Now that minimally invasive procedures are the norm, patients are recovering more quickly from orthopedic injuries and illnesses. Learn how far the field has come, how greatly patients’ lives are impacted by successful surgeries, and where orthopedics research is headed.
McKenzie Krich was looking forward to her senior year at Huntley High School. A dedicated three-sport athlete, she wanted to compete with her friends and maybe even win some state titles before going off to college.
Her plans changed in an instant.
“I was playing basketball, and in the middle of the game, one of my teammates stepped on my foot,” Krich recalls. “Basically, my body went one way and my leg went the other.”
She heard the popping sound.
Krich assumed she dislocated her kneecap. A few days passed, and she could walk around just fine. But the swelling in her knee wouldn’t go away.
When her leg started giving out, she made an appointment to see Dr. William Cox, a fellowship-trained orthopedic surgeon with Centegra Physician Care-McHenry County Orthopedics and medical director of Centegra Sports Care.
“He did both an X-ray and an MRI,” Krich recalls. “About a week later, he called me with the results.”
The MRI showed Krich’s worst fear. She had torn her anterior cruciate ligament (ACL). The injury meant she was out of sports for at least six months.
“I cried,” Krich says. “A lot. It was just before senior year started, and I do three sports: golf, basketball and track. This injury meant I was out of golf and basketball, if not some of track.”
Nevertheless, she scheduled her surgery for as soon as possible. Cox used part of Krich’s patella tendon to construct a new ACL.
Six months later, after much physical rehabilitation, Krich was able to compete for her entire track season. Even while wearing a brace, she achieved her goal of qualifying for state. The accomplishment solidified her plans to do track next year at Southern Illinois University, in Carbondale.
So, even though her injury was a setback, she still made the most of her senior year.
“After a lot of talking, Dr. Cox even let me play at senior night for golf with my huge brace on, and I got to go in for about a minute during basketball season,” Krich says.
Now, she’s completely healed.
Cox similarly experienced an orthopedic injury when he was a senior in high school. A torn rotator cuff meant he had to quit tennis. The experience led him on the path to becoming an orthopedic surgeon.
After completing his residency in orthopedics, Cox completed a fellowship in arthroscopic surgery at Georgetown University. While there, he was the assistant team physician for the Washington Redskins.
“It was a great experience and I was actually offered a position to stay, but my wife and I decided to come back to the Midwest,” Cox says. “We’re both from this area. But, I’m grateful I’ve had the opportunity to treat athletes everywhere from the grade school level through the professional level.”
Whether it’s a professional athlete or a competitive high school player, like Krich, Cox enjoys treating them all.
“To me, it’s really about the personality of the athlete,” Cox says. “It doesn’t matter what level of athlete they are, or what sport they play. I really just enjoy the patients and helping them get better.”
The Basics of Orthopedics
While orthopedic injuries can be painful, they’re at least treatable and oftentimes non-life threatening. That’s what Dr. Jason Rotstein, an orthopedic surgeon at Barrington Orthopedic Specialists, enjoys about the field.
“While other medical professions are dealing with more chronic problems, we oftentimes have the ability to make patients normal again and allow them to regain an active lifestyle,” he says. “It’s not just getting players back on the field. It’s also allowing people to walk normally again, or use their arms normally again. We’re not just managing patients; we’re solving problems.”
Rotstein’s workdays are filled with variety. He splits his time between the operating room, where he does surgical procedures, and the office, where he consults with patients. Most of his procedures occur at Northwest Community Hospital, in Arlington Heights.
His practice is geared toward sports medicine, which mainly concerns knee, shoulder and elbow procedures.
“Every day is different,” he says. “My specialty is arthroscopic surgery, doing minimally invasive procedures. Every surgery is different; every patient is different. You don’t get the monotony that you might find in some other fields.”
Rotstein sometimes works on-call with nearby hospitals to do emergency orthopedic procedures, such as fixing broken bones, but for the most part, the surgeries he performs are planned in advance.
His most common procedure is doing arthroscopic surgery of the knee.
“That’s kind of the bread and butter of a sports medicine physician,” he says. “Looking at the ACL, a primary interest of mine, I’m doing what’s called an all-inside ACL now. So, just through centimeter-long incisions, we’re able to reconstruct the ligament by drilling sockets, rather than full tunnels, in the bone. It limits the amount of post-operative pain and allows patients to rehab a little bit quicker.
