It has been very rewarding teaching medical students from the University of Arizona College of Medicine – Phoenix. We recently completed a workshop on campus using plastic saw-bones to teach a simulated total hip replacement and a simulated knee replacement. We also “fixed” a number of fractures with plates and screws. Our future orthopedic surgeons will be better prepared. See this link to the event! : http://phoenixmed.arizona.edu/news/orthopedic-surgery-simulation-workshop-2014
Posts By: Stuart Kozinn, MD
It has been over six months since new Obamacare rules have affected private practices in Medicine. From my standpoint, this as not been a good thing for patients. Sure, it is laudible and appropriate that every American should have affordable access to health care. But at what price? Patients are already being herded into groups that will have to answer to “ACO’s”, accountable care organizations. Just a new word for HMO’s that require layers upon layers of administrative permission to get the care that is needed accomplished. Who benefits? Corporate America, and Insurance companies, which profit acting as “the middle man”. This happens whenever administration and regulations become more complicated, and too difficult to follow. Soon, it will all be about corporate profits and bonuses paid for with-holding necessary care. While I do see the potential for abuse in a “fee for service” world, at least in that system, patients do get the care they need. In the post Obamacare world, patients will be convinced that surgery is a bad thing ( because momentarily is seems more expensive to payors), and physical therapy and pain medication will be a better option. The truth is, well performed joint replacement surgery is extremely cost efficient when measured in the years of increased economic productivity the recipients enjoy. Imagine the “cost savings” of taking a 50 year old “disabled” man or woman, who has bilateral knee replacement, and who then rejoins the workforce.
Think also of the mental health gains! Already insurance company stock prices are at all time highs. Do you think that is because more premium dollars are going to the care of patients? No, its because they can keep more of it as bonuses for executives. Pharmaceutical companies are at all time highs as well, because Obamacare did nothing to help decrease the ridiculous cost of medications. The exact same drugs used here in the USA cost much more than they do around the world. How does that make sense? This new system is not better, and soon patients will realize that their “access to care”, and their ability to get procedures done will be made more difficult. I do have patients from Canada and Mexico who travel to Scottsdale to get joint replacements done on a timely basis, because the national health services in their countries make them wait in pain for years!
Medicare has come out with so many new requirements and administrative paperwork, that most smaller private practices will need to close or fold into a large corporate backed ACO. This is why I have chosen to opt out of some plans, so I can continue to take the very best care of my patients. I will likely see less numbers of patients in the future, but those who can stick with the Scottsdale Joint Center will benefit from the best orthopedic surgical care available in the world!
TOTAL HIP REPLACEMENT
I feel the best total hip replacement procedure I can offer my patients is the new anterior total hip procedure. There are many reasons I feel the direct anterior approach is a better way to do a total hip replacement. After 27 years of doing over 200 total hips a year, I have seen and done all of the different hip approaches and I have years of results to base my opinion. My anterior hip patients are up walking within one hour of surgery, and many have gone home on the same day as surgery. This was not possible with the older posterior and lateral hip approaches. There is LESS PAIN with the anterior hip procedure, because no muscles are cut.
There are a number of reasons I feel the best total hip replacement that I can offer to patients right now is the anterior total hip. The anterior hips heal faster and get back to their chosen activities with less restrictions much faster. Watch our video on the home page of this website to learn more about the anterior total hip.
Total Knee Arthroplasty is the same as Total Knee Replacment. The word arthroplasty comes from the latin –“arthro” meaning “joint”, and “plasty” meaning to” form or make” (so..to make a new joint).
Any joint in the body can have an arthroplasty, it is a very general term. Partial knee replacement ( also called unicompartmental replacement) is another form of knee arthroplasty. Dr. Kozinn performs both types of lnee arthroplasty at the Scottsdale Joint Center.
We have been in practice for 27 years, and have exceptional experience in complicated cases. If you have been suffering with knee pain, you should come in for an appointment, get a standing X-ray ( so we can see the joint space narrowing), and discuss your options for care. Total knee arthroplasty results are getting better and better. While it is impossible to predict in any specific case how long a given total knee will last, a fair average with modern techniques at this time is 25 years or more, in my opinion.
Waiting until you are older in the hopes that you will outlive your joint, does not seem to be the best strategy to getting back as soon as possible to a more productive life. Please visit out additional website at www.TotalKnee.org for more information of Total Knee arthroplasty.
I continue to be amazed at our results with the Anterior Total Hip Replacement procedure.
We did two anterior hip replacement patients yesterday, and the immediate results (up walking soon after the procedure), is remarkable. I am reminded of this when my medical students see the relatively painless function of the patients so soon after they have seen the actual procedure in the OR. After all, we are cutting the bone ( removing the femoral head), and reaming the pelvic socket (acetabulum). Amazingly, due to the bodies distribution of pain fibers ( mostly in the soft tissues) these bony procedures do not generate much pain.
I love the look in my patient’s eyes when they put weight on the hip for their first steps. Wow!, it really doesn’t hurt..in many cases the preoperative pain was much worse and is magically gone! Patients actually feel better while they are walking, then when they are immobile waiting in bed to get going. We have many travelers coming to Scottsdale to have their anterior hips done here. It is difficult to get this procedure done in Canada and Mexico. The national health services in those countries does not incentivize their physicians to learn and adapt new techniques. I visited with Dr. Matta in Los Angeles to learn his technique for anterior total hip replacement, and I have now done over 1000 cases.
