Preparing for Knee Replacement? What Happens Before the Surgery?

For the most part, knee replacement surgery or total knee arthroplasty is a very common operative procedure. In fact, in the last 20 years, knee replacement surgery has increased in volume by about 160%. And it’s projected that the number of total knee revisions is projected to increase by 600% in the next 15 years. A knee replacement revision occurs after your initial total knee replacement fails or wears out. If you’re preparing for knee replacement surgery, follow along for the latest research and insights.

Preoperative History – Preparing for Knee Replacement

Before knee replacement surgery, your orthopedic surgeon will assess the presence of your comorbid condition. This includes smoking status, alcohol consumption, medication, and mental status. These are very important to help guide preoperative evaluation and medical optimization.

Dr. Michael Tanzer and Dr. Makhdom published a review article on preparing for knee replacement in the Journal of American Academy of Orthopedic Surgeons in April 2016. The authors identified areas that must be looked at prior to joint replacement surgery. This is done to make sure that the patient awaiting surgery does not have any active infections or other health conditions that would negatively affect surgical outcomes.

Orthopedic surgeon preparing for knee replacementWhen preparing for knee replacement surgery, you should be assessed for your overall venous thromboembolic risk. This is the risk for developing a blood clot. Your doctor should ask you if you’ve ever had a blood clot or pulmonary embolism. And if you have, your surgeon may require that you see a hematologist to evaluate why. Your doctor will want to prevent another blood clot from occurring.

Also, your social history will be evaluated. This is important regarding postoperative rehabilitation and discharge planning from a hospital. It should be of note that more total knee replacements are now being done as an outpatient procedure. When preparing for knee replacement, in-home rehab and in-home nursing care will need to be set up before the surgery.

The physician will also identify independent risk factors for complications that occur around the perioperative period. This includes dementia, history of diabetes, morbid obesity with a BMI of greater than 40, renal and cerebral vascular disease. Studies show that postoperative complications are much higher in patients that have these diagnoses.

Your doctor may ask you if you had a neuromuscular condition such as Parkinson’s. This is important since it can cause postoperative instability of the knee replacement.

If your surgeon notes that you have a history of one or more of these conditions, the risk of surgery may outweigh the benefit of a knee replacement.

Physical Examination When Preparing for Knee Surgery

During your physical examination, your knee surgeon will look at your gait pattern. That may indicate whether you need a special type of knee replacement, called a constraint knee design. The assessment of prior surgical scars will be identified because that may change the way the surgeon makes an incision for total knee replacement. A 5 to 6 cm of skin bridging between the new incision and the old incision is desirable to avoid postoperative pain complications. Your doctor will also examine your skin to see if there is any sign of infection or cellulitis or adherence to the underlying bone.

Additionally, your orthopedic surgeon will evaluate your range of motion. We know that if your knee is stiff before surgery, that is the biggest risk factor for having a stiff knee postoperatively. Identification of preoperative knee stiffness can help the surgeon plan intraoperative strategy for correction. (more…)

USA Cycling Hosts Competition in Louisville, Dr. Grossfeld Serves as Event Doctor

The USA Cycling Amateur Road National Championship, presented by Papa Johns, took place in Louisville, Ky on June 30th through July 3rd. This national event featured a total of 850 riders, ages 9 to 23, from all across the country. All competitors must be U.S. citizens or permanent residents with a USA Cycling membership. This event brought together some of the youngest, and talented riders in the United States.

Athletes opened up the four days of competition with time trials at Spencer County High School in Taylorsville, Kentucky. This race is known as “the race of truth,” because it requires intense training and mental strength to achieve a desired time. On Friday and Saturday, Cherokee Park was used for two days of road races. In this type of race, all riders begin at the same time and the winner is determined by crossing the finish line first. The final race (the criterium) on Sunday was held at Shawnee Park. The criterium race is a high-speed bicycle race where riders speed around a closed circuit racecourse to finish first.

With the help of the local community and passionate volunteers, the Louisville Sports Commission and USA Cycling were able to host a great event for these athletes.

