Thursday, 17 of January of 2019

New Study Shows Knee Replacement Surgery Offers Major Economic & Social Benefits

Orthopedic surgeons and patients have long known that knee replacement surgery offers tremendous help to people suffering from end-stage osteoarthritis of the knee. Now a new study sponsored by the American Academy of Orthopedic Surgeons confirms it.

“There is no doubt that knee replacement gets people back to work, improves their quality of life and allows them to be productive and active again, “ said John Tongue, M.D., the past president of the AAOS, in commenting about the study results. “But until now, that value has always been hard to quantify.”

Researchers looked at Medicare claims data, collected patient-reported outcomes and reviewed the literature to compare direct and indirect costs of surgical treatment versus non-surgical treatment. The result was a “quantitative look at the overall cost benefits of knee replacement relative to the societal and economic savings” or what Dr. Tongue calls “the big picture of how the procedure impacts patients’ lives, both daily and in the long-term.”


Photo Credit:

Photo Credit:


The study, published in the August 2013 issue Journal of Bone and Joint Surgery confirms that knee replacement surgery is a cost-effective treatment for people with end-stage osteoarthritis, giving patients an indirect savings of nearly $40,000. Researchers also calculated an estimated lifetime societal savings of about $12 billion from the more than 600,000 total knee replacement surgeries performed in the U.S. at the time of the study, which was in 2009.

Having the procedure allows patients to stay on the job and in the workforce longer. It also reduces absenteeism – the number of days that patients missed work due to pain – and it lowered the number of people who stopped working and applied for disability payments.

The study results are very positive for baby boomers, who are staying in the workforce longer and expecting to remain active throughout their lifetime, but their knee joints can’t always keep up, says Dr. Tongue. Now rather than cutting short their employment or giving up enjoyable physical activities like tennis and golf, they can turn to knee replacement as a viable, cost-effective option. Demand for the surgery is expected to exceed 3 million by 2030.

For more information about knee replacement surgery or other orthopedic-related concerns, visit or call Dr. John Kagan at 239-936-6778.

Osteoarthritis vs. Osteoporosis vs. Rheumatoid Arthritis



Many people frequently confuse the terms osteoarthritis, osteoporosis and rheumatoid arthritis. They each affect the musculoskeletal system, but they are very different medical conditions.

Orthopedic surgeons treat osteoarthritis, which is a degenerative condition of the cartilage, a rubbery tissue that covers the ends of the bones and cushions the joints in the hips, knees, shoulders and other parts of the body. As osteoarthritis wears away the cartilage, the bones rub together, causing inflammation, tenderness, pain and stiffness. Bone spurs can also develop.

Initial treatment for osteoarthritis may include medication, hot or cold treatments, physical therapy and steroid injections.  At more advanced stages, patients can find relief through arthroscopy or joint replacement surgery.


Photo Credit: Medicine Net Inc.


Rheumatoid arthritis is an autoimmune disorder that causes painful inflammation of the lining of the joints – the synovial membrane, whose function is to protect and lubricate the joint. Rheumatoid arthritis tends to affect the fingers, hands and toes first before the larger joints in the knees, hips, ankles, elbows and shoulders. In advanced cases it can cause severe joint deformity. Internists and physicians specializing in rheumatology treat rheumatoid arthritis. If surgery is required, an orthopedic surgeon may perform a joint fusion or joint replacement.

Osteoporosis is a crippling bone disease that primarily affects the elderly and causes bones to become porous, brittle and weak. Over time, the bones can be so fragile that that it doesn’t take much for them to break – even bending over to pick something up, sneezing or twisting can be a problem. Primary care physicians generally treat this medical condition, but an orthopedic surgeon may need to surgically repair fractures, especially hip fractures.

For more information about musculoskeletal conditions and treatment options, call 239-239.936.6778 or visit

AAOS Co-Sponsors Distracted Driving Campaign



Photo Credit: IntelFreePress/Flickr

Photo Credit: IntelFreePress/Flickr

This week, as Florida bans texting and emailing while driving, Dr. Kagan joins the American Academy of Orthopedic Surgeons in raising awareness about the dangers of driving while distracted.

For the past few years, the AAOS has co-sponsored a major national campaign titled, “Decide to Drive,” that emphasizes how easy it is to be distracted and how quickly accidents can occur.

“If you’re doing something else while you’re driving, you’re not focused on the road, and orthopedic surgeons would much rather keep bones strong them put them back together after a traumatic accident,” says an AAOS spokesperson about why the national medical organization has put so much effort into education about this important safety issue.

According to the Florida Department of Transportation, nearly 5,500 people have been killed since 2009 and an additional 448,000 injured from motor vehicle crashes related to distracted driving The National Safety Council (NCS) estimates that nearly 28 percent of crashes — about 1.6 million a year — can be attributed to cell phone talking and texting while driving.

