Is it Too Late for Joint Replacement Surgery?

When is joint replacement surgery called for?

Patients suffering from chronic knee or hip pain know that it can seriously impact mobility as well as overall quality of life. In addition to pain, symptoms may include swelling, stiffness, muscle weakness, and limited range of motion. Causes range from rheumatoid or osteoarthritis to trauma to repetitive strain on the joint. After diagnosis, non-surgical treatments like anti-inflammatory medications, physical therapy, and injections are the first course of action when treating persistent joint pain, but these methods aren’t always effective.

What is involved in joint replacement surgery?

The surgical screening process begins with a full clinical evaluation, using advanced imaging to determine the extent of the joint damage. The orthopedic surgeon will make an incision to access the damaged bone, tendon, and tissue, and replace the knee or hip joint with a prosthetic made of plastic, metal, or ceramic. The procedure can be done using a conventional approach or with robotic-assistance. The physicians at Atlantic Orthopaedics are at the forefront of innovation in knee and hip replacement techniques and technology and have pioneered the use of minimally-invasive robotic-assisted surgery.

What can I expect after surgery?

Commitment to post-operative care is a key factor in long term success. Recovery time will vary based on the individual patient’s response to the procedure and the surgical approach used. Proper recovery usually includes daily movement of the affected joint, physical therapy, and wound care management, along with a post-op follow up with your surgeon.

What if I’ve waited too long to be eligible for joint replacement surgery?

Because damage to cartilage, ligaments, and bone is progressive and won’t improve on its own, some patients wonder if there’s a point at which joint damage is too severe to be corrected by surgery. Atlantic Orthopaedics’ Dr. Michael Morwood, a fellowship-trained orthopedic surgeon who specializes in knee and hip replacement, answers this question.

Is there a point when hip or knee replacement surgery can’t be done?

The short answer is no. We can always individualize our treatment plan for every patient. Joint replacement surgery can be performed on a person of any age, no matter how severe the damage. There are cases where the pain and deformity are so great that the procedure or the post-op recovery are more challenging. Everyone is unique, with their own unique anatomy, and our training as orthopedic surgeons gives us the ability to handle the challenges involved in each individual case.

If non-surgical treatments have not alleviated your joint pain, schedule an appointment to talk with an orthopedic specialist about whether replacement surgery is right for you. Relief from pain is possible, and it is never too late to get back to doing the things you love!

Watch the Morwood Minute episode HERE.

Knee Pain From a Dislocated Kneecap?

Patella Instability Surgery Can Provide Relief!

What Is Patellar Instability?

When the kneecap shifts out of its normal alignment, you may feel pain, trouble walking, a buckling or locking sensation, or a feeling of the knee “giving way.” Patella instability can impact daily life and make it difficult to stay active.

How Does the Patella Instability Procedure Work?

In this procedure, the surgeon carefully realigns the patella within the femoral groove to ensure proper tracking during knee movement. The specific surgical technique can vary based on factors like the patient’s age, and the severity of the injury. In the Medial Patellofemoral Ligament (MPFL) Reconstruction procedure that Dr. Welch describes below, the patient’s ligament was reconstructed to stabilize the patella on the inside of the knee. In cases of severe instability, the surgeon may also reposition the tibial tubercle–the bony bump below the patella–to improve patellar tracking.

What Can I Expect Post-Surgery?

Patients can expect to go home the same day as the procedure. Recovery time varies and patients will need to use crutches and wear a knee brace for a period of time, typically 4-6 weeks. Physical therapy is also an important part of the recovery process.

We sat down for a Q&A with our Orthopedic Surgeon and Sports Medicine Specialist Dr. Welch.

In your own words, how does this procedure benefit your patients?

Patella instability is a condition in which the patella (kneecap) dislocates from the femur (thigh bone). Most patients are young, often teenagers. Fortunately we can fix this condition surgically. This procedure benefits patients because it generally restores one’s confidence and his/her ability to play sports.

Who is a good candidate for the Patella Instability Procedure?

A good candidate for patella instability surgery is anyone who has had at least one patella dislocation or multiple subluxations (partial dislocations).

