Dr. Mark Galland Interview with TWC

Written by admin on May 27, 2014 – 11:24 am -

From the baseball diamond to hitting the pavement to prepare for a marathon, spring and summer can be tough on our bodies. Dr. Mark Galland, an orthopaedic surgeon from Orthopedic Specialists of North Carolina, has details on the best way to avoid injury

Watch the interview HERE

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.


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New Study Reveals the Obese More Likely to Require Knee Replacement

Written by admin on June 6, 2013 – 7:10 pm -

BMC Musculoskeletal Disorders
Obesity and Increased Burden of Hip and Knee Joint Disease in Australia
Results From a National Survey
Ilana N Ackerman, Richard H OsborneDisclosures
BMC Musculoskelet Disord. 2012;13(254)

Abstract

Background Research involving more representative samples is needed to extend our understanding of the broader impact of obesity in hip or knee joint disease (arthritis and OA) beyond clinical settings. Although population-based research has been conducted in the United States, how these findings translate to other countries is unclear. Using a national approach, this study explored associations between obesity and the burden of hip and knee joint disease in Australia (in terms of prevalence, pain, stiffness, function, Health-Related Quality of Life (HRQoL) and disease severity).

Methods

A random sample of 5000 Australians (≥39 years) from the federal electoral roll was invited to complete a mailed questionnaire to identify doctor-diagnosed hip arthritis, hip OA, knee arthritis and knee OA and evaluate the burden of these conditions. Validated questionnaires included the WOMAC Index, Assessment of Quality of Life instrument and Multi-Attribute Prioritisation Tool. Body Mass Index (BMI) was classified into underweight/normal weight (≤24.99 kg/m2), overweight (25–29.99) or obese (≥30). Multiple logistic regression was used to estimate odds of arthritis and OA, with demographic and socioeconomic variables included in the models. Associations between BMI and other variables were investigated using analysis of covariance, with adjustment for age and sex.

Results

Data were available from 1,157 participants (23%). Overweight participants had increased odds of knee arthritis (adjusted OR (AOR) 1.87, 95%CI 1.14–3.07) and knee OA (AOR 2.11, 95%CI 1.07–4.15). Obesity was associated with higher prevalence of hip arthritis (AOR 2.18, 95%CI 1.17–4.06), knee arthritis (AOR 5.47, 95%CI 3.35–8.95) and knee OA (AOR 7.35, 95%CI 3.85–14.02). Of those with arthritis or OA, obese individuals reported more pain (for hip arthritis, hip OA and knee OA), greater stiffness (for hip arthritis, knee arthritis and knee OA), worse function (all diagnoses), lower HRQoL (for hip arthritis and hip OA) and greater disease severity (all diagnoses).

Conclusions

This national study has demonstrated that the odds of arthritis and OA was up to 7 times higher for obese individuals, compared with those classified as underweight/normal weight. Concurrent obesity and joint disease had a marked impact on several key aspects of wellbeing, highlighting the need for public health interventions.

http://www.medscape.com/viewarticle/780602?nlid=31232_941&src=wnl_edit_medp_orth&uac=192786MG&spon=8


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Bone density key to success of hip resurfacing. Osteoporosis need not apply

Written by admin on June 3, 2013 – 8:07 pm -

Histological, Histomorphometric and Microtomographic Analyses of Retrieval Hip Resurfacing Arthroplasty Failed at Different Times
Francesca Salamanna, Milena Fini, Annapaola Parrilli, Matteo Cadossi, Nicolò Nicoli Aldini, Gianluca Giavaresi, Deianira Luciani, Sandro GianniniDisclosures

BMC Musculoskelet Disord. 2013;14(47)

Conclusions
The objective of the study was to examine the characteristics of bone quality and its microarchitecture in retrieved metal-on-metal HR by a specific quantitative histomorphometry and μCT method. The results showed that the morphometric parameters considered were crucial for a good understanding of the mechanical properties of HR and may be of significant and essential importance in the pathogenesis of HR failure particularly in the development of late fractures. Although there are several good reports on the survival rate of HR at mid-term follow up, the biological changes of the femoral head underlying the implant over time should always be considered. It remains to be seen whether other late failures will occur. HR is still a good indication for young and active patients; nevertheless good bone quality remains the crucial element to support the implant at longer follow-up.


