Risk Prediction Tools for Hip and Knee Replacement Surgery

Posted March 24, 2016 by Orthopaedic Specialists

The current healthcare environment in America has been driven by the concepts of quality, cost containment and value. Based on this, the federal government is starting a program that will incentivize physicians to maximize and reduce the patient’s risk factors prior to hip and knee replacement surgery. In fact, a physician’s reimbursement for the procedure will be directly related to post-surgical outcomes of their patients. Because of this, there are many studies right now looking at “tools” to predict high-risk patients to figure out if those patients should even be offered a knee replacement or if there are pre-surgical ways to reduce the risk factors.

There was an article published by Dr. David Manning in the American Academy of Orthopedic Surgeries Journal, this January. This report looked at risk prediction tools for hip and knee replacement surgery.

In this article, Dr. Manning noted that total knee Total Hip and Knee Replacement Surgery and total hip surgeries comprised a largest procedural expenditure in the Medicare budget. And the complication rate for these surgeries varies anywhere between 2 percent and 14 percent. Higher complication rates are associated with the elderly and patients with additional disorders and high risk factors. Between 1991 and 2010, the mean number of comorbidities among Medicare patients undergoing elective total knee replacement nearly doubled from 1.2 to 2.1, and this trend is expected to continue.

Patients treated with total knee replacement show that the rate of diabetes mellitus increased from 10.5 percent to 24.2 percent. The rate of obesity increased from 4 percent to 10 percent during the same period. Complications that are seen after total joint replacement such as infection, blood clots, heart attacks, pneumonia, are associated with poor patient outcomes, and in addition represented a substantial cost burden to the American healthcare system.

Quality Improvement Initiatives Target Total Hip and Knee Replacement Surgery

Over the next five years, elective total hip and total knee replacements will be incorporated into several quality improvement initiatives, developed by the Center for Medicare and Medicaid Services. Because risk prediction tools or risk calculations are being developed, physicians are receiving help to determine who is eligible for a knee replacement or hip surgery. It is also working to understand if those risk factors can be modified pre-surgical efforts. (more…)

YMCA Norton Commons Gym Expansion

Posted March 22, 2016 by Orthopaedic Specialists

Norton Commons YMCA Board of Directors visit the gym expansion site.

Members of the YMCA Norton Commons Board of Directors (including Louisville orthopedic Dr. Stacie Grossfeld) gathered with Norton Commons Elementary School principal, Allyson Vitato, on March 17th, to visit the new gym that is currently being built to connect to Norton Commons Elementary School. This 1,909 square foot expansion will allow the YMCA to increase their kids club space. The administrator of the Norton Commons YMCA, Mike Bramer, gave board members an informal walk-through of the current conditions of this expansion. He announced that construction will begin this summer in August 2016.

The board meeting kicked off with an introductory session, followed by a prayer and a relationship building discussion led by Dr. Grossfeld. She explained the importance of networking and relationship building for the YMCA and other organizations in Louisville. Dr. Grossfeld enjoyed sharing her ideas for this new expansion that involves connecting with the community in various ways. She has an idea to host a joint parent night out with the YMCA and Kentucky Country Day School.

Along with serving on the YMCA Norton Commons Board of Directors, Dr. Grossfeld is also on the Board of Directors for the Louisville Sports Commission. She is hoping to connect these two great organizations while increasing community involvement. The Louisville Sports Commission has discussed ideas for gathering used equipment, as well as creating other benefits through the YMCA. The board is in contact with family medicine practitioner, Dr. Jesse Jenkins, to discuss initiatives that (more…)

Experiencing Elbow Pain? 5 Things it Could be

Posted March 21, 2016 by Orthopaedic Specialists

5 Common Elbow Injuries that Cause Elbow Pain Many people experience elbow pain at some point in time. Your elbow is a somewhat complex mechanism that relies on three different bones for support and movement. The elbow gives your arm the ability to rotate outward and inward, while also working like a hinge upward and downward.

The functional design of your elbow allows movement, flexion and rotation of your arms. Sometimes, these repeated and irregular movements can cause elbow pain. While minor elbow pain may indicate a small strain, more constant or severe pain may be cause for concern. For those struggling with elbow pain, here are 5 common causes.

5 Causes of Elbow Pain

Tendinitis: Elbow tendinitis or “Tennis Elbow” is a real source of pain for many active individuals, and for those repeatedly using forearm muscles often in certain workplace environments. Activities like window washing, swinging a tennis racket, or making home repairs, can aggravate your elbow and cause the tendons to become inflamed. This is often followed by swelling and warmth at the site. Typically, when a physician identifies tendinitis as the cause of your elbow pain, he or she will suggest rest, ice and possibly a brace for the affected area. Anti-inflammatory medications may also be helpful when treating pain and inflammation.
Bursitis: Bursae are fluid-filled sacs designed to provide cushioning between bones and tissue. In the case of elbow pain, the flat olecranon bursa is located at the back of the elbow. When this bursa becomes irritated and inflamed, the area may become fluid-filled and bursitis will start to develop. This injury tends to occur after trauma or prolonged pressure such as leaning on your elbows while typing on the computer. This condition causes pain, swelling and redness to the affected area. Following a physician’s examination and diagnosis, anti-inflammatory medications may be recommended. Changing your activities and wearing an elbow pad may also be advised. This condition is for the most part easily treatable and comes with a speedy recovery.
Arthritis: Arthritis located in your elbow is the cause of swelling, tenderness, pain and decreased range of motion. This condition targets joints and causes inflammation and erosion of cartilage and bone. In order to combat this pain, your doctor may prescribe anti-inflammatory medications, while alternating between heat and ice for the affected area. Other possible treatment options for arthritis in your elbow include: bracing the elbow, changing activities and undergoing cortisone injections.
Sprain or Broken Elbow: During irregular movements, accidents or intense physical activities, your elbow may take the brunt of the pain. A collision or unusual impact could cause your elbow to strain the ligaments or fracture the bones. If you suspect a break or strain, you should see a physician for a physical exam and possible x-rays. If your elbow is broken, the treatment generally requires immobilization or surgery. If a strain is present, your physician will suggest rest, ice, immobilization, compression and anti-inflammatory medications to reduce pain and swelling.
Cellulitis: Another common cause of elbow pain actually involves inflammation of the skin. Cellulitis occurs when an abrasion or puncture wound allows bacteria to move from the surface of the skin, into the deeper layers. The symptoms of this condition are characterized by redness, warmth, swelling and heat on the surface of the skin. Often, individuals with cellulitis will exhibit a low-grade fever. Treatment for this condition involves antibiotic medication, rest and over-the-counter pain relievers. This infection can worsen if left untreated, so make sure to seek medical attention if you suspect cellulitis.

Just because you feel pain in your elbow doesn’t mean you have a broken elbow or cellulitis. (more…)

10 Differences Between Osteoarthritis and Meniscal Tears

Posted March 21, 2016 by Orthopaedic Specialists

Knee Osteoarthritis and meniscal tear types of knee pain Osteoarthritis and meniscal tears are injuries that both occur in the knees. Both knee injuries tend to become more probable to occur with age; however, there are significant differences between osteoarthritis and meniscal tear injuries. The pain associated with both injuries require different treatment approaches. A big factor that decides treatment is if the pain is a result of a particular injury or health factor. To understand these two distinct injuries that occur in the knees, here are 10 major differences between the two.

1. Pain Type

You will be able to identify the type of injury you have as a result of the pain that occurs. Pain from osteoarthritis is a dull pain that aches constantly. Meniscal tears, on the other hand, give off sharp, stabbing pain in the knee area.