I love doing the anterior total hip replacement procedure, and the word is out, Scottsdale joint Center is the place to come for your anterior total hip replacemnt. We have many patients flying in from Canada and Mexico to have their joint replacements here in sunny Scottsdale. We hope to see you in our office soon if you have hip, knee, or shoulder arthritis. Welcome to our practice, and I am happy to have you as our patient!
Shoulder replacement surgery is becoming much more popular. That is because the results have been much better than in years past. Since there are fewer arthritic shoulders than arthritic knees and hips, less are done.
Also the fact that we do not walk on our hands, allows us to tolerate shoulder arthritis much better than hip and knee arthritis. The heavy weight bearing on our legs, magnifies the pain we feel in our worn out hip and knee joints. Shoulder pain is usually very annoying, and can interfere with sleep and sports activities.. but some people can live with it if they choose to modify their activities. More and more, the right decision is NOT to live in pain. Our total shoulder patients have a 95 percent success rate. The small percentage with persistent pain can usually be helped with a second surgery. A few patients will re-tear their rotator cuffs because they feel so good after surgery that they overuse their arms too soon before full healing. Some patients who do not push their own rehab and physical therapy can end up with stiffness in the joint – they may face a manipulation after surgery to regain motion. Sometimes smaller procedures are done to help, for example to remove an arthritic AC joint, or to release a degenerated biceps tendon.
In the past, we only had the traditional shoulder replacement device to use on arthritic shoulders. This device depends on a well functioning rotator cuff (see picture) to keep the joint centered and to allow us to lift the arm overhead. Now with the invention of the “reverse” total shoulder replacement implant, we can replace shoulders that have massive cuff tears, and the patient can still lift the arm by using a “trick” of biomechanics.
By moving the center of rotation of the shoulder joint lower and more towards the center of the body, the large superficial deltoid muscle now comes into play as an elevator of the arm. Many patients feel stronger after the reverse surgery than they have in years!
An Xray and an MRI will allow Dr. Kozinn to determine which implant is best for YOUR shoulder. The revovery is easier than for a total knee, but maybe a bit more inconvenient than our anterior hip recovery. The arm will rest in a sling until the pain is minimal, than you may progressively use the arm as tolerated. We do use post-operative physical therapy for total shoulders and total knees, in contrast to our anterior total hip replacements and partial knee replacements, which rehab just fine without formal PT. Check out this link to learn more about shoulder replacements: https://www.facebook.com/shoulderreplacement
Total knee recovery can be more arduous than total hip recovery. There is generally more pain after a knee replacement then with an anterior hip replacement. I think this is because we push the range of motion of the knee so soon. We do partially split the quadriceps muscle to some extent, and repair then it. It often feels tight, like it is pulling on the suture line when we push you to flex your knee. It has been my observation that the patients who start their Physical Therapy a week later seem to do better than those who start right away. This may simply be due to the recent bleeding and subsequent swelling that occurs immediately after the surgery.
I think functional rehab, like walking, is much more important early on then range of motion exercises. The motion should come easier later as the swelling goes down. Ice works well in the knee to control pain and swelling. We use sophisticated pain blocks to minimize pain initially, and our patients get a head start on functioning. It is rare for patients to not get the motion they need by 6 weeks post op. 97% of the time, the knees loosen up over time on their own. Get outside and hike, walk, climb- use the knee! It will loosen up- it wants to move!
Our total knee replacement patients are recovering faster than they did years ago. We use muscle sparing approaches, and minimize the use of the tourniquet ( used to control bleeding during the surgery). We now have an injectable medication called Exparel* that is a timed release local anesthetic – it can provide pain relief for up to 72 hours. Many patients are requiring less overall physical therapy visits. What used to be 3 times a week is now two visits a week for many patients. Our knee implants are also getting better. The new rotating platform system we use has many more sizes to fit all knees, and the plastic spacers go up in one millimeter increments for maximum accuracy and stability. It is a good time to have a painful knee replaced! Read more about total knees at www.Totalknee.org.
Teaching medical students the basics of orthopedic surgery!
What is your opinion on Hip Resurfacing?
I am a Dentist in the Toronto area. I’m 52 and have moderate osteoarthritis in my right hip. It is limiting my enjoyment of life as it is very painful to golf and I’m limping a lot. I can walk for about 15 mins without pain. I can no longer run. I’m trying to decide between THP and resurfacing.
Submitted by Dr. Steven Millman.
Stuart C. Kozinn, MD Responds:
Hip resurfacing is a dying procedure. I do not recommend it for anyone. Besides the potential long-term problems from wear debris with the large surface area metal on metal articulation, the failure rate is much higher than for standard total hip replacements. Fractures of the femoral neck are common, and loosening of the cemented cap is inevitable. A well performed total hip is cementless ( potentially leading to permanent bone fixation ). Smaller minimally invasive components actually may be more conservative than surface replacement when you consider that socket bone loss is increased to fit the larger cup sizes needed for the larger head implant. The anterior hip procedure, which cuts no muscle (muscle sparing), using E-poly or equivalent longer lasting polyethylene is now the preferred procedure in most people.
I can’t even comb my hair!
My shoulder has become so stiff and painful that I can’t comb my own hair! An MRI said the rotator cuff was not torn but I had arthritis in my joint. My general orthopedist said I need a shoulder replacement, but he does not do them. Do you do shoulder replacements? Do they work well?
Submitted by Theresa R.
Stuart C. Kozinn, MD Responds: