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The Quad City Area’s Only Group of All Board-Certified
and
Fellowship-Trained Orthopaedic Surgeons

The Quad City Area’s Only Group of All Board-Certified
and
Fellowship-Trained Orthopaedic Surgeons

Practice News

Outpatient Spine Surgery: Which Cases are Best for Outpatient Spine?

For close to the last 10 years, there has been a move to perform spine surgeries away from hospitals and into outpatient ambulatory surgery centers. From a clinical standpoint, the advancements in technology have played the largest role in this transition. Minimally invasive surgical instrumentation, such as operating microscopes and enhanced lighting, with changes in pre and post operative drug protocols, have made pain management throughout the process much easier. Surgical techniques have also changed, giving surgeons many different options for less risky, minimally invasive surgery. Overall, these changes have allowed patients to be ambulatory and moving around much quicker after surgery. As a result, the ambulatory setting is likely to continue to grow for spine procedures over the next 10 years.

What Are the Most Common Conditions Requiring Outpatient Spine Surgery? There are several common conditions that Dr. Dolphin commonly sees in patients that are ideal for outpatient spine surgery. Among the most common are herniated discs, spinal stenosis and cervical degeneration. One of the surgeon’s most important roles is to educate you on the different treatment options for your condition and assist you in the decision making process. Part of this process is providing you with options but also making sure that the expectations of what are technically possible, as well as discussing the risk and potential benefits of these options, is communicated.

How does outpatient spine surgery differ from inpatient spine surgery? Minimally invasive outpatient spine surgery, is a surgical technique that allows the spine condition to be surgically corrected with small surgical incisions. When compared to a more traditional inpatient surgery, minimally invasive surgical procedures are much less damaging to the soft tissue and muscles that surround the spine. This typically results in a much quicker recovery. Other common advantages of this approach include less blood loss and a lower rate of postoperative infection when compared to traditional inpatient spine surgery. Patients are typically home within hours of surgery for most cases. Some of the most common outpatient spine surgeries that Dr. Dolphin performs are:

Lumbar discectomy is the most common spinal surgical procedure performed and can safely be done on an outpatient basis. A recent study published Spine (01 February 2013 – Volume 38 – Issue 3 – p 264–271), looked at patients who underwent lumbar discectomy between the years 2005 and 2010 (a total of 4310 inpatient and 1652 outpatient). This study showed that patients undergoing outpatient lumbar discectomy had lower overall short term complication rates then those who had the same surgery performed on an inpatient basis. In addition to lumbar microdiscetomy, Dr. Dolphin also performs cervical discectomies to alleviate the pain associated with herniated/ruptured discs in the neck or cervical spine.

As the only spine surgeon in the Quad Cities to perform spine surgeries in an outpatient ambulatory surgery center, Dr. Michael Dolphin, of Orthopaedic Specialists, has been leading the charge to grow this option for patients locally. “As technology continues to improve and the large baby boomer population continues to grow older, it is my hope that Medicare, like most other commercial insurance carriers have, will begin to see both the financial and quality benefit t of allowing these sort of procedures to be performed on an outpatient basis,” says Dr. Dolphin.  “The data is there to support safety, quality, outstanding results and cost savings.”

For more information on other back and neck conditions that Dr. Dolphin performs please visit www.osquadcities.com. Like us on Facebook at facebook.com/osquadcities. Dr. Dolphin’s next blog in this series will discuss the topic of “Laser Spine Surgery: Is it Really What it Says it Is?”

Ankle Replacement: Fusion Is Not the Only Option

Ankle injuries

One of the most common orthopaedic injuries that Dr. Tuvi Mendel, Fellowship Trained foot and ankle surgeon encounters in both athletes and non-athletes, are ankle sprains.  Depending on how much force or how far off the ankle moves in an awkard direction, ligaments can be stretched and in many cases, completely torn.   Braces, casts, cam-walkers, or boots can reduce pain considerably,  but they can also cause joint damage if used too long. Ligaments heal better when the ankle moves; restricting movement can scar the ligaments and make them painful and prone to re-injury.

Ankle sprains do vary in severity and while some can be treated with conservative treatment, many eventually require some sort of surgical management.

Ankle Arthritis

Regardless of the type of ankle sprain and treatment, occasionally injuries to the ankle will resurface as the development of posttraumatic arthritis, which is arthritis that shows up after an injury due to some sort of unseen inflammation or cartilage injury. It is very similar to osteoarthritis (the wear and tear type arthritis) seen in other joints like the knee and hip. The cartilage simply breaks down and causes inflammation, pain, stiffness and discomfort. Options as it relates to posttraumatic arthritis include lubricating type injection, cortisone or steroid type injection, appropriate bracing, ankle arthroscopy with debridement, ankle fusion and now more recently, ankle replacement.