2. Location

Identifying where your pain is coming from will also help to differentiate between osteoarthritis and a meniscal tear. Meniscal tears are right on the joint line with very distinct localized region of pain. Osteoarthritis has a more generalized pain affecting the whole knee joint and is difficult to pinpoint with one finger.

3. Symptoms

A torn meniscus tends to have a clicking and popping along with mechanical symptoms where the knee will catch. Osteoarthritis produces a dull throbbing aching pain yet has no mechanical symptoms.

4. Diagnostic Imaging

Meniscal tears are diagnosed with an MRI scan while osteoarthritis is detected through a plain standing knee x-ray.

5. Definition

Meniscal tears involve the meniscus which is a shock absorber between the two bones in your knee joint that functions to cushion both bones. Osteoarthritis is the breakdown of the cartilage that covers the ends of your bones within the knee joint.

6. Age of Onset

Meniscal tears tend to occur in a younger population between ages of 40 and 60. Osteoarthritis more commonly occurs in patients over age 60.

7. Signs

Meniscal tear patients tend to have knee swelling with sharp stabbing pain which is localized. Patients with osteoarthritic knees may appear to be bow legged or knock-kneed with palpable bone spurs or osteophytes at the joint line.

8. Gender Predisposition

No gender predispositions effect either types of injury.

9. Genetic Predisposition

No data proves there is genetic predisposition to meniscal tears. Osteoarthritis has a strong genetic component.

10. Treatment

Treatment for meniscal tears in a young active patient involves surgery. However, osteoarthritis treatment involves oral NSAIDS, cortisone injections, hyaluronic acid injections, bracing, and physical therapy. When all else fails joint replacement surgery becomes an option.

If you suspect either type of injury or pain, call Dr. Grossfeld’s office today at 502-212-2663 to schedule an appointment. These injuries require a physical exam and possible further testing to determine either type of knee pain.

Cost Effectiveness of Weight Loss Surgery Prior to Total Knee Replacement In Morbidly Obese Patients

Posted March 18, 2016 by Orthopaedic Specialists

Weight Loss Surgery Knee Replacement With changes in healthcare, one new policy will be in effect in upcoming years that affects doctors and patients alike. A new policy will rate physicians based on their patient’s post surgery complications. This means that doctors will be treating patients’ current issues, and other contributing factors to receive a positive outcome.

We know from the literature and studies that one common reason for post-surgical complications is the patients’ weight or BMI. The higher the BMI and the more obesity is present, the higher the risk of complications.

With patients undergoing joint replacement surgery it has been found that patients that had BMIs greater than 40 are at higher risk for complications than patients with a BMI <40. Because of this, surgeons will be recommending weight loss surgery prior to knee replacement.

Study Results

A study published in the Journal of Bone and Joint Surgery, December 2016 issue took computer model based evaluations and determined it is cost effective for patients that are morbidly obese to undergo bariatric surgery prior to knee replacement. The complications that occur secondary to the patient’s morbid obesity in a dollar value are more than the cost of the patient undergoing bariatric surgery.

Post-surgical complications reduce significantly when patient’s BMIs are less than 40. Therefore, in the future, your orthopedic surgeon may be recommending bariatric or weight loss surgery prior to knee replacement surgery.

Shoulder and Rotator Cuff Tears – Latest Research

Posted March 13, 2016 by Orthopaedic Specialists

We know that rotator cuff tears commonly affect one shoulder, especially in patients who are over age 55. However, there is a group of patients that not only tear one shoulder, but end up tearing their contralateral shoulder as well. There was a study published in the American Journal of Sports Medicine in May, 2015, that specifically looked at patients undergoing rotator cuff repairs and tears on the contralateral side, that is the other shoulder.

The study was completed through the Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea. The first author was Dr. Kyung-Han Ro. Looking at 140 patients who underwent a rotator cuff repair, researchers found that 38.6 percent of them had a rotator cuff tear on the contralateral shoulder.

