By Alexander Germanis
When a bird is not in flight or a fish is not coursing through the water, it goes contrary to their physical nature. Indeed their most notable physical characteristics are indicative of how they move through their respective environments.
While we humans may not have wings or fins, our limbs certainly still indicate we too are supposed to be on the move. Our joints are designed for far more than merely sitting down or remaining stationary. Our knees and hips are machines meant for movement.
But subjecting any machine to too much movement or an incorrect range of motion will eventually cause issues. When a knee or hip starts to break down, the expert orthopedic surgeons of Great Plains Orthopaedics—partnered with OSF Orthopedics—are there to help.
More Than One Problem
Any mechanic will tell you the more complex your machine is the more can go wrong with it. Our joints are definitely not exempt from this rule. Fortunately, modern medical techniques are always being researched, developed, and implemented in order to make fixing those myriad issues less and less invasive.
A common condition for the hip is known as impingement. “Hip impingement is a condition that results in the ball and socket joint of the hip having abnormal rubbing during range of motion,” explains Dr. Keith Corpus, a sports medicine surgeon specializing in hip, knee, and shoulder arthroscopy and replacement. “Essentially, instead of having a round peg in a round hole, you get a square peg in a round hole. That can lead to pain, tears in the labrum (a piece of cartilage that wraps around the socket), and cartilage injury, which can predispose patients to early arthritis.”
Should the joint become arthritic, the only way to fix it is through replacement of the joint itself. Although the same applies to arthritis of the knee, the knee is also much easier to treat with minimally invasive procedures.
“Scope procedures can be done to treat problems in the knee such as tears in the meniscus (a piece of cartilage in the knee that commonly tears), ligament tears, and even focal cartilage defects that can be treated with cartilage restoration or transplant techniques,” says Dr. Corpus.
More Than One Solution
Although they are surgeons in name and by trade, physicians like Dr. Corpus and his colleagues Dr. Jordan Meiss and Dr. Tyler Surma believe in avoiding surgery as much as possible.
“Most conditions for which patients seek treatment can and should be treated non-operatively first,” Dr. Corpus insists. “First, there are multiple activity related options. These would include physical therapy to focus on range of motion and strengthening, low impact exercise to decrease stress on the joints, and weight loss, which can offload the joints.”
There are also anti-inflammatory medications in both oral and topical formulations and several types of injections, of which cortisone is the easiest and cheapest to administer. Cortisone is a steroid that acts as a potent anti-inflammatory, decreasing pain in the joint. “These injections are not actually going to result in any healing,” Dr. Corpus points out, “but more so symptom management.”
Viscosupplementation is another treatment that can have more effective results for early knee arthritis. A type of injection, viscosupplementation uses hyaluronic acid, which mimics the fluid naturally found in the joint. This fluid provides lubrication, compression, and has anti-inflammatory properties.
One treatment may not be as effective as another as each person’s need will differ, so it’s important to consult with your physician as to which regimen will work best for you.
When a machine breaks down, sometimes rebuilding the problematic part is not going to be sufficient—that part needs to be replaced altogether. With hips and knees, a joint replacement is just that, but that replacement can be straightforward or complex.
“If a patient has had previous surgery, deformity of the bone, old hardware, or a congenital condition, then the first-time surgery can be more difficult. This could mean a different surgical approach or additional equipment and parts are needed to safely complete the surgery,” explains Dr. Tyler Surma, a surgeon specializing in total hip and knee replacements as well as complex revision total hip and knee surgery.
“Revision surgery, a surgery which refers to correcting a joint replacement that has already been placed, would fall under the category of ‘complex,’” Dr. Surma continues. “In general, complex joint replacement might take more time, planning, and have higher complication rates, but ultimately may help patients maximize their function and reduce their pain.”
Again, every case is different. More complex issues require more time and energy both in workup and planning as well as in execution. Dr. Surma says it is not uncommon to have multiple plans in place to be prepared for any scenario when revising a failed joint replacement.
New Ways—Better Results
Although revisions still occur, hip and knee revisions only account for about seven percent of total joint replacement procedures, which have an annual failure rate of 0.5-1.0 percent. Nevertheless, technology is always being developed and utilized in order to bring down the need for revisions even further.
For instance, a joint replacement robot arm is now being used by physicians like Dr. Jordan Meiss, a sports medicine and arthroplasty surgeon specializing in hip, knee, and shoulder arthroscopy as well as hip, knee, and shoulder replacements.
First, “the robot takes a pre-surgery series of x-rays to create three-dimensional modeling and data to more accurately place the implant,” explains Dr. Meiss. “This can mean greater precision with less bone and tissue disturbed, which can enhance recovery and improve accuracy for a more natural feeling joint. Currently, we use this for total knee replacement surgery. There will be upcoming utilization for hip replacement surgery.”
Technological improvements also allow the surgeons to create detailed, precise surgical plans for hip arthroscopy and total shoulder replacement surgeries. Increased accuracy, particularly with the use of robotic assistance, may reduce the need for revision surgeries as well.
“A common reason for revision surgery after hip arthroscopy is unaddressed or residual deformity of the hip causing impingement,” Dr. Meiss says. “With new technology, we can three-dimensionally map out the full impingement deformity and make sure we correct it in entirety.”
Also used by Great Plains Orthopaedics at St. Francis Medical Center is a state-of-the-art traction table, which eliminates a groin traction post typically used in hip arthroscopy. “Using our revolutionary post-less traction table allows patients faster recovery and mitigates some of the biggest side-effects commonly experienced by patients after hip arthroscopy,” adds Dr. Corpus.
“Joints in general like to be moved,” Dr. Corpus confirms. “For that reason, keeping active is one of the most important aspects of maintaining good joint health. Maintaining an active lifestyle also has the added benefit of keeping weight under control.”
The influence of weight upon joint health cannot be understated. For every single pound of body weight, your joints feel three to five times that amount of force exerted.
“All exercise, though, is not created equal,” the doctor advises. “Especially for people with joint pain, we recommend low-impact activities. Walking, biking, elliptical trainer, etc. are all great modalities as running and other high-impact activities can cause more pain and breakdown of the joints.” Exercising in a swimming pool is also a great method as the buoyancy of water can decrease your effective body weight, therefore exerting less force on your joints.
Regardless of the course of treatment—be it exercise, injections, or joint replacement—all are meant to bring your joints back to proper function.
That too is the singular goal of the surgeons of Great Plains Orthopaedics: to fix your joints so you can get back on the move.
Serving Peoria, Pekin, Galesburg, and Kewanee, Great Plains Orthopaedics is the only orthopedic group in the area that employs physicians skilled and fellowship-trained in hip arthroscopy. Visit their website at www.greatplainsortho.org.
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