journal - joi jacksonville orthopaedic institute cover.pdfbaby boomers may need lifestyle changes...

Eating Vegetablesis Food Smart

The Gender KneeFact or Fiction?

JournalThe official publication of the Jacksonville Orthopaedic Institute Volume V Issue II

www.JOIonline.net

Care of the Aging Knee:Baby Boomers May Need Lifestyle Changes

Advances in Elbow Arthroscopy

Anti-Aging StrategiesYou Can Turn Back the Clock

Don’t let Golfing Knock You Off Course

The JOURNEY™ DEUCE™ KneePreserve more of youIf you are a candidate for knee replacement surgery, ask about the unique, joint-preserving JOURNEY DEUCE implant. The JOURNEY DEUCE knee:

• Preserves half of the bone and all of the ligaments removed during total knee replacement• Is made with OXINIUM™ material—a lightweight, hypoallergenic and potentially longer-lasting alternative to

traditional implant metal• May be an alternative technology for up to 30% of knee replacement candidates

To learn more about the advanced technology of the JOURNEY DEUCE knee, visit: www.JacksonvilleJointPain.com™Trademark of Smith & Nephew. Reg. US Pat. & TM Off.

Get back in action with next-generation joint implantsThe BHR™ hip implant: • Is the first FDA-approved hip resurfacing implant available in the US• Preserves more bone structure and stability than a traditional hip replacement• Is designed for younger patients whose active lifestyle may lead to the early failure of a traditional hip replacement

The JOURNEY™ knee:• Designed to recreate the natural motion and feel of your own knee• Sized for both men and women• Made from the advanced OXINIUM™ implant material which is hypoallergenic and has the potential to

reduce wear by 85% in lab testing compared to cobalt chrome, the metal used in traditional knee implants

With any surgery, there are potential risks and complications. Results may vary.™Trademark of Smith & Nephew. Certain marks Reg. US Pat. & TM Off.

Not every surgeon uses these advanced technologies. To find one who does, visit www.JacksonvilleJointPain.com.

Greetings from thePresident of JOI...

www.JOIonline.net 3

JournalSummer/Fall 2008

JACKSONVILLE ORTHOPAEDIC INSTITUTE1325 San Marco Boulevard, Suite 701

Jacksonville, FL 32207(904) 858.7199

Patrick A. HintonExecutive Director

The mission of the Jacksonville Orthopaedic Institute (JOI) is to provide high qualityorthopaedic health care for our patients

with musculoskeletal disorders.

The “official sports medicine partner”of the Jacksonville Jaguars

JOI providesexpertise in:

• HAND

• FOOT & ANKLE

• JOINT REPLACEMENT

• SPINE

• SPORTS MEDICINE

We are dedicated to fostering apersonalized and compassionate

level of medical care for our patients.

The JOI Journal is designed & published by Custom Publishing Design Group.

www.mycompanymagazine.com

To advertise in an upcoming issue pleasecontact Rebecca Reed at 800.246.1637.

Jacksonville Orthopaedic Institute (JOI) continues to grow to meet the needs of this region’s individuals and families. As part of our commitment to provide convenient orthopaedic care, we are

pleased to announce Timothy R. Hastings, MD, a new JOI physician, will join us October 1, at the Beaches and Point Meadows offices. He brings JOI to a total of 30 orthopaedists serving seven

office locations supported by seven rehabilitation centers, and three MRI centers. A general orthopaedist, Dr. Hastings offers expertise in Sports Medicine as well as Foot and Ankle care.

Dr. Hastings graduated from Dartmouth College (Hanover, NH), with a BA in Economics/Environmental Studies, followed by a Post-baccalaureate in Science from Bryn Mawr College (Bryn Mawr, PA). He was awarded a Doctor of Medicine degree from Brown University School of Medicine, and completed a surgical internship at National Naval Medical Center (Bethesda, MD). Dr. Hastings was a General Medical Officer at HW Marine Corps, Henderson Hall (Arlington, VA), and also completed Flight Surgeon Training at Naval Operational Medicine Institute (Pensacola, FL). He was a Flight Surgeon for CH-53E Squadron at Marine Corps Air Station-New River (New River, NC), and an Orthopaedic Resident at the National Naval Medical Center (Bethesda, MD). Before joining JOI, Dr. Hastings was the Assistant Department Head of Orthopaedics at Naval Hospital-Jacksonville, where he was an orthopaedic staff physician. Dr. Hastings was deployed to the USS Bataan during Hurricane

Katrina, and served in Iraq from January through October 07. Dr. Hastings is Board Certified with the American Board of Orthopaedic Surgeons. He is married with three children, and lives at Deercreek Plantation where they enjoy a variety of leisure activities. Please join us as we welcome him to JOI!

JOI physicians offer three Continuing Medical Education programs annually for regional primary care physicians. More than 150 referral physicians participate and received 4.0 credit hours. In addition, JOI hosts two annual Case Adjuster and Case Manager Continuing Education programs.

As we enter the fall season, watch for JOI physicians on the field with the Jacksonville Jaguars and physicians and staff volunteering at various community events. Also, you will see a new headline in a variety of media: “Touching Lives: Experience, Expertise and Excellence” – and hope you will join us as we prepare to celebrate our 15th year of service to the greater Jacksonville community in 2009.

For more information on our physicians, office locations or services please go to joionline.net.

Michael S. Scharf, MDSpine, Joint Replacement

SAN MARCOPresident, Jacksonville Orthopaedic Institute

4 www.JOIonline.net JOI Journal

The Doctors and Staff at Jacksonville Orthopaedic

Institute wish to thank the following businesses for

their support:

Akerman Senterfitt

Baptist Health

Beaches Open MRI

Bennetts Business

Biomet

Boger’s Shoes

Converged Communications

DJ Ortho (DonJoy Defiance)

DJ Ortho (CMF)

Durden Surgical

Pavilion Pharmacy

Protocol Orthopaedics

PSS

Smith & Nephew

Stryker

Surgical Concepts, Inc. (Jay Bassett)

For Getting Better, It Doesn’t Get Any Better!When on the road to recovery, every stop on your journey is important. That’s why JOI offers its own first-rate rehabilitation facilities. We find it is the best way to offer cohesive, streamlined care. As with every aspect of your care, JOI will provide expert therapists, the best equipment and technology, and an outstanding environment to bring about the best results. All you need is the desire to improve. We will encourage you along the way to keep you motivated and thinking positive about your treatment. If for a particular reason you choose a non-JOI rehabilitation facility, we can work with other rehabilitation facilities as well.

