Category Archives: Orthopedics & Spine

NAVIO robot-assisted partial knee replacement

Posted on: September 3, 2015

Amazing New Mobility after Advanced NAVIO Partial Knee Replacement Surgery

By Dr. Victor Khabie

Recently, advanced NAVIO robot-assisted partial knee replacement surgery was performed for iStock_18235142_RET3_HiRezthe first time in New York State at Northern Westchester Hospital. The technology uses sophisticated computer modeling that lets the surgeon create a unique, individualized surgical plan and then simulate that plan prior to surgery. The result is a transformation of partial knee replacement surgery – a great leap forward in precision and accuracy. The result for patients? A remarkable new option that restores natural movement as never before possible.

When painful and debilitating arthritis of the knee limits a person’s day-to-day activities, and all non-surgical measures have failed, the person is a candidate for knee replacement surgery. When it affects the whole knee, surgeons perform a full knee replacement. But when arthritis affects only part of the knee, most surgeons still perform a full knee replacement because until now, a partial replacement was a difficult and imprecise procedure. So much so that up to 30 percent of people getting a full knee replacement are actually candidates for a partial knee replacement.

Partial knee replacement requires that the implant synchronize perfectly with the remaining healthy portion of the knee, leaving almost zero leeway for surgical error. If the surgeon miscalculates by even a few millimeters in removing bone to make way for the implant, it will not fit properly. However, when successful, a partial knee replacement offers dramatic advantages, especially to those who enjoy an active lifestyle. The healthy parts of a person’s own knee are preserved, and the knee retains a more natural feel. Typically, the patient remains fully active. Why tear down the whole house just to renovate one room?

 unheard-of mobility post-surgery

Now, thanks to the precision of robot-assisted partial knee replacement surgery, that is no longer necessary. The breakthrough technology offers suitable candidates a viable alternative to a full knee replacement, and makes possible unheard-of mobility post-surgery. This leading-edge technology can provide patients suffering from arthritic pain another 10 to 15 years of an active lifestyle. What’s more, within just a few weeks of surgery, many patients are back to skiing, swimming, golfing, even playing tennis.

How does robot-assisted partial knee replacement surgery achieve
unprecedented results?

The NAVIO technology lets the surgeon do something entirely new in a partial knee replacement operation: remove only the diseased section of bone. The remaining cavity is then fitted with a metal insert that replaces the section of removed bone.

The surgeon starts by brushing a wand containing GPS coordinates over the arthritic section of the knee, thus feeding a 3-D image into the computer system. The computer registers the alignment of the entire limb, from ankle to hip, and how the whole leg moves together. The model shows every feature of a person’s leg – it’s as unique as a fingerprint. Now the surgeon can plan how much bone to remove for the implant and actually test the plan on the computer before beginning the surgery. The computer provides answers to key questions: If I remove this much bone, will the knee fully extend?  Will the knee feel natural — not too tight or too loose?

The technology ensures the accuracy needed for truly successful partial knee replacement.

Once perfected, the plan is coded into the handheld instrument used by the surgeon to perform the operation.  To help ensure safety, the device only permits movements in accordance with the plan – any deviation from the plan and the tools freeze, preventing the removal of any excess bone. The technology ensures the accuracy needed for truly successful partial knee replacement.

Robot-assisted partial knee replacement surgery offers a great new option to many age groups. It lets active people continue to engage in more strenuous sports than they could following a full knee replacement, which limits flexion. They can do anything that involves deep knee bending — rock climb, ski, cycle, hike, play tennis. The new approach also benefits those who may have other medical issues. This is a much smaller operation than a full knee replacement, offering a quicker, easier recovery, and a far lower rate of complications. It is the ideal procedure for those with some arthritic pain and limitation, but who do not want to sacrifice ligaments or remove healthy parts of the knee. By saving as much of a person’s own bone and ligaments as possible, NAVIO surgery lets them remain active for many years.

