SCOLIOSIS

Our spine is naturally curved in order to distribute the weight of the body. A side-view X ray of a soldier standing rigidly at attention would show the cervical spine in his neck arched slightly forward. The twelve thoracic vertebrae curve gently to the rear. Then the lumbar spine, which bears most of our upper-body weight, arches forward as it nears the pelvis. 

About one in twenty-five adolescent girls and one in two hundred teenage boys develop scoliosis. Captured on an X-ray, their spines form, to varying degrees, a more pronounced S shape. When imaged from the back, a normal spine exhibits no curvature. A youngster is said to have scoliosis if her curvature is greater than ten degrees. 

The condition can occur as a complication of polio, muscular dystrophy and other central nervous system disorders, but four in five cases among teenage girls are idiopathic—that is, of unknown cause. Very often, though, a family member will also have had scoliosis. 

Symptoms Suggestive of Scoliosis May Include: 

• Conspicuous curving of the upper body 
• Uneven, rounded shoulders 
• Sunken chest 
• Leaning to one side 
• Back pain (rare) 

Scoliosis can develop quietly for months to years so it may only be picked up by the pediatrician during an examination of the teen’s back. Progression may occur quickly during the teen’s growth spurt. One in seven young people with scoliosis have such severe curvature that they require treatment. 

How Scoliosis Is Diagnosed 

• Physical examination and thorough medical history 
• X-rays 

How Scoliosis Is Treated 

• Bracing: Many such cases never progress to the point that treatment is necessary. Follow-up visits are scheduled approximately every six months for those diagnosed with curves between fifteen and twenty degrees. 

Curvature above twenty-five degrees may call for bracing. There are two main types of orthopedic back braces. The Milwaukee brace has a neck ring and can correct curves anywhere in the spine; the thoracolumbosacral orthosis (TLSO for short, thankfully) is for deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back. 

Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete; usually that’s about ages seventeen to eighteen for girls, and eighteen to nineteen for boys. The braces are more cosmetically appealing than they used to be and can be hidden easily under clothing. Having to wear an orthopedic brace interferes only minimally with physical activity. Only contact sports and trampolining are off-limits for the time being. 

• Surgery: Posterior spinal fusion and instrumentation, the operation to surgically correct scoliosis, is typically recommended when the spine’s curvature is fifty degrees or more. The surgical procedure fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. On average, this takes about twelve months. Although teenagers who have the surgery still face some restrictions on physical activity, they can say good-bye to the brace. 

Helping Teens Help Themselves 

Only about 50 percent of young scoliosis patients wear their braces. Parents need to convey the importance of complying with the doctor’s instructions. At the same time, they should be sensitive to the tremendous impact the condition can inflict on a teenager’s body image, which at this age is inextricably entwined with self-identity and self-confidence. You might want to consider asking your pediatrician or orthopedist for a referral to a mental-health professional experienced in counseling children with chronic medical problems. A patient support group, like those run by the Scoliosis Association may also be helpful.

Source - 11/21/2015

Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)

10 WAYS EXERCISES HELPS DURING CANCER TREATMENTS

Exercise supervised by a physical therapist can help anyone undergoing cancer treatment exercise safely and comfortably during treatment, and remain physically active. It also may relieve many of the side effects of cancer treatment.

With a physical therapist’s help, exercise during cancer treatment can:

1. Reduce fatigue 
Exercise helps boost energy and endurance during cancer treatment.

2. Maintain muscle strength 
Safe exercise can help keep your muscles strong.

3. Reduce stress 
Exercising during cancer treatment can help ward off anxiety, fear, and depression.

4. Prevent or reduce lymphedema and swelling 
Special physical therapy treatments address lymphedema and swelling.

5. Reduce pain 
Safe and comfortable exercise is proven to be effective in reducing pain.

6. Prevent and reduce weight gain
Staying physically active can help you maintain a healthy weight.

7. Reduce brain fog
Exercise has an immediate and long-lasting effect in reducing brain fog.

8. Reduce bone density lossCertain exercises done while standing and moving can stimulate your bones to stay healthy and strong, helping to avoid fractures.