JOI Rehabilitation CentersBEACHES436 Jacksonville DriveJacksonville Beach, FL 32250Phone: 904-247-3324Fax: 904-247-3926

NORTH12961 North Main StreetSuite 201-2Jacksonville, FL 32218Phone: 904-757-2474Fax: 904-757-5541

POINT MEADOWS7740 Point Meadows Drive(Gate Pkwy. and 9A), Suite 1 & 2Jacksonville, FL 32256Phone: 904-564-9594Fax: 904-564-9687

RIVERSIDE/WESTSIDE4339 Roosevelt Blvd., Suite 600Jacksonville, FL 32210Phone: 904-389-8570Fax: 904-389-8599

SAN MARCO1325 San Marco Blvd., Suite 102Jacksonville, FL 32207Phone: 904-858-7045Fax: 904-858-7047

SOUTH14985 Old St. Augustine RoadSuite 106 (Durbin Crossing)Jacksonville, FL 32258Phone: 904-288-9491Fax: 904-288-9698

UNIVERSITY5737 Barnhill Drive, Suite 204Jacksonville, FL 32207Phone: 904-733-9948Fax: 904-733-9984

FT. LAUDERDALE JACKSONVILLE MIAMI NEW YORK ORLANDO TALLAHASSEETAMPA WASHINGTON, D.C. WEST PALM BEACH

The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

Healthcare groups, combination and alliances

Managed care contracting

Estate and tax planning

Asset planning and risk management

Healthcare Law

Stephen G. Prom50 North Laura StreetSuite 2500Jacksonville, FL 32202 904.798.3700www.akerman.com

Provider mergers and acquisitions

Compliance matters HIPAA Labor and

employment Litigation Licensure Contracts

For generations, parents encouraged their children to “Eat your vegetables.” As it turns out, mom knew broccoli may have tasted awful, but was loaded

with valuable nutrients.

Today, the inclusion of vegetables in your diet is one of the tried and true recommendations for a healthy lifestyle. No matter what diet fad is in fashion, no one can dispute the benefits of consuming vegetables.

Vegetables are rich in essential vitamins and minerals. Vegetables are low in calories, sodium, and fat and high in fiber, keeping hunger and weight down. There is compelling evidence that a diet rich in vegetables is linked to many health benefits, including lowered risk for certain cancers, stroke, heart disease, and high blood pressure. It is well known that cultures that follow diets high in vegetable content (like those found in Asia) have higher life expectancies and lower health risks than cultures with diets low in vegetable content.

Vegetables are rich sources of naturally protective substances called “phytochemicals” or “phytonutrients.” Phytonutrients are protective compounds found in plants that boost the body’s immune system and help the body prevent degenerative diseases within cellular structures.

Some familiar protective phytonutrients are: allicin in garlic; isoflavones in soybeans; lycopene in tomatoes; flavanoids in green and black teas; sulforaphane glucosinolate (SGS) in broccoli and broccoli sprouts; carotenoids in carrots; lignans in flax seed; and anthocyanin in blueberries.

Green, leafy vegetables seem particularly beneficial. Carotenoids are the pigments that color dark green and orange vegetables. Many are precursors to vitamin A and act as powerful antioxidants that can protect cells in the body from damage by free radicals, which is thought to lead to a number of health problems. Thus antioxidants may help protect against many diseases.

Dark, leafy green vegetables are also rich in folate. Researchers have linked low blood levels of folate with an increased risk of certain types of cancer and a high intake of folate with a lower risk.

Consumption of vegetables is found to be extremely beneficial to heart health, as cardiovascular strength relies on certain nutrients only found in plants. The fiber and phytochemicals found in most vegetables prevent damage to blood vessels, decrease the risk of strokes, and can help the body eliminate harmful carcinogens and toxins.

Even a small increase in the consumption of vegetables, or at least the addition of vegetable supplements, can improve health and overall well being and increase energy. So for once, your mother was right. ■

Eating Vegetables is Food Smar t

By Charles Hudson© 2

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Jacksonville Orthopaedic Institute www.JOIonline.net 7

The Gender StoryFor the past year, the Gender knee has been

successfully implanted by surgeons at the Jacksonville Orthopaedic Institute. This new knee was the product of years of work by a team of research scientists, engineers, and doctors. JOI Orthopaedist, Dr. Stanton Longenecker, is a member of the design team. He notes, “Orthopaedists for years made adjustments during surgery because existing knee designs just didn’t fit the anatomy of many women.” Researcher Mohamed Mahfouz, PhD, in a landmark paper, illustrated the differences between the femurs of men and women. The needs of surgeons were joined by the striking findings of Dr. Mahfouz and forged into a bold new knee replacement.

The Anatomical DifferencesMen and women vary from each other in

many ways. The anatomical differences between men’s and women’s knees, observed by orthopaedists in the operating room and confirmed by researchers in testing laboratories, were considered by the Gender design team when creating the Gender knee.

First, a man’s knee is wider than a woman’s knee. Second, the angle of the groove that the kneecap travels in is greater in a woman because of her wider pelvis. Third, because of that greater angle, the ridge that helps contain the kneecap is higher in a woman yet the overall mass of the front of a woman’s knee is less. Some orthopaedists refute the new design by stating that the knee design they use already accounts for the differences between men and

women. However, there is substantial evidence that does not support these claims.

