Humeral Head Resurfacing
There are many conservative treatment options for patients suffering from osteoarthritis of the shoulder. Non-surgical options begin with gentle exercise and physical therapy. As the arthritis becomes more advanced and painful, treatment options become more involved.
Humeral Head Resurfacing is a surgical option for patients that have exhausted conservative treatment methods for shoulder arthritis. The procedure may required a smaller incision and less bone removal than traditional shoulder replacements. This can allow for a quicker, less painful recovery. Humeral head resurfacing utilizes a metal cap that resurfaces the head of the humerus allowing for a less invasive sugical technique than that of total shoulder replacement. Should it become necessary for the patient to have a shoulder replacement in the future, humeral head resurfacing allows the surgeon to perform the procedure with a potentially less complicated approach.
If you feel that you may be a candidate for Humeral Head Resurfacing or have any questions pertaining to the procedure, please feel free to contact Dr. Steinfeld at the Orthopaedic Center of Vero Beach. Toll Free: 866-778-2009
Hip Resurfacing: An Alternative to Hip Replacement
(View Animated Video)
Resurfacing of the hip joint offers younger, active patients the ability to live pain-free and engage in most activities. While total hip replacement removes the upper portion of the thigh bone, resurfacing offers a conservative, bone preserving approach to arthritis of the hip. The worn ball and pelvic socket are simply resurfaced removing all bony spurs. The worn surfaces are resurfaced with a smooth metal ball and socket without violating the bone normally removed with a hip replacement. Preserving this bone has significant implications. The size of the hip ball is maintained lessening the chance for dislocations. Hip replacements actually cause loss of bonestock in the surrounding bone over time. From an activity standpoint, hip resurfacing allows most patients to return to more active lifestyles including impact activities such as tennis, running, skiing, etc. Patients with a failed hip replacement usually face a revision procedure resulting in more difficult recoveries, greater potential for complications, and further activity restrictions. Hip resurfacings can be converted to a normal hip replacement should the need arise. Thus the importance of preserving your normal bone! If you feel that you may be a candidate for Hip Resurfacing please contact Dr. Richard Steinfeld at The Orthopaedic Center of Vero Beach (772)778-2009. (Click for more information on Birmingham Hip Resurfacing.)
Bicompartmental Knee Arthroplasty
The Bi-Compartmental Knee System is a prosthesis that offers relief to patients who have developed arthritis involving only the medial and patellofemoral compartments of the knee joint.
Bicompartmental Knee Arthroplasty has several advantages. Not only does the procedure preserve bone, it also preserves the anterior and posterior cruciate ligaments. This potentially minimally invasive procedure may allow for a shorter hospital stay and a faster recovery. Treatment specifically targeted at the arthritic compartments without loss of normal bone and ligaments results in a more rapid return to normal activity and decreased pain.
Research shows us that 70-80% of patients who develop knee arthritis have disease that is localized to the medial and patellofemoral portions of the joint. A patient having pain that involves the inside (medial) part of the knee may be a candidate for this procedure. Xrays along with a physical exam would need to correlate with the patient's symptoms to determine if the procedure is appropriate. For more information or if you feel that any of your patients may be a candidate for the Bicompartmental Knee Arthroplasy, please feel to contact Dr. Steinfeld at 772-778-2009. Toll free 866-778-2009.
"Shouldering the Pain of Arthritis"
Shoulder pain is an extremely common condition. Aside from back pain, shoulder pain is one of the most common joint complaints for people to seek the advice of their physician. In most cases shoulder pain suggests frequently seen conditions such as tendonitis, bursitis, or even tears of the rotator cuff. These represent roughly 90% of the causes of atraumatic shoulder pain seen in the general population. For others, pain within the shoulder joint may represent a long-standing process such as degenerative joint disease of the shoulder (arthritis).
In some cases patients may develop painful arthritis of the shoulder joint in combination with loss of the rotator cuff. This is a condition termed Rotator Cuff Tear Arthropathy. Until recently no reliable long-term options existed for this patient population. These patients not only suffered from painful arthritis but also displayed the weakness of a long-standing rotator cuff deficient shoulder. Most non-operative measures in this group of patients resulted in temporary, inadequate relief of their discomfort.
