Manhattan Orthopedic & Sports Medicine is proud to announce ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT (MAKOplasty®). Through the use of a Robotic Arm our surgeons now perform more precise partial knee replacements using a MINIMALLY INVASIVE technique. This cutting edge technology helps restore a patient’s more natural knee motion.

Unlike Total Knee Replacement, ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT (MAKOplasty®) is a resurfacing of the joint with much less bone being removed. Our surgeons use a smaller incision than required for traditional total knee replacement surgery. During the procedure, the diseased portion of the knee is resurfaced and an implant is then secured in the joint to allow the knee to move smoothly again.

Arthritis is the breakdown of cartilage in a joint allowing the bones to rub together. MAKOplasty® partial knee replacement is an innovative treatment option for adults living with early to mid-stage osteoarthritis in one compartment of the knee. As patients living with arthritis know, this is exciting news!

ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT is an outpatient procedure, therefore patients will have surgery in the morning and go home later in the afternoon.

Other patient benefits include:

• Minimal surgical incision.
• Reduced post-surgical pain.
• Accelerated recovery and improved outcomes.
• A more rapid return to daily lifestyle and activities.
• A more natural feeling knee following surgery

Since the earliest days of surgery, doctors have been working to hone the existing tools and techniques of the operating room in order to allow patients to heal faster and limit the discomfort inherent to such procedures. Now, as we move steadily into the 21st century, new technologies are allowing orthopedic surgeons to achieve a level of surgical precision that goes beyond what we have ever seen before. ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT gets our patients back to work and resuming their active lifestyles faster than ever.

And that’s something worth jumping for joy over—literally.

Today, a total hip replacement is one of the most successful orthopedic reconstructive procedures. 85- 90% continue to function well at 20 years, allowing most individuals to remain active for decades. So where then do the problems arise?

This becomes a story of distinction. The majority of hip implants used today are not the metal-on-metal variety, but rather metal-on-polyethylene (plastic) or ceramic on polyethylene. Metal-on-polyethylene implants are the most commonly used replacements, as well as the oldest. Surface wear and loosening is what causes failure after years of use. Doctors have spent years looking to reduce the amount of wear and instability in these devices. Ceramic on ceramic implants wore well, but a small percentage squeaked and recent use has decreased. Metal-on-metal implants were proposed as a way to introduce an implant that not only reduced the wear but more closely matched the size of the normal hip; allowing a greater range of motion. It soon became clear, however, there were a host of major issues associated with metal-on-metal implants: severe inflammatory responses, the detection of metal ions in the blood stream, and a greater rate of wear and loosening, which can lead to the formation of cysts around the prostheses.

The New York Times and others have spotlighted the toll that the widespread use of metal-on-metal hip implants has had on individuals, physicians, and yes, even insurers. They point out the need for unforgiving precision when inserting these prostheses. Metal-on-metal implants may still be required but care must be taken in order to minimize the chance of complications.

To recap, there is great concern about metal-on-metal prostheses, and they should not be used unless it is necessary, and even then, only by the most accomplished hip surgeons. That is not to say that anyone currently with a metal-on-metal prostheses should replace it with polyethylene or ceramic, but rather, anyone with a hip replacement should be evaluated if there is increased pain, grinding and any changes in how the hip feels.

BE AWARE AND INFORMED. If you’re a patient of Manhattan Orthopedic and Sports Medicine Group, you can be confident knowing that we have never used metal-on-metal implants and only use the most proven tools and techniques for all of our procedures.

When a bone breaks, the broken ends may stay in contact with each other or may move considerably. If there is bony contact after a break, we call this a non-displaced fracture.  As long as the alignment of the bone and the stability of the joint are preserved, these types of fractures can often be treated without an operation. Alternatively, if there is major shifting of bones, loss of alignment, and instability at the joint after a fracture, we term this a displaced fracture. Displaced fractures will not heal on their own and will often require surgery as a result.

