What’s New at AOSMI

Mr. Connolly Knee Replacement by Dr. Michael Greller Testimonial

Michael C had a bilateral knee replacement done late February 2017 and only about 1 month after surgery, Michael is able to move better and is even doing a dance in honor of St. Patrick’s Day.

Here Michael is 6 weeks post bilateral knee replacement surgery, done late February 2017. Michael’s mobility is improving every day and is already to walk, run and dance a jig.

Dr. Greller specializes in advanced, minimally-invasive shoulder, knee, hip, and ankle arthroscopic procedures, including ACL, rotator cuff and meniscus surgery. He also performs minimally-invasive hip, knee and shoulder replacements. Dr. Greller, being on the cutting edge of technology in orthopedics, was one of the first New Jersey surgeons to do computer-assisted joint replacements in the tri-state area and he is always trained on the latest technologies to improve patient non-surgical and surgical outcomes.

See more of Dr. Greller’s testimonials.

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Are My Knuckles Bruised?

As far as durable bones go in the hand, the knuckles are by far the most resilient, but even the strongest of knuckles are susceptible to bruising. There are 27 bones, and 29 joints in the human hand, but how can you tell if you’ve bruised any of these?

Have you ever suffered a direct hit to your hand? Accidentally walking by a table and smacking it with your hand? A fracture or bruise can occur when you incur a direct hit against a hard surface. Bruised knuckles are common injuries we see as orthopedic sports medicine professionals and are most frequently found in people who participate in mixed martial arts, boxing, and baseball activities. But anyone can bruise a knuckle. Below are the symptoms to look for if you think you may have bruised your knuckles:

  • Sharp pain after impact
  • Trouble making a fist
  • Painful movement when opening and extending hand
  • Swelling
  • Stiffness after impact

Like all other injuries, the best route to decipher if your knuckles are bruised is to see a qualified orthopedic specialist for an accurate diagnosis and treatment plan. A splint may be issued to keep the knuckle in a proper position during the healing process. Anti-inflammatory medication may be prescribed; there are also natural anti-inflammatories that can be ingested, such as turmeric and curcumin supplements and teas.

If you feel like you have a bruised knuckle, it is suggested that you immediately visit an orthopedic specialist to treat injuries and enhance recovery.

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A Doctor Gets A New Knee – How this physician handled his knee problem.

A Doctor Gets A New Knee – How this physician handled his knee problem.

William Kohlberg, M.D.

For decades I stayed fit for tennis and skiing by speed walking on a treadmill. But towards the end of 2015 my right knee was giving me more and more pain. Finally I gave up the treadmill and started using the elliptical however the knee was getting worse. It got to a point where I would wake at night and have to walk around the house to help decrease the pain. Soon I was unable to play tennis. X-rays showed narrowing of the space between the femur (thigh bone) and tibia (lower leg bone) and an MRI showed loss of cartilage in the knee and bone marrow edema where the femur and tibia were hitting each other. Without the cartilage present to act as a cushion, bone was hitting bone. This caused pain not only during strenuous activity but also while walking, playing tennis, and even waking me up at night with pain that was unrelenting.

It was time to hit the textbooks and see what could be done. Weight loss was high on the list and after losing 20 pounds there was no improvement. Saw the orthopedist and got two shots of steroids and a shot of hyaluronic acid, which lubricates the knee. This helped for about 6 weeks but then the pain returned. An unloading brace did not help. This brace redirects the forces in the knee from the inside where the cartilage is deficient to the outside. I was considering a platelet rich plasma injection in the knee, which may help new cartilage grow. However, further medical literature search came up with articles that indicated that once bone marrow edema is present, conservative measures will not work.

It was time to consider surgery. But where should I go? I checked out a large New Jersey institution but after checking out the “big” surgeons, I found out things I didn’t like. Same thing in New York City. I know how the system works. I trained in New York. There is nothing magic east of the Hudson. And really I wanted my surgery at CentraState anyway. I have worked at CentraState for 35 years and I know everything that goes on at CentraState. I know the surgeons, nurses, and technicians. I decided this is where I will get my surgery for there is no better place to have a knee replacement.

Dr. Alan Nasar does the most knee replacements at CentraState and Dr. Gregg Berkowitz the second most. I saw them both and they agreed to do a right “Uni” replacement, a surgery where the medial (towards the middle) knee joint is replaced. This is where the loss of cartilage was causing my problem. The lateral (towards the outside of the body) was not giving me a problem as it sustains less of a physical load then the medial.

