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A Tennis Player’s Total Right Hip Replacement


Tennis is my passion and I have been playing for 46 years and I am a solid 4.5 player still.  I was told that I was bone on bone (along with two bone spurs) 5 years ago. At that time I went for meetings with three other hip/knee surgeons, two at Northwestern and one at Rush.  All told me that I needed immediate replacement. They also told me that there was no guarantee that I could play at the same level again after replacement. That scared the heck out of me.  I decided to wait.

Mid-year in 2017, I was limping and pretty sore after any tennis or long walking.  I had heard about Dr. Shah from someone at my tennis club. I went to see him and heard answers that I could have only dreamed of!  Outpatient and home the same day. Back on the Tennis court in 3 weeks making sure to be safe (hitting, not running). I interviewed three of his hip replacement patients and got rave reviews. (they were all tennis players and coaches).   I had my hip replacement on Dec 27th,2017.  It was very cold and icy outdoors so I played it safe and staying indoors and did two weeks of PT at home before going to the Physical Therapist location.  It was amazing to be able to sleep with both legs flat on the bed again and not having to change positions every 45 minutes during the night. As promised, I was back on the tennis court at 3 weeks, standing and hitting tennis balls and feeling pretty happy.  After six weeks, I started to include lateral movement on the court and at eight weeks, I was drilling at almost where I had left off. I continue to do strengthening exercises as everything continues to get stronger!

The attached picture here was shot on April 15th, 3 ½ months after hip replacement and I had just played 90 minutes of doubles.

I can’t say enough great things about Dr. Shah and his team and have already sent two new patients over to him who were very grateful after their surgeries!   

A Marathon Runner’s Bilateral Hip Labrum Tear Story


I am a competitive amateur marathoner who had completed 21 marathons prior to my injury. I began having muscle pain in my stomach and groin area and I thought it was just a muscle pull. The pain was manageable with naproxen but it progressively got worse so I went to my GP. He thought it may be a hernia so he in turn sent me to a surgeon.  The surgeon promptly told me I did not have a hernia, but just a muscle strain and prescribed PT for 6 weeks. The pain got a little better so I just kept running and taking naproxen.  After the pain got worse with more weekly mileage I returned to the surgeon who told me that I still did not have a hernia. The insurance company finally agreed to pay for an MRI that revealed I had torn cartilage in my right hip due to a natural impingement I was born with but did not manage to affect me until I was 48 years old.

I then saw an orthopedic surgeon out of a practice through a major Chicago hospital (many of whom are team doctors to local Chicago sports teams). He told me that he could repair the tear but that I could never run again and if I tried I would be facing full hip replacement surgery in a year or less. I was devastated by this news but thought it would be prudent to get a second opinion. I saw Dr. Shah and he told be that my MRI revealed that I did still have a significant amount of healthy cartilage left and that he felt I had a good chance of returning to running. I did some follow up homework on Dr. Shah with a friend of mine who is a radiologist and he said he had heard good things about him from peers and his patient success rates for my type of procedure were excellent so I scheduled my surgery with him.

Following the surgery Dr. Shah told me that it had been a successful hip scope and that I had 70% of my cartilage left.  I patiently went through the slow process of physical therapy including 3 weeks on the passive motion machine for 4 hours a day, always wearing the hip brace, riding an upright bike 3 days after surgery, walking on crutches for 6 weeks, using an elliptical trainer after 7 weeks and not running until 3 months. I was able start running a few miles a day at first after 3 months and by 4 months post-op I was up to 40 miles per week. 6 months out from surgery in the summer I ran one of my fastest 10k races in several years!  

Then into my fall marathon training my left hip had the same impingement and I tore the cartilage in that one. This time I did not have to go through unnecessary PT and was able to schedule the surgery immediately. I went through the exact same rehab protocol and was running again at full speed in 4 months! Because I caught the injury sooner Dr. Shah reported that I had 90% healthy cartilage in this hip. 7 months after surgery I was peaking at 70 miles per week in the early spring and went on to run my first marathon in over 2 years! I won my age group and had no pain whatsoever in either of my hips. I ran another marathon in the fall and also won my age group and have been running pain free since. Just last week I was in Arizona and had 3 separate long hikes in challenging locations like the Grand Canyon and was able to stay in step with my 20 year old daughter.

