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 […]

Bone Broth to Heal Your Bones, Joints and More

by Soraya Saffarinia

If you’ve ever made bone broth, or had it made for you, you probably know how nourished it can make you feel.  Furthermore, due to bone broth’s mineral and amino acids bioavailability, it can help heal the wounds from a surgery, support your joints, prevent osteoporosis, and much more.

The following are some of the benefits of bone broth:

Bone broth is a good source of the amino acids Proline, glycine and glutamine. These amino acids aid in making collagen and cartilage, raise our immunity and heal our gut. (Daniel,K.T., Fallen,S. 2014).
Bone broth is a source of chondroitin sulfate, keratin sulfate and hyaluronic acid, important components of cartilage, and relieves joint discomfort associated with osteoarthritis. (Grogan, SP., et al. 2013); (Schauss,A., et al. 2012).
Bone broth can reduce inflammation, and strengthen our immune system to combat infectious diseases and cancer (Daniel,K.T., Fallen,S. 2014); (Prudden.1985).
The gelatinous bone broth contains the denatured/broken down collagen proteins that are now easier for our body to utilize. Collagen is the key structural protein in our connective tissues. It is found in our tendons, ligaments, cartilage, skin, bone, and muscle (Axe,J. 2016).
Presence of collagen is essential in prevention of osteoporosis (Shuster,S. 2005).
When collagen is made available to the wound bed, closure can occur, thus bone broth can contribute to wound healing and speed recovery after surgery (Sabiston. 2012).

Here’s a favorite bone broth recipe to try at home:

Ingredients

2-3 pounds bones (It can be from a chicken, turkey, pheasant, lamb, beef, pork or other; marrow bones with all the tendons and cartilage are best).
10-12 cups water
1- 2 tablespoon apple cider vinegar or lemon juice (The vinegar’s/lemon juice acidity helps draw the minerals from the bones.)
3-4 […]

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 […]

Osteoarthritis: Causes and Treatments

As we age, our bodies may not recover as quickly from strenuous activity or long periods spent sitting or standing in a single position. On those occasions, some people may feel stiffness or discomfort, but it usually passes in time. If you’re feeling chronic pain in your joints, hands, hip, knee, lower back or neck, however, you may be suffering from a condition called osteoarthritis (OA).

Causes and Risk Factors

According to the Arthritis Foundation, osteoarthritis is a disease of the joint, and is the result of a variety of factors – some that can be controlled and some that can’t.

Osteoarthritis generally occurs when there is an absence of cartilage, the important connective tissue that cushions the bones in our joints. When that cushion is removed, bones meet, causing pain, stiffness, swelling and reduced mobility. While it is a rare, some patients’ bodies do not produce an adequate amount of collagen, the protein that creates cartilage. Other patients may have a bone structure that breaks down their cartilage cushion more quickly.

Those factors are generally hereditary and not preventable. Other factors, however, can be managed to help prevent OA from occurring.  For example, being overweight or participating in activities that encourage repetitive movements, can increase a person’s risk of developing osteoarthritis.  The Arthritis Foundation explains:

Weight: Being overweight puts additional pressure on hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. Research has shown there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (cytokines) that can damage the joints.

Injury and overuse: Repetitive movements or injuries to joints (such as a fracture, […]

Protect Your Shoulders This Summer

Healthy shoulders are something most of us take for granted. Unless you are a baseball or softball pitcher or competitive swimmer, or work in an occupation that requires a lot of repetitive lifting or overhead reaching activities, you probably haven’t ever really experienced significant shoulder pain.

If this is the case, count yourself among the fortunate. Shoulder problems, left untreated, can be painful, and eventually lead to decreased upper body mobility.

Causes and Symptoms of Shoulder Pain

Pain in the shoulder usually occurs in an area called the rotator cuff (i.e., the muscles and tendons that cover the top of your upper arm bone and attach it to your shoulder blade) and can be mild to severe. According to the American Academy of Orthopaedic Surgeons, pain in the rotator cuff area may be a result of:

Tendinitis. The rotator cuff tendons can be irritated or damaged.
Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

The AAOS describes symptoms as follows:

Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.

Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage. These symptoms may include:

Minor pain that is present both with activity and at rest
Pain radiating from the front of the shoulder to the side of the arm
Sudden pain with lifting and reaching movements
[…]

Using Diet to Reduce Rheumatoid Arthritis Symptoms

In recent years, you may have heard discussions or read articles about “inflammation” in the body and its connection to autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis, and psoriasis. “Inflammation” is a real issue for many of our patients, especially those who suffer from rheumatoid arthritis, a condition we see quite frequently where the patient’s overactive immune system is attacking his or her joints, causing pain. Anti-inflammatory and immune-suppressing medications can and are often used to treat such conditions. However, a patient’s diet can also play a part in reducing inflammation in the body.