While texting, emailing and talking on the phone are a major cause of distracted driving, they are not the only concerns.  Reaching over to adjust radios ,portable music players or navigation systems, eating and drinking, applying makeup, brushing your hair, reading a map or newspaper, and children and pets in the backseat are all potential distractions that can cause drivers to take their eyes off the road, hands off the wheel and mind off the task at hand, says the AAOS.

Here are some recommendations from the AAOS to make sure you arrive safely at your destination.

Before Starting Your Car:

  • Put on sunglasses and other accessories such as Bluetooth ear pieces
  • Adjust seats, headrests and mirrors
  • Fasten your seat belt
  • Adjust the music volume
  • Enter address in your GPS navigation system
  • While You’re Driving
  • Don’t talk on the phone, text or email
  • Don’t eat or drink, change your clothes or groom yourself
  • Pull over any time there is a major distraction such as disciplining a child, retrieving an item, or looking at printed directions

Dr. Kagan strongly supports the AAOS slogan, “Behind the wheel, there is no such thing as a small distraction.” For more than 30 years, the doctor has been serving the orthopedic needs of Southwest Florida.  For information on the practice, go to or call 239-936-6778.

How Exercise Can Help Joint Pain



shutterstock_127325003While joint pain from osteoarthritis may eventually require surgery, before then, it’s a good idea to explore all the non-surgical ways you can decrease discomfort and increase your range of motion. One of the most overlooked options is free, easy to accomplish and effective – exercise.

You might be thinking that exercise is the last thing on your mind if your joints are achy, tender and stiff. In fact, you might be inclined to move as little as possible. But medical experts will tell you that keeping up an appropriate fitness routine is exactly what you should be doing. In fact, Harvard Medical School calls exercise the secret to joint pain relief. It can definitely help improve the quality of your life.

Here’s why. Exercise strengths muscles, tendons and ligaments that hold the joint in place. It allows your body to stretch and be more flexible, helps maintain stronger bones and gives you more energy. It can also help control your weight, or loose weight, which can take pressure of the joints.

You may not be able to doing anything strenuous like run, play tennis or volleyball, but you could walk outside or on a treadmill, swim laps or do water aerobics, ride a bike or just perform stretching exercises at home or the gym. The key is to pace yourself and not overdo it. If you or a loved one is coping with arthritis and unsure which type of exercise is safe for you to perform, ask your doctor for a recommendation. Perhaps you might even consider a few sessions with a physical therapist if you haven’t been active in a while.

For more information about joint pain and treatment options, contact the office of Dr. Kagan at 239-936-6778 or go to


Shoulder Injuries – What to Expect



Football injuriesAs football season moves into full swing across the country, shoulder injuries are inevitable, whether players are NFL pros, college or high school athletes. Most of the time, injuries come from contact with another player as a result of a tackle, block or collision or fall to the ground. Even though players wear protective gear, rotator cuff injuries, sprains, strains, contusions and fractures are common shoulder injuries that can be sustained during the game or practice.

The American Academy of Orthopedic Surgeons describes the shoulder as several joints that combine with tendons and muscles to allow you to move your arm in a wide range of motion. Of course, this also makes the shoulder prone to injury.

But it’s not only football athletes who can suffer from a shoulder-related problem. The discomfort of bursitis, tendinitis or tendon tears, shoulder instability, impingement and osteoarthritis can affect anyone of any age or athletic ability.

If your shoulder is giving you chronic trouble, making it difficult to lift your arm or the pain wakes you up at night, don’t put off scheduling an evaluation to determine the cause and best treatment plan.

What can you expect during a consultation?

In addition to a physical exam, the doctor may order an X-ray or arthrogram, which involves injecting dye into the shoulder to help better visualize the joint and surrounding tissue. Sometimes, diagnostic imaging tests such as, CT Scan, ultrasound or MRI, may be required if the doctor wants to gain a more detailed picture of the anatomy, especially of the muscles, ligaments and tendons. Arthroscopy, which uses a tiny video-camera to allow the doctor to see inside the joint, can be used for both diagnostic evaluation and surgical repair of the problem.

For more information about shoulder pain or other orthopedic injuries, go to or call the office at 239-936-6778 to schedule a consultation.

Keep Seniors Safe By Preventing Falls



As an orthopedic specialist, I am concerned about the prevalence of falls among seniors. Falls are a leading cause of injury and disability for people age 65 and older. Seniors are especially at risk for fracturing their hip, as well as pelvis, shoulder, arm or spine. If the injury is serious enough, surgery may be required, which could require a lengthy recovery time and sometimes, loss of independence.

What causes such a high rate of falls among seniors? Medical factors such as arthritis, osteoporosis, irregular heartbeat and fluctuating blood pressure, as well as dementia, stroke, Parkinson’s disease, vision and hearing loss and urinary dysfunction are often to blame.