Does It Really Work?Several of Dr. Longenecker’s patients have

experienced total knee replacements utilizing an earlier design on one knee and the Gender knee on the other. One such patient was also a member of a study undertaken by Dr. Longenecker which demonstrated the excellent performance of an earlier knee design when evaluated by utilizing cine-radiography to record, in three dimensions, her knee motion while walking and performing deep flexion. This study confirmed the Gender knee performed almost identically as a normal knee. For Pauline (Polly) Holyfield (pictured at left), it was difficult to want to change from a knee that allowed her pain-free motion from 0 to 125 degrees that required a year to fully develop. However, six weeks after surgery, she had attained the same range of motion.

“It was so much easier this time!” said Polly.

In SummaryA new total knee replacement has been

conceived and now tried successfully across the United States, in fact, around the world. The Gender knee is a remarkable new total knee design which takes into account the anatomic variations between women and men. In its first year of use, the Gender knee has provided many women with pain free knees that were truly designed with women in mind.

For more information, the reader is referred to www.joionline.net.

The Kneeby Stanton L. Longenecker, MD

Fact or Fiction?

Gender


Don’t Let Golf Injuries Knock You Off Course

While many of today’s golfers

pass on wearing plaid pants in favor of

sporting more updated apparel, the

increasing number of injuries that result

each year from golfi ng will never become

fashionable. According to the U.S.

Consumer Product Safety Commission,

there were more than 109,000 golf-related

injuries treated in doctors’ offi ces, clinics

and emergency rooms in 2003, incurring

a total cost of more than 2 billion dollars.

Like learning how to avoid driving your

ball into a sand trap, by following proper

techniques from the American Academy

of Orthopaedic Surgeons (AAOS), most

of these injuries can be prevented.

Golf can be a good outdoor fi tness

activity, especially when players walk the

course (as opposed to riding it). However,

the sport does pose potential risk of

serious injury for golfers of all ages. In fact,

nearly one-quarter of golf-related injuries

reported in 2003 occurred in children

under the age of 19. Overuse syndrome,

as well as tendinitis, bursitis, strains and

sprains can put a halt to a golfer’s game.

The most common injured areas include

the elbow, spine, knee, hip and wrist.

“Whether you are a veteran returning

to the green after a seasonal hiatus or a

beginning golfer, it is important to start out

slowly, gradually increasing the number

of holes you play,” explained Matthew S.

Shapiro, MD, orthopaedic surgeon and

vice president at Orthopedic Healthcare

Northwest in Eugene, Ore., and Secretary

of the AAOS Board of Councilors. “Instead

of going for 36 holes your fi rst day back

on the green, hit just a single bucket of

balls the fi rst time out. The next day, see

how your bones and joints feel to gauge

whether or not you can increase your

swing velocity and number of repetitions.

Additionally, Dr. Shapiro recommends

that golfers of all ages regularly

participate in a muscle conditioning

program to not only reduce the risk of

experiencing golfer’s elbow – one of

the most common golf injuries – but also

Orthopaedic Surgeons Provide

Tips to Keep Golfers of

All Ages Injury-Free.

According to the U.S. Consumer Product Safety Commission, there were more than 109,000 golf-related injuries treated in doctors’ offi ces, clinics and emergency rooms in 2003.

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to promote fl exibility and longevity in

their game throughout the season.

The American Academy of Orthopaedic Surgeons offers these simple tips to help prevent golfi ng injuries:

• Take golfi ng lessons and begin

participating in the sport gradually.

• Choose the correct golf shoes: ones with

short cleats are the best.

• Warm up and stretch before golfi ng.

Improving your fl exibility helps your

muscles accommodate to all sorts of

demands.

• Incorporate strength training exercises

into your warm up routine. Visit

http://orthoinfo.aaos.org for golf-related

strength training exercises.

• Do not hunch over the ball too much, as

it may predispose you to neck strain and

rotator cuff tendinitis.

Avoid golfer’s elbow – caused by a

strain of the muscles in the inside of the

forearm – by not over-emphasizing your

wrists when swinging. It is important to

build your forearm muscles by

completing the exercises below:

• Squeeze a tennis ball for fi ve minutes at a

time.

• Perform wrist curls using a lightweight

dumbbell. Lower the weight to the end

of your fi ngers, then curl the weight back

into your palm, followed by curling up

Many people consider golf a

low-level physical activity without the

possibility of injury ever happening to them.

dumbbell. Lower the weight to the end






your wrist to lift the weight an inch or two

higher. Perform 10 repetitions with one

arm, then repeat with the other arm.

• Do reverse wrist curls with a lightweight

dumbbell. Place your hands in front of

you, palm side down. Using your wrist,

lift the weight up and down. Hold the

arm that you are exercising above your

elbow with your other hand in order to

limit the motion to your forearm. Perform

10 repetitions with one arm, then repeat

with the other arm.

Help minimize low back injuries – often

caused by a poor swing – by performing

these simple exercises to help strengthen

lower back muscles:

• Rowing: Firmly tie the ends of rubber

tubing. Place it around an object that

is shoulder height (like a door hinge).

Standing with your arms straight out in

front of you, grasp the tubing and slowly

pull it toward your chest. Release slowly.

Perform three sets of 10 repetitions, at

least three times a week.

• Pull-downs: With the rubber tubing still

around the door hinge, kneel and hold

the tubing over your head. Pull down

slowly toward your chest, bending your

elbows as you lower your arms. Raise the

tubing slowly over your head. Perform

three sets of 10 repetitions, at least three

times a week.

• Keep your pelvis as level as possible

throughout the swing.

• Be alert for dehydration and heat

exhaustion.

• Heed caution when driving a golf cart,

reducing speed for pedestrians, inclines

and weather conditions. Keep hands,

legs, feet and arms inside the confi nes of

the golf cart when it is moving.

Internet users can fi nd additional

safety tips and injury prevention

information on golf and other sports in

the Prevent Injuries America!® Program

section of the Academy’s web site,

www.aaos.org or www.orthoinfo.org

Source:

“Instead of going for 36 holes your fi rst day back on the green, hit just a single bucket of balls the fi rst time out. The next day, see how your bones and joints feel to gauge whether or not you can increase your swing velocity and number of repetitions.”

