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Fri, 22 May 2020

Outpatient Knee Replacement and the Benefits

Knee Replacement Surgery by Miller Orthopedic Surgeons

Outpatient knee replacement is a great way to get a patient in and out of the hospital on the same day. Not everyone qualifies or prefers this method, but many do. Outpatient total knee replacement is becoming more and more common of a surgery. Many, however, do not know what to expect with an outpatient procedure and therefore just stick to inpatient. Outpatient procedures do have their benefits, so it is important to be informed. A good orthopedic surgeon, such as total joint specialist Kent Boese, MD, can help you decide the best option for your knee replacement.

Total knee replacements (also called total knee arthroplasty), both inpatient and outpatient, are very similar. The biggest difference is in where post-op recovery is spent and the length of a hospital stay. The process of a total knee replacement is the removal of damaged bone or cartilage and the insertion of a prosthesis. The healthy bone and cartilage are resurfaced to help with the support of the implant. So, after the removal of the damaged bone and cartilage, the new joint is fused into place. This procedure is intended to reduce pain and increase the mobility of the patient. The goal is an improved quality of life.

Some Benefits to outpatient total knee replacement:

  • Lower infection rates
  • Recover in the comfort of own home
  • More Convenient
  • Cheaper

Outpatient surgery is an option because of less invasive surgical techniques, less blood loss, better pain control, and better anesthesia practices than were previously available. This allows people to be up and walking shortly after surgery. This is not a procedure that is appropriate for everyone, but through careful discussion with a fellowship-trained, Board Certified Surgeon, such as Dr. Kent Boese, a proper diagnosis and treatment plan can be decided.

 Many people will ask the same question about newer procedures, is it Safe?

Many different studies have found that in the proper candidate, outpatient is just as safe as inpatient knee replacement surgery. A lot of it comes down to ensuring the surgeon is a skilled, trained surgeon. Overall, most studies do not find a major increase of risk from inpatient to outpatient. It is important to address any concerns or complications before or after the surgery with the surgeon or nurse navigators to ensure a better outcome and recovery for the patient.

One important thing to note about outpatient procedures is they can turn into an inpatient procedure if needed. This means that after surgery if something is questionable in the post-op evaluation, the surgeon can request the patient to stay overnight to be monitored. This helps resolve unforeseen complications that may have arisen. The patient will have a careful evaluation to be cleared for discharge to be sent home, but even once they get home, it is extra important that the patient have someone around to help monitor them in the case of complications. Communication is very important throughout the entire process.

A nurse navigator is there to help both in and outpatient knee replacement patients. The nurse is there to guide the patient through any problems or questions that might arise before or after surgery. The nurse is there to help put the patient’s mind at ease while helping monitor their recovery status for all knee replacements.

One important thing to note when choosing outpatient surgery is that it is extra important for the home to be prepared prior to the surgery. Because there is less immediate supervision following the surgery, the patient needs to be sure to eliminate potential causes of slips, trips and falls in the home.

There are risks involved with all knee replacements, but there are also so many benefits to people being able to walk around and be more mobile than they have been in years. Outpatient knee replacements have patients up and walking by that afternoon and on their way to recovery. Choose a surgeon that can help prepare you, educate you, and get you back out doing the things you love.

If knee pain is keeping you from doing the hobbies you love then it’s time to schedule an appointment. We are here to help you, give us a call 712-323-5333 (Council Bluffs) or 402-991-9958 (Omaha) or click here to request an appointment.

Tue, 18 Feb 2020

Jumper’s Knee

free sports injury clinic

Jumper’s knee is a condition that involves an inflamed patellar tendon. This is why it is also called patellar tendonitis. The patellar tendon is the tendon that connects the kneecap to the shin bone. This is a condition that gradually weakens the tendon and can eventually lead to muscle tears if left untreated.

Jumper’s knee arises from overuse in the joint. This is often from sports that require a lot of jumping on hard surfaces. The constant jumping and force of the leg hitting the ground causes strains and stress to the tendon. If left untreated, the condition usually worsens.

