St. Joseph's Hospital Health Center's Musculoskeletal Minute

Welcome back to St. Joseph's Hospital Health Center's Musculoskeletal Minute! This video blog features doctors from St. Joseph's Hospital Health Center in Syracuse, NY, speaking on orthopedic topics of interest. You will see a new video blog out every few weeks.

In this edition, Dr. Izant, orthopedic surgeon at St. Joseph's Hospital Health Center, speaks on the differences between osteoarthritis and rheumatoid arthritis.



Dr. Timothy Izant is certified by the American Board of Orthopaedic Surgery.

Education:
MD - Case Western Reserve Univ School of Dentistry

Internship:
University of Pennsylvania Medical Center

Residency:
University of Pennsylvania Medical Center

Fellowship:
Thomas Jefferson University

Areas of Expertise:
Hip and Knee Replacement Surgery

St. Joseph's Hospital Health Center's Musculoskeletal Minute

Welcome back to St. Joseph's Hospital Health Center's Musculoskeletal Minute! This video blog features doctors from St. Joseph's Hospital Health Center in Syracuse, NY, speaking on orthopedic topics of interest. You will see a new video blog out every few weeks.

In this edition, Dr. Glenn Axelrod, orthopedic surgeon at St. Joseph's Hospital Health Center, discusses knee pain in adolescent women.



Dr. Glenn Axelrod is certified by the American Board of Orthopaedic Surgery.

Education:
MD - Univ of Rochester School of Medicine
BS - University of Rochester

Internship:
Strong Memorial Hospital

Residency:
Strong Memorial Hospital

Areas of Expertise:
Arthroscopy
Sports Medicine
Total Knee Replacement

Operation Walk Syracuse: Preparing for Panama

Operation Walk Syracuse is a group of orthopedic specialists (surgeons, medical doctors, nurses, anesthesiologists, and physical therapists) who travel to countries that lack ample access to desperately needed hip and knee replacement surgeries. The surgeries are performed at no cost and patients receive the same state of the art services that our patients receive here at home. This post highlights the “pre-trip” the group made to Panama recently, preparing for their longer trip in November 2012. Last year the group traveled to Nepal, performing more than 75 hip and knee replacements.

Thousands of miles closer, a fraction of the travel time, one hour difference in time, and the luxury of clean, running water, ample electricity, and sound building structures--this is Panama City, Panama.  We joked casually as we were chauffeured from the airport in Panama City to the modest hotel that would serve as home base during our pre-trip visit to St. Tomas Hospital.  We were preparing for our upcoming annual Operation Walk trip in November, 2012.  We (Dr. Brett Greenky, Mike O’Hara, and I) discussed the stark contrast of Panama City in comparison to Kathmandu, Nepal our 2011 Operation Walk Syracuse destination.  We speculated about the hospital, the working conditions, the medical staff, equipment challenges, and our potential patients.  A literal world of difference from the far away and exotic land of Nepal, this mission should be a virtual walk in the park from a comparative standpoint. 

Our small “scouting” team was warmly greeted by the Panamanians and hospital staff, and eagerly embraced and integrated into the Operation Walk Team visiting Panama City for their annual trip.  Operation Walk Denver, a long time established Operation Walk group, had graciously permitted us to coordinate our “pretrip” visit with their scheduled mission trip to enable us to draw from their vast experience as an established team, as well as to permit them to show us the lay of the land at St. Tomas Hospital. 

True to our beliefs, the differences were vast—a modern city with a fairly well equipped hospital rivaling many in the US in terms of the structure and facility features.  Lacking, however, was the capacity to provide the people of Panama with life altering joint replacement surgery primarily due to the supply and demand.  There simply aren’t enough joint replacement surgeons in Panama to meet the surgical needs of their people.  It is for this very reason that Operation Walk teams are warmly embraced and welcomed into this country.  The surgery missions are viewed by both government and hospital officials as a conduit for meeting the needs of their people; in essence, a salvation for them.

Our “perceived” differences between Kathmandu and Panama City rapidly dissipated as we filed into the patient screening clinic that had been assembled in anticipation of our arrival accompanying the Operation Walk Denver team.  As we wound our way through the waiting room crowded with potential patients and their families, applause erupted and cheers echoed from the walls from the hundreds of people crowding the room.  The American team offering the promise to relieve the pain and suffering for some, and restoring the ability to walk for others, had arrived.

The next six hours flew by in what seemed like mere minutes.  Grateful patients and their families were ushered into screening rooms and evaluated by teams comprised of surgeons, medical doctors, anesthesiologists, and nurses.  We encountered elderly people crippled from pain who had limbs misaligned by the long term effects of osteoarthritis.  We met young people, eyes filled with hope for a better future, who had fused hips and/or knees with little or no mobility due to advanced rheumatoid arthritis that had been left untreated due to the lack of availability of disease modifying medications which are readily accessible in the US but not available in this country.

The potential patients were all impeccably dressed in Sunday best for their appointments with the Operation Walk team, wanting to demonstrate respect and admiration for the Americans who had come to offer them hope and relief.  We quickly learned from the Denver team and from the Panama physicians that their lifestyle reality is actually dramatically different from the way they presented to us.  Many live in condition  of complete squalor and poverty, but their pride and respect for Operation Walk inspires them to present themselves immaculately coiffed and wearing what might be their only untattered garment. 