9. Improve the survival rate
Research studies have suggested that consistent exercise during cancer treatment may have beneficial effects that improve the outcome of that treatment.

10. Assist athletes to continue sports training
Athletes undergoing cancer treatment may not have to give up their sport. A physical therapist can help design a special exercise plan that includes an athlete’s chosen sport, a modified version, or aspects of it.

OSTEOPENIA (LOW BONE MASS)

Osteopenia, now called low bone mass, is a term used to describe lower-than-normal bone density or thickness. Approximately 44 million adults in the United States have osteopenia.The condition is different than osteoporosis, which is a disease where normal bone structure becomes thinned out and porous.

Low bone mass can occur at any age, but noticeable and significant bone loss is most likely to occur in women during the 5 to 7 years following menopause. This group is also more likely to experience a bone fracture than someone with normal bone mass.

What is Osteopenia?

Low bone mass is a condition that develops when a person:

• May naturally have less-dense bones due to factors such as body size, genetics, or gender.
• Has gradually lost bone mass over time due to lack of exercise and poor diet.
• Has begun to experience perimenopause, symptoms that signal the onset of menopause or who is in menopause.
• Has rapidly lost bone mass due to an illness or use of medication.

How Is It Diagnosed?

Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.

The results of the scan are reported using T- and Z-scores.

The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.

If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.

The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.

Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.

How Can a Physical Therapist Help?

A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.

When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.

It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.

Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:

Weight-bearing Exercises

• Dancing
• Walking at a quick pace (122-160 steps per minute or 2.6 steps per second)
• Jumping, stomping, heel drops
• Running at least a 10-minute mile
• Racket sports

Resistance Exercises

• Weightlifting
• Use of resistance bands
• Gravity-resistance exercises (pushups, yoga, stair climbing, etc.)

Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.

Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.

Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.

Can this Injury or Condition be Prevented?

Risk factors that you can avoid in order to lower your chances of developing low bone mass include:

• Cigarette smoking
• Excessive alcohol intake (greater than 1 drink per day for women, 2 per day for men)
• Poor diet
• Low calcium and Vitamin D levels        
• Sedentary or low level activity—less than 5,000 steps per day

CERVICAL STRAIN/SPRAINS

What is it?
A strain or sprain is an injury to a muscle or ligament.  There are many parts of the neck that can be injured, such as the muscles, ligaments, bones, discs, and nerves.  A cervical strain or sprain is a neck injury that involves the muscles or ligaments of the neck. This type of injury can happen in any sport when there is a collision between two athletes, a fall, or contact with impact to the head.   In some collisions or falls, the neck may not be directly injured, but the force of the injury may cause a whiplash of the neck and cause a sprain or strain.  This can occur in many sports, but more often in football, ice hockey, lacrosse, wrestling, and soccer. 

Symptoms
The athlete may start to feel symptoms immediately after the injury, or may slowly feel worsening pain over the course of a few days.  He or she may feel soreness or stiffness in the neck muscles.  It may be difficult to move the neck in certain directions.  The athlete may also feel a spasm or tightness in the neck muscles.  This type of neck injury does not typically involve the bones, nerves, or discs of the neck.  The athlete should not have any numbness, tingling, or weakness in the arms from a true cervical strain or sprain.

Sports Medicine Evaluation/Treatment
 A sports medicine physician will perform a thorough physical examination in order to rule out a more serious neck injury, such as an injury to the spinal cord.  If there are any worrisome signs at the time of the injury, the athlete may be referred for evaluation at the emergency department.  The physical examination includes evaluation of neck movement, location of the pain, and evaluation for muscle spasm.  The athlete can expect a neurological exam to make sure there is no injury to a nerve in the neck.  Sometimes, an x-ray will be ordered to rule out a more serious neck injury.

