Thursday, 17 of January of 2019

Tag » orthopedic surgeon

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.”


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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.

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.

Tips for Living With Arthritis


Anyone with osteoarthritis or who has a loved one with the disease knows that it can get progressively more painful over time as the smooth cartilage covering joints in the shoulders, knees, hips, wrist and fingers is affected.

While surgery to replace the joint may ultimately be the best solution, here are some tips from the American Occupational Therapy Association and Arthritis Foundation to make living with arthritis more manageable day to day:

  • Apply a heat pack or cold pack to the painful joint before and after performing activities.
  • Use a pillow to elevate the painful joint and provide support while you sleep.
  • Install a raised toilet seat and grab bars in the bathroom.  Similarly, sit in a chair with arms to help you stand up.
  • Remove throw rugs to prevent tripping.
  • Don’t lift heavy items. Use a cart with wheels to move laundry, garbage cans, grocery bags and other items.
  • Replace doorknobs and faucets in your house with lever-style handles that are easier to turn.
  • Take frequent breaks and pace yourself when doing activities that put strain the joint.

Here are a few additional lifestyle suggestions from the Arthritis Foundation:

Maintain a healthy weight and control blood sugar: Extra weight puts added stress on weight-bearing joints, such as the knees and hips. In addition, new studies show that high blood sugar levels, which increase the risk for diabetes, may trigger inflammation, which can damage cartilage.

Stay physical: It’s the best non-drug treatment for improving pain and function. Exercise stretches the joints and keeps them more flexible, while also strengthening the muscles surrounding the joint. You don’t have to join a gym; just take a walk.

Play it safe if you play sports: Wear protective gear soccer, hockey, rollerblading, baseball and similar sports that can strain joints. Injured joints are nearly seven times more likely to develop arthritis.

For more information about joint pain or other orthopedic-related conditions, go to To schedule a consultation call 239-936-6778.

Summer, Baseball & Sports Injuries




shutterstock_51758455What could be more all-American than hot dogs and baseball in the summertime? We’re fortunate in the Fort Myers area to have our own home team, the Fort Myers Miracle playing at Hammond Stadium.

Summer is also a big time for Little League games. Whether your son or daughter is playing baseball on a Little League team or a professional athlete is playing ball for one of your favorite Major League teams, baseball is a sport that has the potential for injury.

It’s unlikely that your child would be at risk for the same level or intensity of injury that challenges professional ball players, like New York Yankees captain Derek Jeter, who broke his ankle in 2012 and continues to have problems with it, or Henley Ramirez of the Los Angeles Dodgers who tore a ligament in his thumb and had to have surgery.

But STOP Sports Injuries, a safety and public awareness campaign organized by the American Orthopaedic Society for Sports Medicine, wants parents to know that injuries in young athletes are on the rise.

The most common Little League-related injury, says AOSSM, is a tear in the UCL, or ulnar collateral ligament, the ligament that stabilizes the elbow. Typically injury to the UCL is caused by overuse – “throwing too hard, too much, too early and without rest.”

What can you do as a parent to make sure your child’s summer is healthy and fun? Here are some tips from AOSSM. Be sure the coach rotates players so your son or daughter isn’t just pitching. Don’t allow your child to play despite pain or pitch on consecutive days.  And, be sure that the coach teaches players about both control and good mechanics.

Rest, ice and over-the-counter medications will most likely take care of the pain. But if not, examination by a physician and diagnostic tests, such as an X-ray or MRI might be needed. For expert advise, call Dr. John Kagan. Dr. Kagan offers more than 30 years of experience as a successful orthopedic surgeon offering both surgical and non-surgical treatments for sports injuries. For more information, go to

How do you know if you have tennis elbow?



young man playing tennisYou’re playing tennis and feeling good about the powerful forehand or backhand groundstroke you just hit, when a burst of sharp pain on the outside of the bony area of the elbow takes you by surprise.

