.

Osteoarthritis can develop when the bones of your knee and leg do not line up properly. This can put extra stress on on either the inner (medial) or outer (lateral) side of your knee. Over time, this extra pressure can wear away the smooth cartilage that protects the bones, causing pain and stiffness in your knee.

(Left) A normal knee joint with healthy cartilage. (Right) Osteoarthritis that has damaged just one side of the knee joint.

Advantages and Disadvantages

Knee osteotomy has three goals:

  • To transfer weight from the arthritic part of the knee to a healthier area
  • To correct poor knee alignment
  • To prolong the life span of the knee joint

By preserving your own knee anatomy, a successful osteotomy may delay the need for a joint replacement for several years. Another advantage is that there are no restrictions on physical activities after an osteotomy – you will be able to comfortably participate in your favorite activities, even high impact exercise.

Osteotomy does have disadvantages. For example, pain relief is not as predictable after osteotomy compared with a partial or total knee replacement. Because you cannot put your weight on your leg after osteotomy, it takes longer to recover from an osteotomy procedure than a partial knee replacement.

In some cases, having had an osteotomy can make later knee replacement surgery more challenging.

The recovery is typically more difficult than a partial knee replacement because of pain and not being able to put weight on the leg.

Because results from total knee replacement and partial knee replacement have been so successful, knee osteotomy has become less common. Nevertheless, it remains an option for many patients.

Procedure

Most osteotomies for knee arthritis are done on the tibia (shinbone) to correct a bowlegged alignment that is putting too much stress on the inside of the knee.

During this procedure, a wedge of bone is removed from the outside of the tibia, under the healthy side of the knee. When the surgeon closes the wedge, it straightens the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. As a result, the knee can carry weight more evenly, easing pressure on the painful side.

In a tibial osteotomy, a wedge of bone is removed to straighten out the leg.

Tibial osteotomy was first performed in Europe in the late 1950s and brought to the United States in the 1960s. This procedure is sometimes called a “high tibial osteotomy.”

Osteotomies of the thighbone (femur) are done using the same technique. They are usually done to correct a knock-kneed alignment.

 

Candidates for Knee Osteotomy

Knee osteotomy is most effective for thin, active patients who are 40 to 60 years old. Good candidates have pain on only one side of the knee, and no pain under the kneecap. Knee pain should be brought on mostly by activity, as well as standing for a long period of time.

Candidates should be able to fully straighten the knee and bend it at least 90 degrees.

Patients with rheumatoid arthritis are not good candidates for osteotomy. Your orthopaedic surgeon will help you determine whether a knee osteotomy is suited for you.

Read More About Eligibility for Knee Osteotomy

Your Surgery

Before Surgery

At most medical centers, you will go to “patient admissions” to check in for your outpatient arthroscopic surgery.

After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry.

You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room.

Here are some important steps to remember for the day of your surgery:

  • You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.
  • Wear a loose pair of shorts or sweatpants that will fit comfortably over your knee bandage when you leave the hospital.

Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

 

Surgical Procedure

A knee osteotomy operation typically lasts between 1 and 2 hours.

Your surgeon will make an incision at the front of your knee, starting below your kneecap. He or she will plan out the correct size of the wedge using guide wires. With an oscillating saw, your surgeon will cut along the guide wires, and then remove the wedge of bone. He or she will “close” or bring together the bones in order to fill the space created by removing the wedge. Your surgeon will insert a plate and screws to hold the bones in place until the osteotomy heals.

This is the most commonly used osteotomy procedure, and is called a closing wedge osteotomy.

After the wedge of bone is removed, the tibia may be held in place with a plate and screws.

In some cases, rather than “closing” the bones, the wedge of bone is “opened” and a bone graft is added to fill the space and help the osteotomy heal. This procedure is called an opening wedge osteotomy.

After the surgery, you will be taken to the recovery room where you will be closely monitored as you recover from the anesthesia. You will then be taken to your hospital room.

After Surgery

Recovery Room

Following a knee osteotomy, you usually stay in the recovery room for at least two hours while the anesthetic wears off.

This procedure typically causes significant pain. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days.

