ACL tears are extraordinarily common.  While a knee injury is common to athletes due to the nature of sports activity, anyone can suffer a trauma to the knee. Falling down a flight of stairs, motor accidents, and even tripping over a broken piece of sidewalk on the way to the school bus can cause an injury that requires a trip to a surgeon, and possibly surgery. While one surgery may be enough for some, there are factors that can come into play that causes the need for subsequent surgeries.  The anterior cruciate ligament, where most knee injuries commonly occur, is often in need of reconstruction to regain full use of the knee.

This ligament, also known as the ACL, is found running diagonally inside the middle of the knee joint. This, along with the posterior cruciate ligament, which runs perpendicular to the ACL control back and forth movements, along with providing stability. Because the ACL is in the front, it is more prone to tears and breaks during unexpected movements. When this occurs, surgery is often inevitable, and occasionally more than one trip back to the surgeon.

Curious as to the types of factors that are involved to cause a patient to have subsequent surgeries, a study was conducted by researchers at the Sports Medicine and Shoulder Service at Hospital for Special Surgery in New York. The study, spearheaded by orthopedic surgeon Dr. Robert Marx and his colleagues, used the SPARCS (Statewide Planning and Research Cooperative System) database for their information. The SPARCS keeps track of admissions and ambulatory procedures in New York State.

Looking at New York’s data between the years of 1997 and 2006 in New York, the team found that almost 71,000 ACL reconstruction surgeries had taken place. Numbers show that female patients were more likely than men to need more than one surgery.  The team also noted that patients (male or female) who had ACL reconstruction surgery performed by a doctor who had less experience also were more likely to need subsequent surgeries.  Men over 40 with additional disorders, who had less experienced surgeons, had an increased risk of being readmitted within 90 days of surgery.

The most likely group to need more surgeries were patients under 40, especially teenagers, with ACL tears. This age group is at a higher risk for knee injuries, knee pain, and ACL tears in general due to a higher activity level than those over 40. Re-tears are also not uncommon with those under 40 for the same reason. While not all tears require surgery, as some can heal on their own, it is safe to assume that patients that play sports or engage in every day activity will most likely need surgery over someone who leads a more sedentary life.

Because surgery is a craft that needs practiced and honed, reoperation is a risk to be considered when choosing a low volume surgeon.  It is important to conduct research on your surgeon and be confident about his or her abilities before going under the knife.

If you have been told that you are in need of an ACL reconstruction, contact our sports medicine specialists at Orthopedic Surgery San Diego today.

You’re walking along, minding your own business, when suddenly you slip, trip, skip a step, walk on a banana peel, or just generally lose your balance. Your stomach flutters, your muscles tense anticipating the pain, possibly broken bones, and of course, the embarrassment. For minor falls, you jump up, brush yourself off, and look around to see how many people witnessed the event. You may laugh nervously, possibly curse the crack in the sidewalk, or confusedly look about for the cause of the accident.

Major falls, on the other hand, are no laughing matter. Sprains, strains, tears, cuts, bruises, fractures, concussions, broken bones, and even death can occur from a fall.  Statistically, most falls occur at home and among the elderly who often suffer from hip fractures that require hip surgery. Orthopedic surgeons often see elderly patients for fractures and breaks, most often due to falls.

According to National Institute of Health’s Senior Health’s website, one out of every three 65 year olds fall every year. This is usually due to muscle weakness, balance issues, arthritis, osteoporosis, vision and hearing issues, uncontrolled blood pressure, medications, and even incontinence. While accidents happen all the time, but many occur when we are in a hurry, or not paying attention to our surroundings. Home factors for falls usually center on too much clutter, poor vision or lighting, lack of handrails, slippery areas, or loose rugs.

