knee replacement

Don’t fear knee replacement, says surgeon Dr. Stephen Duncan

Dr. Stephen Duncan

Dr. Stephen Duncan

Written by Dr. Stephen Duncan, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

From simple wear and tear to an old high school sports injury, there are many reasons why you might develop debilitating knee arthritis that affects your daily life.

Over time, this arthritis causes the cartilage – protective cushion between the bones in your knee – to wear out. Unfortunately, once the knee cartilage has worn out, there are not great regenerative treatment options to help restore it.

At this point, you might be offered a knee replacement.

Fear of replacement

Once the word “replacement” is said, some patients fear the worst. And this fear prevents many individuals from going through with the surgery.

Although it takes about a year to fully recover from knee replacement, the truth is that the surgery can help you get back to enjoying the activities you love.

One common misconception is that knee replacement is only for older patients. That’s not the case. There isn’t a minimum age for knee replacement, and younger and older patients alike can undergo the surgery.

Surgery specifics

Another misconception about knee replacement is that we remove a large portion of the thigh bone (femur) or shin bone (tibia). Actually, we only remove about 5-9 millimeters of bone, which is about the size of a pen or pencil.

It’s almost better to think of knee replacement as a “recapping” or “resurfacing” procedure. We remove the worn-out portion of the cartilage and place caps of metal on the ends of the femur and the tibia.

This provides a strong surface to then place a plastic or polyethylene spacer in between these two surfaces. The replacement is often held to your bone with cement, which helps keep it in place.

Partial replacement

Another fear about replacement surgery is that it won’t last for very long.

Although early iterations of this surgery typically lasted around 10-15 years, the current implants are designed to last twice as long – between 20-30 years.

That means instead of having to wait until a patient is older, we can offer knee replacement to younger patients to help improve their quality of life earlier in life.

For some individuals, a partial knee replacement may be an option. This entails only recapping one part of the knee. If only one part is worn out, it doesn’t make sense to replace the entire knee, and a partial replacement might be a better option. Today, we’re doing more and more partial knee replacements to help improve patients’ pain and function.

Recovery

Regardless of the surgery, it does take about one year to fully recover and get back to trusting your knee to do activities such as hiking, jogging or tennis.

The good news is that you should be able to return to simple activities like shopping within four to six weeks after the procedure.

How we can help

The team at UK Orthopaedic Surgery & Sports Medicine offers a comprehensive knee replacement program, including advanced partial knee replacement techniques.

This year, the U.S. News & World Report’s Best Hospitals Rankings designated our program as High Performing in Knee Replacement. Learn more about our program and what you can expect during the knee replacement process.


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Making the Rounds with Dr. Ryan Muchow

Dr. Ryan Muchow on the ‘amazing’ field of pediatric orthopaedics

Making the RoundsWe caught up with pediatric orthopaedic surgeon Dr. Ryan Muchow for our latest Making the Rounds conversation. Dr. Muchow works at Kentucky Children’s Hospital and Shriners Hospitals for Children Medical Center – Lexington, where he specializes in hip surgery and hip preservation treatments. 

What conditions do you treat?

We treat the entirety of pediatric orthopaedics, from birth to the young adult years. We take care of all kinds of musculoskeletal injury and conditions.

We see kids at both the Shriners Hospital as well as the Kentucky Children’s Hospital. Most of the kiddos that we work with at KCH are kids that come in in an urgent or emergent basis with an acute injury. We’re able to take care of them at a time of great need as they’ve broken bones or have been involved in a serious accident.

Most of those kids at Shriners were either born with a condition or have developed a condition. They’ve been living with it for some time, and it’s not necessarily an acute or urgent setting. But we get to meet them and help them through their journey with whatever condition they have.

What makes pediatric orthopaedics so enjoyable?

It’s this amazing field where we have the opportunity to restore activity to kids. One of the top motivations for a child is to be able to play, to be able to run around and do things carefree. And we have the ability and opportunity to come in at a special time of their life and provide that service or need to get them to a point where they can do that activity.

Why did you decide to pursue medicine as a career?

Medicine in some ways chose me. I was thinking about other interests in high school, and someone recommended to me that I look at medicine. I got involved in a program that led me into medical school. After that, it was kind of affirmation after affirmation of, “Hey, being with people is awesome, getting to do the sciences is awesome.” And so it all kind of came together in medicine.

Describe your ideal weekend.

I’d come home Friday night after work and make pizza with my wife and kids. We’d put the kids to bed and then watch a movie.