It is important if you think that you have jumper’s knee to go see a specialist. They can help diagnose and come up with a treatment plan to prevent the condition from worsening. Some symptoms include:

  • Pain under the knee cap
  • Swelling
  • Bruising or redness
  • Leg or calf weakness
  • Pain when bending
  • Stiffness when squatting, kneeling, or jumping

Once someone with this condition comes in and is diagnosed with “jumper’s knee” there are a few ways it is often treated. The biggest thing doctors typically say is to take a break from the sports or activities that caused the injury.

Tips on treatments for the condition:

  • Rest
  • Ice
  • Compression (taping, wraps or straps just under the knee cap)
  • Ibuprofen or other pain relieving, swelling reducing medicine
  • Physical Therapy (this can be at home or with a physical therapist to start to know the best exercises and strategies for each individual)

It is important to note that sometimes, when the condition is not treated or the person does not rest the knee to allow it to heal, it can worsen. In some situations, surgery can be required. This is another reason why it is crucial to come in and see a doctor when you start exhibiting symptoms. It is also always a good idea to see a physical therapist upon diagnosis to help provide some guidance on the best way to get you back in the game more quickly.

Miller Orthopedic Specialists offers a free, walk-in sports injury clinic in Council Bluffs from 10:00 – 11:00 a.m. and by appointment in Omaha. The initial consultation is free, but extra will be charged for x-rays, supplies, or follow-up visits if needed. This is a great opportunity to come in and see a specialist to get peace of mind without having to pay a hefty doctor bill. Your specialist can also provide input on what activities you are able (or unable) to participate in. Getting a general timeline and advice on what to do while recovering can make the recovery go more smoothly.

Contact us today for more information or to schedule your FREE* consultation. 

Mon, 23 Dec 2019

Hip Pain May Not Be Because of a Hip Problem

 If you are experiencing hip pain there could be a variety of things impacting it. Sometimes, the hip pain is due to something wrong in the hip, other times it is a deeper, different problem all together. The following injuries could be causing your hip pain. 

hip pain and joint replacement

Fractures

Many times, hip pain is due to a hip injury, such as a fracture. Fractures of the hip are more common as people get older. Often, hip fractures happen in conjunction with falling. The risk of falling is increased in the icy winter, so it is always important to be careful and to remember to walk like a penguin on the ice.

Arthritis

Arthritis is another big factor in causing hip pain. When arthritis hits in the hip, physical therapy is often ordered to help strengthen the muscles around the joint. A joint replacement is often needed once the more conservative treatment options have failed.

Bursitis

One other common cause of hip pain is bursitis, which stems from an inflammation of fluid-filled sac or the bursa. These sacs help cushion tendons, muscles and ligaments. Thus, when they swell it can cause a lot of tenderness and pain. Not all hip pain stems from an issue within the hip, sometimes it is something different.

Sciatica

Another reason one might be experiencing hip pain is sciatica, the inflammation of nerve roots from the spinal cord. Often times, this causes hip pain and pain that shoots down the leg. Sciatica can occur because of a variety of reasons such as spinal stenosis, which is often from osteoarthritis, spasms in the lower back, or bulging or ruptured disks. This pain, despite often occurring in the hip, is actually from an issue in the spine.

Peripheral Neuropathy

The sciatic nerve is not the only nerve that can become inflamed and pose as a hip problem. Peripheral nerves are another set that, when inflamed, can cause hip pain. This is often caused in pregnancy, but there are other triggers for it as well, including diabetes and too tight of clothing.

Receive a Proper Diagnosis Today

A proper diagnosis is crucial when trying to take care of hip pain. For instance, if someone were to get a cortisone shot in their hip, but the issue is a ruptured disk in their back, then the injection is not going to do a ton of good. Proper diagnosis is important to know the proper treatment plan. It can help people know what exercises might help or hurt their condition. It is also important for the patient to know if there is a deeper underlying condition that could be more serious of an issue than they originally anticipated.