The treatment of this condition depends on the severity of the injury.  The healthcare provider may prescribe medications to help with the pain or spasm, such as anti-inflammatory medications or mild muscle relaxers.  If the pain is mild, the athlete may be able to do exercises at home to regain full range of motion of his or her neck.  If the pain is worse, the provider may have the athlete work with the athletic trainer if available, or refer the athlete to a physical therapist.  If the athlete is not improving with these treatments over time, an MRI might be ordered to look for a disc or nerve injury.

Injury Prevention
In any collision sport such as football, it is important to play with proper form.  This includes keeping the head up for any collisions or tackles, and not leading with the helmet or head.  Athletes should be taught the proper form for tackling at practice by their coaches, and avoid tackling other athletes until proper technique has been demonstrated.

Return to play
For a cervical sprain or strain that does not include any other worrisome signs, the athlete can return to play once the pain is controlled and he/she has regained full range of motion and strength of the neck.

AMSSM Author: Kris Fayock, MD

COULD YOU HAVE PATELLOFEMORAL PAIN SYNDROME?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain - and is very, very common in adolescence and young adulthood for active or athletic individuals. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

What is Patellofemoral Pain?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the undersurface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

• Weakness, tightness, or stiffness in the muscles around the knee and hip
• An abnormality in the way the lower leg lines up with the hip, knee, and foot
• Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

• Pain when walking up or down stairs or hills
• Pain when walking on uneven surfaces
• Pain that increases with activity and improves with rest
• Pain that develops after sitting for long periods of time with the knee bent
• A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately. 

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

EXPECTATIONS DRIVE DOCTORS TO ORDER UNNECESSARY IMAGING

Despite knowing (and agreeing with) recommendations to not use imaging for low back pain without “red flag” indicators, doctors are still ordering unnecessary CTs and MRIs for patients. Most do so out of fear of upsetting the patient, and because there is not enough time to discuss the risks and benefits of the images with the patients, according to an October 17, 2016 study of Veteran’s Affairs health care professionals.

The study surveyed 579 VA clinicians, and included a hypothetical scenario in which a patient had requested imaging for nonspecific low back pain (without red flag symptoms). Only 3% of the responses thought that the patient would benefit from a CT scan or MRI. Almost 75% of the clinicians worried the patient would not be able to be referred to a specialist without an image, and more than half worried the patient would be upset to not receive the image.

The study confirms a concern highlighted by the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, that the use of unnecessary imaging, such as CTs, MRIs, and X-rays, can lead to other unnecessary tests or procedures, drive up patient costs, and expose the patient to unnecessary radiation.

“Our study showed that almost all clinicians were aware that an imaging test was not indicated for a patient with low back pain without danger signals of severe spinal problems, and agreed with the Choosing Wisely recommendations to not do testing,” said study coauthor Erika D. Sears, MD, MS, of the Veteran’s Affairs Center for Clinical Management Research, in Reuters Health News (“Doctors still order imaging for low back pain, against recommendations” – October 17, 2016).

Patient education is key to avoiding unnecessary and expensive medical interventions and tests. There is a growing body of evidence that demonstrates early physical therapy for low back pain lowers costs. 

“Patients should first have a thorough history and physical exam to rule out the presence of “red flag” symptoms, and are often first referred to physical therapy in the initial treatment period,” Sears said. “Because low back pain tends to come back, staying active through activities such as walking, yoga, and supervised training, on top of physical therapy, is key to warding off recurrence.”

MEET THE PHYSICIANS: DRISKO, FEE, & PARKINS - PART I

DRISKO, FEE, & PARKINS
2790 Clay Edwards Drive, Suite 600
Kansas City, Missouri 64116
P: (816) 561 - 3003

19550 East 39th Street, Suite 410
Independence, Missouri 64057
(816) 303 - 2400

2040 Hutton Road
Kansas City, Kansas 66109
P: (816) 561 - 3003

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Leslie Michaud, MD

Focus lies within family practice and sports medicine, with special clinical interests including: nutrition, the female athlete and body, musculoskeletal injury, care, and prevention, as well as collision sports. During early fall, Dr. Michaud even treats middle and high school athletes with strains, sprains, fractures, and superficial lacerations on Saturdays!