Where do you perform this procedure?

I perform this procedure at New England Center for Orthopedic Surgery (NECOS) in Portsmouth and at York Hospital in York, Maine.

Do you have a recent patient success story you can share?

Recently, a 15 year old male high school student came to see me with his family. The patient had sustained two dislocations prior to his visit with me. These dislocation events are painful and stressful, and the young man was apprehensive about playing sports ever again unless we fixed his knee. He underwent a procedure–a medial patella femoral ligament (MPFL) reconstruction–to stabilize his patella. Surgery was straightforward and he recovered nicely. He required crutches for 10 days and a brace for four weeks. After six weeks, he had normal motion and no swelling in his knee. I cleared him to return to sports three months after surgery.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?

There are a few important things to consider regarding patella instability surgery. The procedure is very reliable – dozens of studies have demonstrated success rates in the 90-95% range, and my experience has been similar. The vast majority of these patients are happy because they regain “trust” in their respective knees, and recovery is straightforward. Further, patients usually return to the same level of activity that they had prior to the dislocation(s).

If you have knee pain from dislocation, visit our website to learn more about Arthroscopic Knee Surgery or schedule a consultation with Dr. Welc h.

Torn Meniscus? Eliminate Knee Pain With This Procedure

The meniscus is a C-shaped piece of cartilage in the knee joint that plays a crucial role in function and stability. The two meniscii in each knee function as shock absorbers. They are composed of dense fibrocartilage, which is more flexible than bone but firmer than other types of cartilage. Meniscus pads play an important role in walking, running and jumping, and they aid in weight distribution and alignment. The meniscus also helps keep the knee joint lubricated to reduce friction between the femur (thigh bone) and tibia (shin bone).

A meniscus root tear is a relatively common knee injury that occurs when the meniscus separates from its attachment point on the tibia bone. This type of tear can be caused by the wear and tear that happens with age, or by trauma or injury, such as a sports injury. People who suffer a tear often feel a “popping” sensation in the back of the knee, followed by pain, instability, and a loss of function. Untreated, a meniscus root tear can lead to osteoarthritis and degeneration in the knee. Fortunately, there is a minimally invasive procedure available to fix the issue.

Atlantic Orthopaedics’ surgeon Dr. Welch specializes in meniscus root repair, having performed more than 100 successful procedures to restore function, eliminate pain, and prevent further damage. In this surgery, he makes three small incisions, prepares the torn end of the meniscus for repair, then securely reattaches the meniscus to the root attachment site on the tibia bone through a small tunnel in the tibia.

Following surgery, Dr. Welch places the patient’s knee in a brace to protect the repaired meniscus and allow it to heal. Physical therapy is an important part of the recovery process. Recovery from meniscus root repair takes time and it’s important to follow your surgeon’s instructions regarding weight-bearing and the use of crutches. It may take three months for the knee to fully heal, but the vast majority of patients have excellent outcomes and experience a return to normal knee function.

Below, Dr. Welch answers some questions about Meniscus Root Repair:

Q. In your own words, how does this procedure benefit your patients suffering from knee pain?

A. A meniscus root tear is a specific type of meniscus tear that is more serious than a typical meniscus tear. If the root tears, the meniscus becomes loose and unstable. Surgery involves repairing the meniscus back to the tibia bone. This procedure benefits patients because it restores the function of the meniscus, eliminates pain, and helps restore patient confidence in his/her knee.

Q. Who is a good candidate for a Meniscus Root Repair?

A. A proper candidate for meniscus root repair is a patient who sustains a root tear who does not have significant arthritis in the knee.

Q. Where do you perform Meniscus Root Repairs ?

A. I perform meniscus root repairs at New England Center for Orthopedic Surgery (NECOS) in Portsmouth, NH and at York Hospital in York, ME.

Q. Do you have a recent patient success story you can share?

A. I have dozens of patient success stories. Meniscus root repairs are very reliable; as long as the meniscus heals to the tibia, patients usually return to normal function with no issues. Previous studies have revealed success rates > 90%.

