- Men's Health, Orthopedics, Women's Health, UncategorizedGeneral Page Tier 3BlogTotal hip replacement is one of the most successful surgeries for relieving pain and increasing function if you suffer from osteoarthritis in your hip. Traditionally, hip replacements were performed through two approaches – posterior or anterolateral. Now, the anterior method is gaining popularity as the “hip” hip replacement. When you have osteoarthritis in your hip, we always begin with conservative treatments, including: anti-inflammatory medications maintaining a healthy weight physical therapy a cane in the opposite hand to off load the pressure on the joint injections But if your pain persists, it’s imperative to have a surgeon skilled in modern replacement strategies to get you back on your feet and active again. Although originally described in 1881, the direct anterior approach to hip replacement was only sporadically used until recently. Technology advances, coupled with patients’ increased desire for minimally invasive surgery and faster recovery, has the anterior hip replacement gaining in popularity. Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery. The anterior approach is a muscle-sparing procedure that exposes the hip joint with one small incision over the front of the hip. The muscles and tendons are spread apart temporarily, rather than detaching them from the hip or thigh bones, as done during the traditional hip replacement approaches. Anterior hip replacement leads to less trauma to the soft tissues and more stability following surgery. During the surgery the patient is placed on a special table, called the Hana® table, that has independent leg spars allowing us to maneuver the patient’s legs to perform the surgery through the small anterior incision. This table also allows us to use intra-operative x-rays to “fine tune” the alignment of the hip replacement components. This offers better wear properties and increased stability of the hip. We use standing x-rays taken prior to surgery and reproduce this with our intraoperative x-rays to appropriately position the hip replacement components specifically for each patient, as well as make leg lengths equal. One of the biggest differences between the anterior approach and traditional hip replacement is the freedom from “hip precautions” following the procedure. Anterior patients can position the hip anywhere they feel comfortable immediately after surgery. Muscles are not cut and the risk of dislocation is low, which enables patients to have more freedom of movement after surgery. Anterior hip replacement patients are routinely walking with physical therapy within hours following the surgery. Following a traditional hip replacement, the surgeon must give specific instructions on hip precautions to prevent dislocating the new joint. These include avoiding bending the hip and turning the foot, sleeping with a pillow between the legs for six weeks, avoiding crossing the legs and not sitting in low chairs. But, for anterior hip replacement patients these precautions are unnecessary. Many patients go home in less than 24 hours and complete outpatient physical therapy within four to six weeks. The incision is closed with absorbable sutures and skin glue, which enables you to shower immediately and not have to have sutures or staples removed. The direct anterior approach can be utilized for nearly all total hip replacements. Whether patients have osteoarthritis, rheumatoid arthritis, femoral neck fracture or advanced avascular necrosis, the anterior approach is a reliable and reproducible surgical approach. Anterior hip replacement can help you get back to the life you want to be living. Author By Justin Hoover, MD, orthopedic surgeon at AAMC Orthopedics. To reach his practice, call 410-268-8862. Originally published March 31, 2015. Last updated May 31, 2018.0
- Cancer Care, Community, Patient & Family Advisors, UncategorizedGeneral Page Tier 3BlogPatricia Holle describes herself as a “mammogram success story.” When her breast screening showed an abnormality, Pat underwent 18 months of treatment for stage 2B breast cancer at Anne Arundel Medical Center. Once she was pronounced cancer-free, Pat was determined to help others who were facing cancer diagnoses. Luckily, she didn’t have to look far: She joined the volunteers who serve as AAMC’s patient and family advisors. Pat says she was hooked by the program’s theme, Nothing About Me Without Me. Pat had benefited from their services when she was a patient, so she felt it was a natural fit for her to return the favor. “There is something so special about AAMC,” says Pat. “They have such great care, even after treatment is done.” In her advisor role, Pat collaborated on the guide that breast cancer patients are given when they begin their cancer journey. “Empathy is wonderful,” says Pat, “but a unique perspective is given by someone who has been through breast cancer.” One annual event that holds particular meaning for Pat is AAMC’s National Cancer Survivors Day celebration. That’s where she learned about the Annapolis Dragon Boat Club, the local club of an international movement of cancer survivors who paddle and race stylized boats. “We like to say that it is a support group that’s not only about the disease,” says Pat. “Plus, being an athlete again is a great thing.” The dragon boat is featured in a painting that now hangs in The Rebecca Fortney Breast Center at the Geaton and JoAnn DeCesaris Cancer Institute, and is reproduced on note cards that are in a gift bag given to breast cancer patients on the day of their surgery. Pat remarks, “In the face of having a life-threatening diagnosis, it is reassuring to have a visit from a survivor with these special gifts.” Originally published Aug. 10, 2016. Last updated May 29, 2018.0