Baptist Health has received Magnet™ Recognition, the nation’s highest

honor for excellence in patient care, from the American Nurses

Credentialing Center. Studies show that Magnet

hospitals are more likely to have better patient

outcomes than non-Magnet hospitals.

Not surprisingly, Magnet facilities have a

reputation for attracting and retaining the

best nurses, physicians and staff – including

the outstanding team at Jacksonville

Orthopaedic Institute. Together, we are

committed to provide each patient with the

very best orthopaedic care.

Baptist Downtown named among “America’s Best Hospitals” fordigestive disorders, U.S.News & World Report

2007/2008 Consumer Choice Award and “Most PreferredHealthcare Provider,” National Research Corporation

Stroke Centers at Baptist Downtown and Baptist South earnedGold Seal of Approval™, The Joint Commission

Wolfson Children’s Hospital named among top three children’shospitals in Florida, Child magazine

Less than five percent of healthcare organizations in the United States have

earned Magnet status.To learn more, visit

e-baptisthealth.com/magnet.

It’s great to be honored for doing

what you love.

2007/2008 Awards and Recognitions

© 2008 Baptist Health.

Magnet_FP_JOI.qxd 1/31/08 5:11 PM Page 1


lbow arthroscopy is increasingly used to treat both simple and complex disorders of the elbow. The elbow is formed by three

bones, the humerus, ulna, and radius. It is considered a “hinge joint” and is commonly affected by conditions that can lead to stiffness. Arthroscopy is a type of procedure where specially designed instruments are introduced through small portals into a joint, permitting minimally invasive diagnostic and therapeutic surgery. As instruments and techniques have been developed, particularly over the last ten years, there have been significant advances in the treatment of elbow conditions with arthroscopy.

There are significant advantages to using arthroscopy in treating elbow conditions as opposed to the conventional “open approach”. In general, to gain access to the elbow with conventional surgery, a relatively large incision is required. Moreover, as the elbow is surrounded by extensor and flexor muscles, these have to be retracted or divided in order to reach the joint itself. The ligaments and capsule surrounding the joint also must be cut in order to visualize it. This greater amount of dissection tends to lead to more bleeding and pain postoperatively, often necessitating hospitalization for several days. Hence, primary among the advantages

of arthroscopy is its shorter rehabilitation time. Almost all elbow arthroscopy procedures can be performed on an outpatient basis. Additionally, the visualization obtained with an arthroscope is excellent and generally exceeds that obtained through “open” surgical procedures.

Elbow arthroscopy is technically demanding. It requires meticulous technique with a keen understanding of the surrounding anatomy. Injury to the surrounding nerves and blood vessels can lead to significant complications such as numbness and weakness of the hand. This necessitates a planned and careful approach to each elbow arthroscopic procedure performed.

There are multiple indications for elbow arthroscopic procedures. The one that has been recognized for the longest period of time, and is still encountered frequently, is the presence of loose bodies within the elbow. A patient with a loose body will commonly complain of locking, catching or snapping of the elbow. Occasionally stiffness is encountered. Following careful examination which includes measurement of the motion of the elbow and palpation for any crepitation or “catching” of the joint, x-rays are obtained. However, loose bodies may not be seen on x-rays and occasionally more sophisticated diagnostic studies are ordered such

by Garry S. Kitay, MD

Advances inElbow

Arthroscopy

E


as CAT scan or MRI scan. Arthroscopic removal of loose bodies in the elbow is generally very successful with a quick recovery and return to normal activities.

Arthroscopic elbow synovectomy is a proce-dure that is performed for inflammation of the lining of the elbow joint. This is frequently seen in rheumatoid arthritis. Surgery is indicated when appropriate medications are not helpful, and the elbow remains swollen, painful, and often quite stiff. This condition is treated with specialized mo-torized shavers, which are used to debride or ex-cise the abnormal proliferative synovium or joint lining tissue. This often requires multiple portals which are the small incisions permitting access to the elbow, from multiple directions so as to access the entire joint. This generally leads to a significantly more rapid recovery than when done with an open larger surgical approach. However, physical therapy is still often helpful in recovering from this procedure.

Stiffness, or contractures, of the elbow can be caused by multiple conditions but is often related to arthritis. This condition, as well, has seen ad-vances with elbow arthroscopy where motorized burrs can be used to remove impinging spurs in order to diminish pain and improve range of motion. This procedure is usually followed by a concerted therapy program in order to regain motion and strength as soon as possible.

There are many other disorders of the elbow that can be treated arthroscopically. These in-clude tendonitis, commonly called tennis elbow, and disorders of the cartilage, termed osteochon-dritis dissecans. There have been advances also in treating disorders of the elbow arising from high level pitching and competitive throwing that can lead to ligament and bony damage termed olecranon impingement. Fortunately, this can also be frequently improved with an arthroscopic approach.

Elbow arthroscopy, although technically de-manding, can be performed safely and effec-tively on an outpatient basis with consistent and excellent outcomes. Further progress in this field is expected as the instruments utilized in elbow arthroscopy are improved and the available tech-niques are refined.

This figure

demonstrates loose

bodies removed

from a patient’s

elbow who had

developed stiffness

and arthritis. This figure demon-

strates some of the

degeneration that can

occur secondary to

elbow arthritis. Note

the lack of smooth

joint surfaces.


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Touching Lives Experience, Expertise & Excellence

Brandon J. Kambach, MDSpine

Baptist South & San Marco

Gregory C. Keller, MD Spine, Sports Medicine,

Joint ReplacementSan Marco

Garry S. Kitay, MDHand, Joint Replacement,

Sports MedicineSan Marco

Robert J. Kleinhans, MD Hand, Joint Replacement,

Sports Medicine University

Steven J. Lancaster, MD Sports Medicine,

Joint Replacement, HandBeaches & Point Meadows

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Stanton L. Longenecker, MDJoint Replacement,

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David A. Doward, MDSpine, Sports Medicine

San Marco

bones and joints.