If you are experiencing hip pain, come in and see one of our total joint doctors or come see our spine specialist if the pain is running through your back or leg as well. They can help provide a proper diagnosis and determine the root cause of the condition. This will help them work with you to come up with an individualized treatment plan to best address your pain. 

Contact Miller Orthopedic Specialists today for your individualized treatment plan for your hip pain today!

        

Tue, 28 May 2019

Larose marks 30 years at Miller Orthopedic Specialists

Dr. Daniel J. Larose, sport medicine doctor was the first partner under Dr. Ronald Miller, who started with Miller Orthopedic in 1972. Photo and article by Susan Payne

This year, Miller Orthopedic celebrates the 30-year anniversary of Dr. Daniel Larose, one of the first recruited associates under Dr. Ronald Miller in 1988, founder of the practice.

While Miller Orthopedic welcomes the newest physician to the team, Larose is one of the longest standing physicians with 30 years in the field and no plans for retirement.

“We came here in 1988 and it was a nice, easy going place. My wife liked it a lot too, to raise our kids. She felt like she could be here and not worry about heavy traffic or feeling unsafe,” Larose said.

Larose is one of 12 orthopedic specialists on the Miller Orthopedic team, partnering with the University of Nebraska at Omaha Mavericks, Iowa Western Reivers and more recently, College of Saint Mary Flames in sports medicine.

“We don’t formally teach medical students, but we are starting a program with the College of Saint Mary that they will do clinic rotations,” he said. “We cover southwest Iowa clinics and I’ve been going to smaller communities, we have about 10 satellite clinics.”

In the last 30 years, Larose said he’s proud of the growth he has seen first hand.

“I’ve seen a lot of patients and now I’m starting to see the children of the patients I’ve seen. We have grown and Council Bluffs has grown quite a bit, as well,” Larose said.

To read the original story from the Daily Non-pareil, click here

Tue, 07 May 2019

Getting a hip replacement can improve your mobility

hip replacement surgery for back pain


The anterior approach to total hip replacement surgery is an alternative to
traditional hip replacement surgery. The surgeon approaches the hip from the front of instead of the side or behind and works between the patient’s muscle and tendon rather than cutting through it, sparing the tissue from trauma. This approach allows for less pain, faster recovery and improved mobility.

This approach is different than the traditional approach because it uses a smaller incision than most. It is important to note that having a good surgeon is going to be one of the key factors in the size of the incision with any replacement, but this approach helps ensure a smaller one than most surgeons would have with a traditional replacement. Smaller incisions usually mean less overall pain and shorter recovery for the patient.

Most hip replacements are traditionally done from the back or side rather than the front like this one is. This approach helps reduce muscle trauma and pain. Thus, hopefully helping the patient get up and moving more quickly and with less downtime.

The goal of the hip replacement surgery whether it is the anterior approach or a more traditional approach is to replace the top of the thigh bone and the socket of the pelvis with an implant and decrease daily pain. An advantage of the anterior approach total hip replacement is a patient can begin rehabilitation faster because there are fewer muscles that need to recovery from the surgery.

Other potential benefits of the anterior approach total hip replacement surgery may be minimal soft tissue trauma, reduced post surgery pain, less scarring, earlier mobilization and less post operative restrictions.

This approach cannot be done on all patients and it is important to consult with an orthopedic specialist to discuss all of your options and let them help you determine if this would be an appropriate option for you.

Fri, 08 Mar 2019

Stem Cell-Meniscus Treatments

knee replacement surgery

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint.  They can be damaged or torn during activities that put pressure on or rotate the knee joint. Taking a hard tackle on the football field or a sudden pivot on the basketball court can result in a meniscus tear.  However, you don’t have to be an athlete to get a meniscus tear.   Simply getting up too quickly from a squatting position, a sudden pivot or turn, deep squatting, or heavy lifting can lead to a meniscus injury.   The meniscus weakens with age and tears become more common in people over the age of 30.  