I know that there are doctors out there that are not as experienced in reattaching torn cartilage to people's hips and it saddens me to think that there are a lot of runners and other athletes out there with unnecessary total hip replacements that will never have their full active lifestyle back. Obviously everyone's conditions and injuries are different so their outcomes may be worse than mine but just make sure you ask your prospective physician not only how many of these types of procedures they do a month but, more importantly, what their patients outcomes are post-op. Then ask to speak to patients they have worked on who have been able to resume their sport to see how things went for them. 

I cannot thank Dr. Shah enough for his expertise and counsel. He even recommended I started taking yoga to make my tight runner's body more flexible and that in turn has helped me with some back pain I had been experiencing. I now have running back in my life and could not be happier. I am not running as fast as I did when I was 35 but I am still very competitive for my age and get to do what I love- running with my own hips and participating in any physical activity I desire.  

Jack Goldberg

President

BirdDog Media, LLC

IBJI Wins the Award for the Best Physical Therapy in the Entire North Shore!


Congrats IBJI Physical Therapy!
IBJI was voted the Best Physical Therapy in the entire North Shore for the 2019 Choice Awards, presented by 22nd Century Media. Votes are taken over four weeks from their readers in all seven of their newspapers. IBJI staff were happy to accept the award. Staff had a great time at the award ceremony, meeting other winners and watching a performance by a juggler! Be sure to read pages 12, 13 and 20 in 22nd Century Media's publication and check out the pictures below! Keep up the great work team!

Orthopedics Blue Ribbon ARTICLE Award


Dr. Shah was recently awarded a Blue Ribbon ARTICLE Award for his work in changing the way we manage blood clot prevention after total joint replacements. 

Aspirin Alone Is Not Enough to Prevent Deep Venous Thrombosis After Total Joint Arthroplasty


Abstract

Thromboembolic events after total joint arthroplasty are potentially devastating complications. This study evaluated the efficacy of 4 different anticoagulants in preventing deep venous thrombosis and pulmonary embolism after total joint arthroplasty. The demographics and anticoagulant use (warfarin, enoxaparin, and aspirin with and without outpatient mechanical pumps) for patients who underwent primary unilateral total joint arthroplasties performed by a single surgeon from January 2013 to October 2014 were retrospectively reviewed. All patients underwent lower extremity ultrasound at the 3-week postoperative visit. A total of 613 primary unilateral total joint arthroplasties met the study inclusion criteria. There were 288 primary total knee arthroplasties and 325 primary total hip arthroplasties. The patients were 62.2% female, having a mean age of 67.6±10.6 years and a mean body mass index of 30.2±5.9 kg/m2. There were 119 patients in group 1 (aspirin alone), 40 patients in group 2 (aspirin plus pumps), 246 patients in group 3 (warfarin), and 208 patients in group 4 (enoxaparin). The overall 3-week symptomatic and asymptomatic deep venous thrombosis and symptomatic pulmonary embolism rates in the entire cohort were 5.7% and 0.3%, respectively. The venous thromboembolism rate was significantly affected by the anticoagulant of choice (P<.01). Compared with aspirin alone, warfarin decreased the risk of venous thromboembolism (P<.01). Increasing age led to increased risk of venous thromboembolism (P=.05). This study indicated that aspirin chemoprophylaxis alone was not as efficacious as warfarin and enoxaparin in preventing asymptomatic and symptomatic venous thromboembolism found during routine postoperative surveillance with lower extremity ultrasound. Aspirin alone may be inadequate and should be augmented with an outpatient mechanical pump as part of multimodal prophylaxis. [Orthopedics. 2019; 42(1):48–55.]

Read Full Article Here

Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center


Alternative text - include a link to the PDF!

These injuries affect millions of Americans every year


Dr. Shah   There are many benefits to participating in sports at any age, but being in the game is not without risks. With many Americans participating in sports from their toddler years through adulthood, it’s not uncommon for people to experience one or more sports-related injuries. What are some of the most common sports injuries, and how can you avoid them?

