Welcome
Specialties
Anatomical
Elbow, Hand and Wrist, Hip, Knee, Shoulder
Treatment
Arthritis, Arthroscopic Surgery, Joint Replacement, Rehabilitation, Sports Medicine, Minimally Invasive Surgery
My approach to treating patients
Providing state-of-the-art surgical care for adult joint disorders has been my primary focus for the past 18 years. In these years of providing orthopedic care to our community, I’ve found that many musculoskeletal conditions, from sports injuries to advanced arthritis, respond well to non-operative treatments. If surgery is necessary, I believe in treating conditions with the least invasive technique possible.
Hip Arthroscopy
For some hip conditions, the least invasive surgical procedure is HIP ARTRHOSCOPY, which I have been performing since 1989. This technically demanding procedure involves viewing the inside of the hip joint with a fiber optic telescope. By using specialized trimmers, shavers, and graspers I am able to smooth torn or roughened tissues in the hip or remove loose bodies (joint mice) through small 1/4" (one quarter inch) incisions. The patient is routinely sent home the same day as the surgery.
Total Hip Arthroplasty (Total Hip Replacement)
For patients with advanced arthritis of the hip, requiring TOTAL HIP ARTHROPLASTY, I use the anterior single mini-incision technique. This procedure requires only one incision in the front of the hip and has the distinct advantage of not detaching muscles from the pelvis or femur. A specialized table, the OSI PROfx, allows positioning of the hip for femoral component placement -- a positioning option not possible with conventional tables. The lack of disturbance to the lateral and posterior soft tissues provides immediate stability of the hip after surgery. This means the muscles about the hip are preserved, thus enabling patients a more rapid recovery and quick return to normal activities. The anterior approach total hip arthroplasty has the distinction of being the most muscle-sparing technique, and therefore, the most MINIMALLY INVASIVE. The only patient to have climbed Mt. Everest with a total hip replacement had his procedure done with this technique.
In contrast, there are several 'mini-incision' techniques which access the hip from back of the joint. This posterior approach to the hip requires an incision through one of the most powerful muscle units in the hip, the gluteus maximus as well as the complete detachment of six other muscles. Cutting muscles necessitates limitations of activity such as putting weight on your hip as you get out of a chair and increases the risk of dislocation. Posterior mini-incision hip replacement is quicker and easier for the surgeon, however it is moderately invasive and permanently affects the muscles of your hip.
With anterior approach hip replacement, there are no restrictions on positioning the hip, and no restrictions on activity other than running and jumping sports.
Knee Conditions
For KNEE conditions, it is important to choose the right operation for the individual patient. I offer a continuum of care for knee conditions including bracing, physical therapy, cortisone injections and viscosupplementation (Hyalgan). Surgical options include arthroscopy, ligament reconstruction and cartilage transplantation procedures.
For more advanced KNEE ARTHRITIS in younger patients (60's and below), the UniSpacer knee arthroplasty can bring significant pain relief with a relatively conservative procedure (see Links section for more information).
Many patients do well with procedures which resurface only one compartment of the knee; these are called UNICOMPARTMENTAL ARTHROPLASTIES. In these procedures, only one of the three compartments of the knee is resurfaced: the medial (inner), lateral (outer) or patellofemoral (kneecap). A more conservative procedure results in pain relief with a faster recovery.
If two or more compartments of the knee have severe arthritis, it is better to go with the complete knee resurfacing (total knee arthroplasty or total knee replacement). The above knee resurfacing procedures are performed through a muscle preserving approach called the SUBVASTUS approach. This approach leaves the attachment of the main muscle on the front of the thigh (quadriceps) to the kneecap (patella). This is a major advantage because it has been shown to speed up the recovery process by allowing patients to regain strength in the leg. The standard approach, which detaches one third to one half of the quadriceps muscle from the kneecap, requires a longer recovery period.
Shoulder Impingement Tendinitis
SHOULDER IMPINGEMENT TENDINITIS is a very common condition which affects teenagers to seniors. One of the hallmarks of this condition is pain in the shoulder and upper arm when reaching overhead. This very painful condition can interfere with sleep as well as activities of daily living. Sometimes there is associated hand numbness or shoulder stiffness. Generally, the problem is that the ROTATOR CUFF TENDONS do not have enough room to slide easily. This can be due to a normal anatomic variation (which affects about one third of the population) or bone spurs that develop on the acromion or acromioclavicular joint (end of collar bone). If you have had shoulder impingement symptoms for four months or more, it is advisable to have your shoulder examined and have x-rays. In many cases, this condition can be relieved through an outpatient arthroscopic procedure in which the bone spurs are shaved away from the tendon. It is advisable to have this condition treated sooner rather than later because left on its own, chronic impingement can result in a ROTATOR CUFF TEAR. Cuff tears are extremely common: two thirds (2/3) of patients who reach the age of 70 have torn one or both rotator cuffs. Even though rotator cuff tears can usually be repaired with a minimally invasive technique, you will be ahead of the game if you have your shoulder pain treated early.
Carpal Tunnel Syndrome
CARPAL TUNNEL SYNDROME is an extremely common condition in which the main nerve to the hand is trapped as it enters the wrist. Because the median nerve has too much pressure on it, patients have varying degrees of pain, tingling, numbness or weakness in the thumb, index, long and ring fingers, and occasionally the entire hand. The traditional surgical approach to carpal tunnel release was to make an incision directly through base of the palm. This direct approach was effective, however, the skin of the palm has many nerve endings and long-lasting scar sensitivity was frequently a problem. In addition, subcutaneous tissue, tendon and muscles had to be cut to get to the carpal tunnel. Since 1990, I have been using an ENDOSCOPIC CARPAL TUNNEL RELEASE technique. This approach uses a single one half inch incision in the wrist flexor crease—no incision is made on the palm. The transverse carpal ligament is divided from the inside out. Patients have a much faster recovery. Because patients can do most activities immediately after endoscopic carpal tunnel release, patients that have carpal tunnel syndrome in both hands can have both sides released in the same session. This has a distinct advantage in overlapping recovery time and decreasing time away from work.
Physical Therapy
Early physical therapy often plays an important part in an accelerated recovery program. Many patients are pleasantly surprised at the speed of their recovery after arthroscopy of the shoulder, elbow, carpal tunnel, hip, knee or ankle.
Our Doctor/Patient Team I believe the most important aspects of providing quality care are listening to the needs of patients, presenting treatment options to the patient, and involving patients in the treatment plan.
Contact Information
Other staff in my practice
My office manager, Rina Fann, will be happy to assist you with any insurance or administrative questions.
My two practice partners, Brian Brenner, M.D. and Michael McCabe, M.D., both have subspecialty fellowship training and are Board Certified. If you are in the hospital on weekends or while I am at a seminar, Dr. Brenner or Dr. McCabe may be following your progress.