Dr Bruce E Ellison MD - Orthopedic Surgery Expert Witness - Offices Near Sequoia Hospital

BEACH-CHAIR POSITION Dr. Ellison uses the beach chair position almost exclusively. Beach-chair position provides faster and easier patient positioning, reduces risk of neurapraxias because traction is not used. There is reduced distortion of intraarticular capsular anatomy, improved mobility of the patient's arm, and easier conversion to open surgery since repositioning and repreparation is not required. In the beach-chair position, either general anesthesia or interscalene block can be used. Interscalene block allows the patient to be awake and can assist in controlling the posotion of the head. The knees are flexed to provide counterpressure against the posterior thigh, which will reduce the tendency to slide off the table during surgery. Flexion also decreases tension on the posterior neurovascular structures of the legs. The affected shoulder is brought off the side of the table for access during the procedure. The head is supported in a neurosurgical headrest

Osteoarthritis of the knee is a degenerative condition affecting millions of Americans. Though often associated with the aging, osteoarthritis involves an overproduction of degradation enzymes which attack and destroyed cartilage. Healthy joints, including the knee, are covered by a layer of articular cartilage. The cartilage acts as a cushion providing for smooth gliding surface during range of motion. The articular cartilage has no nerves, and thus there is no pain with activity. However as anyone who has broken a bone knows, there are abundant nerves and pain receptors at the bone. In the knee with osteoarthritis, the cartilage wears away and becomes roughened. If the wear becomes significant, the rubbing a one rough bony surface on another can result in debilitating pain, with resulting stiffness and swelling. Nonoperative treatment options include behavior modification, drug therapies including hyaluronic acid and steroid injections, braces and electrical stimulation. Oper