Your knee will be bandaged and may have ice on it. You may have significant pain early on and you should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present, so ask the nurse for medication when you feel pain coming on.

You should try to move your feet and ankles while you are in the recovery room to improve circulation.

Your temperature, blood pressure, and heart rate will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Most patients remain in the hospital for two to four days following an osteotomy.

After knee osteotomy, you usually are taken to a hospital room where nurses, anesthesiologists, and physicians can regularly monitor your recovery. Most patients spend two to four days recovering in the hospital.

As soon as possible after surgery is completed, you will begin doing continuous passive motion exercises while in bed. Your leg will be flexed and extended to keep the knee joint from becoming stiff.

This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion.

There will likely be pain, and you can expect to be given pain medication as needed. Ice also helps control pain and swelling.

For two or three days after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you. The incision usually starts to close within six days and the bandage can be removed. Physicians commonly fit you with a knee brace that may allow a limited range of movement and helps push your knee into the correct position. For a high tibial osteotomy, the knee brace pushes your knee inward, making you slightly more knock-kneed. Please note that some surgeons will cast your knee for 4 to 6 weeks to ensure that the osteotemy heals.

You may be able to put some weight on your knee, but physicians usually prescribe crutches for at least six weeks. You will be given a prescription for pain medication and usually schedule a follow-up visit sometime around six weeks after surgery.

You will most likely need to use crutches for several weeks.

About 6 weeks after the operation, you will see your surgeon for a follow-up visit. X-rays will be taken so that your surgeon can check how well the osteotomy has healed. After the follow-up, your surgeon will tell you when it is safe to put weight on your leg, and when you can start rehabilitation.

During rehabilitation, a physical therapist will give you exercises to help maintain your range of motion and restore your strength.

You may be able to resume your full activities after 3 to 6 months.

Read More About: Knee Osteotomy Recovery

Rehabilitation

Most patients can begin physical therapy around six to eight weeks after surgery. Unlike other surgical treatments for arthritis, osteotomy relies on bone healing before more vigorous, weight bearing exercises in the gym can begin. In the best scenario, people respond to strengthening exercises and stop wearing the brace after the first three to six months of therapy.

Light exercise is one of the most effective ways to relieve arthritis pain by stimulating circulation and strengthening the muscles, ligaments, and tendons around your knee. Strong muscles take pressure off the bones so there is less grinding in the knee joint during activities. In conjunction with a healthy diet, exercise can also help you lose weight, which takes stress off your arthritic knee.

Stretching

In the first few weeks of rehabilitation, your physical therapist usually helps you stretch the muscles in the hamstrings, quadriceps, and calves while flexing and extending your knee to restore a full, pain-free range of motion.

Aerobic Exercise

When pain has decreased, physicians generally recommend at least 30 minutes a day of low-impact exercise a day for patients with arthritis. You should try to cut back on activities that put a pounding on your knees, like running and strenuous weight lifting.

Cross-training exercise programs are commonly prescribed when you have arthritis. Depending on your preferences, your workouts may vary each day between cycling, cross-country skiing machines, elliptical training machines, swimming, and other low-impact cardiovascular exercises. Walking is usually better for arthritic knees than running, and many patients prefer swimming in a warm pool, which takes your body weight off your knees and makes movement easier.

Strengthening

Strength training usually focuses on moving light weights through a complete, controlled range of motion. You should generally avoid trying to lift as much as possible with your quadriceps and hamstrings. Your physical therapist typically teaches you to move slowly through the entire movement, like bending and straightening your knee, with enough resistance to work your muscles without stressing the bones in your knee.

Once your physical therapist has taught you a proper exercise program, it is important to find time each day to perform the prescribed exercises.

Recovery at Home

You will likely feel pain or discomfort for the first week at home after an osteotomy, and you will be given a combination of pain medications as needed. A prescription-strength painkiller is usually prescribed and should be taken as directed on the bottle.

Swelling in your leg usually decreases over a span of three to six months after surgery. There may be some minor bleeding for a few days, but by the time you are released from the hospital, most bleeding should have stopped. If you notice an increase in swelling or bleeding, you should call your physician.