Understanding Different Sizes of Rotator Cuff Tears

Dr. Ro divided the patients into three groups: 1) patients that had a small rotator cuff tear, 2) patients who had a medium sized rotator cuff tear, and 3) those with a large size rotator cuff tear. Researchers compared each of the patient groups to determine the chance of suffering a cuff tear on the contralateral shoulder.

Researchers found that the patients that had a bigger rotator cuff tear, had a higher incidence of tears involving their contralateral shoulder. The patients that had small tears had a lesser chance of having a tear on the contralateral shoulder compared to the group that had large or massive rotator cuff tears. The conclusion of the study showed that the prevalence of rotator cuff tears of the contralateral shoulder tends to be higher in patients who are more symptomatic and have a larger rotator cuff tear on one side. (more…)

Study on Vitamin D Levels in Pro Football Players

Posted March 11, 2016 by Orthopaedic Specialists

Vitamin D Deficiencies Vitamin D deficiency is epidemic that affects an estimated one billion people worldwide. This nutrient is associated with many functions and organs in your body. Research shows that insufficient levels are associated with a greater rate of heart disease and mortality. Vitamin D levels less than 20 ng/mL are associated with a risk increase to 30 to 50 percent for developing colon, prostate, and breast cancer as well as an increased mortality from these cancers. In addition, vitamin D helps to maintain the health of your bones and muscles.

Dr. Joseph Maroon studied the vitamin D levels in 80 professional football players. The department of neurosurgery at the University of Pittsburg Medical Center performed the investigation. The American Journal of Sports Medicine reported the finding in their May 2015 issue.

Before looking into this study any further, you might need to know more about the science behind vitamin D. While this nutrient is used to maintain a healthy musculoskeletal system it’s also converted to 25-hydroxyvimtain D in the liver. Then it is further converted to its active form which is 1, 25(OH)2D. This happens in any of the kidneys or other tissues such as breast, colon, prostate gland, and the knee itself. The production of vitamin D in local tissues regulates cell growth, controls immune function, and affects gene expression. It is also used for calcium and phosphorus metabolism.

We know that calcium and phosphorus are very important to bone and muscle health. Adequate calcium and phosphorus levels promote bone mineralization and also cause increased absorption of calcium and phosphorus from the intestines. It has been shown that phosphorus imbalance from low vitamin D causes muscle weakness, but can be reversed with supplementation. There is a direct effect of vitamin D on the muscle cells and receptors that induces new protein synthesis.

Vitamin D deficiency is at level of less than 20 ng/mL, it becomes insufficiency when your level is between 20 and 32 ng/mL, and normal levels will be greater than 32 ng/mL.

Vitamin D deficiencies have been documented in risk groups including: children, elderly, women wearing burqas, and those with dark skin. More recently, studies have indicated that athletes especially professional ones have an increased incidence of deficiencies.

In the study listed above concerning the 80 professional football players, vitamin D levels range from extremely low to 8 up to 59 ng/mL, with 68.8 percent of the team having levels that were less than adequate. The ages of the athlete range from 22 to 37 years. The majority of these athletes were Afro-American making up 67 percent of the 80 athletes studied. The Afro-American athletes have significantly lower vitamin D levels than the Caucasian athletes.

There was a much higher rate of deficiency or insufficient vitamin D levels. In fact, all of the athletes with deficient vitamin D levels were Afro-American, as were 90 percent of the athletes with insufficient levels.

The authors looked to see if there was an increased incidence of fracture among the Athletes with low vitamin D levels. The researchers found the levels were significantly lower in the athletes who experienced a fracture. Thirty-seven percent of the NFL players have experienced a fracture, 9 of which experienced more than one fracture.

In conclusion, the author stated that the deficiency and insufficiency was significantly greater among Afro-American football players as compared to Caucasian players. Low vitamin D was associated with increased number of bone fractures. The overall prevalence of this deficiency in the studies was 26.3 percent which was comparable with 30.3 percent found in another study authored by Dr. Shindle. When combining patients with this deficiency and insufficient levels, the amount of players in this category was 68.8 percent.