“We have a great working relationship with the Louisville Sports Commission. This is probably our fourth national championship that we’ve had here in Louisville. So it made natural sense. Our last actual national championship here at Cherokee was in 2008 with our Masters Road Nationals. So it just made sense to come right back to a venue that we already knew and work with great partners again,” said Tara McCarthy, events manager for USA Cycling National.

The community and other organizations came together to make this such a successful event. Louisville orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld enjoyed getting involved in a variety of ways. This included hosting a pre-race social gathering for athletes and coaches at her Louisville-area home, and serving as the event doctor for the criterium race held on Sunday at (more…)

2016 USA Cycling Amateur Road Nationals Kicks Off with Social Event Hosted by Dr. Stacie Grossfeld

Dr. Grossfeld Hosts Social Event for Juniors Competing in 2016 USA Cycling Amateur Road Nationals in Louisville

2016 USA Cycling Amateur Road Nationals ParticipantsThe 2016 USA Cycling Amateur Road Nationals is taking place in Louisville, Kentucky, June 30, 2016 through July 3, 2016. Kids from all over the United States are in Louisville to participate in this annual event. The 2016 USA Cycling Amateur Road Nationals includes a criterium, road racing, time trials and a national championship. This cycling event is sponsored by Papa John’s.

In order to bring together kids from across the country, Louisville orthopedic and sports medicine doctor Stacie Grossfeld decided to kick off the event by hosting a special celebration at her home on Tuesday, June 29, 2016. The 2016 USA Cycling Youth Participants in Louisville KYevent included 90 youth cyclists representing top teams from all over the USA. Louisville-area youth in attendance included cyclists from the: Papa John’s Racing Team, Revolution Devo Cycling, Better Cycling of Louisville, Team Louisville, and TWENTY16.Kids participating in the 2016 USA Cycling Amateur Road Nationals

This special social event gave the kids participating in the 2016 USA Cycling Amateur Road Nationals the rare opportunity just to relax, socialize and get to know other cyclists and coaches from across the country.

Describing the event, Dr. Grossfeld explained: “In the
beginning, the kids were hanging out in small groups with their team members but after a little while, it was great to see that kids from all the teams were socializing together, playing tennis, basketball, swimming, eating, and just having a good time.”

Papa John's Youth Cycling Team

Cyclists on the Papa John’s Youth Cycling Team enjoy socializing before the kick off of the 2016 USA Cycling Amateur Road Nationals.

During the event, attendees enjoyed playing basketball, swimming, playing tennis, sharing stories, and eating….(and eating and eating). In fact, Dr. Grossfeld noted that this healthy, fit and active group of kids managed to eat over 100 hamburgers and buns, 30 pounds of fruit salad, 18 pounds of tortellini, 10 pounds of veggie trays , 3 mega bags of chips , 2 pounds of hummus, half pound of pesto, 10 pounds of french fries and 120 cookies!!! (more…)

Don’t Forget Your Brain Exercises

With all of the latest research, studies and exercises created to improve your muscle and bone health, it’s easy to forget to strengthen your brain as well. Your brain is responsible for your thoughts, actions, relationships, and so much more.

Brain Exercises, Puzzles and Games at Orthopaedic Specialists in Louisville KY

Orthopaedic Specialists in Louisville, Kentucky, offers clients the opportunity to do brain exercises in the waiting room (extreme mazes, crosswords, sudoko, coloring, and more!) …

As we age our brains begin to slow down and some cognitive abilities may decrease without proper brain health maintenance. The good news is that there are several ways to increase your brain health at any age. It’s recommended that you follow a healthy diet of exercise, adequate sleep and proper nutrition. Living a balanced and healthy lifestyle, free from tobacco use, will greatly improve your chances of staying sharp in your later years.

While it may be difficult to fight biology and heredity if certain health problems run in your family, there are are several ways to improve and strengthen your brain health.