Physicians generally recommend that you avoid putting stress on your knee until the bones have healed. Putting weight on your knee too early may damage the bone surface and prolong healing time.

Here is what you can expect and how you can cope after an osteotomy:

  • Icing your knee for 20 or 30 minutes a few times a day during the first week after an osteotomy will help reduce pain. Ice therapy may need to intermittently continue for a few months if pain bothers you.
  • As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle.
  • Immobilize your knee in the prescribed, hinged knee brace for about six weeks. You may remove the brace for brief periods to perform passive motion exercises with the aid of a physical therapist or a CPM machine. Range of motion exercises are important for healing. Regaining full extension is just as important as bending your knee.
  • Your leg may appear slightly bent after the surgery as it heals into its new alignment.
  • Most patients have to keep the incision dry for seven to ten days. Your physician can recommend a surgical supply store that sells plastic shower bags. Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower.
  • Crutches or a cane may be needed for between six and ten weeks, depending on the pain. It is difficult to describe the amount of pain any given patient will experience.
  • Six weeks after surgery, your physician usually gives you a check-up. X-rays can determine how your bones are healing and whether you are ready to begin rehabilitation.

You may have to take between six weeks and six months off from work, depending on how much you rely on your knee to perform your job.

Prevention

After rehabilitation, preventing osteoarthritis is a process of slowing the progression and spread of the disease. Because patients remain at risk for continued pain in their knees after treatment, it is important they are proactive about managing their conditions.

A fall or torque to the leg during the first two months after surgery may jeopardize the healing of your bones. You should exercise extreme caution during all activities, including walking, until your physician determines that your bones have healed.

Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.

When you have arthritis in your knees, it is especially important to avoid suffering any serious knee injuries, like torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. You should avoid high-impact or repetitive stress sports, like football and distance running, that commonly cause severe knee injuries. Depending on the severity of your arthritis, your physician may also recommend limiting your participation in sports that involve sprinting, twisting, or jumping.

Because osteoarthritis has multiple causes and may be related to genetic factors, no simple prevention tactic will help everyone avoid increased arthritic pain. To prevent the spread of arthritis, physicians generally recommend that you take the following precautions:

  • Avoid anything that makes pain last for over an hour or two.
  • Perform controlled range of motion activities that do not overload the joint.
  • Avoid heavy impact on the knees during everyday and athletic activities.
  • Gently strengthen the muscles in your thigh and lower leg to help protect the bones and cartilage in your knee.

Non-contact activities are a great way to keeping joints and bones healthy and maintain fitness over time. Exercise also helps promote weight loss, which can take stress off your knees.

Osteotomy can relieve pain and delay the progression of arthritis in the knee. It can allow a younger patient to lead a more active lifestyle for many years. Even though many patients will ultimately require a total knee replacement, an osteotomy can be an effective way to buy time until a replacement is required.

If you are experiencing knee pain call one of our experts at TOCA at 602-277-6211!

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TOCA Performs First Meniscus Replacements in Arizona with NUsurface® Meniscus Implant

The Orthopedic Clinic Association

 

Media Contacts: Merryman Communications for Active Implants
Joni Ramirez joni@merrymancommunications.com
323.532.0746

Lisa Paulson for TOCA (The Orthopedic Clinic Association)
602.512.8525
lpaulson@tocamd.com

TOCA (The Orthopedic Clinic Association) Performs First Meniscus Replacements in Arizona with NUsurface® Meniscus Implant

Phoenix Suns Physician Treats Local Resident with Persistent Knee Pain in SUN Clinical Trial

PHOENIX, Arizona – July 6, 2017 – TOCA (The Orthopedic Clinic Association), a one-stop resource for orthopedics in Arizona, and Active Implants, a company that develops orthopedic implant solutions, today announced that the first meniscus replacement procedures in Arizona were successfully performed by Dr. Tom Carter. TOCA is the only center in the state – and one of just 10 sites nationwide – enrolling patients with persistent knee pain caused by injured or deteriorating meniscus cartilage in the SUN trial, which is designed to assess the safety and effectiveness of the NUsurface® Meniscus Implant (pronounced “new surface”) in restoring function similar to that of a natural, healthy meniscus.