We all slip and fall at some point in our lives, but many falls can actually be prevented.  The type of shoes we wear for different activities can be the main factor in staying safe, and upright. Shoes should fit well, be comfortable, and have non-skid soles. Shoes with laces should be laced tightly, but not so tight as to cut off circulation. For those with balance issues, wear non-skid slippers around the home, avoiding those that have a tendency to fall off the feet when walking.

Seniors can decrease their chances of falling by staying active, and exercising. When walking, be sure to pick your feet up off the ground, rather than dragging or shuffling. Be aware of your surroundings, use handrails when they are available, and try not to walk too fast or even too slow. Laurence Z. Rubenstein, from the UCLA School of Medicine and Geriatric Research Education and Clinical Center in Sepulveda, California writes in the Oxford Journal that the elderly make up 13% of the population, and 75% of deaths due to falls occur in that age group. He states: “…about 1 in 40 of them will be hospitalized. Of those admitted to hospital after a fall, only about half will be alive a year later.”

Ironically, the older we become, the less aware we will be, at a time when it is most needed. If you suspect vision, bone, blood pressure, dementia, or any other problems in yourself or loved ones, seek out a doctor for a checkup. Get second and third opinions if needed to stay safe.
If you have hip pain or would like a second opinion, contact our specialists at Orthopedic Surgery San Diego today.

A hip fracture is an injury that can never be dealt with lightly as it may lead to extremely devastating outcome. The hip fracture has serious life-threatening results in those who are elderly. This is because as we age our bone density decreases and makes them more prone to get fractured at slightest trauma. There is a condition named osteoporosis that makes the bones porous and thereby make them more susceptible to fractures.
There can be sundry causes for undergoing a hip fracture. Vision impairment can be one of the reasons that may lead to a faulty gait and thereby increase the chances to fall and hurt themselves. Some medications have a side effect of trembling which can weaken a person and make him more susceptible to get hurt by a fall or so. There are a number of car accident cases where people have incurred hip fractures. In case of individuals with fragile bones just standing on their legs and mildly twisting them can lead to such dangerous fractures. Orthopaedic surgeons advise such patients to be extremely careful while they walk and recommend to do all their daily jobs at a low pace so that they do not harm themselves.

The only way to correct hip fractures is surgery after which the patient is asked to take bed rest for a definite time period and physical therapy is imperative for better recovery of the patient. A study was conducted to understand and record the rate of complications that develop after hip surgery. Another thing included in the study was to determine the percentage of cases that required institutionalization once they got discharged from the hospital. The cases that were studied for the need for institutionalization were those who had undergone a second surgery for correction of contralateral hip fracture. The study was conducted in a hospital by checking the EMR of 71 patients for a period of 6 years. Among these patients there were 60 women and 11 men and they feel in the age group of 54 to 94 years. These patients had previously undergone their first hip surgery after which they had to go for contralateral hip fracture surgery.

On analysis, it was seen that the second hip fracture had occurred in about 46% of cases within a span of two years after the first hip fracture. After the hip surgery, it was observed that there were at least 13 patients who had one or more complications. Similarly, complications had occurred in 26 patients who had undergone second hip surgery. It was also noted that 27 patients needed institutionalization after their first hip surgery whereas the number increased to 72% of patients who were in need of institutionalization after their second hip surgery.

After taking into consideration all the relevant findings, it was concluded that the rate of postoperative complications was undoubtedly higher in second hip surgery as compared to the first hip surgery. The need for institutionalization was found to be more in those individuals who had undergone second hip surgery than those who had gone for their first hip surgery.

If you have hip pain or would like a second opinion, contact our specialists at Orthopedic Surgery San Diego today.