Saturday morning, I’d get up and go for a run with the family, pushing the kids and running with my wife. We’d go get donuts, and then we love to do things outside – hiking, running around and doing crazy kid stuff.

What’s your favorite food?

If I can have two favorite foods, I’d say I like pizza a lot and I also like steak a lot. Those are two completely different foods, but those are where I’d go.

Steak if I could have a nice meal out and pizza if I could do something every day of the week.


Check out our video interview with Dr. Muchow, where he tells us more about the comprehensive orthopaedic care provided by Shriners and KCH.


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Pediatric patients play ball with UK athletes at No Limits camp

Don’t miss the video at the end of this post to see highlights from this year’s camp!

Patients from Kentucky Children’s Hospital and Shriners Hospitals for Children Medical Center Lexington learned there are no limits to what they can do at the No Limits Baseball and Softball Camps this past Saturday.

After moving to the UK medical campus on South Limestone earlier this year, Shriners needed a new venue for the annual No Limits event. UK Athletics stepped up to the plate, offering Cliff Hagan Stadium and John Cropp Stadium as well as some help from the members of the UK Baseball and UK Softball teams, including head coaches Rachel Lawson and Nick Mingione.

Throughout the day, patients had a chance to practice and develop their baseball and softball skills with drills in batting, catching, throwing and nutrition. A member of UK Baseball or UK Softball accompanied their “buddy” to each of the stations to help them one-on-one.

Fun on the field for patients and parents

JP David, who has participated in the No Limits Camp in previous years, was able to get in on the fun once again. For 12 years, David has seen physicians at Shriners and KCH to receive care for cerebral palsy. David’s mother accompanied him to the camp, as she’s done in previous years. She appreciates that Shriners gives patients the opportunity to have typical childhood experiences.

“He would love to just keep going but his body won’t let him,” she said. “But when they host events like this, he realizes he’s not the only one and he feels like a normal kid.”

For the first time, patients at KCH were also invited to participate in the camps. Jaxon Russell, a big fan of UK Baseball, was glad to be at Cliff Hagan Stadium. Russell has undergone two open-heart surgeries in the first five years of his life. He is also being treated for pulmonary atresia. His parents, Shannon and Miranda, were excited to be a part of the big day.

“For a program like this to take time out of their days to make these kids smile and have a memorable moment is tremendous,” Miranda said. “It’s something that they’ll never forget.”

After Jaxon’s diagnosis, Shannon and Miranda founded a nonprofit organization that helps other children diagnosed with heart conditions enjoy the game of baseball.

Long-lasting benefits

Illness can often take away the opportunity for young patients to have the same experiences as other children or their siblings. Sometimes things that happen outside of a clinical setting can be incredibly beneficial for health and wellness, said Dr. Scottie Day, physician-in-chief at Kentucky Children’s Hospital.

“The opportunity for a child to attend this camp gives them an experience that proves to have a long-lasting effect on psychosocial development, including self-esteem, peer relationships, independence, leadership, values and willingness to try new things,” he said.

Three patients who attended the camp also will have the opportunity to represent Kentucky in the 2018 Shriners Hospitals for Children College Classic next year in Houston, where they will serve as Kentucky’s batgirls/batboys during the tournament.


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hip replacement

Don’t let hip pain keep you down

Written by Dr. Patrick O’Donnell, an orthopaedic oncologist who treats bone cancer and also does reconstructive orthopaedic surgeries. 

When patients have hip pain and other treatment options aren’t providing relief, the next step is often a hip replacement surgery.

Hip replacement surgery can drastically improve your mobility, offer pain relief and allow you to get back to a more active lifestyle. Although it might sound scary, hip replacement is one of the most common and effective surgeries in medicine today. In fact, it’s one of my favorite surgeries because my patients tend to do so well afterward.

So, who’s a candidate for hip replacement and what can you expect during the procedure? Let’s find out.

What is a hip replacement?

The hip joint is a ball-and-socket joint formed by the acetabulum of the pelvis (the socket) and the upper-end of the femur, called the femoral head (the ball). Hip pain is frequently caused by arthritis in the hip joint. When arthritis damages the cartilage between the two bones, it can create friction in the joint, damaging both the femur and pelvis.

During hip replacement surgery, your surgeon will remove the damaged parts of the femur and pelvis and insert artificial replacements that allow your joint to move smoothly.

Who should consider a hip replacement?