Many athletes are at risk for a meniscus tear.   The meniscus can be torn during activities that cause direct contact or pressure from a forced twist or rotation. Sports that require sudden turns and stops may put you at higher risk for meniscus tears. Some of these sports include:

  • Football
  • Basketball
  • Soccer
  • Tennis

If someone has osteoarthritis, they are at higher risk of injuring their knee or tearing their meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in joints caused by aging and wear and tear.  When an older person experiences a meniscus tear, it’s more likely to be related to degeneration. This is when the cartilage in the knee becomes weaker and thinner.    

When a meniscus tear occurs, you may hear a popping sound around the knee joint. Afterward, you may experience:

  • Pain, especially when the area is touched
  • Swelling
  • Difficulty moving your knee or inability to move it in a full range of motion
  • The feeling of your knee locking or catching
  • The feeling that your knee is giving way or unable to support you

You may also experience a slipping or popping sensation, which is usually an indication that a piece of cartilage has become loose and is blocking the knee joint.

Contact your doctor if you experience any of these symptoms and they persist for more than a few days or occur after your knee has been injured. Call your doctor immediately if your knee locks and you’re unable to bend your knee after straightening it.

Treatment Plans

After you discuss your symptoms with your doctor, they will examine your knee, test your range of motion, and look closely at the spot where the meniscus is along the joint.   Initially, they may treat the knee injury with conservative techniques that include rest, ice, compression, and elevation.  If this approach does not provide relief and surgery is not an option, a new procedure utilizing MOS Regenerative Medicine Solutions and Platelet Rich Plasma may be the optimal way to treat the injury.

 PRP (Platelet Rich Plasma) is a concentration of platelets and growth factors created from a small amount of the patients own blood.  It focuses on concentrating the healing factors to increase the speed of recovery.  

The platelets are concentrated down to a cellular level.  Outside of the bloodstream these platelets become activated and release important proteins to help increase growth levels and improve the signaling of recruitment / regenerative cells to the injured area.

A similar treatment can be executed for reoccurring sprains as well.

Do not live in pain; schedule a consultation with an orthopedic specialist at Miller Orthopedic today to receive a customized treatment plan.

Thu, 25 Jan 2018

Heisman Trophy Winner Gets New Knee, Avoids Overnight Hospital Stay

Johnny Rodgers visits Miller Orthopedic Specialists in Omaha for Knee Replacement Surgery

Nicknamed “The Jet” for his rapid speed on the field, Johnny Rodgers won the Heisman Trophy in 1972 then played in the Canadian Football league. He later joined the NFL until a knee injury ended his career. Only after several years of operation and rehabilitation did his knee return to normal.

Now at 64, Rodgers experienced years of knee pain, but he did not want to undergo major surgery. He says, “I found out I needed a total knee replacement, but I didn’t want the surgery because I had to stay in the hospital.” He continues, “Hospitals are full of sick people and I didn’t want to stay in the hospital for two to three days with risks of getting an infection or getting sick.”

Rodgers then found Dr. Kent Boese, orthopedic surgeon with Miller Orthopedic Specialists, who performs total knee replacements on an outpatient basis, allowing patients same-day discharge. Miller Orthopedic Specialists is the only orthopedic group in the Omaha, Council Bluffs and Southwest Iowa community conducting outpatient total knee replacements. Dr. Boese explains, “This is made possible with recent advances, such as improved anesthesia, less invasive techniques, comprehensive pre-operative programs and protocols for post-surgery home-health and rehabilitation.”

Rodgers spent eight hours at the Advanced Surgery Center in Omaha. He received a spinal block instead of general anesthesia and nurse visits that provided similar clinical care at home as he would have in a hospital.

“I was surprised when I was done with surgery that I didn’t have a lot of pain. I even went to my office that afternoon and walked the halls to show everyone I just had surgery and was feeling great,” Rodgers said.

It has been one month since his surgery and he has been undergoing physical therapy to return to activities he could not do before surgery. Both Rodgers and Dr. Boese agree that he is doing better than expected. “I had a great experience and would recommend it to anybody,” claims Rodgers.

