Dr. Bollinger

New Article Highlights the Value of Anterior Hip Replacement Surgery

Patients have been asking us about an article recently published in Forbes Magazine about hip replacement surgery using the anterior approach.

Chronic hip pain—often caused by a condition such as arthritis or a physiological irregularity—used to mean limited mobility and perhaps the use of a cane, walker or wheelchair later in life. The first modern surgical intervention technique to treat hip joint pain occurred in the early 1960’s, when Sir John Charnley of the Manchester Royal Infirmary, designed a low friction arthroplasty that became the blueprint for modern hip replacement surgery. Charnley’s design allowed surgeons to replace a poorly-functioning human hip joint with a manmade femoral stem, acetabular component and acrylic bone cement. The result is an artificial extension of the patient’s femoral bone that attaches to the hip socket.

Several different surgical techniques have been developed to replace the hip joint with prosthesis. One popular technique, known as the posterior approach, involves making an 8-10 inch incision next to the hip, splitting the gluteus muscle, and cutting muscles connected to the top of the femur. Many surgeons have relied upon this technique as it provides an excellent view of the patient’s hip joint.

A newer technique, the anterior approach, involves making a much smaller incision (generally one to two cuts ranging from 2-5 inches long). Proponents of the anterior approach favor it over other techniques: smaller incisions reduce blood loss, result in less pain, shorter hospital stays and faster healing times as well as NO dislocation precautions. No muscle cutting is required with the anterior approach.

“I started performing anterior hip replacements in 2006,” said Dr. Michael Bollinger, an orthopaedic surgeon at Sebastopol Orthopaedics. “At that time, I wasn’t aware of any other surgeons in Northern California […]

Smartphones and Impaired Hand Function

Do you use your smartphone a lot? Have you noticed pain in your hands, specifically your thumb, after a long browsing or texting session? If you have, it’s probably not your imagination. A Turkish study published in June of last year, followed 102 university students–comparing 66 single hand-held smartphone users to 36 students who don’t use them–and concluded that frequent smartphone use may lead to an enlarged median nerve, and impaired hand function (particularly pinch strength).

According to an article published in Medscape about the study:

A hand-held smartphone compels the user to engage in repetitive flexion/extension of the wrist and to use their thumb to text, movements that are involved in the etio-pathophysiology of CTS, the researchers note.

The issue is of increasing importance as more young people use smartphones and other hand-held devices. Research suggests that students now typically spend more than 3 hours a day texting, emailing, scheduling, and browsing the Internet on their mobile phone.

According to Dr. Michael Bollinger, there is a connection to be made between overuse of handheld devices and repetitive use injuries in the hand and wrist:

“The devices, themselves, aren’t the problem.  It’s the usage time.  If you’re spending three to four hours per day browsing or texting on your phone, repeating the same hand and wrist movements over and over, chances are pretty high that you are putting considerable strain on the tendons in your fingers, wrist and thumb.” said Bollinger.  “What feels like discomfort now may lead to more serious problems later and the need for medical intervention.”

Dr. Bollinger noted that while the best way to avoid injury from overuse of handheld devices is to lessen usage, regular stretching of the hands and wrists and periodic icing of inflamed areas may also help lessen pain.

Smartphones […]

Ultrasound Rotator Cuff Evaluations and Guided Injections Now Available at Sebastopol Orthopaedics

Sebastopol Orthopaedics recently began offering ultrasound rotator cuff evaluations and guided injections for those suffering from shoulder pain.  We’re excited to offer this new service which extends the following advantages to our patients:

Painless and Immediate results.
Interpretation by an actual orthopaedic surgeon who has first-hand knowledge of the anatomy through years of experience performing both open and arthroscopic rotator cuff repairs.
No concern for claustrophobia.
Ability to dynamically examine tendons.
Complete cuff exam may take less than 20 minutes.
A fraction of the cost of MRI (around $150 vs. $1,500).
Ability to perform targeted injections to the bicipital groove, subacromial space, AC joint, or glenohumeral joint with greater accuracy, in the same visit, saving patient time.
Minimally invasive treatment for calcific tendonitis available.
Can be used to quickly confirm clinical diagnoses such as proximal or distal bicep tendon tears, or other tendon ruptures such as Achilles injuries without the need for separate imaging and specialty consultations.
Patient Satisfaction!  Many patients enjoy seeing their own anatomy, live on the screen, and ultimately have a better understanding of their condition.

If you are experiencing shoulder pain or have questions about this procedure, please contact our office to make an appointment.

Minimally-Invasive Hip Arthroscopy May Be a Good Option For Sonoma County Hip Patients

Many patients may be aware of arthroscopy – or the process of using a camera to see inside of a joint without having to make a large incision – as a good option for repairing knees and shoulders.  What many may not know is that this technique may also be used effectively on hips.

The Procedure

During the arthroscopy procedure, not only can your surgeon look inside your hip joint to see what’s causing problems, he or she may also be able to fix common hip injuries such as labral tears (where a torn fragment of tissue can get pinched between the ball of the hip joint and the socket, causing a lot of pain to the patient).  Surgeons may also be able to fix impingements – a condition that occurs when your hip’s ball (femoral head) and socket (acetabulum) don’t fit well together and cause pain by pinching surrounding soft tissue.  Impingements are fixed by removing bone spurs and/or re-contouring your hip bones to create a more perfect fit between your hip’s ball and socket.