As a surgeon, I wanted to watch my own surgery. The operating room has a video camera within the surgical lighting and the nursing staff set up a TV screen for me to watch. Anesthesia gave me a spinal and local nerve block, so I was fully awake and alert. The surgery was painless and uneventful. I even went home the same day.

When the anesthesia wore off, I took pain pills. Physical therapy came to the house and started mobilizing me immediately. The biggest problem was the post op pain that prevented sleep. I saw Dr. Mariam Ghobriel for pain management and with the medications she prescribed, there was marked improvement. After a week of physical therapy at home I continued PT at CentraState hospital. I was able to drive myself after one week.

Dan Eskes and Chris Lang were amazing as they pushed me to increase my range of motion and muscle strength. I was very motivated and also did my exercises at home. After three and one half weeks, I was back to work. Soon I was able to walk around the block without stopping. By 4 months I returned to playing tennis and at four and one half months not only could I ski, but I was also skiing the moguls (bumps) as if nothing was wrong with my knee.

I am extremely thankful to all involved with my knee replacement and highly recommend the total joint center at CentraState Medical Center and Advanced Orthopedics.

Figure 1.

a. Narrow disc space with the disc squeezed out medially

b. Bone marrow edema of the tibia

 

Figure 2. Tibial plateau with cartilage around the outside but loss of cartilage in the center.

 

Figure 3.  Femoral condyle (knee side of the thigh bone) with loss of Cartilage in the middle.

 

Figure 4 Femoral Condyle articulating with tibial plateau.

Note how there is no cartilage in the middle from figures 2 and 3. This causes “bone on bone” pain.

 

Figure 5 & 6 Post operative x-rays. Metal cemented in place. The space between the two metal pieces is filled with a plastic disc (not visible on xray).

 

Figure 7. Beaver Creek, CO. Mogul run called “Moonshine”, 4 ½ months post op.

William Kohlberg, M.D.

 

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Gentle Exercises for Post Op Patients

Physical therapy plays a critical role in every healing journey. It is important to stay active and most patients report quicker healing when physical therapy is included in the treatment plan. A strategic exercise routine is imperative to your healing process especially for those who have undergone surgery.

While the physical therapist will determine the best exercises based upon your injury, we have listed below a few general low-impact, gentle, exercises that may be recommended to help your body recover. The goal is strength and flexibility, so you can get to your life and to your loved ones.

Gentle Exercises

  • Heel Slides: Lie on your back, slowly bend and straighten each knee 5 times.
  • Wall Squats: Lean against a wall, place your feet twelve inches in front of your body, slowly bend your knees so that you are at a forty five degree angle, hold for a few seconds, slowly lift yourself back up and repeat 5 times.
  • Hamstring Stretch: Sit on the ground, place your legs in front of you, and gently reach for your toes.
  • Leg Raises: Lie on your back, keep one leg straight, the other bent at the knee. Lift the straight leg a little off the ground, hold for a moment, and release gently. Repeat with other leg.
  • Knee to Chest Stretch: Lie on your back, slowly bend your right knee and pull your leg up to you chest. Wrap your arms around your knee or shin, and gently pull the knee towards your chest. Hold for ten seconds and slowly extend the leg to starting position. Repeat three times each leg.

Many orthopedic conditions require physical therapy in order to achieve the most successful outcomes. If you’re looking for physical therapy that brings a new dimension to the practice of orthopedic care and sports medicine, the onsite sports injury rehabilitation center at Advanced Orthopedic and Sports Medicine Institute is your solution.

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Demystifying Broken Ankles

An ankle fracture is a very common injury in children and adults. A debilitating injury, broken or fractured ankles can sometimes be difficult to pinpoint, and some people may go weeks without knowing their ankle needs professional medical attention.

Ankle fractures are quite common among children between the ages of 8 and 15, this is due to the higher levels of activity associated with sudden movements that are prone to twisting ankles. Furthermore, with growth plates still shifting, it is important to identify if the ankle has indeed been fractured.

An X-ray is the ideal method for identifying where the bone placements are, if any changes are detrimental, and if indeed there needs to be further medical attention. Ankle fracture symptoms include:

  • Tenderness
  • Bruising
  • Swelling
  • Deformed or crooked appearance
  • Inability to bear weight
  • Pain when touched or moved

Because an ankle fracture, or even sprain, can limit mobility, it is critical to get to an orthopedic physician as soon as possible. Once an X-ray is completed, we can determine what type of treatment would be best, whether it be crutches, physical therapy, or a combination of treatments, it’s best to get help as soon as possible.

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