Surgical Options

Ankles can simply wear out, too – primarily due to arthritic changes and pain. In those cases, the treatments are limited to two kinds of surgeries, fusion or replacement. Ten years ago the ankle fusion was the most common treatment option for severe ankle arthritis. With recent advances in technology and technique, the ankle replacement is used commonly to treat arthritis of the ankle with both osteoarthritis and posttraumatic arthritis. The ankle fusion is essentially indicated in every patient. Ankle replacement or arthroplasty does have limitations as it may be contraindicated in people with severe peripheral vascular disease, severe deformity, co-morbidities such as diabetes or people with severe osteoporosis.

When the lower leg’s bone is fused to the ankle’s main bone, the result is an ankle that is pain-free but that doesn’t move. So the other foot joints need to have good mobility.

For certain candidates, great strides have occurred in the area of total ankle replacement surgeries. “Total Ankle Replacement can last longer, perform better and offers quicker recovery,” explains foot and ankle fellowship-trained surgeon Tuvi Mendel, M.D., Orthopaedic Specialists, Davenport. “That surgery offers real advantages over the more traditional fusion procedure: It doesn’t limit joint motion like a joint fusion surgery does,” says Dr. Mendel. “And it provides a quicker recovery for most.” Because the replacement parts installed during the procedure can wear out, however, the procedure is not for everyone.

Dr. Mendel is the most experienced foot and ankle surgeon, in the Quad Cities, with ankle replacement. To learn more about this procedure or Dr. Mendel’s practice, please visit our website at www.osquadcities.com. Find us on facebook and like us to stay up to date with treatment options and information:   facebook.com/osquadcities. For a request for an evaluation, contact our office at 563.344.9292 or click here.

 

 

 

Outpatient Minimally Invasive Back Surgery

Xray spine

About 10 million adults suffer from chronic back and pain each year, making it the number one cause of healthcare expenditures in the U.S. In fact, back pain has a direct cost of more than $50 billion annually for diagnosis, treatment, and rehabilitation.Most patients’ spine disorders are related to degenerative conditions that can result in instability and intrusion into the spinal cord and surrounding nerves. This causes back pain and/or radiating pain in the arms or legs

But while back pain – especially in the lower back – is very common, the causes for the pain and the resulting treatment options are not always straightforward. That’s because lower back pain is different for everyone.

Lower back pain is most commonly a result of inactivity and an imbalance between physical demand on the lower back and the muscles being able to protect the spine from the rigors of everyday activities. Other common causes of lower back pain include obesity and smoking. Complicating the matter is the fact that many times the origins of lower back pain overlap – meaning that many factors play a role. This can make it difficult to pinpoint a specific of singular cause.

Minimally invasive surgery

A majority of the patients Dr. Dolphin sees are not surgical candidates. However, when surgery is the best option, Dr. Dolphin focuses on minimally invasive procedures that shorten recovery time and diminish post-operative pain.

Minimally invasive spine surgery uses technology that helps the surgeon locate the exact area upon which to operate. And, minimally invasive incisions are less than an inch long, thus damage to surrounding muscles and other tissues is very small. This speeds up the healing and recovery process. It also lessens the risk of infection.

“Overall, minimally invasive spine surgery is a less daunting experience – physically, psychologically and cosmetically,” said Dr. Dolphin. “Most people are at home resting within 23 hours or less after surgery and many of the procedures I perform are done on an outpatient basis in a surgery center.”

To learn more about the back and neck procedures that Dr. Dolphin performs or to schedule an appointment with Dr. Dolphin, call 563.344.9292.  Like us on Facebook at facebook.com/osquadcities to stay up to date with treatment options and information.  View one of many patient success stories on our Youtube page.

Rapid Recovery Outpatient Total Joint Replacements

knee painMany people battle knee pain for years.  Joint pain, particularly the knees, can limit your life, but thanks to great strides in minimally invasive surgery, Quad City area patients are staying out of the hospital, recovering faster and more economically than before. Patients usually come to me when they can’t do the things they love” says fellowship-trained orthopaedic surgeon Dr. John Hoffman, Orthopaedic Specialists (OS). “As Baby Boomers age, knee replacement surgery, in particular, and total joint replacements, in general, are becoming common.  Wear and tear is a part of the trend, trauma to the knee can cause problems, and even weight gain as people age puts stress on the knees or other joints such as hips or ankles,” he says.

Rapid Recovery Total Joint Replacement:  Better results, faster recovery, lower costs “The good news is that total joint replacement surgeries and outcomes have improved a great deal.  I’ve been doing total joint procedures for more than 20 years, and in the last decade, improvements in surgical techniques, anesthesia, and joint technology means more patients return to their active lives much faster than before.” What used to take 3-5 days to recover from in a hospital, is now being done in one day in Ambulatory Surgery Centers as well as in hospitals, thanks to new techniques and advancements in pain control and anesthesia.   Dr. John Hoffman has been the driving force behind a new program, Rapid Recovery Total Joint Surgery, which uses a combination of medicines before, during and after surgery to minimize discomfort and pain and a minimally invasive surgical technique, both of which when combined, maximize a patient’s ability to get up and get moving much faster following surgery.