Jeffrey Bradley, MD

Focus lies within the upper extremity, with clinical specialties ranging from trauma, reconstructive repair, and genetic disorders of the hand, wrist, elbow, and shoulder. Dr. Bradley recently completed his fellowship in upper extremity and microsurgery, and is now another physician Kansas City can add to it's list of minimally-invasive hand surgeons. 

Paul Cowan, MD

Focus lies within sports medicine orthopaedics, with a procedural list extending through the upper and lower extremity. Dr. Cowan's clinical interests include ACL reconstruction, multi-ligamentous knee reconstruction, rotator cuff repairs, and many others, on patients spanning all ages. During his fellowship, Dr. Cowan spent time treating athletes ranging from middle and high school to professional level athletes; including those associated with the NHL Wild, MLB Twins, and Gustavus-Adolphus College, while completing his fellowship in Minneapolis, Minnesota.

Robert Drisko, Jr., MD

Focus lies within general orthopaedics, with special interest, as well as extensive academic and clinical expertise in the spine - cervical through sacral. Dr. Drisko has an extensive background in orthopaedics within the Kansas City Area, having served on multiple boards and executive staffs throughout his career.  

Nathan Kiewiet, MD

Focus lies within the foot and ankle subspecialty of orthopaedic surgery, with clinical interests and expertise ranging from complex traumas, post-traumatic reconstruction, Charcot deformities, as well as surgical and non-surgical treatment of flatfoot deformities, bunions, and toe deformities. Another area of expertise of Dr. Kiewiet's is total ankle replacements, and revision total ankle replacements. 

For more information, please visit http://www.dfportho.com/

A newer blog segment called MEET THE PHYSICIANS provides general focus information of some of the best, and most prominent orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy. 

MEET THE PHYSICIANS: DICKSON - DIVELEY ORTHOPAEDICS, PART I

DICKSON - DIVELEY ORTHOPAEDICS
3651 College Boulevard
Leawood, Kansas 66211
and
St. Luke's Medical Campus: Medical Plaza Building 1
4321 Washington Street, Suite 610
Kansas City, Missouri 64111
(913)-319-7600

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Timothy Badwey, MD

Focus is the ankle and foot, with emphasis on conservative treatments of disease and injury, both surgical and non-surgical, ankle arthroscopy, sports-related injury, and achilles tendon injury. 

Mark Bernhardt, MD

Focus is the spine, cervical through sacral. Dr. Bernhardt specializes in spinal surgery for a wide variety of conditions and injuries, including scoliosis. He also performs many surgical correctional procedures involving fusions and instrumentation.

Stanley Bowling, MD

Focus lies within fracture care and orthopaedic trauma for the entire lower extremity, as well as the shoulder. Dr. Bowling has a blog of his own, providing information ranging from post-injury care to procedures he specializes in, that is accessible through the Dickson-Dively website (as to many of the other surgeons!)

Brian Divelbuss, MD

Focus lies within the upper extremity, with special emphasis on the hand. His specialties, however, remain within the distal portion of the upper extremity, in the hand, wrist, and elbow. Dr. Divelbuss is the current President and CEO of Dickson-Diveley Orthopaedics, and carries a reputation that treatment paired with education most often results in a successful procedure and recovery. 

Constantine L. Fotopoulos, MD

As an interventional physiatrist, his focus lies within minimally-invasive, interventional procedures for the treatment of spinal disorders, although he does treat general orthopaedic pain in the shoulder, knee, and hip pain, as well as the neck and back. Some of his specialties include epidural injections, vertebroplasty, kyphoplasty, and spinal cord stimulation.  Dr. Fotopoulos also has extensive knowledge in hyperbaric and diving-related injuries, as well as past experience with athletic injuries due to professional ties with the Kansas City Explorers tennis team, a former KC Royals Team Physician, and the State of Missouri Mixed Martial Arts Physician. He is fluent in english and greek, and proficient in basics of Italian, Russian, Spanish, and Arabic. 