Outpatient total knee replacement is not a new procedure and has been conducted in larger cities for years. “Not every patient who is interested will qualify. We look for patients who are very motivated to return to activity better than pre-surgery and who can follow post-surgical requirements. Someone who is reasonably in good physical condition and has a strong support system in their home for an extra set of eyes and hands to help after surgery is important too,” says Dr. Boese.

A research study published in the Journal of Arthroplasty in 2014 showed costs for outpatient total knee replacement are significantly less than an inpatient total knee replacement. Another study indicated no differences in long-term complication rates between patients undergoing outpatient total knee replacement versus inpatient total knee replacement.

For more information, visit our outpatient total knee replacements page. The phone number to the main clinic in Council Bluffs is 712-323-5333 and the Omaha office is 402-991-9958. Several physicians within Miller Orthopedic Specialists, Drs. Boese and Atteberry, perform this procedure. Convenient locations are available with twelve outreach clinics throughout Omaha, Council Bluffs and Southwest Iowa. Miller Orthopedic Specialists has served the Council Bluffs/Omaha area for over 40 years. The goal is to restore patients to optimum health quickly and safely.

Click here to see our ad about outpatient total knee replacement.

Contact us for more information about how we can help with your knee replacement.

Wed, 24 May 2017

Orthopedic for an ACL Injury

The ACL is the anterior cruciate ligament located in the knee. This ligament helps to prevent the tibia (shin bone) from sliding in front of the femur (thigh bone). It also provides rotational stability to the knee.

An ACL strain or tear is a common sports injury. This kind of injury most commonly happens during a sudden stop, jumping or changing directions. It can also occur during a direct contact collision. Many people hear a “popping” noise and feel their knee give out when injuring their ACL. Other symptoms can include swelling, loss of full range of motion or discomfort while walking.

To help with swelling rest, ice, compression and elevation should be done to the injured knee. Several weeks of physical therapy can be prescribed to help further reduce swelling and work on range of motion. For many cases, ACL surgery will need to be performed to regain full range of motion in the knee, primarily if you’re an athlete wanting to return to your sports. After knee surgery, more physical therapy will be done to restore stability and function of the knee. Click here to download a PDF about the ACL Reconstruction procedure.

If you have experienced your knee giving out and heard a popping noise, call to make an appointment with Sports Medicine Specialists Dr. Larose or Dr. Atteberry.

 

Wed, 12 Apr 2017

Outpatient Total Hip Replacement

Men Golfing

Miller Orthopedic Specialists is the only orthopedic group in the Omaha, Council Bluffs and Southwest Iowa community conducting outpatient total hip and total knee replacement.  Outpatient total hip and total knee replacement are not a new procedure and have been conducted in larger cities for years. This is made possible with recent advancements such as improved anesthesia, less invasive techniques, comprehensive pro-operative programs and protocols for post-surgery home health and rehabilitation. The benefits of outpatient total hip or total knee replacement versus a traditional total hip or total knee replacement are lower cost, less risk of infection, quicker recovery and being able to recover in your own home.

A research study published in the Journal of Arthroplasty in 2015 showed costs for outpatient hip replacement are significantly less an inpatient total hip replacement. Another study indicated no difference in long-term complication rates between patients undergoing outpatient total hip replacement versus inpatient total hip replacement.

Home health care and physical therapy are arranged prior to surgery. A professional arrives at the patient’s home to help access if adjustments need to be made around the house for a comfortable recovery. At home exercises as well as physical therapy sessions continue after the surgery to help retain full range of motion.

Patients who are very motivated to return to activity better than pre-surgery, who can follow post-surgery requirements are in reasonably in good physical condition and have a support system at home are the best candidates for the outpatient surgery option.

To learn if you are an eligible candidate for an outpatient total hip or total knee replacement make an appointment for a consultation with one of our physicians at Miller Orthopedic Specialists.

Thu, 03 Mar 2016

Nan Colwell – Outpatient Total Hip Replacement and Home that Afternoon

March 3, 2016 (Omaha, NE) – At Nan Colwell’s first yoga class she couldn’t wait for the hour to be over. Laying flat on the floor hurt her hip tremendously. But now, she loves it.