When these conservative measures were felt unsatisfactory most would look for surgical options. The treatment for significant shoulder arthritis typically involved replacing the worn parts of the shoulder (Total Shoulder Replacement). While this provides excellent pain relief for the arthritic shoulder, this procedure cannot be performed in the shoulder with the combination of arthritis and significant tears of the rotator cuff. Without an intact rotator cuff there would be insufficient muscular control to properly power the shoulder replacement. Consequently, for most patients this combination resulted in significant ongoing pain, frustration, and despair.
Recently a significant advance has been approved by the Food and Drug Administration and been made available to those appropriately trained for its use. For patients with the pain of shoulder arthritis and deficient rotator cuffs (Cuff Tear Arthropathy) a new procedure exists involving a special prosthesis (the Reverse Shoulder Prosthesis). While a normal shoulder replacement consists of a new ball and socket, the reverse prosthesis employs a large ball in the location of the previous socket and a socket where the ball used to be. The advantage of the Reverse Prosthesis is that the absent or deficient rotator cuff is no longer relied upon as the means by which to power the new shoulder joint. The shoulder is now powered by the overlying muscles of the shoulder (the Deltoid muscle).
While this is a new procedure and prosthesis it appears promising for those with Cuff Tear Arthropathy in an effort to alleviate pain and improve function. This may not be appropriate for all shoulder maladies but provides a new option for Orthopaedic Surgeons to help treat a condition with few prior treatment alternatives.
If you feel that you may be a candidate for the Reverse Shoulder Prosthesis or are affected by Cuff Tear Arthropathy please contact Dr. Steinfeld at 772-778-2009.
“The Role of Extended Thromboprophylaxis following Total Joint Arthroplasty and Hip Fracture.”
Dr. Steinfeld has been granted the opportunity to discuss his experience with a newly developed medication to prevent blood clots following Orthopaedic Surgical procedures. Dr. Steinfeld has been selected for and completed training as a national speaker to discuss his experience utilizing newer pharmacologic agents to minimize patient exposure to harmful thrombosis (blood clots).
Orthopaedic patients are at increased risk for the development of venous thrombosis. While many methods are currently utilized to decrease exposure to this potentially deadly complication, newer medical agents may help limit this exposure considerably. Additionally, further research continues to evaluate the role of these agents for extended duration of treatment.
It is the philosophy of the Orthopaedic Center of Vero Beach to integrate new clinically-proven ideas and concepts into everyday practice.
"New Options for Patients considering Total Hip Replacment"
Loosening of hip replacements appears to be the primary reason for long-term failure. It is felt that this process of loosening may be related to wear of the plastic socket liner. As a result, the new joint surfaces implanted as part of hip replacement surgery have generated significant interest amongst both the media and patients alike. The traditional joint surface involves a metal ball joining with the plastic liner of a newly placed socket. The new alternatives include: metal-on-metal or ceramic-on-ceramic and highly cross-linked plastics.
While introduced years ago, metal-on-metal implants are currently being revisited. Metal-on-metal implants have the potential of very low wear rates. There is minimal risk of breakage or scratching of the components and the newer metals involve better manufacturing. The main disadvantage appears to be related to metal ion release. The potential full-body exposure to metal ions remains the single largest concern with these implants.
Ceramic implants also have the potential to reduce wear. This type of surface has a favorable historical track record and is not associated with ion release. Ceramics, however, are brittle and therefore present a risk of breakage within the body. Further, any improper position of the hip replacement components is poorly tolerated with this type of lining and can lead to further wear.
Highly cross-linked plastic liners have been associated with dramatically improved rates of wear on lab simulators, some as great as 90 percent compared to conventional plastics. There is limited but favorable data in humans, but studies from multiple centers suggest potential advantage over conventional plastics.
These new bearing surfaces offer promising technology and the potential for lowered rates of wear. This becomes important as a greater number of hip replacements are including younger, more active patients.
Dr. Steinfeld would be happy to evaluate you as a potential candidate for hip replacement surgery and discuss these exciting alternatives. For more information or to schedule a consultation call 772.778.2009 or toll free 866.778.2009.
"Getting Rid of Shoulder Pain!"
Arthritis of the major joints is increasing among the general population. Much discussion has centered on involvement of the hips and knees as these joints are weight bearing and result in diminished mobility. As such, much of the available information centers on these joints. A significant number of individuals, however, are affected by arthritic involvement of other joints. While most people are well aware of hip and knee replacements, total shoulder replacement surgery is an extremely effective and reliable method of relieving the pain of arthritis in this all-important joint.