Jacksonville Orthopaedic Institute (JOI) offers 30 specialty–trained physicians, many with fellowships, who are dedicated to delivering comprehensive care for the muscles,

Our diverse practice includes five Centers of Expertise:��

Of ficial Spor tsMedicine Par tner

Rehabilitation CentersBeaches 904.247.3324 North 904.757.2474Point Meadows 904.564.9594Riverside/Westside 904.389.8570San Marco 904.858.7045South 904.288.9491University 904.733.9948

MRI CentersBeaches � Riverside/Westside��San Marco

Office LocationsBaptist South 904.880.1260Beaches 904.241.1204Orange Park 904.276.5776Point Meadows 904.241.1204Riverside 904.388.1400San Marco 904.346.3465University 904.739.3319

1st Call JOI!Questions about our physicians,

facilities or treatment options?

Timothy R. Hastings, MDSports Medicine,

Foot & AnkleBeaches & Point Meadows

Patrick M.J. Hutton, MD Sports Medicine

Orange Park

Sunday U. Ero, MD Spine

Riverside

Richard R. Grimsley, MD Joint Replacement,

Sports MedicineOrange Park & Riverside

Philip R. Hardy, MD Sports Medicine,













































Riverside








San Marco

bones and joints.












Orange Park


Riverside
















































Riverside








San Marco

bones and joints.












Orange Park


Riverside





Timothy R. Hastings, MDSports MedicineFoot & Ankle

��

Many people in the “baby boomer” generation are staying active as they age. This is healthy. But playing team

sports, jogging or doing other high impact activities that repeatedly pound, twist and turn the knees can stress aging joints. Highly active, middle-aged patients may develop painful knees as a result of osteoarthritis (OA). This painful condition happens when the cartilage lining on the ends of bones gradually wears away. It can affect one or both knees.

• Symptoms: You may experience pain when standing or going up and down stairs. The knee may buckle and give way, lock in place, or become stiff and swollen.

• Patients: Most people with OA of the knee are over age 55 and/or obese and/or

have a family history of OA. Younger, highly active people may also develop OA if their knee suffered a signifi cant injury.

• Diagnosis: See your doctor for diagnosis and treatment. The doctor will consider your comprehensive medical history, perform a physical examination and possibly order tests and/or imaging studies before recommending a course of treatment.

EXTENDING THE LIFE OF THE MIDDLE-AGED KNEE

Increasingly, baby boomers with OA of the knee are asking for total knee replacement surgery. But fi rst they should try making changes to their lifestyles. Mayo Clinic orthopaedic surgeon Arlen D. Hanssen, MD presented a briefi ng on “Our Aging Population” at the 2002 Annual Meeting of the

Care of the Aging Knee: Baby Boomers May NeedLifestyle Changes

2006

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American Academy of Orthopaedic Surgeons (AAOS). He said many highly active patients in their 40s and 50s feel inspired by advertising and news reports about the success of knee replacement surgeries. But often they refuse to change their lifestyles to extend the life of their natural knees.

“They come in and say, -fi x me,’” Dr. Hanssen explained, and they hope for a complete end to their symptoms without making any changes in their activities. In reality, doctors use a complex medical process to determine whether total knee replacement is appropriate for a patient - considering age, activity demands and other factors. Long-term results of joint replacement are less certain in younger patients.

For middle-aged people, the earlier a doctor diagnoses OA of the knee, the more likely conservative treatment may help. If OA of the knee

is in its early stages, your doctor may recommend low impact activities and other non-operative treatments that can delay or eliminate the need for surgery. In some cases, activity modifi cation may be the only treatment a middle-aged patient needs. “In other cases when surgery is eventually needed, the patient still has to modify activities fi rst to preserve the replacement joint,” Hanssen advises.

SUBSTITUTE SMOOTH, LOW

IMPACT ACTIVITIES

Moderate physical activity lessens joint pain and improves fl exibility and function. Baby boomer patients with OA of the knee should continue exercising, but change the forms of their activities:

• Stop doing high impact activities that twist and


turn the joints. This includes running, tennis, racquetball, basketball, baseball, etc.

• Start doing smooth, low impact activities that are easier on the joints. Recommended activities include stretching, swimming, water aerobics, cycling, walking on a treadmill or outside, playing golf, etc.

OTHER CONSERVATIVE OPTIONS

Other options that may extend the life of your natural knee include medications, steroid injections, physical therapy and mechanical aids.

• Medications: The doctor may prescribe non-steroidal anti-infl ammatory medications to help

reduce infl ammation. Certain dietary supplements may also help. Glucosamine stimulates formation and repair of articular cartilage, and chondroitin sulfate prevents cartilage from degrading. (Note: The U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications or excessive bleeding during surgery. Always consult your doctor before taking dietary supplements.)

• Injections: The doctor may inject the knee joint with strong anti-infl ammatory medications called corticosteroids. This can relieve pain and swelling for awhile.

• Physical therapy: The doctor may give you a balanced fi tness program including physical / occupational therapy to improve

joint fl exibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. It may also help to ice the affected joint for short periods, several times a day.

• Mechanical aids: You may need supportive or assistive devices such as an elastic bandage, splint, brace, cane, crutches or walker.

Source:



The Human Spine

Since our founding in 1939, Stryker has worked side-by-side with surgeons in the operating room. As medicine has evolved, so have we.

Now, everywhere you look, Stryker Spine is helping people lead active, more comfortable lives. Thanks to our relentless pursuit to design and develop implants for procedural innovations, we can provide neurosurgeon and orthopedic surgeon customers with the tools they need to help their patients.

Stryker has been setting standards within the healthcare industry for years. Stryker Spine continues in that tradition by joining together with surgeons to create new perspectives on spinal health.