Head

According to the Brain Research Institute and the Centers for Disease Control and Prevention, anywhere from 1.6 million to 3.8 million sports and recreation-related concussions occur in the U.S. each year. A concussion, also known as a mild traumatic brain injury, occurs when someone receives a bump, blow or jolt to the head or body that causes the brain to move rapidly inside the skull. “Concussions are much more common than we realize, with teenagers and adolescents being particularly vulnerable,” says Dr. Ritesh Shah, an orthopedic surgeon at Advocate Lutheran General Hospital in Park Ridge, Ill. “When the head is hit, bumped or moves with a sudden acceleration/deceleration movement, the rapid movement can cause damage to the brain tissue. The damage can be mechanical, chemical or metabolic and can make brain cells temporarily unable to function.” Signs of concussion include headache, nausea, fatigue, confusion, changes in mood, sleep disturbances or memory difficulties. Symptoms can appear anytime from immediately following impact to a few weeks after the concussion occurred. If a concussion is suspected, Dr. Shah recommends removing an athlete from play immediately as well as resting both cognitively and physically. Athletes should also seek comprehensive physical and cognitive testing from a trained medical professional sooner rather than later.

Shoulders

Shoulder and elbow injuries are common among athletes, especially among baseball players. Dr. Shah says athletes can experience overuse elbow and shoulder injuries, torn rotator cuffs and shoulder labrum tears. Repeatedly throwing a ball puts baseball pitchers at a greater risk of developing an overuse injury in the elbow. Tommy John surgery repairs the ulnar collateral ligament in the elbow, one of the most common ligaments to be injured due to repetitive use. During this surgery, the ligament in the elbow, the UCL, is replaced with a tendon taken from another place in the patient’s body. Surgery is usually the last option for treating an overuse injury in an elbow. Many athletes try rest, ice and physical therapy before surgery is required. Symptoms of an injured UCL include pain in the elbow, a tingling or numbness in the small and ring fingers and more difficulty throwing a baseball or anything else than before. Several factors can contribute to overuse injuries, but the biggest one is just as the name suggests – overuse. To avoid an overuse injury, a person should pay attention to signs indicate fatigue, take a break when needed and work with his or her coach to develop a plan that allows the athlete to get the most out of practice without overdoing it.

Hips

Dr. Shah has seen an increase in hip injuries in athletes in recent years. Hip labral tears have become more common, particularly in those who participate in hockey, soccer, football, golf or ballet. In a hip labral tear, the cartilage that lines the rim of the socket of the hip joint tears. Like many acute injuries, athletes know when it happens because they’ll feel a pain in their groin or hip, possibly a locking or clicking sensation and experience stiffness with time. “Hip labrum tears usually occur in the setting of hip impingement or a hip developmental abnormality that causes pinching and high level or high impact activity,” says Dr. Shah, who treats patients from all over the region and nearby states for hip impingement. “Hip arthroscopy repairs both labrum tears and impingement and may prevent hip arthritis in the future.” To prevent a labral tear, increase strength of the surrounding muscles and avoid overuse.

Knees

Dr. Shah sees his fair share of athletes with injured knees. Meniscus tears, MCL sprains, patellar tendinitis and cartilage injuries are all common, he says. One of the most common knee injuries he sees is an anterior cruciate ligament tear, otherwise known as an ACL tear. This injury is quite common in sports today, with the number of children sidelined by this injury growing 2.3 percent annually. Females account for just over half the injuries recorded in a study published in Pediatrics  February 2017. The ACL is one of the knee’s stabilizing ligaments. Athletes will nearly always know when the tear occurs; they’ll hear a “pop” and then feel a sharp and intense pain in their knee immediately. Several hours after the tear, the knee will swell, with swelling lasting for several days. Depending on the severity, ACL tears are treated with or without surgery. Colliding with another player or a ball can cause an ACL tear, but non-contact movements can also cause the rupture. Running and stopping suddenly, causing the knee to twist can cause a tear; so can landing a jump wrong in the case of dancers or figure skaters. “Not using the appropriate biomechanics when jumping, landing or pivoting can lead to a higher chance of experiencing an ACL tear,” says Dr. Shah. In addition to using proper mechanics and technique, Dr. Shah says other ways to prevent a tear include stretching to increase flexibility, performing exercise to strengthen the muscles around the knee and avoiding overuse.

