Wednesday, 14 of November of 2018

Tag » joint replacement

Update on the DePuy Hip Replacement Lawsuit




An Articular Surface Replacement, removed from a patient.
Photo Credit: The New York Times

Metal on metal implants for hip replacement surgery have been the subject of intense scrutiny and media attention for some time now. Bloomberg Business News and the New York Times recently reported that Johnson & Johnson has “tentatively agreed” to an estimated $4 billion settlement to settle some 7,500 lawsuits against its DePuy Articular Surface Replacement (ASR) hip implant device.

Metal-on-metal implants were initially thought to be a breakthrough product that would last longer, offer greater stability and improve bone conservation, but unfortunately that is not turned out to be the case. In January of this year, the FDA issued a safety bulletin, citing growing clinical evidence that shows a failure rate two to three times that of non-metal-on-metal devices.

In addition, the impact of metal rubbing on metal can cause tiny metal particles to flake off, causing damage to muscle and bone, as well as a high level of metal ions in the blood. Many patients have been forced to undergo hip revision surgery to remove the flawed implant and replace it with a different design.

Thousands of patients have filed lawsuits against DePuy and other manufacturers of metal implants, claiming the devices were defective and have harmed their health. When formal announcement in the DePuy ASR case is released some time this week, it is expected to be one of the largest product liability claims to be paid involving a medical device. The New York Times reports that only patients who have undergone revision surgery to replace the defective ASR implant will be included in the current settlement.

If you are dealing with chronic hip pain from osteoarthritis or are concerned about a hip replacement that you had in the past, please feel free to call our office at 239-936-6778 to schedule a consolation. For more information about joint replacement or other orthopedic-related conditions, go to

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

Early Stage vs. Advanced Disease for Osteoarthritis

For most people, it can take years before the pain and disability from osteoarthritis becomes extreme. That means treatment options for early stage disease are typically very different from late stage, advanced disease. Most of the time a variety of nonsurgical treatment options will be tried before surgery is recommended. Here’s what can you expect as the disease progresses.

Early Stage Disease

In early stage osteoarthritis, this degenerative disease is just beginning to damage the cartilage that covers and cushions the bone. The cartilage itself doesn’t have nerve endings, but as it thins and wears away, it leaves the bones unprotected, which causes friction when the bones rub together.

During this stage, if you’ve played a strenuous game of tennis, spent the day working in the yard or gone on a long run, you might feel some tenderness in your joints afterwards. Generally rest and over-the-counter anti-inflammatory medication like ibuprofen will take away any lingering discomfort.

Moderate Stage Disease

At this stage, there is more pronounced damage to the cartilage and inflammation of the tissues. You may have developed bony spurs, a benign bony growth that the body naturally creates in response to pressure, rubbing or stress, but which can also cause discomfort. Joint pain may be worse first thing in the morning or at the end of the day, especially after physical activity.

Your doctor may want to perform outpatient arthroscopy to evaluate the extent of damage to your cartilage and bone.  Besides taking non-steroidal anti-inflammatory drugs (NSAIDIs) such as Motrin, Advil, Aleve or Celebrex, the doctor also may suggest glucosamine and chondroitin supplements.  Steroid injections can help too, as can injections with hyaluronic acid or platelet-rich plasma (PRP) therapy.

To reduce pressure on your joints, switch from sports like tennis or running to swimming and walking.

Advanced Disease

By now, there is most likely considerably friction from “bone on bone” since the cartilage has been destroyed. Wearing a brace, applications of hot or cold, water therapy, as well as the treatments suggested for moderate level disease may offer limited relief. However, these treatment options are designed to reduce symptoms – not fix the problem. At this point, surgery may be the best solution if pain and stiffness limit your lifestyle.  Surgical options include arthroscopy to “clean the joint” and remove bone spurs and repair torn cartilage; partial joint replacement; or full joint replacement.  

For more detailed information about how joint replacement surgery is performed, go to

New Medical Study Finds Vitamin D Doesn’t Help Arthritic Knees

Taking vitamin D supplements does not stop the progression of osteoarthritis in the knees, according to a new medical study published this week in the Journal of American Medical Association.

Because of vitamin D’s importance to bone health, it was thought that it might alleviate the pain of osteoarthritis and reduce damage to the cartilage. But results of a two-year study showed this was not the case. Physicians at Boston’s Tufts Medical Center directed the randomized, placebo-controlled trail that evaluated 146 people with advanced osteoarthritis of the knee.