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Posted in Health and Fitness, Hip, Joint Replacements | No Comments »

Pushing Limits…

Written by admin on February 26, 2013 – 2:14 pm -

Younger Patients Choose Surgery; Some Sports Are OK, But Which Are Too Much?

(WSJ, April 19, 2011)

John Jeffries, a 49-year-old money manager in Dover, Mass., had hip-resurfacing surgery in 2008 and is now coaching his son’s basketball team and long-distance cycling.

Alex Douglas, a Wall Street software architect, had both knees replaced last year at 39 after years of sports injuries. He can’t wait to go kite-boarding this weekend. “I’ve been cleared to have fun,” he says.

Hard charging baby boomers and Generation X-ers are wearing out their joints at younger ages and turning to joint replacement surgery. But is it a quick fix? WSJ’s health columnist Melinda Beck discusses with Kelsey Hubbard.

Joint-replacement patients these days are younger and more active than ever before. More than half of all hip-replacement surgeries performed this year are expected to be on people under 65, with the same percentage projected for knee replacements by 2016. The fastest-growing group is patients 46 to 64, according to the American Academy of Orthopaedic Surgery.

Many active middle-agers are wearing out their joints with marathons, triathlons, basketball and tennis and suffering osteoarthritis years earlier than previous generations. They’re also determined to stay active for many more years and not let pain or disability make them sedentary.

To accommodate them, implant makers are working to build joints with longer-wearing materials, and surgeons are offering more options like partial knee replacements, hip resurfacing and minimally invasive procedures.

More younger people also need joint-replacement surgery due to obesity, and some orthopedists refer them for weight-loss surgery first to reduce complications later.

Even the most fit patients face a long period of rehabilitation after surgery and may not be able to resume high-impact activities.

“There is, to be honest, some irrational exuberance out there,” says Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn., and president of the American Academy of Orthopedic Surgeons. “People may be overly optimistic about what joint replacement can do for them.”

One big unknown: How long will the replacement joints last? In the past, many doctors assumed implants would wear out in about 10 or 15 years, and they urged young patients to put off surgery as long as possible to minimize the risk of needing a costly and difficult revision surgery—or even two. (A total knee replacement typically costs $15,000 to $22,000. A revision can be $45,000 or more, with a higher risk of complications.)

Read more


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…”effect of repeat injections of hyaluronic acid unclear. May not halt progression of OA nor delay knee replacement”…

Written by admin on December 29, 2012 – 11:02 am -

“Osteoarthritis (OA) is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth, which ultimately lead to pain and joint stiffness. Most commonly affected joints are the knees, hips, and joints in the hands and spine. OA of the weight bearing joints (e.g. knee and hip) typically have the most clinical significance. The causes of OA are presumed to be related to mechanical and molecular events in the joint (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm).

OA usually begins after the age of 40. OA affects 13.9% of adults aged 25 and older and 33.6% of those aged 65 and over (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm). Among those affected, approximately one quarter of them are severely disabled. [3] Osteoarthritis is the leading cause of mobility disabilities such as difficulty walking or climbing up stairs. OA of the knee is one of five leading causes of disability among non-institutionalized adults. [4]

Knee OA is the most prevalent, followed by hip OA. Both knee and hip OA result in joint pain and stiffness which can ultimately interfere with function and restrict activities of daily living [5].

There is no cure for OA. In addition, there are currently no known therapies that can prevent progression of OA. Treatment of OA typically focuses on minimizing pain and swelling, reducing disability and improving quality of life.
Treatment typically starts with non-pharmacologic therapy approaches including exercise programs, weight loss, patient education and shoe insoles. [6] Non-pharmacologic approaches are typically tried before medications are started.