Ankles

Ankle sprains are very common. They account for 15 percent of all athletic injuries, and it’s estimated that 23,000 ankle sprains are suffered in the U.S. every day. Playing any sport can increase the risk of spraining an ankle, but really any activity, even walking through a street festival, can pose a risk. Rolling, twisting or awkwardly turning your ankle can all cause a sprain. Symptoms of a sprain include pain, redness and warmth at the site of injury and swelling. Dr. Shah recommends the tried and true P.R.I.C.E. method to heal a sprained ankle:
  • P – Protection. Right after the injury, avoid weight-bearing activities. If you need to move around, use a brace or walk with crutches or hiking poles to reduce the amount of weight you’re placing on the ankle.
  • R – Rest. After a sprain, rest the ankle. Avoid playing sports or engaging in activities that will cause pain or stress the ankle further. However, a little movement is okay and possibly even helpful in recovery. Engage in gentle exercises that keep you moving but don’t worsen the sprain.
  • I – Ice. While resting, be sure to apply ice to the injured ankle. Dr. Shah suggests icing 15-20 minutes every hour for the first week. Make sure there is not prolonged direct contact of ice to skin to avoid skin burns.
  • C – Compress. Compress the ankle by wrapping with a bandage or ankle brace to stabilize the ankle, but don’t wrap too tight. Dr. Shah suggests compressing the ankle for three to six weeks and seeing a trained medical professional sooner to confirm the severity of the sprain and absence of a fracture.
  • E – Elevate. For the first two days after the injury, elevate the ankle higher than your heart whenever you are laying down to control pain and reduce swelling.
Take our Joint Pain Assessment to evaluate your knees and hips, gauge the severity of your issues and figure out what you could do moving forward.    Read the original article here.

Special Lunch & Learn Workshop: October 19, 2018


Current Trends for Success in Bundles and Strategies for Financial Changes: Orthopedics and Beyond

Friday, October 19th 12:20 PM - 2:05 PM Montreux 1, Swissotel, Chicago   The value-based landscape is rapidly changing. Implementing a bundle requires an investment in time, alignment and resources of all providers who care for bundled patients. This includes physicians, nurses, social workers, and administrators. The discipline necessary to be successful at bundled payments enhances the financial viability of hospitals, ASCs, and clinicians by benefitting the entire TJA product line, and most importantly, these strategies result in improved outcomes and better care for our patients, which is the ultimate goal of all providers.  

SPEAKERS:

Ritesh R. Shah, MD

Hip Arthroscopy, Hip and Knee Replacement, Outpatient Hip and Knee Replacement, Illinois Bone and Joint Institute, LLC   James Slover, MD, MS Associate Professor, Adult Reconstructive Division, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital   Lorraine H. Hutzler, MPA Associate Program Director, The Center for Quality and Patient Safety, NYU Langone Orthopedic Hospital

Hip Pain Is Becoming An Epidemic Among Young, Fit Women


Shakira is right—these puppies don’t lie.

Beautiful thighs
Getty ImagesSrdjanPav
Nicole Jefferson was in her late twenties but felt as if she had the hips of a senior citizen. It seemed as if something in her hip was constantly catching and snapping. Pain pinballed from her lower back to her groin to her hip. Short jogs—something that should have been a breeze for the former high school and collegiate runner—were excruciating. “I just wanted to sit through a movie or a long car ride without aching,” she says.
Hip replacements have increased 40 percent among 45- to 54-year-olds.
Given her athletic history, doctors suspected a sports hernia, an injury to the soft tissue in her groin. But surgery to address that problem only made her agony worse. Finally, five years ago, when she was 35, an MRI identified tears in her labrums, the gasket-like rings of cartilage around the hip sockets that cushion and stabilize the joint. Prior MRIs (using older machines) had failed to pick up the problem. Her doctor said there was so much inflammation in and around her hips, it was as if they were “on fire.” She had surgery to fix her labrums and joint, followed by physical therapy. Still, she has some pain while running. Jefferson’s experience isn’t a one-off. In recent years there has been a dramatic rise in the number of young women developing hip pain tied to current or past activity. Rates of hip arthroscopy, the surgery Jefferson had, have skyrocketed, particularly among younger people, while hip replacements have increased 40 percent among 45- to 54-year-olds.

What’s up with the soaring surgery rates?