We Understand Every Angle.

www.stryker.com

The Perfect Swing©

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THE SET UP

Back straight. Knees slightly bent.Buttocks out. Feet set at shoulder-width. Feet, knees, hips and shouldersparallel to target line. Ball located incenter of stance. Chin up from chestto allow the left shoulder room duringthe backswing. Arms hang relaxedalmost straight down to the club,which angles out toward the ball.Arms form a strong triangle to thebody.

THE TAKE AWAY

Arms slowly and smoothly pullthe club back to the right in an arcwhile the knees begin to gently twistclockwise, following the path of thearms. Left arm stays straight, forcingleft shoulder to follow smoothly.Upper body begins rotating to theright while legs continue twisting inplace, building tension. Hips twistclockwise. Weight slowly transfers toright foot.

THE BACKSWING

Arms extend completely to createmaximum torque. Wrists hinge up,cocking the club near the top of thebackswing. Weight almost fully onright foot. At the top of the swing,tensed knees should be pointedslightly to the right of the ball. Righthip turned about 45 degreesclockwise. Shoulders turned about 90degrees clockwise. Left shoulderunderneath chin. Head remains overthe ball. Club’s shaft parallel to theground, facing target.

THE DOWNSWING

Hands drop slightly from fullextension as body uncoils from thehips. Legs release from coiledposition, forcing upper body tofollow. As the club swings down,about two-thirds of the way to theball, it gains a direct plane toward thetarget. Wrists remain cocked until justbefore impact.

IMPACT

Left hip well in front of the ball,straightening left leg. Right foot startsto rise as weight shifts completely toleft foot. Right arm slightly bent,pushing straight left arm through theball. Club head perfectly square to theball. Wrists snap through the ball,both straight and firm at impact. Headin same position as at address.

THE FOLLOW THROUGH

Club follows a path directlytoward the target. Arms both extendstraight to the club, hips continue toturn, and shoulders follow until theclub extends fully around. Rightshoulder turns under chin. Left armbends to accommodate the club’sfollow-through. Hands finish behindturned left shoulder and high behindhead. Most of the body weight is onleft side of left foot. Torso faces thetarget. Head finally follows body well after the shot has been hit.

By Bobby Armstrong


Falling For Fashion – The Footwear Dilemmaby GEORGE JOSEPH

Mention falling, and what’s the fi rst thing that comes to mind? Balance?

Coordination? Eyesight? The problem may not be all that complex. It could come down to something as simple as your shoes!

Properly-fi tting footwear is essential to maintaining stability. This hard fact of life is especially important for women to consider, as studies show that about 9 out of 10 females are forcing their feet into shoes that just don’t fi t. If they’re choosing style over comfort, we could say that they are literally falling for fashion.

But falling isn’t the only problem associated with improper footwear. The wrong shoes can lead to numerous other dilemmas. Perhaps that’s partly why more than 11 million people

age 65 and older—that’s one out of three seniors—have foot problems, including soreness, blisters, callouses, and permanent disfi gurements. Add another 30 million people who aren’t seniors, and the scope of the problem becomes clear. The price tag on a fashionable pair of shoes is more than a matter of dollars and cents. So how can you prevent falls and orthopaedic problems related to shoes?

A Fitting Solution

The American Orthopaedic Foot & Ankle Society (aofas.org) spells out the fi rst step to choosing footwear: “Your shoes should conform to the shape of your feet; your feet should never be forced to conform to the shape of a pair of shoes.”

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“Properly-fi ttingfootwear isessential to

maintaining stability.”


With that basic premise in mind, consider the following factors when shopping for shoes.

The sole: The shoes you select should have non-skid soles. If the soles are slick, ask a shoe repair shop to add textured strips.

The heel: High heels place excess stress on the ball of the foot and on the forefoot. The American Foot & Ankle Society notes that “this uneven distribution of weight, coupled with the narrow toe box characteristic of most high heels, can lead to discomfort,

painful bunions, hammertoes, and other deformities.”

A lower heel that’s thin—think stiletto instead of chunk—will provide an elongated look without sacrifi cing the well-being of your foot.

The toe box: It’s exactly what it sounds like—the area of the shoe that provides space for the toes. Is it rounded or pointed, narrow or wide? A pointed, narrow toe box tends to force your toes into an unnatural, triangular shape. High heels only worsen the problem.

The size: Once a size 8, always a size 8? Don’t count on it. It’s not uncommon for foot size to change. Also, be aware that a size 9 in one shoe brand may feel like a size 8 in another. Your feet aren’t fooling you. Shoe sizes may vary from one brand to the next.

The measurement: It’s best to have your feet measured each time you purchase shoes. Because your feet expand when they’re supporting weight, get the measurement while you’re standing, not sitting. Remember, too, that your feet tend to swell during a day’s activity. So you’ll probably get a more accurate measurement toward the evening.

Additional tips

Make sure that your heel is not slipping out of the back of the shoe as you walk.

Don’t fall for the idea that your shoes will expand after you buy them. The idea of a “break-in period” is a myth.

Make sure you take both shoes into consideration, since it’s common for one foot to be longer and wider than the other.

Always select your shoes according to the comfort of the bigger foot. An insole can be added to a shoe that’s too loose. But nothing can be done to a shoe that’s too tight.

Shoes with laces are safer than loafers or slip-ons, but a caution is in order: Always make sure that your laces are tied. Laces that are loose—or just too long—can cause you to fall.

In the end, you should always choose your footwear based on comfort, not fashion alone. Remember, as the American Orthopaedic Foot & Ankle Society puts it: “Your feet need to carry you around for a lifetime. Treat them kindly!”

All things complex have simple

beginnings. The decision to improve

the condition of your body seems

simple enough at fi rst, but the complexities

have derailed many a determined soul.

Before you suffer information overload, build

a foundation. In fi tness, you will fi nd that all

improvements come from certain basics. These

are the fi ve ground rules that anyone serious

about personal health should employ in order

to continually improve himself or herself.