Robert Gardiner, MD

Focus lies within the hip and knee, as he's been performing hip and knee total joint replacements for over 20 years. Dr. Gardiner does have expertise in treating athletic injuries, as well, as he served as the Team Physician for the KC Blades hockey team from 1992-2001. 

Danny Gurba, MD

Focus lies within the hip and knee, with emphasis on total joint replacement procedures. Dr. Gurba himself reports spending 95% of his clinical and surgical time between the hip and knee. Dickson-Diveley reports that Dr. Gurba has performed over 9,000 hip and knee replacements throughout his career with them. 

James Halloran, MD

Focus lies within diagnosis and treatment of conditions, deficits, and defects of the distal joints in the lower extremity, including the knee, ankle, and foot. Dr. Halloran has completed fellowships in both foot and ankle surgery, as well as sports medicine which has lead to his extensive knowledge of repair and reconstruction possibilities for a wide array of circumstances. This combination lead to his professional ties with the Detroit Pistons (NBA), the Detroit Red Wings (NHL), the Detroit Tigers (MLB), and the Duke University Men's Soccer team, all prior to relocating back to Kansas City.  

For more information, please visit https://www.dd-clinic.com

A newer blog segment called MEET THE PHYSICIANS provides general focus information of some of the best, and most prominent orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy. 

2015's FOREFRONT OF ORTHOPEDIC INNOVATION

The SourceTrust custom contracting team recently traveled to Las Vegas for the 2015 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS), the nation’s leading educator in the specialty. The team met with suppliers, networked with peers and learned about the latest technologies and trends in orthopedics. Hot topics this year included:

1. 3D printing technology: Biomet released the G7 OsseoTi shell, to be used with its acetabular platform launched last year that employs color coding to reduce instrument sets and increase efficiency flow in the OR during hip arthroplasty procedures. One of the surprisingly innovative aspects of this product is the use of human CT data in combination with 3D printing technology to build a structure purported to directly mimic that of human cancellous bone. Biomet claims that this process generates a single porous architecture allowing creation of complex shapes while maintaining the consistent porosity and strength necessary to facilitate bone and tissue ingrowth and implant stability.

2. Advanced technology for total knee revision arthroplasty: One innovative technology for revision knee procedures is DJO Global’s Exprt System, which has the potential to improve patient outcomes as well as efficiencies in the operating suite. Exprt’s streamlined, compact design reduces turnaround times, minimizes waste and has proven implant design technology―all for 40 to 70 percent of the cost of comparable knee revision systems. A simple, comprehensive two-tray system replaces the traditional eight-tray setup used during complex total knee revisions, reducing prep time, eliminating unnecessary surgical steps and improving the precision skills of revision surgeons.

Lowry Barnes, M.D., chairman of Orthopaedics at University of Arkansas for Medical Sciences, comments that “the Exprt approach leads to efficient operations that save both time and money, while providing excellent early results. My operating team especially appreciates the fact that only two pans of instruments are opened. I believe that I can speak for the entire Exprt design team when I say that we have met our goals in offering a high-value, high-quality revision knee system for the accomplished surgeon.”

“In today’s value-driven healthcare environment, cost effectiveness is crucial in order to provide stakeholders with a high-quality result at a reasonable cost,” says Dr. Richard Lorio, chief of Adult Reconstructive Surgery at NYU Langone Medical Center. “Putting the patient ahead of profits, the Exprt System allows skilled surgeons to provide TKA [total knee arthroplasty] patients with a functional knee at a fraction of traditional costs.”

3. Robotics: As with AAOS 2014, robotics continues to be an area of great interest. The two main players in this arena are MAKO Surgical Corp. and Blue Belt Technologies. Limitations of the former include restricting surgeons to using only MAKO or Stryker implants, increasing disposable costs. In addition, MAKO manufactures implants for use in total hip and partial knee arthroplasty (although it anticipates launching a total knee platform later this year). Acquiring MAKO robotics is also costly. Blue Belt is more economical and provides surgeons with the option of using its STRIDE implants as well as those manufactured by Smith & Nephew, DJO Global, StelKast and DePuy Synthes. However, Blue Belt is currently approved only for partial knee procedures. Like MAKO, it expects to release a total knee implant in late 2015.