Consistent prior literature, African-American football players have a much higher prevalence of inadequate levels when compared to Caucasian players, 77.6 percent versus 23.1 percent. Due to inhibited ultraviolet absorption and increased amount of melatonin in the skin pigmentation, dark skin is a known risk factor for low levels.

Additionally, researchers found the vitamin D levels were inversely related to fracture prevalence. The authors recommended based on their findings of their research that routine monitoring and optimization of these levels should be considered as part of the routine care of NFL players with special attention to African-American athletes.

If you are an athlete suffering from multiple fractures then a Vitamin D deficiency may be the problem. Contact Dr. Stacie Grossfeld of Orthopaedic Specialists today at 502-212-2663.

Orthopedic Practice Owner Receives Small Business Owner of the Year Award

Posted March 7, 2016 by Orthopaedic Specialists

Dr. Stacie Grossfeld Award Recipient The 22nd Annual National Association of Women Business Owner EPIC Awards dinner was held on Thursday, March 3, 2016, at 5:30 p.m. at the Mellwood Arts & Entertainment Center in Louisville, Kentucky. Louisville orthopedic surgeon and sports medicine doctor Stacie Grossfeld M.D. received the Small Business Owner of the Year Award.

Dr. Grossfeld is the owner of Orthopaedic Specialists, an orthopedic and sports medicine practice with two area locations in Louisville, Kentucky. Other NAWBO EPIC award categories included: Large Business Owner of the Year, Humanitarian Award, Supporting Partner Award, Phoenix Award and Associate Owner Award.

Business Owners Award Recipients This special event, designed to recognize and celebrate the accomplishments of women business owners, included a cocktail reception compliments of Hilliard Lyons and a three-course dinner. Twelve award finalists gave brief speeches (complete with live voting from the audience) while Tim Laird, Chief Entertainment Officer of Brown-Forman Corporation, served as Master of Ceremonies, and Heather Howell, Director of Innovation at Brown-Forman, was the guest speaker.

Reflecting on her success as a female business owner, and her receipt of this special award: Dr. Grossfeld explains: “At the end of the day, my advice to all women business owners is to follow the golden rule: do onto others as you would have others do onto you.” She also emphasizes the importance of having a great team, stating: “If I didn’t have the crew of people I have working with me, I would not have received this award. They make all the difference.”

And the staff at Orthopaedic Specialists share similar sentiments when talking about Dr. Grossfeld’s success as Small Business Owner of the Year. For example, as explained by Marti Spencer, a medical receptionist at Orthopaedic Specialists: “Words cannot express how incredibly honored I am to work for this woman. She is an amazing boss and a phenomenal physician. We really do have such a wonderful group of people at work and it feels so much like family. I am so proud of my doctor and I want to give her major accolades for doing so well for herself. Dr. Stacie Grossfeld thank you so much for being you and for being such a wonderful boss. Congratulations you deserve this award!”

Award recipient and son Other 2016 EPIC Award recipients included Summer Auerbach, Owner of Rainbow Blossom, who received the Large Business Owner of the Year Award (for companies with more than 50 employees). EPIC stands for: Excellence as a woman business owner. Professional accomplishments during the past 5 years. Initiative and creativity in addressing major business challenges. Civic and community involvement.

Read the full article here.

Core Conditioning – Why It’s Important and What You Can Do About It

Posted March 7, 2016 by Orthopaedic Specialists

Your core is not just a 6-pack of abs or something that turned into a beer belly. Your core is responsible for some of the most basic functions your body is able to perform. While your core provides support and strength, it’s also responsible for reducing pain and accomplishing tasks. Your core affects the way you sit, walk, stand and exercise. Because your core is connected to your back, glutes, spinal cord and legs, this part of your body helps you balance and keep everything together. Core conditioning exercises are important

Your core is made up of three areas of muscle: the upper abs, side muscles or obliques, and then a deep layer of muscle. These deep muscles help support your spine and the rest of your body.