RULE ONE is that you need a goal. Deciding to

“get in shape” is like deciding to “buy low and

sell high” on the stock market; you need to be a

bit more specifi c. The good news is that fi tness

goals are easy to quantify. For example, losing

3 percent body fat and gaining 15 pounds of

strength on the leg press machine in a month is

a legitimate goal; it’s realistic and measurable.

RULE TWO is that you must pursue your goal

with intensity; you must train hard. If you

don’t push your body past its everyday level

of exertion, you won’t improve beyond your

current condition. If 15 years of little or no

exertion hasn’t gotten you the body you want,

what makes you think that going to the gym

and not exerting yourself will? Remember,

the process of muscle conditioning starts with

the muscle being broken down. A muscle,

if allowed to heal properly, will make itself

stronger than it was before. It is true that you

will experience some degree of soreness. Relish

the ache as a reminder of a workout well done.

RULE THREE is that you employ a variety of

techniques in your training. If you want a day

away from the weights, try rock climbing. If

it’s the treadmill you despise, then try running

stadium stairs. As long as you change your

workout on a regular basis, your muscles will

The Five Rules of FITNESS

It is true that you will experience some degree of soreness. Relish the ache as a reminder of a workout well done.

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always be confused, and a confused muscle is

forced to adapt and become better conditioned.

RULE FOUR is that you must eat specifi c foods in

specifi c portions to elicit the desired response from

your body. When used properly, food can have

an enormously positive effect upon your body. The

portions of macronutrients (protein, carbohydrate, fat)

you need from different foods is complex, to say the

least. Many nutritionists have been recommending

low-carbohydrate diets for years. If counting

carbohydrates, fat, and protein is not realistic for

you, then simply try to take in a moderate portion

of each macronutrient at every meal. A moderate

portion of protein and carbohydrates each would be

roughly the size of your fi st. A moderate fat portion

might be one-fi fth of that. A sample meal might

be the following: scrambled egg beaters (protein),

cheese (fat), and strawberries (carbohydrates).

Once you gain an understanding of which

foods have which macronutrients in them, you can

further improve your diet by committing yourself to

eating several small- to medium-sized meals each

day instead of the standard two or three. This steady

fl ow of food cranks up your body’s fuel furnace. The

result is higher, more stable energy levels. On the

other hand, if you fast for long periods between large

meals, you are sabotaging your healthy eating habits.

A large meal requires a large quantity of blood to be

diverted to your stomach to aid in digestion, leaving

you listless and out of energy. To make matters

worse, you have taken in considerably more calories

than your body can use at that point. (Think about

trying to force twenty gallons of gas into a car with

a ten gallon tank.) Those excess calories have to go

somewhere, so they often are stored as fat. At some

point during your bloated fast, your body will begin to

worry that food had become scarce, and will engage

its self-preservation mechanism. Your metabolism will

slow so that you burn fewer calories, making it easier

to store the extra calories as, you guessed it, fat.

You also may have guessed that a slow metabolism

burns fewer calories and supplies less energy,

thereby rendering you tired, weak and overweight.

You can further fi ne tune your diet by eliminating

as much of your sugar intake as possible. Sugar

causes a release on insulin, the storage hormone.

Excessive insulin causes calories to be stored

as fat regardless of whether they were protein,

carbohydrate, or fat calories originally. As if nutrition

weren’t complex enough, now you fi nd out that

even if you don’t take in any dietary fat, you still

can gain body fat. Fried foods also should be on

the hit list. Most fried foods are dangerously high

in saturated (bad) fat. “Good” (unsaturated) fat is

found in such things as nuts, fi sh and avocados.

RULE FIVE, the fi nal rule, is that you must be

consistent in your training, nutrition, and

positive mental approach to fi tness and life.

As cliché as it may sound, it remains true that

where the mind goes, the body will follow.

by Charles Hudson

If you don’t push your body past its everyday level of exertion, you

won’t improve beyond your current condition.


Anti-Aging StrategiesYou can turn back the clock.

TRUE, the “fountain of youth” turned out to be amere legend. But that doesn’t mean you can’treverse the effects of aging, at least to a degree. The

good news is that there’s a difference between your chrono-logical age and your biological age. Your biological agemeasures the status of your physiology. This includes yourcholesterol level, your muscle strength, and so forth. Ifyou’re healthy in these areas, there might be truth to theadage: “You’re not getting older—you’re getting better.”

Experts say that it is indeed possible to extend your lifespan and to become healthier in the senior years, simply bychanging certain patterns of behavior. Much of the advicefocuses on three areas: Diet, exercise, and attitude.

An Adjusted Diet

The key with diet in later years is maintaining a levelof adequate nutrition. With the advancement of age,

energy needs are reduced. Hence, the amount of foodtaken in will be lowered. The problem is that the

elderly person’s nutritional needs are the same asyears before. The challenge, then, is to provide

adequate amounts of nutrients despite the reduc-tion of intake.

One way to do this is to make use of nutri-tional supplements. Writing in Bottom

Line, Dr. Deepak Chopra recommends thefollowing: “Take a multivitamin-mineral

supplement every day at double therecommended dose. That will give

you the folic acid, B-12 and B-6you need to prevent heart dis-

ease. Also take 400 internation-al units (IU) of vitamin E tohelp prevent heart diseaseand cancer. Women over 45should take 1,200 mg to1,500 mg of calcium with400 IU of vitamin D dailyfor bone health.”

The elderly shouldavoid food that is rich in

fats—especially saturatedfats. Intake of simple sugars

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by Leonard Taft

should be reduced too, since these con-tain empty calories. Fiber can aid suchconditions as constipation, diabetes,and cardiovascular disease.

The Benefits of Exercise

“Many older patients look at meskeptically when I suggest they exer-cise more,” writes Dr. Elif Erim at theweb site C-Health. “Yet the evidencesupporting the beneficial effects ofexercise is growing, and almost everyday a new article appears in medicalliterature to suggest the same.”