Cognitive training games have been proven to sharpen the mind and slow down the effects of aging on the brain. These different games may involve memory challenges, strategy formation, problem solving and socialization. Action and adventure games, for example, have been proven to provide cognitive benefits to users that can carry over to real life situations or work.

Brain games come in many varieties to help strengthen different areas of the brain like language and logic puzzles, optical illusions, and memory and pattern recognition. All of these different games work to target specific areas of the brain and keep the mind sharp. There are many games and puzzles available in print and online. If you want to improve your brain health, no matter your age, try out some of your favorite puzzles and games.

5 Interesting Medical Facts About Your Brain:

  1. The typical brain weighs around 1.4 kilograms.
  2. Seventy-five percent of your brain is water.
  3. There are about 100 billion neurons in your brain.
  4. Your brain does not have pain receptors.
  5. Your brain has around 100,000 miles of blood vessels.

For more information about your brain, check out this interesting article in National Geographic.

Dr. Grossfeld and the entire team at Orthopaedic Specialists believes in promoting your health and well-being. It’s important to strengthen your entire body from your brain to your toes. The waiting room (more…)

What Does it Take to be a Team Physician?

The American Academy of Orthopedic Surgeons published an article this June where they interviewed four prominent orthopedic surgeons who are also team physicians for pro sport teams. Dr. James Andrews, Dr. Brian Cole, Dr. Anthony Miniaci, and Dr. Frederick Azar. The orthopaedic surgeons talked about what it takes to be a team physician. This includes some of the trials and tribulations that come with being a team physician for a pro-team or high school and college teams.

Being a Team Physician — “It Takes a Team”

Dr. Cole explained the first role of the being a team physician is always remembering that he/she is part of a larger medical team. He quoted author and humorist Mark Twain, saying that: “really great people make you feel that you, too, can become really great.” He stated that there is a large group of people that are needed to take care of a sport team. He used the example of a hub and spoke diagram. The athletes comprise the hooks and the team members are the spokes. The team members involved are the physicians, the athletic trainer, the nutritionist, the sport psychologist, and any other providers that are helping take care of the athletes. Dr. Cole stated that he followed the SCOR which emphasized the importance of knowing when to Support, Collaborate, Oversee, and Refer the athletes.What does it take to be a team physician?

Dr. Jimmy Andrews stated that the athletic trainer is the “glue that holds it all together, and does not forget about the emergency medical technicians.”

Dr. Cole also talked about the importance of the “six Cs of being a team doctor.” He discussed the six Cs as showing Compassion, Communication, Confidence, Charting, Coverage and Contract. He noted that compassion means letting the athlete know you care and you are available 24-7. Communication encompasses a do it yesterday mentality. He continues with a clear instruction about the treatment plan and information about the risk of condition and sports participation. Confidence means a physician must stay current. Charting means documenting all encounters no matter when they occur. Coverage involves clarifying malpractice insurance and asset protection, and the contract means filling out the details of services provided, insurance coverage, volunteered or paid status and the final say about return to play. The physicians all noted that you must remember these student athletes or pro-athletes are patients first, athletes second, and that there is life after sports.

“It Takes Trust”

Dr. Cole noted one of the greatest challenges a team physician faces especially at the professional team physician for professional athletes level, is earning and cementing the trust of the athlete. “Loyalty is earned in this field and can be very temperamental,” Dr. Cole said. He noted that in the national football league, it was reported recently that a significant percentage players distrusted their team physician.

Another part of the team physician’s job that can bring headaches is dealing with the media. Dr. Cole stated this can be a challenging area. “My general approach is that I do not talk to them. The only time I will talk is when an organization ask me to address the press, and then it is a talking point.” You never want to be called off guard. The athletes have privacy law that protects them such as HIPAA and ethical concerns abound. Dr. Cole stated that he always respect the player first and the organization first.