Editor’s Note: Victor Khabie. MD, FAAOS, FACS is Chief of the Department of Surgery, Co-Director of the Orthopedic and Spine Institute and Director of Sports Medicine, at Northern Westchester Hospital.

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Neurosurgeon Sheds Light on Former President Jimmy Carter’s Cancer Diagnosis

Posted on: August 27, 2015

Neurosurgeon Sheds Light on Former President Jimmy Carter’s Cancer Diagnosis

By Dr. Ezriel Kornel

Former President Jimmy Carter recently received his first radiation treatment targeting four Kornel, (Ezriel Kornel, MD)spots of melanoma on his brain.

Many people have only heard of melanoma on the skin. However, melanoma has a high rate of metastasizing to the central nervous system, including the brain and spinal cord. In the case of a single metastasis, surgical removal is typically an option. In the case of Jimmy Carter, he has multiple melanoma spots on his brain, and is being treated with radiation.

At Northern Westchester Hospital, we treat many of our brain cancer patients with radiation using a Gamma Knife. Not to be confused with an actual knife or incision, it is a large helmet-shaped device which the patient slides into after having a head-frame placed under brief sedation.  It delivers high doses of radiation in one sitting that lasts  from a half hour to a couple of hours.

The primary goal of this procedure is to stop the cancer from growing, and it has a very high success rate – more than 90% – with minimal if any side effects. It is very successful in that it is so precise that it does not damage surrounding areas in the brain.

While I’m not treating Jimmy Carter, I would say that at the age of 90, if he has no new cancerous lesions elsewhere, he can continue to maintain his current schedule and activities. And if there are new lesions discovered in the future in his brain, he can repeat his radiation treatments.

The melanoma, itself, presents risks. Some patients experience seizures or neurologic symptoms such as balance issues. And melanoma has tendencies to bleed, which can have devastating neurologic consequences.

The good news is that melanoma is to a large extent preventable. Avoiding excessive exposure to sunlight is important, and wearing sunscreen is always imperative with prolonged sun exposure. If you see any questionable spots on your skin, or spots that change, make an appointment with your primary care physician or dermatologist as soon as possible. Like many cancers, if melanoma is caught early, it is treatable.

Editor’s Note: Ezriel Kornel, MD, FACS, is a Neurosurgeon and a Director of The Orthopedic and Spine Institute at Northern Westchester Hospital. 

Read additional blog posts about the gamma knife, melanoma and sun safety.

Elbow Pain: It’s Not-So-Funny

Posted on: July 15, 2015

Elbow Pain: It’s Not-So-Funny

By Dr. Michael Gott

Elbows can be surprisingly problematic—pain can plague tennis players, golfers, and even Elbowgardeners. Although elbow pain can limit your activities, plenty of solutions exist for resolving the pain.

If you experience elbow pain after a fall, an accident, or the pain comes on suddenly, you should head to the emergency room right away. You could have a fracture or dislocation. Other signs that you should see a doctor are numbness, tingling, sudden swelling, or difficulty moving your arm.

Patients often end up in my office due to more chronic concerns. Arthritis, bursitis (inflammation of a fluid cushioning sac in the joint), and pinched nerves (especially the ulnar nerve—your “funny bone”) can all create the kind of persistent pain that will lead patients to seek medical help. The most common complaints I see are tennis or golfer’s elbow. The pain is usually a form of tendonitis—inflammation in the tendons that connect forearm muscles to bone.

The first step for patients to try is RICE: Rest, ice, compression, and elevation. Resting your arm and applying ice for 15 to 20 minutes, three times a day will help reduce inflammation and ease the pain. You can achieve compression with elbow braces and wraps easily found at the drugstore; these will help take pressure off the tendon. Finally, keeping your elbow elevated above your heart will also help reduce swelling.