Lastly, there is the stress fracture. Stress fractures result from continual, repeated loading of bone. These types of fractures occur almost exclusively in the bones of the legs and feet. Stress fractures were first recognized in new recruits to the army, who were forced to complete long marches in training. Today, we often diagnose stress fractures in distance runners.

Non-displaced and displaced fractures are often the result of a specific injury and there’s little we can do to prevent the fluke stumbles and slips that cause them. Stress fractures, however, are a little more particular as to who is affected and why. Individuals who suffer from anorexia have a higher incidence of stress fractures due to a lack of necessary nutrients for proper bone strength. Sometimes, however, it is the healthiest and hardiest of us who succumb to stress fractures as we push ourselves beyond our limits while training for our first marathon or entering the new season after a few months off.

The good news is that stress fractures can be avoided by staying healthy and smart. That means knowing your limits when it comes to repetitive exercises like jogging, and eating right. As always, speak to your primary care physician about any questions or concerns you may have, and find out if there are any risk factors that could increase your risk of a stress fracture. Exercise should keep you healthy, not harm you, so don’t let a stress fracture get in your way of staying active and well.

Let’s start with the quotidian. Nor’easters can come out of nowhere, and no matter how much canned soup you’ve stocked up, the deluge often means a ton of shoveling on short notice. That means doctors’ offices are soon filled with sufferers of pulled back muscles and slipped discs. The problem is that many people slow down their activities during the winter months, so a normal chore quickly becomes a painful lesson in the benefits of daily stretching and regular exercise.

Stretching, as always, is one of the most important activities you can do to prevent common back injuries from snow shoveling and the like. There are a number of great back stretches out there, but if you require some assistance or if you have a history of back issues, you should definitely speak to a physical therapist or personal trainer for some tips and techniques. Try adding a few exercises that isolate your core muscles so they’re fortified against the additional strains of winter chores.

Winter chores are just one way that the seasonal weather can wreak havoc on our fitness. Slipping on ice may seem cartoonish, but as anyone who’s spent a cold December night in the emergency room can attest, a broken wrist or fractured tailbone is an easy way to lose that holiday cheer.

Preventing such an injury is usually only evident through hindsight, so it’s important to remember that if you’ve hurt yourself by falling you should immediately see an orthopedic surgeon for a thorough assessment of your injury. Thinking your injury will heal itself can lead to further injury or worse, so don’t take any chances and schedule a consultation as soon as possible. As beautiful as winter can be, it has a knack for laying us out, so be careful and remember to stay active and be aware of these common winter injuries in the coming months.

It seems obvious, but simple endurance exercises are important to staying safe this winter. Did you know that most skiing and snowboarding injuries occur after lunch because we’re tired? Any good cardio exercise will keep your legs from turning into jelly and reduce the risk of falling. Conditioning your hamstrings and quadriceps is a good place to start, so if you haven’t focused on your lower body as much this summer, you should try to incorporate lower extremity strengthening exercises into your weekly workouts.

Before you’re on the mountain, it’s important to know that skiers and snowboarders are prone to different types of injuries. Wrist injuries are more common in snowboarders, while skiers are more prone to knee injuries, especially their ACL’s and collateral ligaments. Skiers’ poles also make them vulnerable to the dreaded “skiers thumb,” a type of injury to the interior ligament of the thumb that can quickly put an end to any more skiing for the season.

Consider this startling fact: Beginners make up more than half of all injuries in any given year, something to keep in mind when you find out your kids want to take up snowboarding for the first time this year. The most effective guard against injuring your wrist while snowboarding is a wrist guard. The problem used to be that snowboarding safety equipment was about as comfortable as being wrapped in Styrofoam. But today there’s an entire industry based around gloves with protective guards built into the lining, lightweight helmets that are comfortable and aerodynamic, and goggles that don’t get completely fogged by the first run.

Wrist guards have been shown to reduce the risk of hand, wrist and forearm injuries by 85%. The physicians here at Manhattan Orthopedics, rarely, if ever, come across a patient who has fractured their wrist while wearing a wrist guard. In fact, the most common response we hear is usually, “I should have worn a wrist guard!”