And the ACL is just as strong as, if not stronger than, it was before the injury.”
In general, Rotstein says arthroscopic surgery is today’s standard.
“We’re at a point in orthopedics now where if you’re not doing arthroscopic surgery on rotator cuffs, ACLs and minimally invasive joint replacement, you’re absolutely behind the times,” he says. “We’re seeing patients rehab faster, and post-operative pain is less of an issue.”
Sometimes, a patient may not want to do surgery, Rotstein adds. They’d prefer conservative management of their injury. In that case, Rotstein helps the patient rehab back to their normal lifestyle.
“It just depends what each patient is looking for,” he says. “Do they want to get back to overhead throwing, or do they just want a painless shoulder that can perform daily activities without much discomfort? It’s extremely important to tailor a treatment plan and rehab protocol to the patient. And that may not mean surgery. I give patients all the options and help them make the best decision for their lifestyle.”
Recently, Rotstein had a patient who tore his Achilles tendon. The patient was extremely concerned because he wanted to walk down the aisle at his son’s wedding without a cane or crutch.
“I said, ‘OK, if that’s your goal, let’s do our best to get you there,’” Rotstein recalls. “We had him in surgery the next day, and two weeks later I put him in a boot.”
Two weeks after that, the patient sent Rotstein pictures of himself walking down the aisle – no cane, no crutch.
“He was even able to dance a little bit, which I wasn’t thrilled about,” Rotstein laughs. “But we got him where he needed to be, and it’s a testament to how far the field has come. Little things like that are what’s most rewarding.”
When the Doctor Becomes the Patient
Dr. John Daniels, an orthopedic surgeon at OrthoIllinois, has operated on thousands of patients throughout his career. But not even that could fully prepare him to be on the other side of the operating table.
“I’m 56 years old, and I have a condition called hip dysplasia,” says Daniels, who subspecializes in hip and knee reconstruction. “This is a condition where the ball doesn’t fully fit into the socket of your hip. Patients with hip dysplasia generally develop pretty significant, painful symptoms in their 50s.”
Before experiencing ongoing pain in his hip, Daniels was very active. He’d climb mountains, run triathlons and even run marathons. But suddenly it got to a point where he couldn’t walk across a parking lot without needing a pain medication like Advil or Aleve.
It was a huge impedance on his lifestyle.
“The pain of arthritis and hip dysplasia tends to come and go, and I think that’s why patients wait to get an operation,” Daniels says. “You can be in a lot of pain one day, and then all of a sudden you’re fine. But ultimately, it just continues to get worse.”
Now that replacement joints are lasting longer, the days of waiting as long as possible to undergo an operation are long gone. Daniels underwent a total-hip replacement procedure and was back to work within six weeks. Now, four months later, he’s back to walking three to five miles a day, riding his bike regularly and playing golf. He’s hoping to play tennis again soon.
People oftentimes ask him how he knew it was time to get the operation.
“I usually run through five scenarios with patients,” Daniels says. “Are you having pain most days of the week? Does the pain get over a five or a six? Do you need medications? Does it bother you at night? And have you had conservative treatment that failed? If you answer yes to those things, if your lifestyle revolves around your hip or knee, then you’re becoming a candidate to get your hip or knee replaced.”
When it comes to hip and knee reconstruction, Daniels says there are four improvements that have made the procedures less intrusive.
The first improvement is seen in anesthetics.
“There are nerve-block techniques where you can numb the patient’s leg without taking away their function,” Daniels says. “Therefore, their pain is controlled postoperatively and we don’t have to use as many opioids.”
Second, when it comes to surgery, orthopedists have refined their approaches.
“We’re using smaller incisions for less muscle and tendon disruption,” Daniels says.
Third, the sizes of hip and knee implants have improved.
“We’ve asked manufacturers to give us more sizes and shapes to better fit the bone,” Daniels says. “Imagine your shoe being a size nine instead of a 9.5. That’s where we were 10-15 years ago. And now, there are so many options in modularity that we can really get a much better fit for the patient.”
Finally, advanced technology has come into play. For example, a device called OrthoCenter can give surgeons live feedback during a total knee replacement procedure.
Now that he’s had his own hip replaced, Daniels has a new appreciation for his patients.
“It’s amazing,” he says. “You really realize how much trust patients have in you. Even though I’ve done thousands of these operations, there’s still the element of the unknown. That’s why I think patients are afraid. But, almost every patient will tell you after their surgery that they’re so glad they did it, and they should have done it sooner. I hear that all the time.”