4. Patient-reported outcomes measures (PROM): These days, surgeons and hospitals can’t just say they are good at orthopedics. To gain market share, they have to prove they are clinically excellent. That means demonstrating that they are high-quality, low-cost providers of care while providing a good patient experience. The measures used to prove value are evolving from research-focused tools toward scoring instruments that are meaningful to patients. A good example is PROMIS, a means of measuring patient-reported physical, mental and social health status that is backed by the National Institutes of Health. InVivoLink demonstrated its platform for capturing PROMIS scores pre- and post-procedure to better understand clinical performance across patients, procedures and surgeons. When these PROM measures are analyzed along with implant consumption and cost data, they’re a powerful tool for driving surgical volume, surgeon engagement and cost savings. 

5. Outpatient surgery: To get ahead of this increasing market trend, Zimmer rolled out its Z-23 initiative that endeavors to limit hospital stays for hip replacement patients to no more than 23 hours. The program stresses the importance of better patient selection and creating efficiencies in the OR. More total joint procedures are moving entirely to outpatient settings thanks to better medications and anesthesia, the popularity of minimally invasive approaches, younger patients seeking such procedures, and private payer support.

6. Shoulder market: Matthew P. Willis, M.D., a fellowship-trained orthopaedic surgeon at Baptist Hospital and TriStar Centennial Medical Center in Nashville who specializes in disorders of the shoulder, discussed emerging technologies and pricing in the shoulder market at a HealthTrust-sponsored dinner during the annual meeting.

“More than hips or knees, shoulder technology continues to make significant advances,” Willis says. “This is particularly true with regards to reverse shoulder arthroplasty technology. Impending developments such as universal glenoid baseplates for total and reverse arthroplasty as well as patient specific instrumentation are on the horizon.”

Willis also addressed pricing and reimbursement. “As reimbursements for hospital systems continue to decline, competitive pricing on shoulder implants becomes more important than ever. There are no shoulder implant companies that currently offer technology to justify significantly higher pricing than [their] competitors.”

On the subject of hospital and physician alignment, Willis says the “best approach to achieving hospital and physician alignment is for the two parties to have open and transparent discussions about what is important to each. Most physicians are willing to help on cost containment if approached with reasonable alternatives and accurate data. The best case scenario is when both parties are incentivized to manage costs. If not currently, such a model may be attainable in the future. “

OBESITY LINKED TO ORTHOPEDIC CONDITIONS

The concept of obesity is a touchy one in today's social atmosphere, and being sensitive so as to not insinuate "fat-shaming" can be very tricky. As society constantly tries to ride the thin line between "fat-shaming" and educating, it is vitally important that everyone, no matter of age or sex, be aware of the risk they implement on their health. 

It is absolutely necessary for men and women, both, to be comfortable in their own skin, and be confident in who they are as a person and what their body looks like.  Finding a self-confidence-boosting activity to add to the daily regimen has not only proven to lead to an increase in dopamine (happy hormone) production, but also a decrease in cortisone (stress hormone) production. Emotional health is a vital portion of overall health status. 

Being comfortable in your own skin was meant to help people understand that their body will not always look like models or even other average individuals. We all respond differently to caloric intake, exercise, and lifestyles. For example, some people were born with incredible metabolisms - and good for them! Many of us are not, however, and we must make adjustments to our mindsets to understand that although we may never be as thin as some, we can be comfortable in our own skin. Medically speaking, however, being comfortable in your own skin is not validating obesity. 

Obesity traditionally has been defined as a weight at least 20% above the weight corresponding to the lowest death rate for individuals of a specific height, gender, and age (ideal weight). 