Skiing and Snowboarding can be fun, but it’s easy to forget how physically demanding each of these sports are as well. Preparing yourself over the coming weeks will ensure that you have a safe and fulfilling season of winter activities ahead of you.

Question: How will patients get the best care when they need the help of several specialists?

Answer: By creating communities where healthcare professionals from different concentrations can collaborate.

On the surface, repairing an injury like a torn rotator tendon seems straightforward: the patient has arthroscopic surgery and soon is back to playing tennis. But in truth, the journey from diagnosis to recovery may involve more disciplines than just your primary physician.

Let’s call this patient John. Initially, he will see his primary doctor for diagnosis and surgical repair. After recovering from surgery, John will require the expertise of a physical therapist for several months to regain use of the shoulder and reduce any pain. The transition from physician to physical therapist is critical to the success of treatment, but once therapy is complete,

John may require the ongoing care provided by Pilates instructors massage therapists, athletic trainers, and acupuncturists. But how will he know what’s best?

Start Talking

Historically, there has been limited communication or coordination of care amongst these groups; healthcare professionals have existed in separate silos, each specialty with its own experiences, culture and scientific literature. Patients require the skill and care of multiple disciplines to get well, but in addition, those professionals need to agree on one course of treatment. Success requires a continuity of care and collaboration, and that requires communication. Physicians and therapists need to be on the same page. A physical therapist needs to understand the principles of fixing a rotator tendon and how these may impact what they can do with the patient in their clinic. Likewise, the surgeon needs to understand what the therapist is able to do and how it may benefit their patient, as well as which therapy treatments should be implemented for each specific case.

The Prognosis

Caring for a patient is a team effort. Through the creation of cross discipline communities, healthcare professionals from several specialties learn from each other and collaborate on research, education and treatments. By encouraging PTs to spend time in MD offices and operating rooms, and encouraging MDs to learn more about alternate treatments, professionals will understand, and begin to develop, the best possible treatment for every patient.

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Our minds need time off from physical activity as much as our bodies, so let the change in seasons be your cue to ease up and focus on simple, easy exercises and stretches. A month of rest can help remedy a number of built up aches and pains, so use this time to rejuvenate your spirit, when sunlight is at a premium and the weather may force us indoors.

Transitioning to indoor workout routines in the fall and winter shifts the focus on a different set of muscles and tendons, so make sure your body is ready for the slight changes that can have a big effect on musculoskeletal health. As always, consult your doctor for professional advice on any nagging injuries from your adventures this summer.

Getting a fresh start for each season means fresh equipment, and new shorts and shirts go a long way in prepping for a new workout routine. Additionally, the crisp treads of new sneakers can help limit the danger of slipping on wet fallen leaves or unseen ice slicks, further protecting you from injury. Winter’s early sunsets make for dark afternoon jogs, so consider investing in a lightweight reflective vest and check your bicycle lights for brightness. No matter your age or experience, getting the most out of your workouts in the coming months means preparing against factors outside of your control.

The best thing anyone can do at this point, however, is take up to a month-long break and start looking towards your accomplishments from this summer with an eye towards the next.

Keeping your knees healthy begins with maintaining motion and strength through regular exercise. The catch-22, however, is that the more we exercise, the more wear and tear builds up, leading to arthritis.

Stiffness and soreness begin to show up in the knees just about the time your children begin to outplay you on the tennis court. But take heart! This is an opportunity to a) congratulate your children on their fine achievement, and b) talk to your orthopedist about maintaining knee health for the long-term.  In fact, building a relationship with your orthopedist can slow the arthritic process and delay the need for surgery.   Seek professional attention and care.

Physical therapy and sensible amounts of anti-inflammatory medicine are the start of any regimen to ensure strong knees through continued sports and exercise. Your orthopedist may recommend occasional injections of steroids to  decrease inflammation and maintain movement. The arsenal to protect your knees also includes lubrication injections, non-invasive arthroscopic surgery, or partial knee replacement, leaving total knee replacement as the last resort for repairing damaged knees.