You’ve injured your tendon that attaches the forearm muscles to the outside of the elbow. Microscopic tears in the tissue develop from overuse, leading to what is commonly known as tennis elbow or in medical terms –lateral epicondylitis.

Tennis elbow is not just limited to tennis; it can also develop from sports like golf and baseball, and it’s common to certain occupations, such as painting, carpentry, plumbing, gardening/landscaping and mechanics. When the same motion is repeated over and over again, such as elbow bending and straightening, the tendon gets stressed.

How do you know if you have tennis elbow? The American Academy of Orthopedic Surgery reports that common symptoms  include pain or burning on the outer part of the elbow, weakened grip strength and difficulty lifting or squeezing objects, including using tools, opening jars or handling a tennis racquet. Usually symptoms appear gradually over time and increase in intensity, but you can have an acute injury.

Nonsurgical treatment is the first step. This includes resting the arm, wearing a brace, taking over-the-counter anti-inflammatory medication or using a topical gel, as well as physical therapy exercises and steroid injections. The goal of treatment is to reduce pain and inflammation, promote healing and decrease stress on the elbow.

If six months to a year of nonsurgical treatments fail to provide relief, surgery may be recommended.  Arthroscopic surgery using minimally invasive techniques can remove loose cartilage and bone fragments, release scar tissue and treat the damaged tendon.

For more information about tennis elbow or other orthopedic-related medical conditions, go to

Meniscus Tears of the Knee




Meniscus Tear 1Meniscus tears of the knee are a common orthopedic injury for people of any age. In younger adults, it’s often related to sports. A sudden twisting, turning or forceful squatting can cause a tear. Even the repetitive pounding the knee takes during jogging can increase the risk for this type of injury.

In older adults, a meniscus tear is usually related to degenerative disease. As the cartilage thins out and weakens, it can rip. Something as simple as stepping off the curb the wrong way or twisting when getting up from a chair can tear the tissue. Without treatment, a piece of meniscus could come loose and drift into the joint, causing pain and swelling and making it difficult to bend and move the knee.

Years ago, treating a meniscus tear required a two-to-three inch incision to repair the tissue and a two or three day hospital stay. Today, the procedure of choice is minimally invasive arthroscopic surgery, in which a small endoscopic tube is inserted through a half-inch incision. Patients go home the same day. Recovery is quick and pain is minimal.

What does the treatment involve? Surgeons can remove fragments of torn tissue, trim and smooth rough edges and use sutures to stitch the torn pieces back together.  The type of treatment best for your situation will depend on the size, location and type of tear.

How do you know if you have a meniscus tear?  Symptoms include a dull ache, swelling, tenderness, sensations such as locking, popping or catching, as well as difficulty bearing weight on the knee and limited range of motion.

Seek advice from an experienced orthopedic surgeon if you have lingering knee pain and problems walking. For more information about meniscus tears or other common orthopedic conditions, go to

Women Are More Likely To Tear Their ACL

Orthopedic surgeons have long known that female athletes rupture their ACL or anterior cruciate ligament more often than men. The ACL, one of the primary ligaments in the knee, helps stabilize the knee and leg bones.

Now a team of researchers at Yale University has published an article in this month’s issue of the Journal of the American Academy of Orthopedic Surgeons suggesting that women are three times more likely to suffer from this injury – and the reason may be the unique difference in anatomy between male and female athletes.

Female Anatomy vs. Male Anatomy

The lead author of the article, Dr. Karen Sutton, assistant professor of orthopaedics and rehabilitation at Yale, suggests that the quadriceps angle or “Q angle,” which is where the upper and lower leg bones meet, is larger and angled downward more sharply in women than in men. That’s because women have wider pelvic structure than men. Where is the quadriceps? It’s the large muscle in the front of the thigh.

Because of this unique structure, women may experience a “greater stress and pull of the knee muscles” during strenuous activity like running, soccer, basketball, volleyball and similar sports, says Dr. Sutton.  