Virtually everyone knows that asedentary lifestyle can be hazardous toyour health. Indeed, according to theAmerican Heart Association, lack ofphysical activity increases the risk ofcoronary heart disease—which hap-pens to be the number one killer ofpeople over 65 years of age. Physicalactivity and light exercise can help youprevent such problems as arthritis andobesity. But what kind of exercise pro-gram should an elderly person adopt?

Walking the dog is not enough. Youneed a variety of exercise, includingstretching, aerobic activity, andstrength training. But don’t worry:That doesn’t require strenuous joggingor the lifting of 50-pound barbells. Onthe contrary, walking for 20 minutes

three or four times a week will workwonders. Before heading out, taketime to stretch—about five minutes orso. Add to your program lifting moder-ate weights—even soup cans (full, ofcourse) can fill the bill.

At the web site webmd.lycos.com,one elderly woman (all she’ll say isthat she’s over 70) tells of an exerciseroutine she’s had for two decades, andwhich she holds to religiously.Recently she added weights to her pro-gram. “I’m a great-grandmother,” shesays, “and I only took up weight train-ing five years ago. Sticking with it,I’ve found, isn’t so tough—as long asyou follow a few simple steps.” Sherecommends writing out a scheduleand then sticking to it. By all means,tell others what you’re doing! “I tellfriends, enemies, and acquaintances allabout the weights I work with, thenumber of reps I do, and how often Igo to the gym. I’m sure it bores themto tears, but having said all that, howcould I possibly quit?”

Fitness expert Richard Weil stronglyrecommends strength training for sen-iors. “Any exercise that causes themuscles to contract against an externalresistance is strength training,” hesays. But isn’t strength training toodangerous for the elderly? “Research

says otherwise,” asserts Weil. Strength,muscle mass, coordination, and qualityof life all increase with strength train-ing. “In many studies,” says Weil,“even bones get denser, and that’simportant because osteoporosis effectsmore than 28 million Americans.”

You’re As Young As YouThink You Are

That’s more than just a clever adageto pacify the elderly. It’s also a fact,when we’re talking about ‘biological’age. So try to keep a youthful mind.That means recapturing the spontane-ity you had in bygone years and main-taining a healthy level of curiosity.Last but not least, play! Spend timewith children, go to the movies, taketime to do some leisurely activity thatyou’ve kept putting off, just for the funof it!

You may not be able to turn backthe chronological clock, but you cando something about the biological one.Yes, at least to a degree you can be incontrol of the dial, as long as youwatch your diet, maintain an adequateprogram of exercise, and maintain apositive outlook. By doing so, youwon’t only be adding years to yourlife. You’ll also be adding life to youryears.

Casey Stengel spent 54 years as a professional baseball man. His legacy

includes a remarkable championship run as the Yankees skipper and an equally striking tenure as manager of the expansion Mets. But he’s probably most famous for “Stengelese,” a collection of quotes that fi lled his career.

The WandererAfter fourteen years as a journeyman

outfi elder, Stengel became manager of the Brooklyn Dodgers at the age of 44. “The secret of managing,” he realized, “is to keep the guys who hate you away from the guys who are undecided.” Though the philosophy seemed sound, he bounced from Brooklyn to Boston to Milwaukee to Kansas City to Oakland before settling in to New York and the Yankees.

The Bronx BombersSomewhere along the way Stengel picked

up the questionable axiom that “good pitching will always stop good hitting and vice versa.” Somehow he convinced his players to do both, and the Yankees responded with a World Series championship in 1949. They followed that with another, and another, and another. And then another, making fi ve straight titles.

The Yankees won ten American League pennants in Stengel’s twelve years at the helm. During that time he managed a record 63 World Series games and won a record 37 while winning seven World Championships. However, a few days after losing the 1960 Fall Classic to the Pittsburgh Pirates, he was let go for being too old. He responded with the remark, “I’ll never make the mistake of being 70 again.”

The Amazing MetsThe expansion New York Mets

signed the senior citizen to manage their inaugural 1962 season. He decided, “The Mets are gonna be amazing.” As it turned out, they were amazingly bad.

“Been in this game one-hundred years,” he quipped, “but I see new ways to lose ‘em I never knew existed before.” The Mets set a record pace, driving the man now known as ‘the Old Perfessor’ to distraction. After a particularly wrenching defeat, Stengel told the media, “Don’t cut my throat. I may want to do that later myself.” Eventually, the Amazing Mets lost 120 of 160 games – a feat of ineptitude that still stands.

Stengel retired before the Mets became miraculous. By then he felt his time in baseball was complete. “There comes a time in every man’s life,” he said. “And I’ve had plenty of them.”

Casey StengelA Life in Words By Louis Bradford

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Advanced science for real living.™800.647.9174

www.oxfordknee.com/FLOr visit:

Not all patients are candidates for partial knee replacement. Only your orthopedic surgeon can tell you if you’re a candidate for joint replacement surgery, and if so, which implant is right for your specific needs. You should discuss your condition and treatment options with your surgeon. The Oxford® Meniscal Partial Knee is intended for use in individuals with osteoarthritis or avascular necrosis limited to the medial compartment of the knee and is intended to be implanted with bone cement. Potential risks include, but are not limited to, loosening, dislocation, fracture, wear, and infection, any of which can require additional surgery. For additional information on the Oxford® knee, including risks and warnings, talk to your surgeon or visit Biomet.com.

© 2008 Biomet Orthopedics, Inc.

ASK YOUR DOCTOR ABOUT THE OXFORD® PARTIAL KNEE.Now there’s an alternative to total knee replacement. The Oxford® Partial Knee from Biomet. It’s the only one of its kind in the United States. The Oxford® Partial Knee lets you keep up to 75% of your healthy knee — for a more rapid recovery with less post-operative pain and more natural motion. Why get a total knee when maybe all you need is a partial knee from Biomet? To learn more, or to find an Oxford® Knee trained surgeon in your area, call or visit our website.

Mary Lou Retton1984 Olympic Gold MedalistBiomet Joint Replacement Patient

Why get a total kneeif you only needa partial?

“

Why get a total kneeif you only need

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