Most of the patients were candidates for bilateral hip or knee replacements, and whenever medically feasible, procedures on both sides would be performed.  For those patients only able to tolerate a single procedure, they were offered the hope of having the second surgery done when we, Operation Walk Syracuse, returns in November.  The same held true for those patients who had medical conditions such as heart disease or diabetes that had to be brought under control prior to undergoing a surgical procedure.  These patients were all considered to be in our “bullpen” and in the queue for surgery in November upon our return. 

So, back to the differences—Nepal versus Panama City—the city, the hospital, the environment couldn’t not have been more in contrast, but the differences end there.  Glance into the eyes of the people, old or young, patient or family member, and we were witness to the same basic need and hope for relief from suffering. It transcends several continents and many thousands of miles.  Once again as we embark on this new journey to Panama City, we are forever humbled by the honor and privilege of caring for those less fortunate brothers and sisters in our world. 

A patient in Panama, who will receive total knee replacement surgery. 

St. Joseph's Health Musculoskeletal Minute

Welcome to the first edition of St. Joseph's Health Center's Musculoskeletal Minute! This video blog features doctors from St. Joseph's Hospital Health Center in Syracuse, NY, speaking on orthopedic topics of interest. You will see a new video blog out every few weeks.

In this first edition, Dr. Seth Greenky, chairman of Orthopedic Surgery at St. Joseph's Hospital Health Center in Syracuse, NY, speaks on partial knee replacements - specifically, patellofemoral knee replacement.




Dr. Greenky is Board Certified in Orthopedic Surgery and is an Assistant Clinical Professor.
Education: MD, Upstate Medical University, BA, Biology, Northwestern University
Residency: Upstate Medical University
Fellowship: Cleveland Clinic Foundation
Areas of Expertise: Total hip, knee and shoulder replacement, hip resurfacing, revision total joint surgery

What factors affect the result of my knee or hip replacement success?

Dr. Brett Greenky

            Experience,Experience, Experience

           

Increasingly patients are accessing health care services to increase mobility, functionality, and pain-free lifestyle choices through joint replacement services.  This year more than 560,000 knee replacements and over 400,000 hip replacements will be performed in the United States alone.  As our population ages, becomes more active and in some cases heavier, the need for joint replacement surgery is expected to increase over 300% in the next decade! Where should you go to get fixed? Data is available to help you make an informed decision.

Consider these facts:

            10 years ago, 60% of knee replacements were performed by surgeons who did less than 30 cases per year and in institutions that performed less than 100 cases per year. 

            Currently there is a strong trend towards specialization in the delivery of hip and knee replacement services. Select hospitals that perform more than a 1000 cases per year are emerging.  These institutions and the surgeons who work there have dramatically better results and lower complication rates when compared to the nonspecialized hospitals and surgeons.

            Studies over and over have shown lower pneumonia, urinary tract infection, deep infection, heart attacks, and blood clot rates after joint replacement surgery performed in these institutions. They all show the same thing: experience breeds excellence. The more experience, the bigger the gap in performance over the low volume centers. 

See for yourself:

1.    Journal of Bone and Joint Surgery (JBJS) 2004.  95-99% confidence levels are exhibited; high volumes equal lower risks and better results.

2.    JBJS 2004.  At the Brigham Hospital in Boston, surgeons doing less than 25 cases per year did 11% of the knee replacements but had problems at a rate twice as high as surgeons who do more than 100 cases per year.

3.    JBJS 2004.  81,000 Medicare patients were reviewed and results were superior in cases performed by surgeons with volumes above 50/ year compared with those done by surgeons with less than 12/ year.

4.    JBJS 2006.  High volume surgeons superior results seem to benefit all patients, but especially those with co-morbidities (that means lots of other medical issues that could complicate an otherwise routine procedure).

5.    JBJS 2010.  High volume surgeons and institutions provided care with lower rates of readmission, shorter lengths of stay in the hospital, more common discharge to home versus a rehab center, and lower risks of bleeding, infection, blood clots and pneumonia.

6.    The Proceedings of the Knee Society 2010.     High surgical volumes increase the likelihood of positive patient outcomes.

            Higher volumes equal superior results---Period. 

            It is becoming clearer that super high volumes are even better than high volumes.  Major joint replacement centers are emerging in many of America's major cities.  Hospitals that perform more than 1000 joint replacements per year are now available.  These centers have established treatment protocols which streamline care and give reliable and reproducible results.  There is little doubt that these centers and the corresponding surgeon staff will have the most experience in providing surgery services and exceptional patient outcomes.

          We are fortunate in our community to have one of these centers:  St Joseph's Hospital Health Center. St. Joe’s performed nearly 1400 joint replacement surgeries in 2010, the most of any hospital in Central New York. Indeed, data from 2004-2005 suggests 46% of ALL of Central New York joint replacement operations are performed at St Joe's! The team at SJH, headed by Drs. Seth and Brett Greenky is proud of our elite program and is dedicated to not only maintain an outstanding level of care, but to seek continuous improvement.

                        Brett Greenky