The idea that milk does the body good isn’t just a marketing premise, but rather an important fact. Milk contains Vitamin D which helps the body absorb the calcium it needs to have healthy bones. Vitamin D is also essential for building up the immune system. It is important for children to get enough in their diet, and those that have low levels are at risk for bone fractures at a young age. Adults that had Vitamin D deficiency as a child are more likely to have arterial issues after the age of 30.
Milk is not the only way to get enough Vitamin D in your diet, which is great for those that are lactose intolerant. Sunlight, of course, is an easy, and free way to obtain the vitamin, but is more difficult for those living in colder areas or those with darker skin to obtain through sunlight, than those living in warmer or tropical areas. Fatty fish, such as tuna, salmon, or trout are high in Vitamin D. If fish is not an option, incorporate orange juice, mushrooms, and egg yolks into your diet. Grains, and some meats are also high in Vitamin D.
While adults need to maintain a healthy diet rich in Vitamin D, it is even more important for children to have enough. Because their bones are still growing, they are risk for growth plate and pediatric bone fractures. The growth plates are found along the longer bones of the body, like those in the thigh or arm. Fractures of this type can cause serious problems if left untreated, such as a crooked limb, or one limb longer than its opposing limb.
Growth plate fractures are categorized into one of five types by using the Salter-Harris Classification. Type I fractures across the plate and occurs in young children, while Type 2 starts in the growth plate, but continues through the bone. A Type 3 fracture starts in the growth plate, but goes through the end of the bone and into the nearest joint; Type 4 is similar to Type 3, but the fracture extends through the nearest joint’s cartilage. Type 5, the worst case scenario, is a crushed growth plate. While getting enough Vitamin D is not a guarantee against pediatric bone fractures, it is still a crucial element for bone health.
Low levels of Vitamin D as a child can cause complications into adulthood. A study has found a correlation between Vitamin D deficiency in youth and arterial hardening in adults. The study, conducted in Finland, began in 1980 on almost 2,200 children aged 3 to 18. Their vitamin D levels were checked along with lipid levels, blood pressure, diet, and activity. They were then tested up to the age of 45. The study showed that those with low levels of Vitamin D as a child had a much higher risk of arterial hardening as an adult. More research and studies will need to be conducted to find the cause.

If you have questions about your health or have pain, contact our specialists at Orthopedic Surgery San Diego for an evaluation.

Total hip arthroplasty is one of the most successful orthopedic surgeries today. THA or total hip arthroplasty involves the replacement of the damaged hip joint with prosthetic implants. Since the first such surgery was performed in 1960; there have been rapid improvements and innovations in the technique and technology involved in this surgery. These positive and rapid improvements have only made THA a trusted and popular choice among orthopedic surgeons for degenerative and debilitating disorders involving the hip joint. Not surprisingly, the Agency for Healthcare Research and Quality estimates that more than 285,000 total hip replacements surgeries are performed in the United States alone anually.
Indications for a total hip arthroplasty:
Medical conditions such as hip osteoarthritis, hip arthritis (rheumatic or post-traumatic), and hip fractures often cause irreversible degenerative damage around and within the hip joint. Such damage subsequently results in restricted hip joint movements and sometimes moderate to severe pain around the hips, sometimes also accompanied with groin pain. So much so that individuals with hip arthritis, are likely to find walking, climbing stairs, squatting, sitting in or getting out of a chair painful and difficult. Even simple tasks such as putting on one’s socks and shoes are hampered due to stiff and painful hip joints. Today, total hip arthroplasty is turning out to be a boon for such patients. Besides, most individuals with hip arthritis, etc. hardly find relief with medications, lifestyle changes, and walking supports alone. On the other hand, hip arthroplasty is likely to provide pain relief and a marked improvement in the hip joint movements.
Importance of reducing the short-term complications of total hip arthroplasty:
Just like any other surgery, total hip arthroplasty is prone to a few short-term and long-term complications too. Up until now, the focus was largely on reducing the long-term complications of this surgery such as improving the wear and tear of the prosthetic implants to increase their longevity and enhance the cost-effectiveness of total hip arthroplasties. However, a recent study by David W. Shearer MD, etal. published in ‘clinical orthopaedics and related research’ now proposes that reducing the short-term complications of total hip arthroplasty surgeries is much more effective in increasing their cost-effectiveness.
These short-term complications include post-operative infections, blood clots or pulmonary emboli, and fractures. Reducing the instances of post-operative infections around the prosthetic implants is likely to reduce the chances of readmission due to infections drastically, in turn improving the cost-effectiveness of total hip arthroplasty.
Measures to reduce short-term complications after hip arthroplasty:
• Avoidance of infection post-surgery. Dental procedures, skin infections, and urinary tract infections are the most common pathways that are likely to result in the entry of bacteria into one’s bloodstream consequently resulting in peri-prosthetic infections. Hence, it’s recommended to take precautionary antibiotics (over the counter) before and during any dental procedure within 6 weeks of a THA.
• Blood clots and pulmonary emboli can be avoided with regular blood thinners post-THA. However, blood thinners should be taken only with proper medical advice and consideration.
• Avoid activities that may result in falls and subsequent fractures or dislocations of the prosthesis.
• Perform regular and light exercise programs recommended by a physiotherapist or orthopedic surgeon to maintain strength and mobility of the hip joint post-THA
• Proper follow-ups with the orthopedic surgeon for routine examinations and X-rays.
If you have been told that you are in need of a hip replacement by an orthopaedic surgeon or would like to obtain a second opinion, contact our specialists today at Orthopedic Surgery San Diego for an evaluation to determine a treatment plan that best suits your needs.