However, there are a number of nonsurgical treatment options, including hyaluronic injections, prolotherapy treatment and platelet rich plasma (PRP) that can help reduce discomfort and improve quality of life for people with chronic knee pain until joint replacement surgery becomes necessary. To learn about these options, go to

Joint Resurfacing May Be a Good Alternative For Some Patients

Joint resurfacing is a relatively new orthopedic treatment for patients who have pain and limited mobility due to arthritis or other degenerative conditions of the knee, hip or shoulder. In some cases, it may be a good alternative to total joint replacement.

What’s the difference between the two? Total joint replacement replaces all of the damaged arthritic bone and cartilage in the knee, shoulder or hip joint with an implant. Joint resurfacing is just what it implies – it replaces only the surface of the joint. That allows more of the bone to be conserved. Because of that, some orthopedic surgeons feel joint resurfacing can be performed at an earlier stage of disease than is usually recommended for total joint replacement.

What can you expect during a joint resurfacing procedure? For shoulder resurfacing, the head of the arm bone is reshaped and a cap or implant is placed over it, leaving the shoulder socket in place.

With hip resurfacing, the head of the high bone is trimmed and covered with an smooth metal implant. Then, damaged tissue within the pelvic socket is removed and replaced with a metal shell implant, similar to a total hip replacement.

Partial knee resurfacing treats only the damaged surface of the knee joint in one compartment in the knee rather than replacing the entire joint.  For example, during patellofemoral knee resurfacing, only the worn patella (kneecap) and the trochlea, a groove at the end of the thighbone, are treated. Unicompartmental knee resurfacing repairs only the damaged arthritic tissue in the femur and tibia.

There are both advantages and disadvantages of joint resurfacing. Selecting the right patients for the procedure is one of the most important considerations. Often patients who are younger, with healthy bones, are considered the best candidates.

If you have arthritis pain in your knee, hip or shoulder and it with your normal daily activities, you might want to consider joint resurfacing. For more information, or to discuss your treatment options, please call 239-936-6778 or visit

What to expect after surgery

Replacement, recovery and rehabilitation are the three
“r’s” of joint surgery. Following joint replacement surgery, patients are
monitored during a brief recovery in the hospital. Generally after 3-5 days, patients
are released home and recovery begins. Following surgery, I refer my patients
for post-surgical rehabilitation to help speed recovery. This may include
at-home exercises and/or outpatient rehabilitation with a physical therapist.

Rehab generally continues after you leave the hospital
until you are able to function more independently and you have recovered as
much strength, endurance, and mobility as you can. Total rehab after surgery
will take several months.

For the first six weeks, activity is limited. Moderate
exercises and stretching may begin as soon as six weeks after surgery. This
generally continues until three months after surgery, depending upon recovery
and improved range of motion.

Once released from rehabilitation, patients can generally
resume normal activities. In some cases, patients are more active than before

Overall, our goal is to help patients regain as much
mobility and independence as possible to return to healthy living.

If you have questions or would like a consultation, please
contact my office at 239-936-6778.

Questions to ask your doctor when considering joint replacement




If you are considering  joint replacement surgery or curious about alternative relief options, here are a few questions to ask your doctor:

  • Are there any pain relief options for me that could work as well as joint replacement?
  • If I have joint replacement, how much will it relieve my pain?
  • How is the procedure done?
  • What do you do to manage the pain after the surgery?
  • What are the risks or complications of joint replacement?
  • How long will I be in the hospital, and how soon after having the procedure can I get back to normal daily activities?
  • Is joint replacement covered by my insurance?
  • After the procedure, will I see you or my regular doctor for follow-up care?
  • If I decide to have joint replacement, which company’s product do you think will be best for me? Why?
  • If I have joint replacement, will you perform my surgery? How many of these procedures have you performed?
  • What kind of activities will I be able to participate in after joint replacement?

 For more information, call 239-936-6778 or join me for my next free seminar on Saturday, March 12, 10a.m. to Noon at Athletic Orthopedic and Reconstructive Center, 3210 Cleveland Ave., Suite 100, Fort Myers. For reservations, call 239-936-6778 ext. 2227. To register online and for more information, visit Space is limited.

Joint Replacement Technologies and Treatment Options


Want to learn more about the newest joint replacement technologies and treatment options?

View our educational animations to learn about common orthopedic procedures and pain management. Visit to learn more about your condition and its treatment.

Your treatment and recovery is a team effort of physician and patient. I encourage you to take an active role in returning to the lifestyle you seek.

If you have questions about orthopedic procedures, feel free to call 239-936-6778, ext. 2227 or visit to request an appointment.

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