Pharmacologic treatment is typically the next step and focuses on relief of pain. Pharmacologic therapy typically includes acetominophen, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase (COX-2) inhibitors and opiates. Each of these medications can be beneficial in some patients and each is associated with characteristic side effects. Given that the patient population is typically an older one, often with other comorbid conditions, the side effects associated with long term use of some of the OA medications can be particularly problematic.

Intra-articular glucocorticoid injections are another potential component of OA treatment….”

For the entire article please click below.

Hyaluronic Acid for Treatment of Osteoarthritis of the Knee…


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PRP May Be Superior Knee OA Treatment When Compared With Visco Supplementation

Written by admin on December 6, 2012 – 8:18 pm -

Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.

Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M.


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Posted in Joint Replacements, Knee, Platelet-Rich Plasma Therapy (PRP) | No Comments »

Deep Vein Thrombosis (DVT)

Written by admin on November 10, 2012 – 9:43 pm -

When hearing of a blood clot, one typically considers a person who recently had major surgery, for example, a knee replacement, or a traveler after a long plane ride. While these assumptions may be accurate, many are surprised to learn that athletes can develop blood clots as well. Serena Williams (Tennis) and Phil Dalhausser (beach volleyball) are two examples.

Blood clots are also referred to as a DVT or Deep Vein Thrombosis. They are most common in the legs, causing extreme calf pain, swelling and tightness, but also can occur in the upper extremity where they cause similar symptoms. DVT results from: diminished flow of blood through the veins, injury to the veins and hypercoagulability (“thickening” of the blood). Typically after surgery, patients are less able to move the lower extremities and joints due to pain and swelling. Since the flow of blood in the veins is dependent upon movement and contraction of muscles, this lack of mobility results in a decrease in blood circulation and increased viscosity (or thickness) of the blood. Both factors predispose to developing a clot. Upper extremity DVT is much less common, comprising only 10% of all cases of DVT. The typical cause of an upper extremity DVT in an athlete is repetitive micro-trauma of the subclavian or axillary veins (as is typical of a high level overhead athlete: tennis, volleyball, or baseball).

Signs and symptoms of an upper extremity DVT are similar to those seen in the lower extremity: pain, swelling and tightness of the affected arm/shoulder region.

DVT is a serious medical condition and can progress into an even more serious complication–pulmonary embolism. PE occurs when the blood clot or portion thereof, dislodges itself and travels into the lungs, causing shortness of breath, chest pain, dizziness and rapid pulse. PE can be fatal, and immediate medical attention must be sought if these symptoms occur.

Months before the London Olympics, Phil Dalhausser experienced significant swelling in his left arm. He was admitted to the hospital, diagnosed with DVT and treated with blood thinners (anti-coagulants and thrombolytic agents) to dissolve the clot. It was determined that the DVT was precipitated by scar tissue in his subclavian vein which resulted from being pinched between his first rib, collar bone and the surrounding muscles each time he struck the ball or reached for a block. Since his DVT, Dalhausser has successfully competed in the London Olympics representing the United States in men’s beach volleyball.

Serena Williams’ case, while much different was more typical. After sustaining a laceration in her foot, she first developed a hematoma in the wound. They are a local collection of blood but not related to DVT, nor can they ever become DVT or lead to PE. Hematomas result from blunt force trauma or within a healing wound. She subsequently developed a DVT in the same leg. Presumably this was the result of the immobilization required to allow the injury to heal. The pulmonary embolism occurred months after she cut her foot, and required immediate hospitalization. She recovered fully and won the 2012 US Open and gold medals in the London Olympics.