“Recently I just started going to a yoga class again; I have no pain at all,” said Colwell of Missouri Valley, IA. “My flexibility is getting better and better all the time.”

After having pain in her hip for over a year Colwell, 57, wasn’t shocked when Dr. C. Kent Boese, orthopedic surgeon at Miller Orthopedic Specialists, said she needed a hip replacement. For her, a traditional total hip replacement wasn’t the only option. Dr. Boese told Colwell she was an eligible candidate for an outpatient total hip replacement.

“I was a little afraid of (the procedure) but the longer I thought about it and (Dr. Boese) explained the lesser risk of infection and faster recovery, it made a lot of sense,” she said.

Outpatient total hip replacement is different than a traditional total hip replacement because the patient has surgery that morning and is in the comfort of their home that afternoon to continue recovery. With a traditional total hip replacement patients stay at the hospital for an average of 3 – 4 days after surgery. Colwell’s surgery took place at the Advanced Surgery Center in Omaha.

“My family couldn’t believe when they came back from lunch that I was all dressed and ready to go,” Colwell said.

Miller Orthopedic Specialists is the only orthopedic group in the Omaha, Council Bluffs and Southwest Iowa community conducting outpatient total hip and knee replacements. Outpatient total hip and knee replacement are not a new procedure and has been conducted in larger cities for years.

“This is made possible with recent advances, such as improved anesthesia, less invasive techniques, comprehensive pre-operative programs and protocols for post-surgery home-health and rehabilitation,” Dr. Boese said.

The benefits of an outpatient total hip replacement versus a traditional total hip replacement are lower cost, less risk of infection, quicker recovery and being able to recover in the comfort of your own home.

A research study published in the Journal of Arthroplasty in 2015 showed costs for outpatient total hip replacement are significantly less than an inpatient total hip replacement. Another study indicated no differences in long-term complication rates between patients undergoing outpatient total hip replacement versus inpatient total hip replacement.

Home health care and physical therapy are arranged prior to surgery. A professional arrives at the patient’s home to help assess if adjustments need to be made around the house for a comfortable recovery. At home exercises as well as physical therapy sessions continue after surgery to help retain full range of motion.

“It wasn’t easy-peasy,” Colwell said. “Every day it just got better and better.”

Eleven days after surgery Colwell arrived at Miller Orthopedic Specialists’ Council Bluff Clinic for her hospital follow up with Dr. Boese. She was able to walk down the hallway of the doctor’s office without a walker or a cane. After the appointment Colwell continued to use a cane throughout her day and used a walker while walking around her home at night.

A couple months after surgery, Colwell said she feels no pain and was able to mow her lawn and walk on the treadmill again, as well as give yoga a second chance.

“I try to walk 10,000 steps a day,” Colwell said. “Every day I could see improvement. I was really pleased with how recovery went.”

To learn if you are an eligible candidate for an outpatient total hip or total knee replacement, make an appointment for a consultation with one of our physicians at Miller Orthopedic Specialists.

“We look for patients who are very motivated to return to activity better than presurgery and who can follow post-surgical requirements,” Dr. Boese said. “Someone who is reasonably in good physical condition and has a strong support system in their home for an extra set of eyes and hands to help after surgery is important too.”

Colwell said she would definitely recommend Miller Orthopedic Specialists to family and friends.

“Dr. Boese and his staff were just wonderful to work with and sought to any need that I had,” Colwell said. “The overall experience was wonderful. I would do it again in a heartbeat if I had to. I just wouldn’t wait as long.

For more information about outpatient total hip or knee replacements with Miller Orthopedic Specialists, visit millerortho.com. The phone number to the main clinic in Council Bluffs is 712-323-5333 and the Omaha office is 402-991-9958. Several Physicians within Miller Orthopedic Specialists, Drs. Boese and Atteberry, perform this procedure. Convenient locations are available with 12 outreach clinics throughout Omaha, Council Bluffs and Southwest Iowa. Miller Orthopedic Specialists has served the Council Bluffs/Omaha area for over 40 years. The goal is to restore patients to optimum health quickly and safely.

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