Women have ACL tears not from a direct blow to the knee, but from a hard landing after a jump, or stopping and turning abruptly when using techniques like pivoting and cutting. Female athletes also tend to land in a more upright position, rather than bending their knees like men do. They also land more frequently with a slight inner rotation of the knee, which puts stress on the ligaments.

Researchers not involved in the Yale study have also suggested that the difference in injury rate between men and women may be due to muscle strength – women tend to have weaker hamstring muscles in the back of the thigh relative to their quadriceps muscle in the front, a structural difference than can compromise knee stability.

In addition, women’s ligaments are known to be more flexible or “lax” than men’s, which could make the tissue more susceptible to tearing. However, Yale researchers found “no conclusive link between female hormones, the menstrual cycle and increased risk of ACL injury.”

Prevention Tips

Prevention is the key when it comes to ACL tears. Dr. Sutton recommends that women undergo fitness conditioning routines that improve core strength and increase knee stability by building up the gluteal, quadriceps and hamstring muscles. Female athletes should also be taught the correct way to jump and land, pivot and turn to prevent injury, she says.

Other prevention tips include an adequate warm-up to stretch the various muscles, including hip flexors, and crosss-training to avoid overuse injuries.

An ACL tear can be a painful injury that may require reconstructive surgery, followed by physical therapy for a full recovery and return to the game. For more information about how the ACL is reconstructed, go to

Choosing The Right Orthopedic Surgeon – 4 Things To Know

Choosing the right doctor is an important part of your treatment process, especially if you’re looking for a orthopedic specialist. But how do you make the decision about which physician is best? Here are a few guidelines to keep in mind.

1. Check The Doctor’s Educational Background

The first step in learning more about the doctor’s qualifications is to ask about education and training, which includes medical school, internship and residency training. The surgeon should also be board-certified, which means he or she has achieved a certain level of expertise by passing a rigorous national examination and demonstrating in-depth knowledge in a particular specialty. In addition, ask about ongoing training and certification, which ensures that the doctor values staying at the forefront of advances, such as minimally invasive and computer-assisted techniques.

2. Ask About Expertise

How do you determine the doctor’s level of expertise? Years of experience in practice is one indication. Just as important is how often the doctor performs the particular type of procedure that you are considering. Practice makes perfect. The more frequently the doctor undertakes the procedure, the better he or she will be at it and the better the outcome will be for you.

3. Find Out The Doctor’s Reputation in the Community

Chances are someone you know – friends, family member or co-workers may have first-hand experience with the physician you are considering. Another good source of advice is your primary care physician. Although it’s not essential, you might also find out if the physician participates in the community outside his or her private practice. For example Dr. Kagan and his partners are involved with Florida Everblades minor-league hockey team and the Minnesota Twins Baseball Team during spring training in Fort Myers.

4. Evaluate Your Comfort Level

Once the physician’s credentials have been established, you’ll want to make sure that you have a certain level of comfort, confidence and trust in the physician – that the doctor-patient relationship works for you and the doctor has your best interests in mind. For example, does the doctor take time to listen, answer your questions, address your concerns and explain exactly what will take place during the procedure? Patients today are more educated about their healthcare and most want to feel they have an important voice in their treatment options.

In addition to feeling confident about your doctor, you’ll also want to make sure that the office staff is friendly, professional and caring. When you call the office, is the receptionist pleasant? Are you placed on hold for very long? Are your messages returned? Is there a process for reaching the doctor after hours during an emergency? And finally, is your time respected? While you may occasionally wait longer than expected to see the doctor because of an unexpected emergency or other situation, an hour-long wait in the lobby gets tiresome very quickly.

Want to learn more about orthopedic surgery or find out Dr. Kagan’s scope of practice and expertise? Go to


Sprains & Strains

Whether you’re a teen playing high school sports, an adult who is an avid runner or a senior who plays weekly doubles tennis, chances are that at some point, you’ll experience the discomfort of an occasional sprain and strain – the most common injury sustained in sports today, reports the American Academy of Orthopedic Surgeons.