A growing number of nutritional and medical experts suggest that a body’s autoimmunity problems are caused by tiny holes in the gut that allow particles of food, bacteria and other substances from inside the intestines to escape into the rest of the body. This is important because a “leaky gut”, and more specifically, an invasion of foreign substances into the body, can trigger the body to respond by producing inflammation – the same process used to fight any other bacterial infection. Over time, that chronic inflammation can cause tissue damage, resulting in an autoimmune disease such as the ones listed above.

Enter the Paleo autoimmune protocol (a stricter version of the more popular Paleo Diet). The Paleo autoimmune protocol seeks to seal the holes in the gut wall by eliminating the foods thought to cause them, namely:

Processed, fried and high fat foods (especially those that contain high amounts of salt, preservatives, additives, or sugar)
Alcohol
Breads & Grains (including whole and heritage grains)
Potatoes
Legumes
Dairy
Eggs
Nightshade vegetables such as tomatoes, eggplant, and peppers
Nuts and seeds
Certain spices such as curries, paprika and chili powder
Refined sugar

Those who follow this protocol typically eliminate the trigger foods mentioned above for […]

The PEP Program Shown to Help Reduce Occurrence of ACL Injuries

If you are a young female athlete, parent or coach of an athlete, you may be aware that adolescent girls have a 4 to 8 time higher risk of sustaining a non-contact anterior cruciate ligament (ACL) injury than male athletes participating in the same sports. While reasons for this may vary, an article published in Contemporary Pediatrics suggests that this higher risk factor is related to a female athlete’s neuromuscular control of knee motion during athletic activities such as landing from a jump or quickly changing direction:

Current evidence suggests that the primary reason girls are at greater risk than boys for noncontact ACL injuries is that girls tend to have less neuromuscular control of knee motion during athletic maneuvers. In other words, girls tend to use their muscles differently than boys when landing from a jump or quickly changing direction. Biomechanical studies have identified 4 neuromuscular strategies that are more common in girls and that may lead to dynamic knee valgus, a position that places the ACL at a high risk of tearing.

(1) Girls tend to use their quadriceps muscles much more than their hamstrings. Kinetic and kinematic analyses have found that during a jump landing or quick change in direction, girls have reduced knee flexion, increased quadriceps activity, and decreased hamstring activity compared with boys. This “quadriceps dominant” strategy has been shown to increase both anterior tibial translation and strain on the ACL.30 Notably, ACL strain is significantly reduced when there is co-contraction of the hamstrings.4

(2) Girls tend to have 1 leg stronger than the other, whereas boys tend to have equal strength in both legs. Asymmetry in leg strength promotes asymmetric weight distribution between the feet upon landing, causing a shift of the […]

The Link Between Diet and Recovery from Orthopaedic Surgery

When we speak of “diets” in the United States, we generally do so in the context of losing weight or improving certain medical conditions such as high blood pressure, heart disease or diabetes. Most of us have heard or read that a diet high in fresh fruits and vegetables, with moderate amounts of lean proteins and whole grains, is generally better for overall health than, say, a diet consisting of processed foods and sugar. Did you know though, that your diet, specifically what you eat before and after surgery, may help you recover faster, and experience a better overall outcome?

A 2014 article written by Dr. Levi Harrison, a prominent orthopaedic surgeon in Southern California, suggests that the Paleo Diet, consisting chiefly of lean proteins, fresh fruits and vegetables, and excluding dairy, grain products and processed food, may aid patients in faster healing after surgery:

It has been astoundingly clear that the patients who follow the Paleo Diet suggestions, do better post-operatively than the conventional eating patients whose diets are filled with sugar, salt, and highly processed, refined foods that do not have substantial nutritional value and minimal EPA and DHA. After observing the correlation between the use of the Paleo Diet and efficient recovery times in operative patients, it has become clear that the Paleo Diet yields excellent postoperative healing benefits. More high-powered double-blind studies may provide further illumination of this apparent truth about the life-enhancing virtue of the Paleo Diet.

The Paleo Diet, which is superior in nutritional value to many restrictive standard diets, provides a patient with appropriate vitamin, mineral, Omega-3 and antioxidant profiles. This is critical for healing due to the post-operative decrease in gut motility, potential increases in leaky gut syndrome, insomnia (poor […]

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 […]