But lack of exercise from a sedentary lifestyle is also a factor. Weak muscles, loss of balance and poor condition all contribute to the risk for falling. The key is to stay physically active with regular exercise you enjoy.

Other concerns include side effects from medications, such as dizziness and lethargy. Ask your doctor to periodically review all medications you may be taking, including over-the-counter drugs and herbal remedies.

It’s also a good to look around your home and see if there are potential hazards that can be easily corrected. Here are several tips from the Lee County Injury Prevention Coalition’s Step Wise Lee program to make your home safer.

  • Get rid of small throw rugs or use double-sided tape to keep rugs stationary and eliminate the chance of slipping on them.
  • Clear all papers, books, clothes and shoes from hallways and stairs.
  • Fix all loose or uneven floors, particularly tile so you don’t trip.
  • Rearrange furniture so you have a clear pathway through halls and rooms.
  • Improve the lighting with brighter wattage light bulbs. Put night-lights in every room.
  • Install grab bars next to the toilet and in the tub or shower. Use non-slip bath mats in the tub or shower
  • Rearrange cabinets so items you use frequently are easy to reach, eliminating the need to use a step stool or chair.
  • Organize lamp, telephone and computer cords and other electrical wires so you don’t have to step over or around them.
  • Wear shoes in the house and outside – avoid going barefoot or wearing slippers.
  • If your home is more than one level, be sure to have handrails or banisters on all staircases.
  • Consider an alarm device that will call for help if you fall and can’t get up.

Dr. John Kagan has been treating orthopedic-related injuries for more than 30 years. For more information or to schedule a consultation, go to or call 239-936-6778.

What Is That Bump On The Back Of My Wrist?




Photo Credit: Mayo Clinic

Have you ever had a small, round, fluid-filled lump develop on top of the wrist or at the base of your palm? These non-cancerous lumps are called ganglion cysts and they are very common. They can be a little as a pea or as large as a small tangerine. In addition to the hand and wrist, they can develop at the ankle and foot and at a finger joint.

Quite often ganglion cysts “appear and disappear” without concern and don’t require treatment. But sometimes they can become large enough to put pressure on the nerves, which can create pain, tingling and muscle weakness. They can also interfere with moving your wrist or simply be unsightly in appearance.

What can you do? The American Academy of Orthopedic Surgeons suggests that the first step might be to take over-the-counter pain relievers and wear a wrist brace or splint to relieve discomfort. But if that option proves ineffective, there are two minimally invasive choices.

Needle aspiration involves inserting a small needle into the cyst to drain the fluid and reduce the pressure on the nerves.  The cyst and part of the joint capsule or tendon sheath can also be surgically removed. Both of these choices are good ones, but it’s important to know that even if the procedure is successful, unfortunately, ganglion cysts have a high rate of recurrence.

Who’s at risk for developing a ganglion cyst? The Mayo Clinic reports that although anyone can bet them, the cysts are more common in young women between the ages of 20 and 30, as well as in people who have osteoarthritis of the finger or wrist or who have had a joint or tendon injury.

For more information about hand conditions or other orthopedic-related concerns, call Dr. John Kagan at 239-936-6778 or go to

What is Trigger Finger?



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The term trigger finger may sound amusing, but it is far from humorous if you have this chronic, painful condition. Why is it called trigger finger? According to the American Academy of Orthopedic Surgeons, the condition can cause one or more fingers or your thumb to get “stuck” or “caught” in a bent position. Then when you try to straighten the finger, it may feel like it snaps or pops. This is different from osteoarthritis where your finger joints feel achy, stiff and swollen.

The official medical name for trigger finger is stenosing tenosynovitis. It’s basically a tendon problem. A substance called tenosynovium releases lubricating fluid that allows the tendon in your fingers or thumb to bend and straighten smoothly inside a protective sheath of tissue. But if the tenosynovium becomes inflamed and swollen, it can cause the space within the sheath to become narrowed and constricted. As you bend or straighten your finger or thumb it can “catch” for a moment before releasing and “popping” like a trigger. Over time, the chronic inflammation can cause a thickening of the tendon and bumps or nodules to form at the base of the thumb or finger.

Who’s at risk for trigger finger? People whose occupation requires repetitive gripping, such as working with power tools or musicians who have to grip a musical instrument like a guitar for extended periods of time. People with health conditions like diabetes, thyroid disorders, gout and rheumatoid arthritis are also more prone to it. In addition, it’s more common in women than men.

For mild symptoms, nonsurgical treatment is the first step. Wearing a splint keeps the fingers extended and prevents you from curling them at night when you sleep. Finger exercises can help  improve range of motion. Anti-inflammatory drugs like Advil and Motrin can reduce the swelling and steroid injections may offer some relief.