Many people think of sprains and strains as the same injury. They’re similar, but distinct. Here’s the difference.

A sprain occurs when you overstretch or tear a ligament. For example, step awkwardly off the curb and land on the side of your feet and chances are you’ll sprain your ankle. Jump down from break wall at the beach onto a sidewalk and you can twist and sprain your knee. Or try to break your fall by stretching out your arm and chances are you’ll sprain your wrist or shoulder.

When you sprain something, it means that you’ve injured one or more ligaments, the fibrous band of connective tissue that connects the bones and stabilizes the joint. Overstretching or tearing a ligament puts pressure on the joint and can force it out of alignment.

A strain is an injury to a muscle or tendon. Just like ligaments connect the bones, the tendons connect the muscles to the bones. Overstretching or the opposite, contracting a muscle or tendon, can cause injury. Chronic overuse and repetitive movement, perhaps caused by intensive training, can set up a repetitive injury cycle.

Who’s at risk for sprains and strains?

Just about everyone, but especially athletes. RICE or rest, ice, compression and elevation are typically the first line of defense prescribed by the physician. Anti-inflammatory over-the-counter medication can also help reduce swelling and decrease discomfort.

But a severe sprain or strain may require medical treatment. If the pain and swelling continue after initial treatment with RICE, call your doctor. You may need X-rays, more intensive treatment or even physical therapy to help strengthen and rebuild the injured tissues.

Prevention Tips

It’s not always possible to prevent a sprain or strain if you’ve an avid athlete. But NIAMS (The National Institute of Arthritis and Musculoskeletal and Skin Disease) offers these prevention tips: 1. Wear appropriate shoes for the sport and make sure they fit well. 2. Warm up and stretch before intensive exercise. 3. Run on flat surfaces. 4. Stop exercising when you’re tired or in pain.

Want to know more about orthopedic-related injuries? Go to

Back Safety For The Holidays: Travel, Tree Trimming and More

Tis the holiday season and time to reflect on the many blessings in our lives and to enjoy the company of friends and family. But it’s also the time of year when we’re busier than ever and often feeling stressed, which can show up as tense shoulders, neck and back pain. Add to that all the lifting, pulling, pushing and twisting we do to clean and decorate the house, set up the tree and put up the outdoor lights. It’s easy to hurt yourself or aggravate old injuries.

For many people, the holidays also mean traveling by airplane to visit to family and friends. And improperly lifting or carrying heavy suitcases and carry-on bags can literally be a real pain in the neck. Even if you’re not traveling, heavy shopping bags full of presents can put a strain on your back, shoulders and neck, too.

Here are some holiday safety tips from the American Orthopedic Association:

Choose the right luggage. Two smaller bags are easier on your back than one heavy one – and make sure you are using a lightweight suitcase with a handle, one you can pull behind you, not carry.

Lift properly. Bend your knees and lift using your leg muscles, being careful not to twist your spine. Never stretch and reach for anything heavy – that’s a sure way to hurt your back. Carry heavy suitcases or shopping bags close to your body for better balance and carry the bags in both hands, rather than on just one side. The same applies to backpacks. Carry a backpack over both shoulders rather than slinging it onto one shoulder only.

Be careful of overhead compartments. Lifting your luggage into an airplane’s overhead compartment can be a challenge, especially if you don’t have a lot of upper body strength. Don’t lift your bag straight up into the compartment. Instead, lift luggage onto the top of the seat. Then place both hands on either side of the suitcase and lift up. If your luggage has wheels, put the side with wheels in first; then push the bag to the back of the compartment.

Ask for help and avoid rushing. If your suitcase is heavy or awkward, ask a flight attendant for assistance. It’s not worth attempting it yourself and making your holiday miserable because of neck or back strain.

Dr. John Kagan and his staff wish all of their patients and their families a safe and happy holiday. For more information about orthopedic-related medical conditions, go to

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