Tucson Orthopaedic surgeon helps new hip replacement procedure

23 Aug 2016 Doctors, Media , , ,

Source: KVOA 4 Your Health published on August 22, 2016

Written by John Overall

TUCSON – The first hip replacement surgery was performed in 1960. Now, more than 300,000 total hip replacements are performed each year in the United States.

Dr. Russell Cohen from the Tucson Orthopaedic Institute joined a team of other surgeons to develop a new surgical technique that allows their patients to get back on their feet sooner.

59-year-old Mindy Sparks suffers from severe arthritis in her hips. About six months ago the pain became unbearable, “I would walk across a parking lot and almost feel like crying it hurt so badly,” Sparks said.

Dr. Cohen showed News 4 Tucson Mindy’s X-Rays, “You can see here that her hip joint is completely gone. There’s no separation between the ball and the socket. So these two hips are about as bad as a hip needs to be before we recommend it be replaced,” Dr. Cohen said.

Dr. Cohen has been performing minimally invasive hip and knee replacements since 2003. About three years ago Dr. Cohen joined six other surgeons and came up with a procedure they call The Direct Superior Approach to the hip.

Most surgeons make an incision along the femur bone, cutting into the Iliotibial Band which causes pain and requires more recovery time.

“The Direct Superior Approach stays at the very upper end of that incision so we come down to the top of the femur bone but we don’t go into the I-T band,” said Dr. Cohen.

Since the I-T band isn’t compromised and fewer muscles are disrupted, patients like Mindy experience less pain, less bleeding and fewer restrictions when they’re released from the hospital.

“Traditional hip patients are told don’t cross your legs, don’t bend past 90 degrees, watch out for dislocation, all these things. Well, I don’t do that anymore, I haven’t for quite some time,” Dr. Cohen said.

Sparks says she bounced right back after surgery, “It was easy, it was easy in the hospital. I felt better in the hospital instantly. They had me up and walking that day.”

Mindy started physical therapy the day after having her left hip replaced.  Three weeks later she’s walking much easier and looking forward to having her right hip replaced in a few weeks.

Dr. Cohen and his team are now traveling around the world teaching the Direct Superior Approach to other surgeons.

To learn more, visit the Tucson Orthopaedic Institute 4 Your Health page.

Muscle-sparing surgery for hip replacement

1 Jul 2016 Joint Health , ,

Joint replacement surgery is one of the oldest procedures in history. Since 1891, orthopedic surgeons have been replacing faulty hips due to fracture, arthritis, and structural abnormalities. Thanks to 125 years of innovation, modern-day hip replacements are arguably the most advanced orthopedic surgery performed today.

The way the artificial hip is designed and the material it is made of has been the focus of many researchers and companies. The goal is to provide an artifical joint that functions and feels like a natural joint as much as possible.

Orthopedic surgeons are continually looking for ways to make surgery less invasive, less painful, and less risky. Minimally invasive procedures are the way of the future. For hip replacements, the anterior approach is gaining popularity as a less-invasive alternative to your grandmother’s hip replacement.

The anterior approach to hip replacement is a muscle-sparing technique that offers the following benefits:

  • Less pain and bleeding
  • Faster recovery
  • Better results
  • Most people are candidates

Instead of making an incision on the side or back of your hip, the surgeon accesses the hip joint from the front (anterior) side. From this side, there are no muscles that need to be cut in order to remove and replace the joint. This makes it easier to resume activity after hip surgery, because the supportive muscles remain intact. It’s also less painful than traditional hip replacement. Additionally, using the anterior approach allows for better placement of the new joint, which leads to improved outcomes for patients.

To learn more about the technique, check out this YouTube video.

Many people do not realize that the anterior hip replacement is not new. It was first done nearly 70 years ago in France, although the modern-day version was implemented in the 1960s. The reason it has not been widely performed is likely due to the complexity of the procedure. Advanced training is needed to master this technique, but there are clear benefits for the patient that make it worth the extra work.

To learn more about this muscle-sparing procedure for hip replacement, please contact Tucson Orthopaedic Institute for an appointment.

Image Source: Johns Hopkins Mediicne

What Really Matters to Joint Replacement Patients

18 May 2016 Doctors, General, Media , ,

Written by: Ali Dalal, MD

view post on original source – LinkedIn

5/17/16 – Orthopaedic surgeons are often guilty of being “high tech” but “low touch.” Throughout our training we are taught that the best way to care for our patients is to do a good surgery. In joint replacement, surgeons quantify excellence by things we can measure: the efficiency with which the surgery was done, the length of the incision, the appearance of the x-rays after surgery. This however, neglects the patient’s perspective on their disease, and why they sought out care.

There can be a disconnect in results after joint replacement. Some patients achieve satisfaction without reaching what some surgeons consider routine post-operative goals. This is not as frustrating as the opposite scenario when patients are dissatisfied despite exceeding what many surgeons would consider an excellent result. The latter can occur anywhere from 10-15% of time after hip and knee replacement.