Pain about the shoulder region is an extremely common reason for people to seek the advice of their primary care physician. While the soft tissue structures of the shoulder can be a common source of problems (bursitis, rotator cuff tears), arthritic involvement of the shoulder joint is becoming a more frequently recognized source of pain and disability.
A variety of conditions can affect the shoulder joint resulting ultimately in arthritis and wearing away of the joint surfaces. Osteoarthritis (wear and tear arthritis) is the most common condition resulting in shoulder arthritis. The second most common condition is Rheumatoid Arthritis. The process involves chronic synovitis (inflammation of the joint lining) resulting in destruction of the bone and surrounding soft tissues. Osteonecrosis (death of the bone) results from poor blood supply to the bones of the shoulder. This condition commonly follows prolonged steroid use, alcoholism, sickle cell disease, and Lupus. Occasionally, the cause of this condition is never fully appreciated. Post-traumatic Arthritis may follow fractures involving the bones of the shoulder. These bones may heal in an abnormal position resulting ultimately in abnormally shaped surfaces rubbing against one another with motion.
Management of patients with arthritis of the shoulder focuses on reducing pain and taking measures to maintain and restore motion and function. From a non-operative standpoint this involves the use of medications and Physical Therapy. Over the counter analgesics (Tylenol) and anti-inflammatory medications (Motrin, Aleve, ibuprofen) are used to reduce the pain and inflammation of arthritis. Other oral medications include substances such as glucosamine and chondroitin sulfate. These medications may provide some symptomatic relief. Injections deep within the actual shoulder joint may provide significant relief but are often short-lived. In addition, there are neurologic and vascular structures that cross the front of the shoulder joint rendering these potentially susceptible to injury with repeated attempts at injection. Physical Therapy is utilized to help maintain motion and strength.
When these non-operative measures fail to adequately relieve the painful symptoms surgical options should be considered. In the setting of arthritis of the shoulder this typically involves shoulder replacement. Total shoulder replacement removes the worn joint surfaces including the humerus (arm bone) and glenoid (socket). The primary indication for this procedure is relief of pain. Following surgery, it has been estimated that up to 96% of patients experience mild to no pain. The restoration of motion and function are secondary goals of shoulder replacement surgery. These conditions depend upon the integrity and function of other structures within the shoulder (i.e., rotator cuff).
In general, multiple non-operative and operative options exist for those suffering from arthritis of the shoulder. Success depends upon correct diagnosis and proper patient selection. If you have been suffering from persistent shoulder pain and limitations in motion or wish to discuss these options further Dr. Steinfeld can be reached at 772-778-2009.
Technology of Total Knee Replacement: OXINUIM “As Strong As An Ox”
A surgeon’s long-term goal for total knee arthroplasty is extended life for the replacement. Not all implant devices are made of the same material. Due to significant advancements in technology, there is now a revolutionary new material for implant devices that, quite literally is “As Strong As An Ox.” OXINIUM* Oxidized Zirconium was introduced to reduce the wear rate over the standard cobalt chrome metal total knee implants. OXINIUM material has proved to be a far superior metal for use in production of total knee implants because of its hardness, smoothness and resistance to abrasion and scratching. Physically active patients can have the utmost confidence in an OXINIUM implant because it demonstrates lower wear rates in lab testing. Patients who desire a return to an active lifestyle may also benefit from OXINIUM total knee implants because they are better able to tolerate activity and may last longer than traditional cobalt chrome total knee implants. Laboratory wear testing has indicated that OXINIUM total knee implants demonstrate the scratch and wear resistance necessary to be long lasting. The smooth, hard surface of the OXINIUM total knee implant is the result of a process that allows oxygen to absorb into zirconium metal, which changes only its surface from metal to ceramic. The ceramic surface makes OXINIUM implants 4,900 times more abrasion resistant than cobalt chrome and reduces friction between the implant and plastic surface. The Oxinium material contains no detectable nickel, the leading cause of negative reactions in patients with metal allergies. If you are allergic to metals, you can feel safe about an Oxinium implant because it is one of the most biocompatible metals know to man.
Dr. Steinfeld performs various total joint reconstruction procedures. He employs the use of new materials, including Oxinium, in an effort to promote longevity of joint replacements.
For more information on Oxinium Total Joint Replacement, please visit MyLifeInAction.com or StrongAsAnOx.com.