What are the Advantages of Rapid Recovery Total Joint Surgery?  As Dr. Hoffman recently presented to the Iowa Orthopaedic Society, his outcomes data show patients are able to navigate stairs and walk several hundred feet unassisted the evening of surgery, walk several hundred feet the and stairs the morning after surgery, with 80% of all his patients are able to comfortably return home the day after surgery.  80% of Dr. Mendel’s knee replacement patients return to the comfort of their own home within 2 days of surgery.  As a result of the unique and minimally invasive approach and medication protocol that Dr. Hoffman, Director for the Quad Cities Rapid Recovery Program at Unity Health,  has developed, patients also benefit from:

  • Decreased pain and nausea:  A combination of local anesthetics and non-IV narcotics minimize discomfort and allow for only oral pain medications to be used, which typically results in decreased nausea and vomiting post operatively.
  • Accelerated post-operative rehabilitation:  Muscle paralyzing nerve blocks are avoided which allows for patients to be able to walk up and down stairs and walk several hundred feet evening of surgery.  Most patients typically are fairly independent with just the use of a cane or walker the day after surgery.
  • Advanced pain management: No IV pain narcotics
  • Comprehensive Pre-operative education program
  • High volume practice (Dr. Hoffman performs over 600 total joints performed each year and Dr. Mendel performs close to 200 total joint procedures each year)

Recent medicare data was released and showed that surgeons that performed over 50 total hip procedures had much better outcomes and less infection and complication rates then surgeons who did not.  On average, Dr. Hoffman performs close to 100 total hip procedures each year. For more information about this procedure and other procedures that Dr. Hoffman or Dr. Mendel performs, visit https://www.osquadcities.com/specialties/joint-replacement/ or call 563.344.9292. Visit our youtube page to review video testimonials from some of our patients who have had great outcomes and experiences with this and other procedures at www.youtube.com/osquadcities.

New Minimally Invasive Treatment for Plantar Fasciitis

Plantar fasciitis is one of the most common complaints relating to the foot that Dr. Tuvi Mendel of Orthopaedic Specialists, sees in both men and women.  “The most common complaint that I receive from patients is that the bottom their heel feels stiff and is painful”, according to Dr. Mendel.  “In most patients, pain is usually worse first thing in the morning when a patient takes their first steps, but may also be experienced after exercise or after standing or sitting for an extended period of time and is most commonly seen in men age 40-70.”

Plantar Fasciitis is a result of the plantar fascia, which is the soft tissue that supports your ach, becoming inflamed.  Acting as a shock absorber with each step that is taken, it can sustain small tears which lead to pain and inflammation.  Some common factors that lead to plantar fasciitis are poor shoe wear, loss of your arch, obesity, abnormal running or walking and trauma.

Until recently, there really has not been a viable treatment option that relieved the pain of plantar fasciitis permanently or long term.  Dr. Mendel is the only foot and ankle surgeon in the Quad Cities that is currently able to offer a new minimally invasive treatment, which is designed to break down the damaged tissue in the heal.  Dr. Mendel uses an ultrasound imaging system during the procedure, that locates the damaged tissue in the tendon.  This is done by making a very small incision and then the tip of the ultrasound machine is inserted delivering ultrasonic energy which in turn, breaks down the damaged tissue and removes it.  Typically no sutures are required and patients leave the operating room with a steri strip covering the small incision.

Most patients are back to normal activities in 6 weeks or less with little to no pain.  For more information about this procedure and other procedures that Dr. Mendel performs, visit https://www.osquadcities.com/specialties/foot-ankle/ or call 563.344.9292.

QC Patients Benefit from New Strides in Total Joint Replacement

Benefits to patients include shorter rehabilitation times and lower costs

(September 29, 2008, Davenport, IA) – Quad City patients can now undergo total joint surgery that gets them walking within hours of surgery and back home for recovery within 24 hours without a hospital stay – a cost-effective alternative addressing the future of health care as current debate over rising health care costs continues.

Davenport-based Orthopaedic Specialist Dr. John Hoffman, a fellowship-trained 20-year veteran who performs approximately 600 minimally-invasive total joint operations a year, says revolutionary improvements in surgical techniques, anesthesia, and joint technology are saving patients money and allowing them to return to their active lives much faster. It’s also a procedure expected to grow as the population ages.

“Joint replacements five years ago required a major incision (8-12 inches vs. 4 inches today), long-acting anesthetic and extended convalescence. Medical innovation now allows doctors to perform them safely and effectively so that patients recover at home and get back to life quicker,” explains Dr. Hoffman.

Better techniques lead to faster recovery and less need for hospitalization. “We employ new surgical techniques that spare patients’ muscle tissue,” explains Dr. Hoffman. “We have also fine-tuned regional anesthetic and pain management protocols. These factors allow most patients to be walking within hours of the procedure and home for recovery,” he adds. Dr. Hoffman has fined tuned his technique under the guidance of Richard Berger, M.D., a pioneer of minimally invasive hip and knee replacements practicing at Rush-Presbyterian-St. Luke’s Medical Center in Chicago.

(more…)

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