The Somatosensory System.
This is the main brain sensory receptive area for the sense of touch. This system as a whole is extremely refined and very sensitive, allowing us to detect, feel and interpret a whole range of sensations. Touch is in fact not a single sense, but involves several different sensory experiences, including specific sensitivity to pain and temperature.
The Somatosensory Cortex area also handles information from other senses such as vision, smell and hearing. If this part of the brain is damaged through injury or disease you could experience problems relating to the sense of touch. This may take the form of loss of sensation in some body parts, insensitivity to temperature or an inability to recognize objects simply by touch.
If neurological problems that interfere with sensation are identified, tests are always conducted to identify the source of the problem so that the appropriate treatment can be applied.

The Somatosensory System and Smartphone link.
The prolific use of smart phones has forced people to use their hands in ways never before used in the entire history of mankind. Recent research has shown that people who use touch screen phones are likely to develop a larger Somatosensory cortex – the area at the centre of the brain which controls the thumbs. Experts now believe that the more time spent fiddling with a smart phone, the bigger the link between brain and hand.
It has been noted that the digital technology we use on a daily basis alters the form and function of the sensory processing in our brains.

Are there any dangers relating to the altering of the Somatosensory system?

Although the brain has long been known for its ability to adapt to particular situations, there are times when it becomes unable to adjust. As a result there are both benefits and potential dangers if the Somatosensory system is altered by overuse of the smart phone.
• A major benefit is the speeding up of the reaction time between the brain thumbs and fingertips, with heightened connection and sensitivity.
• However, altering the size or shape of the Somatosensory cortex can lead to chronic pain in the hands, as well as a movement disorder such as dystonia that causes muscle spasms and contractions.

The digital revolution.
Like the Industrial Revolution of days gone by, the development of digital appliances has burgeoned unbelievably and touches everyone’s life. This is especially true of the digital phone, in particular the smart phone.
Almost every child is the proud owner of one kind of phone or another, and those who only have the humble fixed button cell phone, all aspire to own a fancy smart phone.
It is the young children of today who are most at risk for future problems as they blissfully use their smart phones for hours each and every day.
For some there could very well be chronic pain and neurological movement issues lying in wait for them, if the overuse of smart phones is not controlled or reduced.

If you have questions about maintaining a healthy lifestyle contact our specialists at Orthopedic Surgery San Diego today to help develop a program that is best for you.