In part, docs have gotten better at ID’ing hip problems that were previously diagnosed and treated as back injuries or groin strains. High on the list of overlooked conditions: labral tears and hip dysplasia, a genetic condition in which the hip socket is too shallow to fully cover the ball portion of the femur. (It’s the leading cause of hip arthritis in women under 50.) But the rise is also the result of more women spending the past few decades participating in sports that, sadly, put their hips in harm’s way. Both recreational and competitive running became popular in the 1980s, following the debut of the women’s marathon in the 1984 Olympics. A decade earlier, Title IX’s passing created a more even athletic playing field. That led to a spike in female participation in cross country, soccer, and track—high-impact sports that involve a lot of hinging. Make no mistake, this uptick in female sports involvement is awesome—but it’s also considered a factor in our hip woes. One condition increasingly diagnosed in women who started sports young: femoroacetabular impingement (FAI), a mismatch between the hip’s ball and socket. Teens who play hip-taxing sports often develop extra bone in the socket as growth plates in the joint begin closing. That extra bone can pinch the labrum and, in time, cause tears and eventually arthritis, especially when individuals remain active as adults. The sexes are equally prone to FAI, but women are likelier to suffer its effects over time, partly because our biology creates the perfect recipe for hip pain of all varieties. Women also tend to have wider hips than men and need extra-strong glutes—especially the gluteus medius, the muscle at the top of the butt—for support and stability. Problem is, many of us spend more time sitting on our backside than strengthening it (no judgment!). Further weakening the joint: hormones. Fluctuations during our cycles may loosen tendons and ligaments surrounding the hip, leaving it open to injury. That might also explain why Omer Mei-Dan, M.D., head of the University of Colorado’s Hip Preservation Service, who works mostly with amateur female athletes, says he repairs many women’s labrums that were torn during labor.

How to save your joints.

If basic biology, genetics, or earlier activity has left you with creaky hips, you don’t need to live with the pain or table your gym routine. Low-impact workouts like swimming can strengthen hips while preventing further wear and tear. (Yoga is great for boosting balance, but just beware: Poses such as pigeon can overstretch and weaken muscles around the hips.)
20:1 Number of adult women treated for hip dysplasia compared to men.
Physical therapists can also spot movement and muscle imbalances in the glutes, core, and hip flexors that can lead to labral tears or aggravate FAI and dysplasia, and prescribe moves to fix them. If six months of gentle workouts and PT don’t lead to significant improvement, it’s time to have your hips evaluated by a specialist, since the end stage of hip dysplasia or FAI is osteoarthritis and, in some cases, hip replacement, says K. Linnea Welton, M.D., hip preservation specialist at MultiCare Auburn Medical Center. If you do require a surgical fix, it may be minimally invasive. Fiber-optic cameras are now used to make some repairs that once required major surgery.

If your hips are happy, keep them that way.

Show some love to the muscles that support them. Foam roll glutes, hammies, and quads pre-workout to improve mobility. Then focus on butt builders like froggers (a tweak on the basic glute bridge in which you bring your heels together on the ground), side-lying leg raises, lateral stepups, and lateral mini-band walks. Please find the full article here. This article appeared in the October 2018 issue of Women's Health. For more great tips, pick up a copy on news stands.

The Impact of Technology and Alignment on Improving Value for the Total Joint Replacement Episode of Care


Tuesday, October 2nd, 2018 | 1:00 - 2:00 PM CST The value based care landscape is rapidly changing. Implementing a bundle requires an investment in time, alignment and resources of all providers who care for bundled patients. This includes physicians, nurses, social workers and administrators. The discipline necessary to be successful at bundled payments enhances the financial viability of hospitals, ASCs and clinicians by benefitting the entire TJA product line, and most importantly, these strategies result in improved outcomes and better care for our patients, which is the ultimate goal of all providers. Learning Points: Gain an understanding of bundled payments and their impact on patient care and physician reimbursement Learn the key strategies for successfully implementing bundled payments Understand the importance of risk modification and risk stratification Understand the critical role of modern pain management and goal of opioid minimization Identify changing metrics important to payers Overview of government and private payer changes and its impact in the ASC What to expect going forward, mandated or voluntary Presenters: Richard Iorio, MD, Chief, Adult Reconstruction and Total Joint Arthroplasty Service, Vice Chairman, Clinical Effectiveness, Brigham and Women’s Hospital and Member of the Faculty, Harvard Medical School Ritesh R. Shah, MD, Hip Arthroscopy, Hip and Knee Replacement, Outpatient Hip and Knee Replacement, Illinois Bone and Joint Institute, LLC James Slover, MD, MS, Associate Professor, Adult Reconstructive Division, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital   Read the full article here.