Q. Anything else you’d like patients to know about this procedure?

A. I have many patients (>100) who have had tremendous success after a meniscus root repair. Unfortunately, one issue with this procedure is that each patient must use crutches or a walker for the first 5-6 weeks after surgery. This is inconvenient, but necessary, so that the meniscus has time to heal.

If you’re suffering from knee pain and loss of mobility from a meniscus root tear, you may be a good candidate for this minimally invasive procedure. Schedule an appointment with Dr. Welch for an evaluation: https://www.atlanticorthopaedics.org/providers/tyler-welch-md/

Torn ACL? Get Educated About BEAR

Atlantic Orthopaedics & Sports Medicine now offers patients an alternative to surgical reconstruction – a less invasive procedure called Bridge Enhanced ACL Restoration, or BEAR. Clinically tested and FDA-approved, this promising new procedure has been adopted by our own Dr. Tyler Welch, who performed the first BEAR surgery in the state of Maine! Dr. Welch is an orthopedic surgeon and partner at Atlantic Orthopaedics who specializes in Sports Medicine, with a focus on the knee, shoulder, and hip. His mission is to restore his patient’s function through compassionate, evidence-based care.

Anterior cruciate ligament, or ACL, tears are one of the most common knee injuries, affecting more than 100,000 Americans each year. The ACL is a band of tissue that connects the thigh bone (femur) to the shinbone (tibia) inside the knee joint. It is one of the two cruciate ligaments, along with the medial collateral ligament (MCL), that stabilize the knee joint and prevent the tibia from sliding forward. ACL injuries most often occur when playing sports that involve sudden changes in direction, like:

Basketball
Soccer
Gymnastics
Downhill skiing

Pivoting with your foot firmly planted in place, landing awkwardly from a fall or jump, stopping suddenly, or getting a blow to the knee, along with wearing shoes that don’t fit properly or using ski bindings that aren’t correctly adjusted, can all increase your risk. ACL tears are also more common among women than men. Signs that you’ve torn the ligament, either partially or fully, include severe pain, a popping sensation, rapid swelling, and a feeling of the knee “giving way” when you put weight on it.

If you think you’ve torn your ACL it’s important to be evaluated by an orthopedic doctor as soon as possible. It is possible that the ligament has been stretched or only partially torn, and in those cases the injury may respond to non-surgical treatments like ice, rest, elevation, or physical therapy. Unfortunately, a complete ACL tear can’t heal on its own. This is because the synovial fluid in the knee that keeps the bones from rubbing together also prevents the formation of blood clots needed for healing. Until recently, the only fix for a complete tear has been surgical reconstruction, where a tendon is taken from another part of the patient’s body, or from donor tissue, to reconstruct the torn ligament.

We recently sat down with Dr. Welch to ask him a few questions about the new BEAR procedure.

Q: Tell us Dr. Welch, how does this new procedure benefit your patients?

A: This procedure can benefit patients because it is less invasive than a typical ACL reconstruction. Unlike typical ACL reconstruction, the patient does not need a “graft” to replace the ACL with the BEAR technique. As a result, the procedure may lead to less pain and swelling in the post-surgery period.

What makes BEAR unique is that it doesn’t require patient or donor tissue, instead using an implant made from collagen to bridge the gap between the torn ends of the ACL ligament. The implant is secured via suture, and the patient’s own blood is injected into it during the surgery to form a clot that surrounds the device. This facilitates cell proliferation and enables the body to heal itself. Within about eight weeks of surgery, the implant is absorbed, and replaced by the patient’s own tissue, which will continue to strengthen over time.

Q: Who is a good candidate for a BEAR Procedure?

A: Anyone with an ACL tear is a candidate. Based on recent research, individuals over the age of 20 are the best candidates.

Q: Anything else you’d like patients to know about this new procedure?

A: This is an exciting time in the world of ACL surgery. The BEAR procedure may be a game-changer, but the jury is still out. It is important for patients to know that we do not have any long-term clinical data regarding the BEAR technique. We do not yet know if the re-tear rates (failure rates) are higher in patients who have a BEAR compared to those who have a typical ACL reconstruction over the long term (more than five years). However, current research (two year outcomes) has revealed similar success rates when comparing the BEAR technique to traditional ACL reconstruction. This is encouraging data that suggests that the BEAR technique is reliable.