Prioritizing Patient Satisfaction
Historically, joint replacements were considered a procedure for the elderly. But times have changed, says Dr. Shawn Palmer, an orthopedic surgeon and hip/knee specialist at The Hip and Knee Center – Elgin.
“As the durability of implants has improved, and through minimally invasive procedures, people younger and younger are coming in for surgery because they don’t want to tolerate the pain of the dysfunction they have,” he says.
Last year, he even did a joint replacement on a 14-year-old.
“He had an injury in a football game – the same injury Bo Jackson had – where he broke the neck of his femur and his femoral head died,” Palmer explains. “That’s not very common, but still, there was no other course of treatment for him. Then, also last year, I had a patient who was 102. So, patients really do span the age spectrum.”
While hip and knee implants have improved over the past 15 years in terms of materials and durability, Palmer says the basic design of the implants hasn’t altered.
What’s changed the most, across multiple fields of medicine, is having a patient-focused mentality.
“When I first started practice, patients were admitted the night before surgery,” Palmer recalls. “They’d have a 2-hour operation, a tube in every hole, and they’d spend a week in the hospital. It was a 2-month recovery, incisions were longer, the blood loss was more, and while they still had great outcomes, it wasn’t a patient-focused way to do things.”
Twenty years into his practice, Palmer has been part of the switch to prioritizing patient satisfaction. Patient education, shorter hospital stays, better pain control, early intervention with physical therapy and shorter recovery times have all been achieved for a better patient experience. It’s all tied in with minimally invasive procedures.
“Actually, minimally invasive isn’t a very honest term,” Palmer says. “All surgery is invasive. That’s more of a marketing term, really. But, when you think about it from a patient standpoint and not from a surgical standpoint, there’s a minimal impact on a patient’s life after the fact. They’re back functioning much faster, and I think that’s what minimally invasive really means.”
Procedures themselves only take about 20 to 30 minutes, Palmer says. And now, with regional anesthesia to the hip or knee, patients can stay awake during their procedure, if they want. They can immediately put their weight on their new joint and go home the day of their procedure. However, as good as hip and knee replacements are, they’re not perfect.
“It’s not the joint that you were born with,” Palmer explains. “You’re going to have some degree of limitation at some point. It’s important that patients have realistic expectations.”
In general, Palmer says patients with a hip replacement can return to work in about two weeks, while patients with a knee replacement typically need about six weeks.
“Knees are a little more uncomfortable,” he explains. “With hip and knee replacements, it’s mostly the result of osteoarthritis, which is primarily genetic. So, there’s not a lot people can really do about it. But, a healthy, active lifestyle is the best way to live for every condition, whether you’re concerned about your bones and joints, or your lungs, kidneys and heart.”
Relieving Pain and Treating a Patient’s Spirit
When Dr. Marc Angerame was growing up in the northwest suburbs of Chicago, he was very active in playing sports. But, a knee condition made it difficult for him to give 110 percent. Needing two operations by age 15, Angerame had to step away from athletics for an extended period during his adolescence.
The silver lining? He was able to witness the grace and compassion of orthopedic surgeons.
“That’s what really drew me to the profession,” he says. “The ultimate result in returning to sports in high school, and being able to remain athletic throughout my lifetime, has really been inspirational for me. I wanted to deliver that same type of care and affect someone’s life as greatly as those doctors did for me.”
That led Angerame to medical school, orthopedic residency, and subsequently completing an orthopedic fellowship in adult joint reconstruction. Now, he’s returning to the Midwest to serve the community that raised him. On Aug. 28, 2018, Angerame will start a new life chapter at Lake Cook Orthopedics (LCOA) a division of Illinois Bone and Joint Institute, in Barrington.
“It’s an honor and a privilege to be able to come home,” he says.
During his training, Angerame spent five years in Charlotte, N.C., learning from the top orthopedists in the country. In addition to working at one of the busiest trauma centers in the country, he also worked with world-renowned shoulder, hip and knee reconstruction experts.
After that, he spent a year in Denver, Colo., at a prestigious fellowship under the tutelage of Dr. Douglas Dennis, a world-renowned hip and knee surgeon, for his fellowship training in primary (first-time) and complex, revision hip and knee replacements.