Core conditioning exercises are very important for every person, regardless of your fitness goals and abilities. When targeting your core during training sessions, it doesn’t always doesn’t always mean crunches. You can exercise your core through things like yoga, Pilates and other strength training activities. And you can always engage core muscles during popular exercises like squats and lunges. Keeping your stomach tight and clenched during these exercises creates an added benefit for your abdominals.

6 Exercises You Can Do For Core Conditioning

Here are some specific core conditioning exercises you can do at home or at the gym to strengthen your core:

Crunches: Lie down on your back with your knees bent and feet flat on the floor. While keeping your feet firmly on the floor, move your upper body toward your knees, and then go back to the floor. Use only your stomach muscles to lift your upper body from the floor. Complete 12 to 15 reps for 3 rounds, if possible.
Planks: While resting on your elbows, press up from your toes and balance in this position for 30-60 seconds for 3 rounds. Keep your hips in line with the rest of your body without letting them sag.
Arms and Leg Raise with a Stability Ball: Using a stability ball, rest your hips on top of the ball, with your feet and arms touching the floor. Alternate between lifting opposite arms and legs at the same time. For example: tighten your core and raise your right arm and left leg. Complete 12 to 15 exercises for 3 rounds.

For those stuck at a desk all day, there are some stretches and exercises you can incorporate into your workday to strengthen your core.

Ab Squeeze: Sit upright in your chair. Squeeze your abs for as long and tight as possible for 2 to 5 seconds. Release and then repeat this for 12 to 15 reps for 3 rounds.
Accordions: Balance on your chair without resting your back on your chair. Hold on to the arms for support while you move your legs out and in from your body. This will target your lower abs and get your blood pumping. Perform 12 to 15 reps for 3 rounds.
Alternating Elbows and Knees: Just like the bicycle abdominal exercise, you can perform something similar from your office chair. Place your opposite arm on the side of your head and raise your opposite leg at the same time. Twist your upper half while moving your lower half to meet your elbow. Try 12 to 15 reps for 3 rounds.

Core conditioning exercises are a great compliment to any fitness routine. (more…)

A Broken Wrist – Signs, Symptoms and Treatment Options

Posted March 3, 2016 by Orthopaedic Specialists

Common Symptoms of a broken wrist At some point in time, many people suffer from a broken wrist. Children and the elderly are at higher risk for this common injury. Follow along for more important information about symptoms and treatment options for a broken wrist.

There are eight small bones that make up your wrist called carpal bones. And there are two longer bones attached in your forearm called the radius and the ulna. These bones work together to allow your wrist to move and bend.

The wrist allows four different movements: Flexion, extension, adduction and abduction. Most wrist injuries occur after people try and catch themselves when falling. An unexpected and awkward landing causes the bones in a person’s wrist to break or crack after taking the brunt of the fall. Along with falls, sports injuries and motor vehicle crashes are common causes of a broken wrist.

Signs and Symptoms of a Broken Wrist

If you have sustained an injury to your wrist, there are many signs and symptoms you might experience including the following:

● Pain when gripping or squeezing your hand
● Swelling
● Tenderness
● Bruising
● Deformity
● Stiffness
● Loss of motion
● Numbness

All of the above symptoms can be indicators of a broken wrist. It is important to pay attention to these symptoms before your pain worsens. You will want to seek medical treatment immediately if you suspect a broken wrist.

When you meet with a physician, you should be prepared to provide a detailed description of how the wrist injury occurred, as well as any past medical problems you have. If your doctor suspects a broken wrist, imaging scans like x-rays may be required to further examine the injury.

If your doctor diagnoses you with a broken wrist, he or she will manipulate your bones to place them back to their proper alignment. After this process, your physician will most likely immobilize this area with either a splint or a cast. Your physician will also prescribe (more…)