Resources:

Associated Press. (2011, March 02). Serena Williams hospitalized after suffering blood clot in lungs. Retrieved from http://www.foxnews.com/sports/2011/03/02/serena-williams-hospitalized-suffering-blood-clot-lungs/

Joffe, H. (2012). Upper-extremity deep vein thrombosis. Retrieved from http://circ.ahajournals.org/content/106/14/1874.full

Vein Specialists of the South. (2012). Olympic beach volleyball star develops blood clot in subclavian vein. Retrieved from http://varicoseveintreatmentga.com/wpi/deep-vein-thromobosis/olympic-beach-volleyball-star-develops-blood-clot-in-subclavian-vein/

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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New Article: Fits Like a Glove

Written by admin on May 1, 2012 – 10:33 am -

To view this as a PDF, click here: Fits Like A Glove

Customization has become de rigueur in almost every facet of modern life. Very few things, today, are “one size fits all.” The same is true for knee replacement (TKA or total knee arthroplasty).

For years manufacturers and surgeons have tried in vain, to personalize the fit and match of joint replacement prosthesis to the exact physiology and mechanics of each individual patient. All too often the end result of these labors represents a triumph of marketing over science—the so-called gender-specific knee is a classic example. Recently much has been made of computer assisted surgery. We have all read about and seen television images of large computers in the operating suite directing a “robot” to make “incisions and cuts.” These purport to improve accuracy and imply better performance and longevity of the implant. Unfortunately, and not surprisingly, the results have yet to meet the expectations of such promising technology. As computer assisted surgery is dependent upon collection of independent patient data obtained in the Operating Room, the results are necessarily limited by the quality of the collection method. The accuracy of the data varies greatly by surgeon and by individual patient– “Garbage in=Garbage out.”

As the data entered into the computer is obtained via relatively inaccurate means, the results are little improved compared to earlier techniques employed by surgeons for decades. Even more, this method requires significantly increased OR time.

“Ok . . . so, computer assisted surgery offers no advantage in performance but adds cost and time. So far, doc, you are not selling me on this concept. What gives?”

It is important to understand that while the results engendered by the implementation of computer assisted surgery have been mixed, at best, the concept is excellent—Personalization of the surgical procedure to meet the exact biomechanical needs of the patient has been the Holy Grail of joint replacement surgeons. Traditionally, TKA is performed utilizing cutting blocks, “jigs,” alignment rods, plumb lines, etc.; not dissimilar from standard cabinetry techniques. These have provided good to excellent results for decades. Unfortunately these methods are limited by individual patient factors (body weight, joint alignment, range of motion) that make it difficult, time consuming, and sometimes impossible to restore the appropriate anatomic alignment for any given patient.

Many manufacturers, in response to this dilemma, now offer a solution to this problem.  In particular, I find the Biomet Signature system to provide the most intuitive and elegant approach.  This is the system that I use for all TKA that I perform. 

Signature is a software-based system that allows the  measurement and much of the technical work to be completed on computer BEFORE the patient enters the OR.  Imagine that!  Doing one’s homework, before the test– What a novel idea! 

Not surprisingly, the results are just as predictable (study before attending class, Ace the test).  The concept and execution are rather simple.  MRI images are obtained of the patient’s Hip, Knee and Ankle.  This information is used to determine the limb alignment and to create a 3-D model of the knee.  This then allows the surgeon to essentially “perform” the surgery on the computer to correct the limb alignment to normal.  Once this data is finalized, a model of the knee is created and precision cutting instruments are manufactured that are unique to each patient.  These models and instruments are then used by the surgeon to perform the procedure according to plan.  Restoration of the patient’s natural limb alignment, improved fit and range of motion are the typical result.Utilizing this technique, the procedure can be performed more quickly and with less blood loss when compared to the traditional method of knee replacement.  Patients normally report less pain, improved range of motion and sometimes a shorter duration of hospitalization and outpatient rehab. 

Today, for the first time in history, with modern surgical and computer assisted techniques you can finally have a knee replacement that “fits like a glove”

 

 Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, AA Affiliate of the Cincinnati Reds of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.


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