- News & Press Releases, Heart CareGeneral Page Tier 3BlogAnne Arundel Medical Center and community partners have brought life-saving technology to Anne Arundel County. Working together with the city, the Fire Department and Leadership Anne Arundel, the new PulsePoint app aims at improving bystander response to cardiac arrest victims and increasing the chance of survival. Here’s how it works: The app alerts CPR-trained citizens to someone nearby having a sudden cardiac arrest so they can help while professional responders are on the way. The app is activated by the local public safety communications center concurrent with the dispatch of local fire and EMS resources. Anne Arundel County residents can now easily download the app and register. PulsePoint looks to reduce the time between the victim’s collapse and CPR response through citizen awareness. It also increases awareness of public access defibrillator (AED) locations through real-time mapping of nearby devices. “Heart disease is still the number one killer in the United States,” said Jerry Segal, MD, medical director of cardiovascular services at AAMC. “ Timing is critical in these situations. Bystander CPR is important because it really does save lives. There have been studies done showing that it increases the survival rate in these patients by about threefold.” The app also shows fire and EMS activity in the community, strengthening community engagement. The app is only functional where adopted and implemented by the local fire/EMS agency because it requires a connection to the local public safety communications center. “In 2017 there were 534 people in Anne Arundel County who experienced a sudden cardiac arrest and 34 percent of the time bystanders performed CPR before first responders arrived,” said Allan C. Graves, Anne Arundel County fire chief, noting that the launch of the app was happening during the 44th Annual National EMS week. “The launch of PulsePoint is a demonstration of how we are stronger together.” An example of the potential of the app is Carl Smit, 47, of Annapolis. On Jan. 27, Carl was sailing in a local regatta when he had a sudden cardiac arrest. “I told the woman next to me that I was going to sit down and shut my eyes for a minute,” he said. “I wasn’t breathing or responding but luckily a good friend conducted CPR until they got me to shore. Not a lot of people there were trained on how to do CPR.” Carl Smit Having someone on site who was CPR-trained saved Carl’s life. And today, he was able to share his story during the launch because of this. “The team at AAMC is amazing. I have to thank Dr. Iliff, Dr. Reineck and Dr. Kilical,” Carl added. “I just graduated a couple of weeks ago from three months of cardiac rehab and it’s fabulous, the team here is outstanding.” Carl said he felt discouraged in the beginning since most people in rehab were much older than him. “I didn’t know how long recovery was going to be,” he said. “But I started walking on a treadmill and by the time I got out I was already rowing.” Carl understands the importance of quick response firsthand. He said the app might not only save lives, but also encourage more people to learn how to respond. “I think PulsePoint is going to make a huge difference in the Annapolis area by increasing awareness.” The PulsePoint app is now available in Anne Arundel County. If you’re a CPR certified or trained member of the community, learn more about PulsePoint here. Want to get CPR certified? We offer classes for the community. Sign up today!0
- Men's Health, Orthopedics, Women's Health, WellnessGeneral Page Tier 3BlogBarefoot and minimalist running became a popular trend over the last several years. The barefoot running technique, as its name implies, involves wearing little to no footwear while you run. The developers and advocates of this technique believe the human foot is evolutionarily designed to run barefoot, and shoes only hinder our performance and cause us injuries. David J. Keblish, MD, an orthopedic foot and ankle surgeon at AAMC, disagrees. “There is a romanticized notion that somehow the world would be a happier place if we didn’t wear shoes,” he says. “I think that’s nonsense. The human foot is not evolutionarily designed well for running, and I don’t think shoes are causing the problem.” Dr. Keblish believes it is our modern lifestyle that ruins our feet, not our choice of running shoes. “We’ve turned the earth flat, and most of us spend all day long in shoes without ever exercising the many muscles in our feet” he says. While early humans had a variety of terrains under their feet, we have mostly flat surfaces. Running on sidewalks, roads and gym floors is tough on our feet—the repetitive motion of feet hitting hard, flat pavement adds stress on our joints and prevents us from adapting to other