“It Takes Understanding”

Dr. Andrews discussed some of the challenges specific to sports at the amateur or professional level. He also identified differences among the major sports. In college, he explained one issue looms the largest — pre-participation clearance. Dr. Andrews stated that it is pretty well accepted in the sports medicine world that team physicians have the final word on disqualification for participation though he/she can use consultants. He also stated that some pre-participation issues might not be so self-evident. For example, should walk-on athletes be able to participate with a medical problem that could be compounded? He believes that they should not allow walk-on athletes to take much risk especially with preexisting problems. (more…)

MRI Research Reveals Cause of ACL Injury

ACL injuries are responsible for pain, surgery and lots of physical therapy. Most of these injuries occur through non-contact sports or accidents sustained off of the courts or field. Researchers and physicians are working tirelessly to understand the cause of ACL injury to develop preventive programs to reduce this knee injury. Because of the current known information and a recent study that was published, athletes are learning how to lower their risk of sustaining an ACL injury.

We know at the time of ACL injuries, there are bone bruises that occur during MRI results. The bone bruises tell us that there has been contact with the femur and the tibia at the time of the ACL injury. A very interesting study published in the American Journal of Sports Medicine in October 2015, examined the position of the knee during non-contact ACL injury determined from the bone bruise location. The study was performed at Duke University with the lead author, Sophia Kim.

ACL and Knee Position Explain Cause of ACL InjuryRemember that the most common way to sustain an ACL injury occurs through non-contact situations, such as the basketball player dribbling the ball down the court, stopped quickly, and tears his ACL. This is similar to the soccer player who is running down the field and she stops and pivots quickly and tears her ACL. A contact ACL injury occurs when there was actually contact from another player to the injured athlete’s knee, which is less common that the previous examples.

The researchers looked at MRI results of eight subjects with a non-contact ACL injury. They examined MRI results from a subject who suffered a non-contact ACL injury and created a 3D model of each subject’s knee and its position during the MRI position. (more…)

What Are Rotator Cuff Treatment Options for Patients with Massive Rotator Cuff Tears?

For athletes involved in sports like baseball, tennis and swimming, there is often a common fear of sustaining a shoulder injury like tearing a rotator cuff. As a board certified orthopedic surgeon and shoulder doctor, Stacie Grossfeld MD offers effective rotator cuff treatment to people in the Louisville, Kentucky area. Rotator cuff tears can become severe and may even halt a person’s athletic career. Shoulder Injuries and Rotator Cuff Treatment OptionsAthletes are not the only one’s susceptible to this type of injury, but their level of activity and repetitive movements put athletes at a higher rate of risk for sustaining this injury. Fortunately there

The rotator cuff is a group of tendons and muscles that form around the shoulder joint that is located at the top of the humerus. All of these parts work together to form a “cuff” that is responsible for stability and moving the arm in different directions. Too much stress, repetition and fatigue can cause the tendons to swell and tear.

This type of injury produces pain, fatigue, reduced range of motion and other symptoms. It is important to seek medical attention if you suspect a shoulder injury that may require rotator cuff treatment. This could help you get back out on the playing field or pool much more quickly and successfully than if you try to ignore your symptoms. For athletes that have been diagnosed with this injury, it is important to discover all of your rotator cuff treatment options.

What are the Surgical Options for Rotator Cuff Treatment?

With massive rotator cuff tears, this often requires surgical treatment to repair the tear to allow the patient to heal properly before returning to their sports. There have been several studies performed and research has uncovered the outcome of massive rotator cuff repairs through surgery.

As an experienced orthopedic surgeon and shoulder doctor, Dr. Grossfeld explains that patients with massive cuff tears, greater than 3 cm or the involvement of two of the four rotator cuff tendons, have high risk for their tendons not healing or re-tearing very quickly after rotator cuff surgery. (more…)

Study Finds that Vitamin D is a Risk Factor for Stress Fractures

Stress Fracture Treatment and Vitamin D

Stress fractures are known for causing tiny cracks in a bone and pain to the affected area. This type of injury is often sustained through repetitive movements or overuse common in sports like long-distance running. Many individuals and athletes that run long distances or those that engage in activities that Stress fractures are a result of vitamin D inefficienciesinvolve a lot of jumping can be prone to developing stress fractures. Also, those with osteoarthritis often developed stress fractures due to their weakened bones.