Data from a small study published online in the Journal of Sports Science & Medicine suggest that hill running may not negatively affect the Achilles tendon (AT), compared to running on level ground. The researchers used Doppler ultrasound to image AT cross-sectional area (CSA) for twenty women who ran for 10 minutes on each of three randomly ordered grades: -6 percent, 0, and +6 percent. They found similar decreases in AT CSA from pre- to post-run for all three grades, suggesting that decrease in CSA may be a normal response to running independent of grade. The researchers did note that active peak vertical forces were different across grades, with the largest occurring during downhill running and smallest during uphill running.
If you have been suffering from foot and ankle pain or would like a second opinion, contact our sports medicine specialists at Orthopedic Surgery San Diego today to devise the treatment plan that best suits your needs.
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Many people are affected by joint pain as they get older and this is more prevalent in menopausal women. Typical symptoms of menopausal joint pain include aches, stiffness and swelling around the joint that may be worse in the morning but improve as the day continues.

Hips and knee joints which experience high impact tend to be most affected by this “menopausal arthritis” although hands and fingers can also be affected. In the past, high impact exercise like jogging was considered to be harmful for the integrity of articular cartilage. It was believed that it could worsen the problem although this has never been proved scientifically.

According to a recent study, high-impact loading – jumping type of exercise – and a rapid change of movement directions are shown to be the most efficient exercise modality to improve bone strength.

Nearly any form of arthritis can affect the knee and cause knee pain and swelling. Cartilage breakdown and infections in the joint are some of the problems that trigger pain in the knees. Knee arthritis occurs when there is a breakdown of the cartilage that cushions the ends of the bones where they meet to form the knee joints. This causes the bones to rub against each other causing stiffness, pain and loss of movement in the joint.

There are cases where knee replacement also referred as knee arthroplasty may be needed in order to help relieve pain and restore function in the seriously diseased joints. This happens when medical cures are not satisfactory and knee replacement surgery is considered to be an effective treatment.

A study was carried out in the Department of Health Sciences at the University of Jyväskylä, Finland on the effects of high-impact exercise in postmenopausal women. The effects of high-impact exercise on knee cartilages, osteoarthritis symptoms as well as physical function in postmenopausal women with mild knee osteoarthritis were examined.  The study revealed that progressive high-impact training enhanced the patellar cartilage quality of postmenopausal women who may be susceptible to osteoporosis (bone loss) and also in danger of osteoarthritis.

The study enrolled 80 eligible postmenopausal women aged between 50 to 65 years and having knee pain during most days of the month, who were then randomly assigned into a training group or a control group. Before the randomization and intervention was done by radiographs, all the participants had their mild knee osteoarthritis confirmed. The training group exercised as per supervised progressive high-impact exercise program thrice every week for 12 months. The control group was however left to continue with their normal physical activity.  The impact of exercise on the texture of patellar cartilage and the quantity of liquid were measured using T2 relaxation time at MRI imaging.

According to Jarmo Koli, a Doctoral Student and OMT –physiotherapist from the Department of Health Sciences, the breaking of collagen network and increased free water in the articular cartilage is thought to signify the onset of osteoarthritis degenerative process.  The disease progression might be slowed down if those cartilage breaking changes can be delayed, stopped or even improved by the quality of the cartilage through physical activity.

The study established that training improved the patellar cartilage’s quality as well as physical functions like the strength of knee extensors and cardiorespiratory fitness. However, the most significant finding was that high-impact jumping exercise enhanced the biochemical composition of cartilage as shown by MRI in those with mild knee osteoarthritis.  The 12-month training was reportedly well tolerated and it didn’t induce any knee pain or stiffness. The training compliance was also generally high.

If you have knee pain or would like a second opinion, contact our specialists at Orthopedic Surgery San Diego to schedule an appointment to determine a treatment measure best suited to your needs.