But if nonsurgical treatments don’t seem to help, minimally invasive outpatient surgery may be the answer, especially if the condition becomes painful enough to interfere with your ability to use your fingers. The surgery is fairly straightforward. The surgeon makes a tiny incision and releases or “opens up” the tightened portion of the tendon sheath, which releases the stress on the tendon and provides relief.

Don’t let chronic pain in your hand or fingers prevent you from enjoying life. Dr. Kagan has been treating patients with a variety of musculoskeletal conditions, including trigger finger, for more than three decades. Schedule a consultation by calling 239-936-6778 or for more information, go to

Arthritis of the Hand, Wrist & Fingers





Think of the demands we place on our hands, wrist and fingers nearly every waking moment. From grasping, pulling, twisting, turning and bending to texting and typing, our hands are constantly busy. Over the next few weeks, we’ll talk about medical conditions like osteoarthritis, ganglion cysts and trigger finger and how they can affect our hands and interfere with quality of life. Today’s blog will be about osteoarthritis: causes, symptoms and how to live with it.

The joints in the hand, wrist and fingers, just like the knees, hips and shoulders, can be damaged by osteoarthritis. The  loss of cushioning cartilage creates pain, stiffness and swelling, making it hard to bend the fingers or turn the wrist. Did you know that swelling results from the body’s attempt to make up for the loss of cartilage by producing extra fluid in the joint lining? However, the swelling stretches the joint covering, which is uncomfortable. The swelling may also make the joint hot to the touch.

What causes all of this to happen? Age can definitely be a factor, but so can heavy usage and an injury like a fracture. The American Academy of Orthopedic Surgeons reports that an injured joint is seven times more likely to become arthritic, even if the injury is properly treated.


The main goal of treatment is to relieve pain and swelling. Anti-inflammatory drugs such as Tylenol and Advil and prescription drugs such as Celebrex can be helpful. So can the use of finger or wrist splints; application of hot or cold, topical creams, special therapeutic exercises and steroid injections.

Surgical treatment is less common for hand, wrist and finger osteoarthritis. However, the AAOS reports that the development of tiny instruments make arthroscopy of the small joints of the hand and wrist now possible. In addition, some orthopedic surgeons specializing in hand surgery are performing joint fusion or joint replacement of the wrist and finger knuckles.

The first step in diagnosing osteoarthritis of the hand is to schedule a consultation for a physical exam and X-rays. For more information, go to or call 239-936-6778.

The Latest Info on Treatment of Osteoarthritis of the Knee



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Photo Credit:

Earlier this summer, the American Academy of Orthopedic Surgeons released new guidelines on treating osteoarthritis of the knee, the disabling chronic condition in which damage to the knee joint occurs when cartilage begins to break down, the tissues become inflamed and bone spurs may develop. Did you know that:

  • More than 30 percent of people over age 50 have knee osteoarthritis
  • The most common average for people with osteoarthritis is 65
  • Some 33 million Americans have osteoarthritis
  • Osteoarthritis is the leading cause of physical disability

New AAOS 2013 guidelines for nonsurgical treatment of knee osteoarthritis include the following recommendations:

Based on new FDA guidelines, the recommended dose for acetaminophen, a mild pain-relief medication commonly sold as Tylenol, has been reduced from 4,000 mg per day to 3,000 mg per day.

Non-steroidal anti-inflammatory drugs, commonly sold is Celebrex, Ibuprofen, Motrin or Advil, are effective in reducing inflammation and relieving mild to moderate pain.

Intra-articular corticosteroid injections are effective for short-term pain relief. The steroid medications is injected directly into the joint space of the knee to help reduce inflammation in the tendons and ligaments of the joint.

Intra-articular hyaluronic acid injections are no longer recommended after a 14-study review showed no measureable improvement in the majority of patients.

Hyaluronic acid, a natural substance made by the body that helps lubricate the joints, can become “thin” due to osteoarthritis. The goal of injections was to counteract the depletion of this fluid.

Results are also inconclusive whether glucosamine, chondroitin sulfate or hydrochloride are effective in knee osteoarthritis. These over-the-counter supplements are often recommended for joint pain.

Patients with knee osteoarthritis should participate in low-impact aerobic exercise, such as walking, swimming and bicycling to improve their muscle tone and bone strength. In addition, individuals with a body mass index greater than 25 should pursue a diet and exercise plan to help lose weight to reduce stress on their knee joints.

Because every patient’s situation is unique, the AAOS advises individuals suffering from knee pain to consult an experienced orthopedic surgeon for a treatment plan that is tailored to their specific needs.

Dr. John Kagan has more than 30 years experience as an orthopedic surgeon treating patients in Southwest Florida. He specializes in treating patients with knee, shoulder and hip pain, as well as general orthopedics and hand surgery. For more information go to

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