Hip replacement is usually recommended for patients who have hip pain despite having tried other nonoperative treatment options. For many patients with end-stage arthritis, a replacement might be the best option.

Not everyone is a candidate for hip replacement, however. If you’ve had a history of infection, blood clots or pulmonary embolism, hip replacement might not be right for you.

How long does the procedure take and what’s recovery like?

Usually between 45 minutes and an hour. Many patients are able to walk soon after their surgery, though most people require about three months of rehabilitation before the hip joint is fully recovered.

I hear old myths about people not being able to walk after a hip replacement surgery, but the truth is that it’s a much easier recovery than other surgeries, such as knee replacements. We expect each of our patients to make a full recovery and return to the activities they love with reduced pain.

We can help

What makes UK unique is our breadth of care for anyone with hip pain.

We offer hip preservation treatments for patients who aren’t ready for a hip replacement, but we also have a team of surgeons who can take care of you, no matter what kind of surgery you need.


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Dr. Eric Moghadamian

Broken bones of his own inspired this surgeon’s lifelong passion

Making the RoundsFor our latest Making the Rounds interview, we chatted with Dr. Eric Moghadamian, an orthopaedic trauma surgeon at UK HealthCare. Dr. Moghadamian is originally from Elizabethtown, Ky., and attended medical school at the University of Kentucky. 

What kinds of patients do you see?

I tend to see patients on their worst day, after they fall off a roof or they’re involved in a motor vehicle collision, motorcycle accident or even a sporting activity where they just break a simple bone.

My job is to put those folks back together and to restore them back to their normal function that they had prior to their accident.

How did you become interested in medicine?

During the course of my own sporting activities as a kid, I wound up breaking quite a few bones. And through my visits in and out of the doctor, I ended up having an affinity for orthopaedics. That’s kind of what set me on the path that I ended up following.

Are you a sports fan?

Oh yeah. I grew up playing soccer and baseball. I played sports in high school and some in college, and I still watch sports on a regular basis. I watch a lot of Premier League soccer and, of course, UK basketball and UK football.

What’s something that most people don’t know about you?

Most folks, in general, are surprised that I’m from Kentucky. They see my name, they see my picture and they tend to ask, “Where are you from?” And I’m like, “I grew up down the road.”

You have young kids – what’s your favorite part about being a dad?

It’s all good! The hugs are the best, I guess.


Check out our video interview with Dr. Moghadamian, where he explains how his team works to provide the best care possible for people with traumatic injuries.


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sports injuries in kids

Coaches and parents, help your kids avoid sports injuries this year

For many families across Kentucky, the start of the school year also means the start of the fall sports season.

Almost three out of every four families with school-aged kids have at least one child who plays organized sports. That’s great! Sports provide physical, emotional and social benefits for kids of all ages. But with sports unfortunately also comes the risk of injury.

The good news is, as parents and coaches, there are lots of simple things you can do to prevent injuries and keep kids playing the sports they love.

Use proper equipment

Make sure young athletes are wearing appropriate and well-fitted safety equipment. This includes:

  • Helmets, for sports like football and lacrosse.
  • Mouth guards, which are inexpensive and can help reduce injury to the mouth, teeth, lips, cheeks and tongue.
  • Sunscreen for outdoor sports.
  • Properly fitting shoes or cleats.

Be aware of heat-related illness

Compared to adults, children are at an increased risk of suffering heat-related illness because they have a lower sweating capacity and produce more metabolic heat during physical activities.

  • Kids just getting back into sports shape after a summer off are especially vulnerable to heat-related illness. Keep an eye on those children in particular.
  • Recognize the signs and symptoms of heat illness, which include nausea, dizziness and elevated body temperature.
  • Reduce the risk of heat illness by making sure young athletes stay hydrated. That means drinking water before, during and after all activities.

Avoid overuse

Nearly half of all sports injuries are from overuse or overexertion and can be easily avoided with proper rest.

  • Plan at least one day off per week to allow a child to rest and recuperate.
  • Coaches, rest players during practice and games to avoid overuse.
  • Children who play multiple sports that use the same body part (like swimming and baseball, for example) are at a higher risk of overuse injuries and should be extra careful.
  • Kids should take two to three months off from each sport every year to avoid overuse.

Be smart when it comes to head injuries

Concussions are serious, traumatic brain injuries that get worse each time they happen. It’s important to know the warning signs of something as serious as brain trauma. Concussion symptoms include:

  • Headache, vomiting or nausea.
  • Trouble thinking normally.
  • Memory problems.
  • Fatigue and trouble walking.
  • Dizziness and vision problems.
  • Changes in sleep patterns.

