Wednesday, July 4, 2007

Doctor Bruce Ellison Palo Alto Calif 94305 Discusses Shoulder Arthroscopy

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 and reinforced with coban which is secure without being restrictive. Additional tape reinforces the thorax as necessary. The arm hangs free but support on a Mayo stand as necessary. The patient is draped for routine shoulder surgery.

Once the patient has been positioned, prepared, and draped, the bony anatomical landmarks and proposed portal sites are identified and outlined. Bony sites marked are the anterior, lateral, and posterior outline of the acromion, the acromioclavicular joint, and the coracoid process. The usual portal sites marked are the posterior, anterior, and lateral portals.

As in the knee, a 4-mm, 30-degree oblique arthroscope, with a short bridge that allows fluid inflow and interchangeable cannulas, is used for routine arthroscopy. This arthroscope allows viewing of the entire shoulder joint with manipulation of the arm.

Control of Bleeding During Arthroscopy

Bleeding can be an annoying obstacle during shoulder arthroscopy because the tissue planes penetrated by the arthroscope and instruments are much thicker and more vascular than those in the knee. Also, no tourniquet can be used during shoulder arthroscopy. In addition to using an arthroscopic electrocautery device, an arthroscopy pump for inflow, maintaining a constant fluid flow and pressure minimizes bleeding. The inflow can be through the arthroscopy sheath or a separate inflow cannula for the arthroscopy pump is occasionally placed. Often with "beach-chair" positioning, hypotensive anesthesia is also used. All of these techniques minimize bleeding.

Sunday, July 1, 2007

Dr. Bruce E. Ellison, Orthopaedic Surgeon, discusses ConFormis Bone Sparing Minimally Invasive Knee Replacement

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. Operative treatments include partial and total knee replacement.

The Conformis iPD is a custom-made minimally invasive "knee replacement" system. It is indicated for patients with mild to moderate osteoarthritis isolated to the medial or lateral compartments of the knee. The device is precisely made based upon MRI [magnetic resonance imaging] of the individual knee.

The device is bone sparing, meaning that no bone is cut or removed from the knee. The surgery is slightly more extensive than a standard knee arthroscopy, and patients leave for home following surgery the same day. Because of device is custom made to match the contours of the knee, it is self seating. There is no need for bone cementing. There is nothing to get loose with time. More importantly, there is to get loose with use.

Unlike a standard knee replacement which requires avoidance of certain sports activities, there are no such restrictions following iPD knee surgery. The procedure takes roughly one hour, involves an incision between one and two inches long, and the patient walks a few hours after surgery with a knee brace, cane, or crutches.

Patients return to regular activities as tolerated, performing exercises for strengthening and endurance.