A Healthy Eating Program Plan for Schools.
Through the Healthy, Hunger-Free Kids Act, supported by the First Lady, Michelle Obama, and signed into law by President Obama, the U.S. Department of Agriculture (USDA) set out nutrition standards for school meals. The aim is to help raise a healthier generation of children who will be less vulnerable to adverse effects from obesity and poor dietary habits.
These innovative reforms will impact positively on children’s health in a way that is achievable in schools across the nation.
Children who participate in sports will benefit from more stamina and better performance levels when nutritious meals are eaten on a regular basis. Kids in general will also be more resistant to succumbing to colds and flu and other infections when the new nutrition standards for school meals is fully under way.

Putting nutritious and healthy food on the plate is not enough if the kids don’t eat!
The results of a recent study in Utah suggested that a simple solution of moving lunchtime until after recess prompted kids to eat more and waste less. The theory is that children are hungrier after recess, and as they were not in a rush to get out and play, were inclined to eat more. The lunchroom also became a much calmer, more orderly area.
Researchers noted that after conducting studies at some schools which had switched the order of lunch/recess, there was a measurable per child improvement in the consumption of fruit and veggies.
Children who came from less affluent homes where fruit and vegetables are not in plentiful supply, were encouraged to eat healthy meals which afforded nutrition that they might not be getting at home.

The future generation.
The children of today are the generations of tomorrow. Improving the quality of school meals for every child across the nation is an important step in building a healthy future for our kids. Parents at home need to do their part a by encouraging their children to eat more healthily. Reducing the amount of junk food consumed is also critical.
Schools should also strongly consider changing the lunch/recess order which could motivate students to eat better meals.
The implementing of this simple suggestion could be the answer to years of struggling to get children to finish eating the school lunches and so put an end to the frustrations of the lunch ladies.

If you have questions about proper nutrition for you or your family, contact our specialists at Orthopedic Surgery San Diego.

Our hip can be injured in various ailments. Arthritis is one of the primary reasons for hip pain. Osteoarthritis is due to the natural wear and tear of the joint that occurs in individuals as age progresses. Rheumatoid arthritis is another form arthritis that occurs in case of an overactive immune system. Out body starts destructing our own bone and joint cells thereby leading to a debilitating condition. In case of hip injury there may be a significant amount of hip pain and discomfort. Such cases cannot be left unattended as it can interfere with the normal day-to-day activities. Hence the best way to manage such conditions is to go for hip replacement or total hip arthroplasty.
Infection is one of the major complications one has to face after THA. It is a serious matter of concern for the health provider and the patient as well. The chances of infection have been reported to be on a rise in individuals with BMI higher than 35 or 40.

Morbid obesity is a condition in which a person has a Body Mass Index (BMI) greater than 40 or fall in the range of 35 to 40. To make it easy to understand, one can say that in case of morbid obesity a person will have a weight at least 100 pounds more than the normal level. Morbid obesity is an alarming issue as it has a lot of complications associated with it like development of infection and failure of implant placement.
A study was conducted between two groups of patients who were morbidly obese and non-obese. The study was aimed to achieve a comparison between the results of two-stage revision THA (total hip arthroplasty) done for periprosthetic joint infection. For this purpose a total of 653 patient records were studied. For this study their preoperative BMI was taken into consideration. A total of thirty-three patients who were morbidly obese were in one group and in another group 66 non-obese patients were taken into consideration.
After the completion of study, the results were compared and it was observed that the rate of reinfection was extremely high in morbidly obese patients (18%) when compared to the non-obese patients (2%). Almost a similar response was seen in case of revision as it was 42% in morbidly obese patients and 11% in non obese patients. Reoperation for any specific reason was seen in 61% of morbidly obese patients and 12% in case of non obese patients.
To conclude, the study determined the fact that morbidly obese patients are at a significantly higher risk of developing complications of reinfection or reoperation after total hip arthroplasty for periprosthetic joint infection as compared to those who are non obese.

Contact our specialists at Orthopedic Surgery San Diego to discuss your options if you are faced with hip pain.