These symptoms can occur right away, but may not start for weeks or even months. If your child or athlete has any of these symptoms, contact a doctor immediately.


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hip preservation

Hip pain? Replacement surgery may not be the only option

Dr. Stephen Duncan

Dr. Stephen Duncan

Written by Dr. Stephen Duncan, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

Individuals today are more active than previous generations. Although this means improved health and wellness for many of us, it also means more wear and tear on our joints.

Patients young and old can experience pain in their hip joints. Although hip arthritis might be the first culprit to come to mind, there are other causes of hip pain that are aren’t as well known.

Some of these conditions, such as labrum tears, can be treated through hip preservation surgery – a treatment option that provides relief in lieu of a hip replacement and allow physically active people to get back to doing the things they love as quickly as possible. Hip preservation is one of my specialties, and as an avid cyclist myself, I understand the importance of staying active.

Labrum tears

While we are growing as adolescents, there is a growth plate in our femur bone located in the hip joint. Research has shown that individuals who participate in activities that require repetitive hip flexion (when the femur moves closer to the chest) are at risk for this growth plate to react and form extra bone. This is called a CAM lesion.

The CAM lesion is a bump on the femur that can eventually tear the hip’s labrum – a piece of cartilage that helps form the suction seal of the hip joint. When the labrum is torn, you can experience pain in the hip and groin area.

Hip preservation

Pain related to a tear in the labrum can be improved with hip preservation surgery called hip arthroscopy.

Hip arthroscopy involves making tiny holes in the skin that allow us to place a camera and our instruments into the hip joint to fix the torn labrum.

It’s an outpatient procedure takes about two hours to perform, and patients will be on crutches for about two weeks afterward. The hardest part is the recovery after surgery. Although the hip may feel great initially, the body still needs to heal. This takes a minimum of three months.

Folks looking to return to recreational or even competitive sports will be out of action for four to six months. The good news is studies have shown that patients do return to their preinjury level of play following surgery. This surgery might also help to prevent or delay the progression of hip arthritis and help patients avoid a hip replacement in the future. However, more research is needed to determine if this is the case.

If you think you might be a candidate for hip preservation, call UK Orthopaedic Surgery & Sports Medicine at 800-333-8874.


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Dr. Carolyn Hettrich

Shoulder specialist, researcher joins UK Sports Medicine team

UK Orthopaedic Surgery & Sports Medicine welcomed shoulder specialist Dr. Carolyn Hettrich to the team earlier this summer. Hettrich will see patients, take care of UK athletes and conduct research.

Originally from Portland, Ore., Hettrich has studied and worked across the country. She completed her undergraduate studies in Los Angeles at Pomona College and went to medical school at the University of Washington. After graduating medical school, Hettrich completed a residency at the Hospital for Special Surgery in New York and a fellowship at Vanderbilt University. She has spent the past six years working in Iowa.

As a member of the team at UK Sports Medicine, Hettrich said she is looking forward to providing care for patients with shoulder disorders and conducting leading-edge research studies.

In fact, one of the reasons Hettrich decided to join UK HealthCare is because of UK’s emphasis on research.

“I’ll have the opportunity to do the research I’m interested in,” she said.

Hettrich’s research interests focus on three areas: clinical outcomes after shoulder surgery, computer modeling for shoulder replacement, and tendon and bone healing. Hettrich is the principal investigator on the largest prospective study in the world for shoulder instability surgery. The study has 950 patients currently enrolled and is operating at 12 sites nationwide.

Her research expertise meshes well with work already being done at UK Sports Medicine, particularly the work of Dr. Christian Lattermann. Hettrich and Lattermann are both part of the Multicenter Orthopaedic Outcomes Network (MOON) and share a mentor.

“We are very proud Dr. Hettrich joined UK Sports Medicine,” Lattermann said. “She brings an extraordinary expertise in shoulder-related, patient-centered translational research, which accelerates our efforts at UK to become a national leader in patient-related outcomes research.” Additionally, she is an outstanding shoulder surgeon, Lattermann said.

When she’s not conducting research, treating patients or working as a team physician for the UK football team, Hettrich is looking forward to continuing her advocacy work on behalf of her patients. Her master’s degree in public health focused on health policy gives her insight into how she can advocate for her patients and research funding.