Candidates for the BEAR procedure must have a complete rupture of the ACL. Eligible patients must also have a stump still attached to the tibia to allow for repair. Dr. Welch currently performs this procedure at York Hospital in York, ME and the BEAR procedure should be available soon at AOSM’s state-of-the-art orthopaedic ambulatory surgery center, NECOS in Portsmouth, NH.

If you think you may be a good fit for the BEAR procedure, schedule an appointment for an evaluation with Dr. Welch. To learn more, click HERE.

Dr. Welch Becomes First Surgeon in Maine to Perform a BEAR Procedure

ACL tears are one of the most common knee injuries, affecting more than 100,000 Americans each year. Until now, the only way to repair the torn ligament was with invasive surgical reconstruction using tendons from other parts of the body or from donor tissue.

We’re excited to announce that there’s now a simpler, less invasive treatment available called Bridge Enhanced ACL Restoration (BEAR), pioneered by our own Dr. Welch, who recently performed the first BEAR procedure in the state of Maine. The surgery uses an implant to ‘bridge’ the torn gaps of the ACL without the need for donor tissue but instead, using patient’s own blood encourages the body rebuild the tissue, typically within 8 weeks.

Congratulations Dr. Welch on this outstanding achievement!

If you’re suffering from knee pain, and would like to discuss your options with one of our knee specialists, please contact us today.

*Other resources on BEAR Procedure can be found here.

Advances in Hip and Knee Replacement: ‘All About Robotic Surgery’ – An In Person Event with Dr. Morwood

Is hip or knee pain keeping you from the activities you love?
Take the first step towards recovery and learn how robotic assisted joint replacement surgery can improve your quality of life. Attend this FREE educational event with Dr. Michael Morwood!

Advances in Hip and Knee Replacement: ‘All About Robotic Surgery’
Thursday, July 14th, 2022 | 5:30pm – 7:30pm
Sheraton Portland at Sable Oaks
200 Sable Oaks Dr. South Portland, ME 04106
Light refreshments will be provided.

REGISTER NOW!
Scan the QR Code below or click HERE to get your tickets!

Dr. Michael Morwood Published in the Journal of Arthroplasty

Dr. Morwood was recently published in the Journal of Arthroplasty. Dr. Morwood, who specializes in knee replacements says, “One of the main causes of total knee replacement failure is micromotion of the implants. This study was performed to see if the addition of a short stem extension onto the tibial component in a total knee replacement limits the motion of the implant. We were able to show the addition of a short stem provides a significant reduction in micromotion during cyclic loading of a cementless tibial baseplate in a synthetic foam bone model, similar to a cemented implant. The findings of this study may help lower the rate of tibial component loosening in total knee replacement.”

To read the entire study, please click HERE.

Dr. Sastry Leads MAKO Robotics Training at The New England Baptist Hospital

July 2020 – Dr. Akhil Sastry, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine recently led a MAKO Robotics training at the New England Baptist Hospital in Boston, Massachusetts. Dr. Sastry was the sole faculty member to facilitate the launch of their MAKO Robotics training program.

As robotic-assisted knee and hip replacement surgeries penetrate Boston’s most elite academic and fellowship programs, Portsmouth’s very own Mako Master Surgeon Akhil Sastry was selected to facilitate the launch at the New England Baptist, one of the most heralded institutions of orthopedics in the country.

To prepare for their first robotic knee surgery in a few weeks, Dr. Sastry trained a total of 8 surgeons in this one-time training session and has been invited back to provide additional training to another group of surgeons on August 6, 2020.

Dr. Sastry provided hands-on training and proctoring on how to perform this innovative and cutting-edge procedure. Dr. Sastry was not only one of the first surgeons to perform a robotic-assisted knee replacement in the world in 2017, in addition, he continues to teach and advance robotic concepts with joint replacements nationally. He has been selected to Chair these programs on many occasions and has trained over 100 surgeons from across the country.

Schedule a consultation with Dr. Sastry.