Twenty to forty percent over ideal weight is considered mildly obese; 40- 100% over ideal weightis considered moderately obese; and 100% over ideal weight is considered severely, or morbidly, obese. More recent guidelines for obesity use a measurement called BMI (body mass index) which is the individual's weight multiplied by 703 and then divided by twice the height in inches. BMI of 25.9- 29 is considered overweight; BMI over 30 is considered obese. Measurements and comparisons of waist and hip circumference can also provide some information regarding risk  factors associated with weight. The higher the ratio, the greater the chance forweight-associated complications. Calipers can be used to measure skin- fold thickness to determine whether tissue is muscle (lean) or adipose tissue (fat).

Much concern has been generated about the increasing incidence of obesity among Americans. Some studies have noted an increase from 12% to 18% occurring between 1991 and 1998. Other studies have actually estimated that a full 50% of all Americans are overweight. The World HealthOrganization terms obesity a worldwide epidemic, and the diseases which can occur due to obesity are becoming increasingly prevalent.

Obesity affects quality of individual patient care, the strain the healthcare system must endure to adjust, possible health insurance coverage, and nearly every organ in the body. People with obesity often have other health problems, including diabetes, heart disease, certain tumors and cancers, and psychiatric disorders. However, the role of obesity in orthopedic conditions and their treatment is less well-publicized.
 

According to orthopedic surgeon William M. Mihalko, MD, PhD, of Campbell Clinic Orthopaedics in Memphis, Tenn., “obesity can accompany a multitude of comorbidities that can have a significant impact on a patient’s outcome from elective orthopaedic surgery.” He and his co-authors of “Obesity, Orthopaedics, and Outcomes,” a study published in the November issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), suggest that even though patients with obesity face higher surgical complication rates, orthopaedic procedures can help minimize pain and improve bone and joint function.
 
The Pains of Excess Weight
Obesity is a strong independent risk factor for pain. Adolescents with obesity were more likely to report musculoskeletal pain, including chronic regional pain, than their normal-weight peers. The disease nearly doubles the risk of chronic pain among the elderly—causing pain in soft-tissue structures such as tendons and ligaments, and worsening conditions such as fibromyalgia in individuals already living with constant pain in their muscles and joints.
 
Obesity and osteoarthritis
Osteoarthritis (OA)—a progressive “wear and tear” disease of the joints—is frequently associated with obesity. Every pound of body weight places four to six pounds of pressure on each knee joint. Research suggests that excess weight increases pressure, or the biomechanical load, on the knees and increases the likelihood of wearing away the cushioning surface of the knee joint, resulting in the development of OA and the need for total knee arthroplasty (TKA). The need for a TKA is estimated to be at least 8.5 times higher among patients with a body mass index (BMI) greater than or equal to 30, compared with patients who have a BMI within the normal range of 18.5 to 24.9.
 
Obesity and Injury
In addition to the increased likelihood of wear and tear on joints, excess weight also affects injury status. The odds of sustaining musculoskeletal injuries is 15 percent higher for persons who are overweight and 48 percent higher for people who are obese, compared to persons of normal weight.
 
Statistically, overweight and obese children also have significantly greater odds of lower extremity injuries and pain than do children of normal weight. Back and lower extremity pain, especially of the knee and foot, are more common among children with obesity.
 
Pre-surgical Considerations
“Although no upper weight limits have been established that would contra-indicate elective orthopaedic surgery, every surgeon must understand the unique risks an obese patient faces and understand how to optimize and treat each of these patients on an individual basis,” says Dr. Mihalko. The study authors recommend that patients with morbid obesity (BMI of 40 or higher) be:

• advised to lose weight before total joint arthroplasty (TJA);
• offered resources for weight loss before surgery; and,
• counseled about the possible complications and inferior results that may occur if they do not lose weight.

While patients with obesity may experience slower recovery and higher risks of surgical complications that can compromise outcomes, outweighing the functional benefits of TJA in some cases, orthopedic interventions still can provide improvements in quality of life for even for extremely obese patients.