Patients in need of joint replacement surgery have a disability that affects their independence and can cause anxiety. This anxiety can be carried into the preoperative period as a fear of their disability becoming worse after surgery. Many of these fears can be addressed pre-operatively by giving patients high quality information on what to expect before and after surgery as many of the questions patients have are similar— “When can I drive?  How do I get my home ready? How long can I expect to be out of work?” The similarity of patient questions makes guides such as mine very helpful. Attending a joint replacement class like the one offered at Tucson Medical Center can also be a therapeutic in demonstrating to patients that they are not alone in the process and that other people have the same fears and questions as they do.

Addressing the similarities of the condition and the process however, is only one part of completely caring for a joint replacement patient. Finding out what individually matters to each person can go a long way.  A study found that satisfaction will not occur unless the patient achieves their most important reason for having the operation. This can mean something different to each person—not limping in public, being able to get on and off the floor with grandchildren, or being able to get back to taking walks or biking. By asking patient’s what their goals are after surgery, we can effectively counsel them on whether they have a realistic expectation of what the surgery has to offer. Being sensitive to people’s cultures or occupations can also be very important in helping set expectations. For example, patients that kneel during worship or work should be counseled that this activity could be difficult or painful after knee surgery.  Patients may not always know what questions to ask, it is our job to anticipate our patient’s needs.

Joint replacement surgery is offering patients longer lasting implants, new techniques in pain management, and accelerated rehabilitation. Patients are leaving the hospital and getting back to their homes and jobs sooner than they expected. Pairing these advances with effective surgeon-patient communication and good surgical technique can make joint replacement a positive experience for the vast majority of patients.

1. Dorr LD, Chao L.  The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res. 2007 Oct;463: 7-12

How Long Do Modern Joint Replacements Last?

31 Mar 2016 Doctors, General, Media , ,
Written by: Ali Dalal, MD

view post on original source – LinkedIn

3/31/2016 – Every patient that has bone-on-bone arthritis in the hip or knee has thought of this question when considering whether or not to have surgery.  All mechanical parts have a working life, but trying to answer this question for parts that are implanted into people is difficult because each person is different, and may put different demands on their artificial joints.  Nevertheless, it is important to give patients an idea of what they can expect out of their surgery.  The question becomes harder to answer as significant improvements are made in artificial joint design, but these advances also hold the promise of providing better longer lasting implants.

The biggest scientific advancement in total hip and knee replacement has been in the polyethylene or “plastic” liners. The majority of hip and knee replacements implanted in the United States consist of a metal and plastic articulation or bearing surface. This is the part of the joint replacement that actually moves.  One of the most common sources of failure is the metal or “hard” surface wearing away the plastic or “soft” surface. A recent article on the long term results of new plastic liners in hip replacement found that at 13 years after surgery in relatively young, high demand patients (age 45-65), 100% of the hip replacements done with new plastic had survived. Furthermore, none of those hips had any indication of plastic wear visible on x-rays.

The newer plastic technology was adopted later in total knee replacement, and long term data are not as clear. Mechanical simulator testing, however, has shown no wear in knee replacement plastic liners after one million cycles.  A recent study found that when including all risk factors for failure of knee replacement including those that are unforeseen such as infection, 95% of artificial knees lasted at least 10 years.

As doctors we must give our patients a thorough explanation of risks, benefits, and alternatives to joint replacement surgery.  That being said, delaying an effective and durable treatment that has been shown to improve quality of life because of a fear of implant failure may not be necessary for a large number of patients.

Tucson Ortho Surgeon Offers Help to Local Patients in Need

21 Sep 2012 Doctors, John Wild, Media , , ,

Russell Cohen, MD, Tucson Orthopaedic Institute hip and knee surgeon, developed a program to provide free total joint replacement surgeries to local underserved patients with debilitating hip or knee arthritis.

This is the first program of its kind in Tucson and the idea came to Dr. Cohen because he has done similar programs in Vietnam and Haiti, with Operation Walk – a non-profit organization that sends volunteer surgeons to developing countries to perform joint replacements.

The first recipients of this program will take place September 29, 2012 – there will be six surgeries performed by Dr. Cohen, including two hip replacements and four knee replacements, and one of those will be performed by both Dr. Cohen and fellow Tucson Orthopaedic Institute surgeon, John Wild, Jr., MD.

Exhaust Options Before Joint Replacement Surgery

21 Dec 2011 Doctors, Edward Petrow, Media , , , ,

Non-steroidal anti-inflammatory drugs (NSAIDs) acetaminophen, glucosomine and chondroitin nutritional supplements, cortisone injections and rooster cartilage – yes, rooster cartilage – may help avoid the need for hip and knee joint replacement surgery.

About 65 people came to the East Social Center on Thursday to hear Dr. Edward Petrow, a surgeon at the Tucson Orthopaedic Institute, talk about remedies for stiff and weak joints before considering joint replacement surgery.