surfaces.” “People who don’t have shoes don’t have better feet,” he says. “You don’t see marathon runners running barefoot or in minimalist shoes.” There is one aspect of barefoot running that Dr. Keblish does agree with—the forefoot strike technique. This running technique involves landing on the balls of your feet each time you take a step rather than heel striking, or landing on your heels first. Proponents of barefoot running suggest that forefoot striking is more intuitive when running barefoot, while shoes with thick soles and heels cause us to heel strike. “We shouldn’t be heel striking heavily, if at all, when we run,” Dr. Keblish agrees. Training ourselves to forefoot strike is hard to do, he adds, but is better for our feet in the long run. Dr. Keblish also advises that we take time to exercise our feet. “We wake up and immediately stuff our feet into slippers or shoes and most of us keep them there all day, which is not good,” he says. “Feet are like hands; we need to get those joints moving.” To do this, Dr. Keblish says, take the time to wiggle your toes, rotate your ankles and massage the soles of your feet before you get out of bed. He also advocates going barefoot or in minimalist shoes when doing balance drills and resistance training, such as squats and lunges to develop strong feet. Return to Finding the Right Running Shoes for Your Feet Contributor David J. Keblish, MD, is an orthopedic surgeon at AAMC Orthopedics with offices on the AAMC campus in Annapolis and in Pasadena. Prior to joining AAMC, Dr. Keblish deployed with Marines in Afghanistan where he led a military medical unit in caring for severely wounded US troops and coalition forces injured in battle. In addition to serving our nation, he has extensive experience covering NCAA division 1 intercollegiate sporting events and caring for athletes at every level. He can be reached at 410-268-8862. Originally published November 17, 2015. Last updated May 23, 2018.0
- Orthopedics, Senior CareGeneral Page Tier 3BlogJoint replacement surgeries are some of the most successful and popular operations in the medical field. These procedures have helped countless people achieve more mobility and less pain with brand new hips or knees. Sounds like the perfect solution to joint pain, right? But how do you know if you’re ready for joint replacement surgery? It’s not a simple answer, and the timing of your surgery can greatly affect your result. An orthopedic surgeon who specializes in these operations can help you decide if and when to have surgery. A surgeon will talk to you about your pain level and mobility, examine how you walk and evaluate your x-rays before recommending a plan. If you’re experiencing joint pain and thinking about surgery, it will help to be familiar with the following points before you start a conversation with your surgeon: Arthritis and cartilage The most common form of arthritis is called osteoarthritis, a degenerative process which causes your cartilage cushion to wear down. Since cartilage covers the bones in your joints, this can affect how your joints move and feel. If your x-rays show that your cartilage cushion around your joints is gone, it may be time for surgery. Patients call this state “bone on bone.” If your x-rays show you still have your own cartilage, it’s probably too soon for replacement surgery. Hip vs. knee replacement Deciding on hip replacement can be easier than choosing to have a knee replacement. Here’s why: Hip pain is constant, and non-surgical methods of relieving pain aren’t as effective as with knees. Knees are more difficult. Knee pain will come and go, so it’s harder to recognize your pain level. Also, there are other effective ways to relieve pain for knees besides surgery. Injections and physical therapy tend to work better for knees compared to hips. Knee replacement patients often don’t expect the pain that comes with rehab after surgery. Your symptoms: A personal choice Ice and heating packs, joint injections, weight loss, over-the-counter medications and physical therapy can all help reduce pain. However, if you’ve tried these methods and you still have severe pain in your groin or around your knee, it’s time to see a surgeon. While we can make medically based recommendations, remember that having joint surgery is a personal decision. My patients often make the choice to have surgery when their pain is so bad they can’t even sleep or it prevents them from traveling or doing something they love. Patients ready for surgery often stop asking what they can’t do with a total joint, and start looking forward to what they can do after surgery. Still not sure? If you have daily pain that limits your activities, you may benefit from surgery. Surgeons can certainly guide your decision, but the final choice is yours. We want you to feel a big enough improvement after your surgery to be glad you went through the procedure. And remember, joint replacement surgeries have been helping people for decades and most patients are very happy with their results. To learn more about joint replacement surgery, visit https://www.luminishealth.org/en/services/joint-replacement-surgery. Author By James MacDonald, MD, orthopedic surgeon at Luminis Health. To reach his practice, call 410-268-8862.0
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