Seeing your orthopedist regularly can keep you one step ahead of meniscal tears, ligament damage and the development of arthritis. The vast majority of individuals who undergo knee surgery return to most sports other than running, but who needs running when you’ve got tennis, golf, skiing or even badminton?

Any long-term regimen for maintaining healthy knees requires an awareness of boundaries. Don’t push yourself too hard.  Know that your active lifestyle has only just begun.

As Tennyson so resolutely stated: “to strive, to seek, to find, and not to yield,” so too should we approach our active lifestyles—and most surely the health of our knees.

Advice is one thing, but results speak for themselves. Manhattan Orthopedic understands that any long-term plan to keep your knees healthy must be personalized and comprehensive. We not only guide you through the available medical options, we also administer and supervise the process to make sure that you receive the best care possible.

One of the modes of failure has been wear of the articular or moving surfaces, namely the ball within the cup.  The original implants used in the United States consisted of a metal ball articulating within a high density polyethylene (plastic) socket.  With time the plastic tends to wear and needs replacement.  This usually occurs within 15 – 25 years.  The newer highly cross-linked polyethylene may last longer.

There have been attempts to use surfaces that are more durable, namely ceramic on ceramic, or metal on metal.  Ceramic seemed ideal, but for some still undiscovered reason about 10% of the hips produce a loud squeak and their use has decreased.

Metal on metal replacements have been around for many years and there has always been some concern about high levels of cobalt and chromium ions in the blood.  Studies for this condition have not demonstrated any long term problems.  The use of metal on metal increased as surface replacement, rather than total replacement became more popular in the younger (? Under 65) population.

Now a new problem has presented.  Particles of cobalt and chromium in the tissues around the hip have caused an inflammatory response that loosens the prosthesis and causes very early failure.  A revision is required and is never as successful as the primary procedure.  Therefore, surgeons must be very cautious in using metal on metal prosthesis and must not be in a rush to operate on younger and younger patients.

We must never forget the old adage, “Be not the first to try the new or the last to give up the old”

Marvin S. Gilbert, M.D.
Clinical Professor of Orthopedic Surgery
Mount Sinai School of Medicine

The two most common shoulder injuries for tennis players are tendinitis and bursitis. Bursitis affects the tiny fluid-filled bursa that provides a cushion between the bones and tendons around a joint. Tendinitis is a result of inflammation and damage to the tendons.

If you feel the wear of your stroke in your shoulder, then start by asking a tennis pro to evaluate your form and equipment so that you have the right grip and a proper racket. Similarly, never play with dead balls, which can needlessly tax the mechanics of your arm. And while it’s not ideal, replacing your overhead shots with ground strokes can greatly alleviate the strain on your shoulder. Your serve may have to take a backseat for a few games, but altering your technique in this way can greatly divert the strains on your shoulder that are the root cause of inflammation.

And what about in the gym—how often do you focus on building strength and endurance in your shoulder’s rotator cuff or scapula muscles? Because these tissues are involved in many overuse injuries, a physical therapist or personal trainer should be able to suggest some workouts that strengthen this muscle region that is often an afterthought of most workout routines.

The rest is quite easy: stay hydrated, remember to ice your shoulder when done playing, and, if your physician recommends it, take an anti-inflammatory medication to help relieve discomfort. These tips may seem straightforward, but the simplest preventative steps are sometimes the easiest to overlook, no matter your age or skill set.

Off the court, try not to sleep on the shoulder that’s bothering you. You might want to even consider taking a break for a few weeks—overuse injuries can oftentimes heal with rest, allowing the inflammation to go down while the tissue heals. If the pain persists, consult an orthopedic surgeon about further options.

There are a number of ways to get the best out of your tennis game, but prevention and knowing your limits will keep you swinging for plenty of hot summers to come.