Dr. Edward Petrow speaks to members of the audience after his talk.

Petrow explained that osteoarthritis is the wearing down of articular cartilage of the joints and begins at 25. As one ages, symptoms of the wearing down may result in joint soreness, stiffness and pain caused by weakening of the muscles surrounding the joint due to inactivity.

Acetaminophen doesn’t decrease or reduce inflammation, but will reduce pain, he said.

Glucosomine and chrondroitin, a food supplement not regulated by the Food and Drug Administration, doesn’t work for everyone and usually takes three months to determine whether it is effective.

Cortisone injections can reduce swelling and discomfort, and if effective may be repeated every three months.

Hyaluronic acid injections, which comes from the cartilage of rooster combs, is said to restore lubrication and fluid in joints and can last six to 12 months.

Weight loss can affect joints in a positive way.

“Lose one pound and it reduces three to four pounds of pressure on your knees,” Petrow said.

If All Else Fails

Though he advises trying non-surgical remedies first, Petrow said the time to consider joint replacement is when there is loss of function.

About 500,000 hip replacement surgeries are done annually in the U.S. Though knee replacement is the gold standard of care, minimally invasive knee surgery will result in less trauma, less bleeding and pain and a smaller scar,

Exhaust all non-surgical options. Minimally invasive technology reduces complications, Petrow advised.

New advances include computer-assisted surgery where a computer makes a model of a patient’s hip or leg, and intra-operative imaging is now available for more accurate leg length with hip replacement surgery.

For an appointment with Petrow, call the Tucson Orthopedic Institute at (520) 382-8200.

Written by Ellen Sussman, Special to the Green Valley News

As published in the Green Valley News, Wednesday, December 21, 2011

Orthopaedic Surgeon Takes a Look at the ‘Hip Side of Things’

7 Aug 2010 Doctors, Media , , ,

“So what’s new on the hip side of things?” Dr. Edward P. Petrow Jr., asked a room full of people at the Quality Inn Wednesday afternoon. And no, Petrow wasn’t asking about the most à la mode musical beats or in vogue fashion trends. When Petrow, the orthopaedic surgeon and recent Virginia transplant, asked about the “hip side of things” he really was asking about, well, the hips.

Petrow, the sixth Tucson-area guest speaker invited to Nogales by the Mariposa Community Health Center, specializes in joint replacements, specifically knee and hip replacements. Norma Villaseñor, a spokeswoman for Mariposa, said the clinic started holding the biannual luncheons thee years ago as part of the “Mariposa Series.” Some 30 people, both local health professionals and other community members, filed into a room at the Quality Inn around noon, ate lunch and then listened to what Petrow described as “what’s cooking in what we do.”

Villaseñor, who said the list of past speakers included a neurosurgeon and a cancer treatment specialist, said, “We want to invite them to learn about the latest innovations and intermingle and network.”

Major Changes

Petrow said joint replacement surgery has changed noticeably since he finished residency eight years ago. He now works for Tucson Orthopaedic Institute. Petrow said two big changes in hip and knee replacement surgery are the size of surgery incisions and the lifetime of the replacements. Thanks to new computer-assisted surgery techniques, the size of incisions has shrunk noticeably to around 10 centimeters, he said. And because of innovations in plastic, metal and ceramic, implants can now last up to 25 years. They used to max out around 10 years, he said. “Don’t be scared of implants, longevity is a lot better,” Petrow said.

Despite the innovations, he reminded the audience of the dangers that always accompany surgery. For example, with the metal-on-metal implants there is a very slight risk that metal debris could form a pseudo-tumor.

Because of the longer lifespan and soaring levels of obesity, the number of hip and knee replacements per year in America, currently resting around 500,000, continually increases, Petrow said. Since many people live to 100 now, if they have bad knees by age 50, they’ll probably get surgery, instead of spending the second half of their life in pain, Petrow explained.

And, extra weight equates to a disproportionate addition of joint pressure, he said. “Lose 10 pounds and that’s like taking 30 pounds of pressure off the knees with every step,” Petrow said.

Need to Educate

Judge James Soto, who is on the local hospital board, attended the event and invited his friend and former college roommate SCVUSD Superintendent Dan Fontes, because he said he knew he had bad knees. After Petrow finished his Powerpoint presentation, Fontes, who said he’d “heard all of this before” but was “still deciding” whether or not to get surgery, asked him a question.

Fontes wanted to know the risks associated with post-surgery infection, asking specifically about taking preventative medicine before dentist visits. Petrow said he tells his patients to “take antibiotics for forever. Your goal is to never have an infection.”

Soon before the audience members shuffled out and on with their day, Petrow encouraged doctors in the audience to keep their patients up-to-date – or shall we say, hip – on all procedures. “We’re the guys putting scars on people. We need to educate them,” Petrow said.

By Marisa Gerber

As published in Nogales International, Monday, August 16, 2010

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