Recovery Time

The incision made during surgery is small.  While experiences vary from patient to patient, recovery after a hip arthroscopy procedure, often involves only 1-2 hours in the recovery room before being discharged home.  Patients will often require assistance at home during the first night and should expect to use crutches or a walker for a period of time after the surgery.  In many cases, your surgeon will also prescribe a physical therapy regimen to help you restore your strength and mobility after surgery.

Dr. Michael Bollinger is an expert in the North Bay on this procedure and one of a limited number of surgeons in Sonoma County to perform it.

“Hip arthroscopy is a […]

Are Women and Girls Really More At Risk For ACL Injuries?

We’ve been getting questions lately from some of our more active female patients about whether or not they should worry more about anterior cruciate ligament (ACL) injuries because of their gender and their propensity for “high-risk” sports like skiing or soccer.  The answer it seems is yes…and no.  Last year, the Journal of Bone and Joint Surgery*(JBJS), published a study where they compared MRI scans of male and female athletes with non-contact ACL injuries with athletes who participated in similar sports, but did not sustain injury to their ACLs.  What they found was that the common factor between those who sustained injury wasn’t gender, it was geometry.

Here’s how an February 2012 article published by the American Academy of Orthopaedic Surgeons** described it:

The ACL is a ligament that runs through, and stabilizes, the middle of the knee joint. While the ACL can be injured through contact, it is most commonly strained or torn without contact, when a person suddenly changes direction, stops abruptly or lands incorrectly after a jump, such as in soccer, basketball and skiing.

The study found that most of the women (those who had ACL injuries and those who did not) and only the ACL-injured men shared a common geometry on the outside of their knee joint: The upper part of their shin bone at the joint (tibial plateau) was much shorter and more rounded. This may help to explain why women have an ACL injury rate that is two-to-five times greater than that of men.

“A lot of people who have ACL tears have a high degree of laxity (loose ligaments) in their knee joints,” said Christopher J. Wahl, MD, the study’s lead author and an orthopaedic surgeon and team physician in the Department of […]

Beware of Herbal Supplements if You’re Having Surgery

It’s not unusual to see patients in our practice taking herbal supplements.  We don’t weigh in one way or another on the efficacy of “natural” vitamins and supplements but we do caution our patients who are considering having a surgical procedure done against taking them prior to and after their surgery.

While every patient experience is different, what many may not realize is that these supplements may cause abnormal blood pressure, heart rates, and bleeding.  They may also interfere with other medications, including anesthesia during your surgery.

We generally recommend to our patients that they disclose any “over-the-counter” medication they are taking (including aspirin, herbs, vitamins and dietary supplements) to their physician.  We also ask patients to stop taking them one week prior to surgery to reduce their risk of excessive bleeding, or negative interactions with other medications that we prescribe to treat orthopaedic problems and manage pain.

Not sure if your supplement may be a problem?  Here’s a list of common herbal supplements that we recommend against:

  Dong Quai
  Gingko Biloba
  Ginger
  Ginseng
  White Willow Bark (salix alba)
  Devil’s Claw (harpagophytum procumbens)
  Turmeric (curcuma longa)
  Boswellia (bosellia serrata)
  Stinging Nettle (urtica dioica)
  Cat’s Claw (uncaria tomentosa)
  Quercetin
  Reservatrol
  Cayenne
  Omega-3 FA
  St. John’s Wort

If you’re a patient and have questions about how a supplement you may be taking may interact with your prescribed medication, please contact our office.

Dr. Bollinger Featured In Washington Post Article About Anterior Approach Hip Replacement Surgery

In March, Dr. Michael Bollinger was featured in a Washington Post article* discussing the benefits of the anterior approach method used for replacing hips.  The article mentioned that the number of Americans having total hip replacements over the past two decades has risen to more than 300,000 per year (more than doubling the figures from 20 years ago), and that patients are eventually able to walk again without pain or the aid of a cane, but only after a lengthy, rigorous and sometimes painful recovery and rehabilitation period.

From the article:

The surgery is extensive: As its name suggests, it involves removing the joint — the damaged bone and cartilage — and replacing it with prosthetic parts made of metal, plastic or ceramics. Typically, surgeons enter the joint from the rear, which requires cutting through muscle and cartilage. But with a relatively new procedure, surgeons enter from the front and only stretch the muscles aside, avoiding the cutting and minimizing pain and recovery time. According to those who use this anterior technique, the benefits are substantial.

The article goes on to say:
Anthony Unger, medical director at the Institute of Bone and Joint Health at Sibley Memorial Hospital and a clinical professor of orthopedic surgery at George Washington University Hospital, says the anterior approach is “truly minimally invasive.” Unger, who has done about 4,000 hip replacements over 26 years and has used the anterior technique for the past eight years, says “patients have better overall functionality, can sleep on their sides and be confident the new hip won’t dislocate.”

But, as with many transitions in medical techniques, some surgeons have been reluctant to change. Although agencies and hospitals don’t track hip replacements by the type of procedure used, Unger says […]