“Many patients with failed hip and knee replacements have difficulty with the simplest of daily activities,” Angerame says. “I’ve learned a plethora of techniques to help reconstruct those joints during my training. I’m bringing that expertise back to the Midwest to help patients become active again.”
Though he performs trauma and sports medicine surgeries – such as knee arthroscopy, arthroscopic rotator cuff repairs and shoulder replacement – Angerame’s primary focus is on hip and knee replacements and revision surgeries. He’s an expert at a relatively new hip replacement technique called the direct anterior approach.
“This is a minimally invasive surgery that allows me to operate from the front side of the hip joint by pushing aside the muscles instead of cutting across the muscles,” Angerame explains. “The literature suggests that the direct anterior approach for hip replacement results in less pain in the early post-operative period and a faster recovery. There’s also a dramatically lower dislocation risk compared to other approaches, which can oftentimes be a complication following a total hip replacement.”
When it comes to knee replacement, Angerame is trained in multiple approaches, one of which is conservative management of disorders should a patient choose to forgo surgery. In that case, he designs a protocol to help patients work through their injury and lead a healthy, active lifestyle.
However, for patients with arthritis who wish to be as active as possible, knee surgery is typically the best solution. Angerame performs an operation, for both total-knee and partial-knee replacements, called gap-balancing.
“I utilize the smallest incision possible, while performing the procedure safely, to give my patients the most stable knee possible,” Angerame says. “In the literature and in my clinical experience, it produces some of the most precise knee kinematics that most closely replicate normal knee joint movement.”
Besides exceptional surgical training, Angerame has also made a point to focus on the bedside manner element of being an orthopedic surgeon. Last year, he participated in Operation Walk – a national organization that focuses on mission trips to underserved Central American countries.
“It’s an impressively emotional experience to see these underserved patients walk into our clinic, with crutches or walkers or wheelchairs, entirely disabled from arthritis,” Angerame says. “It’s very gratifying to see them walk just hours after their procedure, some for the first time in years. To restore the oftentimes taken-for-granted ability to walk and to see the smiles on their faces is an incredible experience, one that I’ll continue to take part in throughout my career.”
For Angerame, it’s not only about treating the patient’s orthopedic injury. It’s about treating the patient’s spirit.
“I take that to heart every day when I am entrusted to take care of patients in the clinic and operating room,” he says.
The Future of Orthopedics
Like many orthopedists, Dr. Michael Gitelis has performed thousands of minimally invasive surgeries. But unlike many others, Gitelis is also an innovator in the field of orthopedics.
The orthopedic surgeon specializes in arthroscopy, sports medicine and orthobiologics – a specialty field of medicine that includes the use of a patient’s own cells or donated tissue to aid in healing and regeneration. His practice, Gitelis Orthopedics, is located in Hoffman Estates.
Gitelis is a surgeon who is on the forefront of medicine and is working to improve the arthroscope – an instrument that orthopedists use when operating on a joint.
Gitelis is creating the next generation of this device. He feels it’s important to keep making improvements on the current arthroscope, as he says it hasn’t changed much in the past 50 years. That’s why he invented a disposable arthroscope with an improved field of vision.
“We’re dealing in a world of antibiotic-resistant bacteria, and unfortunately that has become a major problem that we have to deal with in surgery,” Gitelis says. “But, having one patient per scope greatly protects the patient from infection.”
When he’s not innovating, Gitelis is offering the best care for his patients. He’s a surgeon, but he doesn’t always believe surgery is the answer.
Most patients have heard of stem cells, Gitelis says, and this is one orthobiologic that Gitelis uses when he feels patients will benefit from this treatment. The human body is designed to heal itself, Gitelis explains, and regenerative orthobiologics are not a magical cure, but a way to amp up the body’s own process so it can work better and faster.
A huge benefit to using orthobiologics alongside other treatments is that it can reduce pain, Gitelis says.
“With a nationwide opioid crisis, a far safer alternative is to consider orthobiologics as a way to treat pain,” he adds.
Gitelis uses his vast experience to benefit his patients while also providing the newest and most innovative options. He customizes treatment options for his patients’ needs. He provides a full array of surgical, non-surgical and orthobiologic treatments and a combination of standard and innovative care.
“I’m a medical doctor first, a surgeon second,” Gitelis says. “This means that I take the time to focus on my patients and give them options based on what works for their needs. This can mean non-surgical treatments, orthobiologics, surgery or a combination of these options. It’s important to evaluate each patient as an individual and create a treatment plan together.”