Each year, on Research Capitol Hill Days, Hettrich takes patients to meet with congressional leaders in Washington D.C. to show the direct impact of research funding. Hettrich is especially interested in musculoskeletal research because musculoskeletal conditions affect half of the adult population in the U.S., with expenditures related to these conditions accounting for nearly 6 percent of the gross domestic product.


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SMRI

Video: Take a tour of the Sports Medicine Research Institute

Lisa Cassis

Lisa Cassis, UK vice president for research

Written by Lisa Cassis, PhD, UK vice president for research.

The new UK Sports Medicine Research Institute, or SMRI, is a state-of-the-art, multidisciplinary facility that will allow UK researchers to study injury prevention and performance for professional and collegiate athletes, the tactical athletes of the U.S. military, and physically active people of all ages.

Watch the video below for an inside look at the equipment and technology that makes the SMRI such a unique and exciting endeavor.

The 10,000-square-foot facility, part of the UK Nutter Training Facility on campus, is spearheaded by the UK College of Health Sciences and is supported in part by a $4.2 million Department of Defense grant.

The SMRI is outfitted with sophisticated equipment to assess biomechanical, physiological, musculoskeletal and neurobehavioral health and is supported by a team of eight core faculty, staff and research assistants as well as 40 affiliate faculty.

A biomechanics laboratory conducts motion analysis studies using 14 cameras and a dual-force plate system in the floor, like the technology used to make video games and animated movies. Equipment shaped like a horse simulates realistic movement for jockeys and other equestrians.

A neurobehavioral lab uses virtual reality to assess visual acuity, reaction times and balance, which are critical measurements for concussion recovery. Other equipment is designed to measure oxygen consumption, workload and metabolic costs, physiological stress, and the influence of sleep deprivation and fatigue, all of which are important contributors to musculoskeletal strength, endurance, operational performance and injury risk.

The different branches of UK’s mission – education, research, service and care – converge in the work of the SMRI, and we look forward to the discoveries that will come out of this UK institute.


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ultrasound-guided injections

Innovative pain-relief treatment allows woman to enjoy trip to Italy

Geri Maschio spent more than a year planning a girls trip to Italy, but pain in her hip threatened to keep her from getting on a plane and experiencing the cities she’d been dreaming about.

Maschio started experiencing pain in her hip two years earlier. She tried a variety of treatment options to find relief, but none fixed the issue. Unfortunately, physical therapy didn’t help, and Maschio needed a hip replacement.

She was referred by her primary care doctor to Dr. Jeffrey Selby, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

By that time, Maschio’s pain had become too severe for her to continue without treatment. Hip replacements require about four to six weeks of recovery, but Maschio’s trip was quickly approaching, and she refused to forgo her long-planned vacation.

“I wasn’t going to be the person who bailed at the last minute – the trip was a year in the making,” she said.

Another route to pain relief

Luckily, Selby knew of another orthopaedic physician at UK who might be able to help. He referred her to Dr. Kyle Smoot, who suggested using ultrasound-guided injections to treat Maschio’s hip pain. The procedure required little recovery time and would allow Maschio to travel.

Ultrasound-guided injections are used to treat pain stemming from conditions like chronic tendinopathy, muscle tears and carpal tunnel. They’re used in a variety of joints – including the hip and knee – and can also be used diagnostically to identify and differentiate a patient’s pain.

Maschio felt prepared for the procedure, which was performed while she was awake and numbed, but wasn’t sure what the outcome would be.

“I trusted Dr. Smoot because I was totally confident seeing anyone Dr. Selby recommended,” she said. “And Dr. Smoot and the athletic trainer [Amy Waugh] were so kind when they explained everything to me.”

The day before her trip to Italy, Maschio had an appointment with Smoot to receive her injections. Recovery was simple, she said. She let the numbing medication wear off and then felt immediate relief from the pain that had threatened to keep her from going on the trip of a lifetime.

The very next day, Maschio got on the plane for an eight-hour trip. She spent 12 days in Italy walking five to seven miles a day – pain-free.

“I know I wouldn’t have made it on this trip without Dr. Smoot and Dr. Selby – I couldn’t have done it without them,” she said.


Next steps:

  • Learn more about UK Orthopaedic Surgery & Sports Medicine, which provides leading-edge treatment for a variety of injuries and conditions.
  • When Patty Lane was diagnosed with arthritis in her hip, she was told her time as a competitive triathlete was over. Not willing to give up on her dreams, Patty turned to UK Orthopaedic Surgery & Sports Medicine for a second opinion. Read Patty’s story.