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Jonathan Cluett, M.D.

Orthopedics Blog

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Rotator Cuff Rehab

Friday May 30, 2014

Healing from surgery for a rotator cuff tear is entirely dependent on a patient being able to perform proper rehabilitation and avoid activities that may injure the healing tendons.

Rehab after rotator cuff surgery can vary widely, but there are some general principles that are true for most patient having surgery for treatment of a rotator cuff tear.

Key to Successful Hip Replacement

Thursday May 29, 2014

What makes a hip replacement last as long as possible, with the fewest complications?  There are many things people talk about:

The truth is, while these may matter, it is almost certainly not the most important factor.  The truth is, what matters most is how well the surgery is technically performed.  While technical ability is related to surgeon experience, this is not the perfect measure.  Unfortunately, surgeons are not graded according to how well they do surgery, but maybe they should be, as that is likely one of the most important factors in determining the success of surgery like hip replacement.

Tommy John Surgery

Wednesday May 28, 2014

Baseball pitchers are especially prone to injuries to the ulnar collateral ligament, and important stabilizing ligament of the elbow joint.  Pitching places tremendous force on the inner side of the elbow, and by throwing at such a high velocity, over and over, the ligament can sustain damage.  It is because of this that baseball managers pay very careful attention to pitch counts and early signs of a problem.

The usual treatment of ulnar collateral ligament tears in a professional baseball pitcher is with reconstructive surgery, better known as Tommy John surgery.  The surgery has become alarmingly common in baseball pitchers, but is frequently successful.  However, the rehab following surgery often lasts more than a year, and not all pitchers get all the way back to their pre-injury level of performance.

Greg Fiume/Getty Images

Are Steroids Bad for You?

Monday May 26, 2014

The word "steroids" means different things to different people.  To some it means a way of cheating, and to others it may be the key to surviving.

So what are steroids?  Are they helpful or harmful?

Steroids are a diverse group of molecular compounds that share some common structural characteristics.  But not all steroids are the same!  Steroids include cholesterol, cortisone, and sex hormones.  Different steroids have very different effects, and very different side-effects.

Learn about steroids, and how different types of steroids have different uses--both legitimate medical uses, and inappropriate misuses.

Not Every Meniscus Tear Needs Surgery

Friday May 23, 2014

Many patients who hear they have a torn meniscus fear that surgery is inevitable.  However, we know that many people have no knee pain despite having a torn meniscus.

In fact, a new study has shown that surgery for a meniscus tear, called an arthroscopic partial meniscectomy, may be of little help to many patients who have a torn meniscus.  The study followed patients who had this standard surgery, and those that had a sham surgery, and found their results a year later were very similar.

Like many studies, this does not mean surgery is a bad treatment, in fact there are probably some situations where it is best.  However, the diagnosis of a torn meniscus does not mean surgery is mandatory, and non-surgical treatment may be best.

Sources: Common Knee Surgery Does Very Little for Some, Study Suggests

Orthopedic Procedures to Avoid

Wednesday May 21, 2014

The American Academy of Orthopedic Surgeons has recommendations of orthopedic procedures that you should not have done!  These include:

These treatments have been shown to be ineffective for these conditions, and you should ask why you are having these done.

Have you be told to have one of these done?  Share your story in the comments section!

American Academy of Orthopaedic Surgeons: Five Things Physicians and Patients Should Question

Possible Complications of ACL Surgery

Tuesday May 20, 2014

ACL surgery is often a recommended treatment for athletes who injure the anterior cruciate ligament.  ACL surgery can have complications with serious implications.

The possible risks of surgery include:

  • Stiffness
  • Infection
  • Re-tear of the ACL
  • Persistent knee pain

Learn about the possible complications of surgery and what you can do to avoid these problems.

Is Surgery Necessary? Maybe Not...

Wednesday May 7, 2014

The decision to have a surgical procedure can be difficult, and patients often are conflicted about how to proceed.  Often, they defer to their surgeon who may be recommending an invasive procedure.  But is that the best way to go?

A recent study found that an alarming number of surgical procedure may be performed that are not necessary.  The truth is, our bodies heal very effectively.  Most ailment get better, but sometime surgery is a helpful step in the healing process, and sometimes surgery is a necessary step to save your life.

This study estimated that 10-20% of surgical procedures may not be necessary.  A few of these occur because of greedy doctors, but that was the small minority.  The majority seem to be the result of doctors who may not have sufficient training about the indications for surgery or the appropriate nonsurgical treatments.

This is a difficult problem to study, because in many cases in orthopedic surgery, problems may get better with either surgical or non surgical treatment.  For example, rotator cuff tears can be a reason for surgery, but the vast majority of patients can recover from a rotator cuff tear with nonsurgical treatment.  However, if a patient has immediate surgery, they may believe that was a necessary step for healing--there is no way to know if they would have recovered with simpler treatments.

These are complex questions, but the bottom line, is every patient should understand why they are having surgery, and what their options are.  If there are questions, it never hurts to have a second opinion to explore what options may exist.

Source: Doctors perform thousands of unnecessary surgeries

Delaying Hip Replacement Not Helpful

Wednesday April 30, 2014

A recent analysis found that delaying hip replacement was not a cost effective way to address the treatment of severe hip arthritis.

Hip arthritis may require you to have a hip replacement surgery, but often patients and doctors worry about doing this too soon.  The common thinking is that simple treatments should be exhausted, and patients should be older before hip replacement.

While this study is not the definitive answer, it does suggest that delaying surgery may not be necessary.  First, it may not save on cost.  Second, because of improvements in hip materials, the likelihood of needing revision hip replacement is very small.

Related: Hip Replacement in Young Patients | Hip Replacement Implant Options

Source: Early Hip Replacement Cost-Effective

Effective Pain Treatment

Monday April 28, 2014

Pain is frequently associated with orthopedic problems, and proper treatment of the painful symptoms is one of your priorities. However, controlling pain is not always a simple process. Many patients are easily discouraged when their treatment efforts to control pain fail. So what options do you have.

The first thing to do is to understand pain is a complicated problem, and treating it effectively can take some time and effort. There are a number of options for medications that can be used to help treat pain. With your doctor, you can try to establish a regime to effectively treat your pain.

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