2017-18 Sentara Orthopedics Annual Report

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Sentara Surgical Innovations

Surgical & Procedural Innovations

The care teams at Sentara Orthopedics strive to improve patient care by developing, adopting and implementing the most sophisticated and proven techniques, technologies and protocols. Our commitment to advancement in orthopedic care ensures an exceptional patient experience. Our innovative approach is multifaceted.

Our goal for orthopedic care is to not only restore our patients’ function but to also improve their quality of life. One of the many ways we do this is by offering more procedures that are minimally invasive, with reduced risk, minimized pain, shorter hospital stays and faster recovery.

All-Arthroscopic Rotator Cuff Repair for Even the Most Complex Tears

Although arthroscopic rotator cuff repair was introduced over 15 years ago, the procedure has evolved to the point where even the largest and most complex cases can be repaired by this less invasive technique. With arthroscopy, the surgeon uses an endoscope to operate through a small incision while a camera sends images to a high-definition monitor. Now surgeons who practice at Sentara surgical centers are able to perform repairs on virtually all tear sizes and types. With the latest innovative techniques in arthroscopic repair, if a tear is able to be fixed, it can be done through the scope in a less invasive fashion.

Arthroscopic rotator cuff repair, which requires special training, allows orthopedic surgeons to not only access and see places in the shoulder through a less invasive approach but to also fix problems – often much better than the prior traditional open repairs. Our experience and expertise allow us to perform arthroscopic procedures on a wider range of patients. We no longer say the tear is too large to repair arthroscopically. Additionally, for years we have been performing the latest innovative techniques, such as arthroscopic superior capsular reconstruction, for a subset of rotator cuff tear patients who are good candidates.

Patients benefit from less pain in recovery due to the less invasive approach while surgeons can actually see better, compared to open rotator cuff surgery. Arthroscopic rotator cuff repairs are performed as outpatient procedures, so patients do not need to be admitted to the hospital. Patients routinely undergo the procedure with regional anesthesia, avoiding intubation and heavy general anesthesia.

Navigation for Fracture Fixation

When a bone breaks, a doctor needs to reset it by bringing it back into alignment and stabilizing it. Depending on the severity of the fracture, the doctor may need to make an incision. Severe fractures might also require surgical fixation – wires, nails, screws or plates – to hold the bone in place.

There is now a minimally invasive method for treating these severe fractures. Orthopedic surgeons can use a specialized camera and continuous X-ray imaging (fluoroscopy) to guide fixation as they work through a needle-size incision. This percutaneous approach enables surgeons to safely navigate tight spaces inside the body, reducing risk to surrounding structures and limiting blood loss.

We are seeing an increased demand for joint replacements – a surgery known to potentially improve quality of life. At Sentara Orthopedics, we are constantly working to innovate so that these procedures are available to, and successful for, our most complex patients.

Navigation for Shoulder Replacement

Shoulder replacement is challenging — the joint is very complex and hard to access because of its structure and location deep in the body. Shoulder implants also need appropriate placement for joint stability and long-term surgical success.

Replacement is even more difficult for patients with trauma, a fracture or a congenital abnormality in the shoulder, for two reasons:

  • These factors limit the surgeon’s view of the implant area.
  • The complexity places these patients at higher risk for significant complications.

To address the challenges of complex shoulder cases, orthopedic surgeons at Sentara now use computer navigation. It gives them a 3D view of the implant area and confidence knowing they are operating in the precise location.

Custom 3D Implants for Complex Reconstruction

While patients with complex foot or ankle problems may require joint replacement, “off-the-shelf” implants do not always correct the problem.

A new technology allows orthopedic surgeons to customize implants to specific needs, avoiding the possibility of amputation and providing a more durable option. These stronger implants help patients who have been told they are too heavy for joint replacements to last.

Micro Implants for Shoulder and Hip Replacement

Orthopedic surgeons need to make room in the femur for the stems of hip implants, and in the humerus for the stems of shoulder implants.

But new smaller implants for hips and shoulders contain half the amount of metal as traditional implants. Orthopedic surgeons are tracking outcomes and finding that this allows them to remove less bone during surgery.

Arthritis in the big toe causes cartilage to wear down, leading to joint pain. Historically, orthopedic specialists have treated this condition by “welding” together the bones forming the joint — reducing pain and increasing stability but constraining motion.

This constraint makes shifting weight onto the ball of the foot painful, if not impossible. A range of activities are affected, from squatting, kneeling and standing on toes to wearing high heels, playing sports, running, and doing yoga and Pilates.

Patients now have a constraint-free option for relief: a synthetic implant that mimics human cartilage but does not transfer feelings of pain or pressure. Called Cartiva®, it is made of contact lens material and placed after an orthopedic surgeon removes the focal area of arthritis.

In addition to maintaining motion, Cartiva offers reliability, durability and is bone sparing. Should patients still need fusion in the future, they retain the amount of intact bone needed for surgery.

From a sample of 15 of the earliest Cartiva patients at Sentara, patients experienced about a 10-degree improvement in range of motion. The average pain score at follow-up (typically around five months) was reported as less than one on a 10-point scale (10 being the most pain). None of the patients needed revision surgery, demonstrating the implants’ success.

As part of a large arthroscopic rotator cuff repair group (267 patients) that underwent outpatient all-arthroscopic rotator cuff repair (including what are considered “massive” tears) we asked patients if they would go back and have their surgery all over again.

96.2% – 97.9%

of patients, depending on their age, said yes, they would have their surgery over again.

The study by Jordan-Young Institute was approved by the Eastern Virginia Medical School Institutional Review Board. All patients had a minimum of two years post-op since their surgery.