Stress fractures frequently occur in the weight-bearing bones of the lower leg and foot. This type of pain tends to worsen over time and could potentially cause swelling to the affected body part.

Stress fractures are a common sports injury, and treating stress fractures typically involves a simple treatment plan of resting the area. Additionally, there is new information that has been found to reduce a person’s risk of developing stress fractures.

Latest Research on Stress Fracture Treatment Identifies Vitamin D as Key

An article published in the American Journal of Sports Medicine in August 2015 looked at serum 25-hydroxyvitamin D levels and stress fractures in military personnel. Dr. Dyda Dao and a team of researchers began this study by searching multiple databases and doing a meta-analysis on nine studies looking at lower extremity stress fractures and Vitamin D levels. They found that military people that sustained stress fractures had a lower Vitamin D level than the military personnel with normal level of Vitamin D.

The authors concluded that normalizing Vitamin D levels could potentially lead to a lower rate of sustaining a stress fracture. (more…)

Doctor, What Happens to My Harvested Hamstring Tendon After ACL Surgery?

The most common graft used for ACL reconstructions is a hamstring tendon graft.  Once you’ve torn your ACL, you cannot sew the end of the ACL back together.  A ligament needs to be reconstructed. Most ligament reconstructions use the semitendinosus and gracilis tendons. These make up part of your hamstrings: the central part of your patellar tendon also known as bone-patellar-bone graft, and the mid region of his quadricep tendon. This decision comes with less anterior knee pain or kneecap pain after surgery and it also requires a smaller incision compared to other types of grafts.Hamstring Tendon Regeneration

Many patients often wonder about the outcome of a hamstring tendon, if it is used as a graft to replace the ACL. Many studies have shown that the hamstring tendon will regenerate within a year after ACL reconstruction after using the hamstring tendon as an autograft.

Researchers Study Hamstring Tendon Regeneration After Harvesting

There was an excellent article that did a systematic review of the worldwide literature looking at hamstring tendon regeneration after harvesting. This was published in the October American Journal of Sports Medicine in 2015.

The lead author, Dr. Suijkerbuijk, BSc, reviewed 18 publications that met the inclusion criteria. The researchers found that the majority of athletes (70%) that had their ACL reconstructed with a hamstring autograft had regenerated the tendon. They noted that in some of the studies, tendon regeneration started at approximately one month post-op, but in all cases, regeneration occurred within one year of surgery.

Though the authors were not able to identify the exact time frame upon which the tendon most likely regenerated, they did note that in 100% of the cases, by a year, if tendon regeneration was going to happen, it had occurred.

So, to answer the question: What Happens to My Harvested Hamstring Tendon After ACL Surgery?The answer is in 70% of the patients, the hamstring tendon will regenerate and this occurs within a year after surgery.

ACL Reconstruction Surgery and Sports Participation in Athletes

We’re constantly learning new information regarding ACL injuries and sports participation. This common sports injury requires extensive rehabilitation, handwork and commitment. And there is always the fear of tearing the ACL again for athletes that gotten back out on the court or field. While ACL Reconstruction Surgery Return to Sportevery case is specific for each athlete and injury, new information about ACL reconstruction surgery has been published to provide a better insight into this type of injury.

The American Journal of Sports Medicine published an article written by Dr. Clare Ardern, PT, PhD, assessing athletes that had undergone ACL reconstruction surgery and had not returned back to play one year post-injury. The authors wanted to decide why these athletes had not returned back to playing their sport. The ACL injury is a common injury among young, active and otherwise healthy athletes.

Typically, this group of athletes would like to return back to their pre-injury sport. Recognizing this is generally an important part of the recovery process. After ACL reconstruction surgery most athletes are not released to return back to twisting, turning, jumping sports until six to 12 months post-injury, and there is a constant need for more information on this process. (more…)