One of the first patients to receive the implant in Arizona was Robert Nowlan, a 55-year-old Anthem resident, who first tore his meniscus 17 years ago while hiking in the Grand Canyon. Although he underwent three surgeries and injection therapy to treat the injury, he experienced constant pain that limited his daily activity. Nowlan’s knee was consistently throbbing with pain whether he was walking, working or even sitting. The pain became so intense, he had to give up hobbies he loved like running, hiking and karate.

The meniscus is a tissue pad between the thigh and shin bones. Once damaged, the meniscus has a very limited ability to heal. Over 1 million partial meniscectomies to remove or repair a torn meniscus are performed in the U.S. every year, about the same as the total number of hip and knee replacement surgeries combined. However, many patients still experience persistent knee pain following meniscus surgery.

“There aren’t many options for patients who experience persistent knee pain following meniscus surgery,” said Dr. Tom Carter, orthopedic surgeon at TOCA. “We hope the NUsurface implant decreases or alleviates pain in these patients, helps them delay knee replacement surgery, and improves their level of activities.”

Nowlan received the NUsurface Meniscus Implant in October 2016 through a small incision in his knee and completed a six-week rehabilitation program. Eight months into his recovery, he is most looking forward to biking and hiking the Grand Canyon again with his family – but this time pain-free.

“My knee pain over the last 17 years had reduced my quality of life, as I was too young for knee replacement and had resigned myself to just living and working with constant pain,” Nowlan said. “A couple weeks after receiving the NUsurface Meniscus Implant, the knee pain I was used to living with was gone. It felt like I drank from the fountain of youth – I can finally walk around and do all the activities I’ve been missing out on.”

The NUsurface Meniscus Implant has been used in Europe under CE Mark since 2008 and Israel since 2011.

About the Clinical Trial
The SUN study (Safety Using NUsurface®) will enroll approximately 120 patients as part of regulatory process to gain approval from FDA to sell the device in the U.S. All patients who meet study requirements and agree to enter the trial are offered the NUsurface Meniscus Implant as treatment. Treatment with NUsurface in the SUN trial is eligible for coverage by Medicare and some private insurance companies. To be eligible for the study, participants must be between the ages of 30 and 75 and have pain after medial meniscus surgery that was performed at least six months ago. To learn more about the SUN study, please visit http://sun-trial.com or call (844) 680-8951.

About the NUsurface® Meniscus Implant
The NUsurface® Meniscus Implant is an investigational treatment for patients with persistent knee pain following medial meniscus surgery. It is made from medical grade plastic and, as a result of its unique materials, composite structure and design, does not require fixation to bone or soft tissues. The NUsurface Meniscus Implant mimics the function of the natural meniscus and redistributes loads transmitted across the knee joint. Clinical trials are underway in the U.S., Europe and Israel to verify the safety and effectiveness of the NUsurface Meniscus Implant.

About TOCA (The Orthopedic Clinic Association)
TOCA (The Orthopedic Clinic Association) has served the Valley with orthopedic care since it was founded in 1949. TOCA is a one-stop resource for orthopedics in Arizona, led by nationally recognized, established orthopedic physicians who are passionate about quality care. TOCA brings expertise in orthopedics and sports medicine, numerous sub-specialties, physical therapy and hand therapy. Each TOCA Physician brings their own passion and integrity to a common purpose, honoring TOCA’s mission statement: “Serving our Patients through Innovative and Comprehensive Orthopedic Care.” Our physicians and staff are dedicated to providing for each person’s needs and ensuring the highest level of care for a wide range of musculoskeletal conditions. For more information, visit https://tocamd.com/.

About Active Implants
Active Implants, LLC develops orthopedic implant solutions that complement the natural biomechanics of the musculoskeletal system, allowing patients to maintain or return to an active lifestyle. Active Implants is privately held with headquarters in Memphis, Tennessee. European offices are in Driebergen, The Netherlands, with R&D facilities in Netanya, Israel. For more information, visit www.activeimplants.com.

CAUTION Investigational device. Limited by United States law to investigational use.