Services
Total Hip Arthroplasty
This is indicated for patients with severe hip pain from a variety of conditions including osteoarthritis (wear and tear), rheumatoid arthritis, osteonecrosis and certain hip fractures. It involves the removal of the femoral head, reaming of the acetabulum (hip socket) and replacement with a metal and plastic articulation. Both Dr. Dawson and Dr. Bowen prefer a direct anterior approach if possible for better early recovery and improved dislocation rates. First performed in the United States in 1940 by Dr. Austin Moore, it has now become very common with approximately 300,000 cases being performed annually in the United States and has been shown to safely and reliably improve quality of life in many studies.
Total Knee Arthroplasty
This is indicated for patients with severe knee pain from a variety of conditions including osteoarthritis (wear and tear), rheumatoid arthritis, osteonecrosis and post traumatic arthritis. It involves cutting off the diseased portion of the end of the femur and the top of the tibia. Metal components are cemented on either end and a plastic liner is placed in between. The back side of the patella (knee cap) is also resurfaced with a plastic button. This was first performed in the 1960s and 70s in the United states and refined over time, now 600,000 are performed annually in the U.S, more than any other type of joint replacement.
Total Shoulder & Reverse Total Shoulder Arthroplasty
This is indicated for patients with severe shoulder pain from a variety of conditions including osteoarthritis (wear and tear), rheumatoid arthritis, some proximal humerus fractures and massive, irreparable rotator cuff tears. It involves cutting off the humeral head and reaming the glenoid (other side of the shoulder joint) and replacing with a metal and plastic articulation. The “reverse” refers to putting a ball on the socket side and a socket on the ball side. This is an option for people without rotator cuff function or pain from severe rotator cuff tears. This decision may be made at the time of surgery regarding which is better for a certain patient. Dating back as far as 1893 in France and more recently in the U.S in the 1950s by Dr. Neer, shoulder arthroplasty is now more common with approximately 53,000 surgeries per year in the U.S.
Knee Arthroscopy
This is indicated for patients with severe knee pain from a variety of conditions most commonly including meniscal tears or loose bodies. Small incisions allow access to the joint. Sterile saline inflates the joint and then a pencil sized camera is introduced to see the damage. Small instruments can then be introduced including biters, shavers and burners to remove and shape the damaged tissue. The most common treatment is a partial mensicectomy where the torn meniscus (two fibrocartilage O-rings at the top of the tibia) is taken back to stable margins to prevent mechanical symptoms in the knee. Occasionally a meniscal tear in a young person is appropriate for a repair, which can then be accomplished using different specialized instruments. Technology continues to improve the capabilities of this surgery by the use of more powerful cameras, video and HD viewing screens.
ACL Reconstruction
This is indicated for patients with symptomatic instability with clinical and diagnostic evidence of a partial or full ACL disruption. The ACL stands for the anterior cruciate ligament and provides some rotational and front/back stability of the knee. Although some people can live full active lives without an ACL, many ultimately require surgical reconstruction to get back to baseline activities. The surgery involves arthroscopic evaluation of the joint as described above, drilling of tunnels in the femur and tibia, and placement of a graft through the tunnels. Graft options include a portion of patients own patellar tendon (BTB), two of the patients’ hamstring tendons or donor allograft tissue.
Shoulder Arthroscopy & Rotator Cuff Repair
This is indicated in patients with severe shoulder pain resulting from various conditions most commonly including rotator cuff tear, shoulder impingement, AC joint arthritis, labral tearing, biceps tendonitis or tearing and shoulder instability. Conservative treatment includes medications, injections and physical therapy. Surgery includes making small incisions and introducing a pencil sized camera to evaluate the damaged joint while inflating with sterile saline. Small instruments can be introduced including shavers, scissors, burners, burrs and rasps to perform release of the biceps, subacromial decompression, distal clavicle excision, removal of damaged or frayed labrum and rotator cuff. In severe cases a rotator cuff repair can be performed with arthroscopic anchors and suture. If a repair is not able to be performed arthroscopically an open approach may be needed.
Trauma & Fracture Care
Bones are strong but almost anything when put under enough load will break. Fracture, crack, break are words that describe the same thing. If bones poke out through the skin this is called an open fracture. These are typically higher energy injuries with worse outcomes including infection, non union (not healing) and so merit aggressive surgical cleaning and prolonged IV antibiotics. Other fractures are termed closed fractures. These may be treated non-operatively with immobilization or operatively with internal fixation such as plates, screws and rods. The exact treatment depends on the natural history of the injury, the specific bone, specific pattern and age/health of the patient that it occurred to.
Carpal Tunnel Release
This treatment is indicated for people who have classic symptoms of carpal tunnel syndrome. These include numbness of the first three digits of the hand, symptoms that are worse at night and with certain daytime activities. Weakness, dropping things and loss of muscle mass in the hand may be later signs of the disease. An electricdiagnostic study of the nerves may be helpful in confirming the diagnosis, especially in those who have atypical symptoms. A stout ligament holds the tendons of the wrist/hand and the median nerve within the tunnel. This ligament can be released surgically to allow more space and less pressure on the median nerve. Conservative treatment includes use of a wrist brace at night.
Trigger Finger Release
This treatment is indicated in people who have pain and symptomatic catching of any finger at the base of the finger in the palm. Injections may be attempted prior to surgical release to try and relieve swelling of the tendon the causes clicking. The flexor tendons of the fingers run through a sheath and they can get caught on the edge of the sheath. Surgical release of the sheath can allow the tendon to again glide smoothly. This usually relieves associated pain. Locked digits require immediate attention as profound stiffness can occur even after release depending on the chronicity.
Campbells Operative Orthopaedics Volume 1, and orthoinfo.aaos.org