All About Robotic Surgery – Free Webinar – July 8th, 2020

Please join us on Zoom for another FREE virtual webinar with Dr. Michael Morwood on Wednesday, July 8, 2020, from 5:30-6:30pm.

Dr. Morwood will discuss common causes for hip and knee pain and advances in robotic assisted joint replacements that can help you get back to doing what you love. There will be a brief Q & A session following the presentation. If you’re experiencing joint pain, you won’t want to miss this FREE event.

Topics will include understanding joint paint, your treatment options, joint replacement surgery and recovery expectations.

**Registration is required to attend this webinar, to register please click HERE.

Dr. Sastry Achieves Accreditation as Master Surgeon in Robotic Surgery

Dr. Akhilesh Sastry of Atlantic Orthopaedics & Sports Medicine has recently achieved accreditation as the first Master Surgeon in Robotic Surgery in New England by Surgical Review Corporation. This accreditation distinguishes Dr. Sastry from many other surgeons by providing the highest quality of care to patients as determined by an independent, external process of evaluation.

Status as an accredited Master Surgeon means that Dr. Sastry has met nationally recognized standards. Not all hospitals and surgeons seek accreditation; not all that undergo the rigorous on-site inspection process are granted accreditation.

Healthcare organizations and surgeons seeking accreditation by SRC undergo an extensive self-assessment and on-site inspection. This process includes physicians, nurses and administrators who are actively involved in the accredited program. The inspection is consultative and educational, presenting best practices to help an organization or surgeon improve its care and services.

Dr. Sastry began using the MAKO Robotic-Arm Assisted Surgery System in 2016, and was the first surgeon in New Hampshire and Maine to perform a robotic-assisted knee replacement.
Dr. Sastry is also the premier robotic-assisted orthopaedic surgeon at Atlantic Orthopaedics and Sports Medicine and has privileges at both Portsmouth Regional Hospital and York Hospital.

About SRC – Established in 2003, Surgical Review Corporation (SRC) is an internationally recognized patient safety organization dedicated to recognizing and refining surgical care. SRC is the leading administrator of quality improvement and accreditation programs for surgeons and hospitals worldwide. SRC’s proven methodology, know as the “Cycle of Excellence,” results in quantifiable and unparalleled improvement in outcomes, patient safety and costs across surgical specialties. For more information, visit www.surgicalreview.org.

Morwood Published in Injury: International Journal of the Care of the Injured

Our very own Dr. Morwood has been published in the journal, Injury.

Dr. Morwood recently wrote about treating tibial fractures around total knee replacements. Although they are rare, tibial fractures can cause some serious complications, but chances of successful healing can be improved with the techniques detailed in Dr. Morwood’s paper!

You can read Dr. Morwood’s piece by clicking here.

Dr. Akhil Sastry Will Teach at the Champions Mako Program

Dr. Akhil Sastry, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, will be on the faculty of Stryker’s Champions MAKO program on May 9 and 10 in Philadelphia, Pennsylvania.

Stryker is one of the world’s leading medical technology companies, and their MAKO system is a surgeon-controlled robotic arm that enables accurate alignment and placement of implants.

Their Champions program is a master’s instructional course for surgeons who have robotics experience, and are working to enhance their skills, technical know-how and understanding of the applications on the partial knee, total knee, and total hip with the MAKO robot.

Dr. Sastry has taught and chaired multiple MAKO courses for Stryker nationally. He began using the MAKO Robotic-Arm Assisted Surgery System in 2016, and was the first surgeon in New Hampshire and Maine to perform a robotic-assisted knee replacement. Dr. Sastry has been participating in their educational programs throughout the country, teaching full knee, partial knee and total hip replacement on the robotic platform.

Dr. Sastry is also the premier robotic-assisted orthopaedic surgeon at Atlantic Orthopaedics and Sports Medicine. He states that the robot allows for a level of precision that enables a quick recovery and fewer issues for the patient once fully rehabilitated.

Atlantic Orthopaedics & Sports Medicine is a leading practice on the Seacoast, with offices in Portsmouth, New Hampshire and York, Maine. Their physicians have full medical staff privileges at both Portsmouth Regional Hospital and York Hospital.