To help manage pain, I recommend starting with over-the-counter pain relievers such as ibuprofen or naproxen. However, if you don’t find relief with these measures, your doctor may suggest a cortisone (steroid) injection, especially for tennis or golfer’s elbow. This can provide immediate pain relief and, with physical therapy, allow patients to gradually return to play. If the pain persists, surgical solutions also exist. A surgeon can perform arthroscopic surgery to address structural problems like bone spurs.

An exciting new option is platelet-rich plasma (PRP), a therapy used by athletes such as Tiger Woods and Rafael Nadal. Blood is drawn from the patient and platelets—which contain proteins called growth factors—are separated, concentrated, and then re-injected into the problem elbow. The concentrated growth factor seems to speed healing. We’ve had some excellent success in treating chronic tennis and golfer’s elbow with PRP.

Editor’s Note: Michael Gott, MD is the Medical Director of Northern Westchester Hospital’s Orthopedic and Spine Institute at Yorktown. Dr. Gott specializes in conditions of the shoulder, elbow, wrist, hip, knee and ankle including traumatic and sports related injuries as well as arthritic conditions.

Leg Injury After Hip Replacement Surgery

Posted on: June 19, 2015

Impact of Leg Injury After Hip Replacement Surgery

Dr. Eric Grossman details the impact of a leg injury following hip replacement surgery, in light of U.S. Secretary of State John Kerry’s recent broken femur and subsequent surgery.

Eric L. Grossman, MD, FAAOS; Co-Director, Joint Replacement Surgery, Orthopedic and Spine Institute Northern Westchester Hospital

Eric L. Grossman, MD, FAAOS; Co-Director, Joint Replacement Surgery, Orthopedic and Spine Institute, Northern Westchester Hospital

As we’ve seen in the case of Secretary Kerry, if you fall or sustain a major accident, individuals can break the bone around a hip implant. Typically the implants of a hip replacement reside in the patient’s bone without compromising the bone’s strength. However when a fall or traumas strike the leg, the bone can still be vulnerable to breaking.

The location of the break also determines the impact on the hip implant. A fracture in the femur below or above the implant typically does not jeopardize the implant. Yet a fracture closer to or occurring around the implant could disrupt the implant’s fixation and therefore its stability. This will result in the need for a “re-do” or revision surgery where a new hip implant is placed. These procedures are typically performed by a Joint Replacement Specialist as they are more complex than first time hip replacements.

“Hip replacement patients should feel
optimistic about their future physical abilities.”

Secretary Kerry is a great example of how most hip replacement patients return to a high level of physical functionality. Whether it is a “normal” return to physical activity, or rigorous exercise, hip replacement patients should feel optimistic about their future physical abilities.

Editors Note: Eric L. Grossman, MD, FAAOS is Co-Director of Joint Replacement Surgery at tge Orthopedic and Spine Institute at Northern Westchester Hospital. Dr. Grossman specializes in all aspects of hip and knee joint replacement surgery including primary and revision total joint replacement, with a focus on the Anterior Approach to Total Hip Replacement.  

Watch Dr. Grossman discuss the Anterior Approach to Total Hip Replacment and hear what several patients have to say about Dr. Grossman, the anterior approach and their experience at Northern Westchester Hospital, www.nwhorthoandspine.org/DrGrossman.

 

Likely treatment and rehab that U.S. Secretary of State John Kerry will Face

Posted on: June 2, 2015

The Road Ahead: What Treatment and Rehab Options Might Look Like for Secretary Kerry

Dr. Victor Khabie, Chief of the Department of Surgery and Chief of Sports Medicine at

new york orthopedist, orthopedic surgeon westchester

Dr. Victor Khabie, Co-Chief of Orthopedic Surgery,  Orthopedic and Spine Institute, Northern Westchester Hospitl

Northern Westchester Hospital in Hospital in Mount Kisco, NY explains the likely treatment and physical rehabilitation that U.S. Secretary of State John Kerry will receive after breaking his right femur in a bicycling accident.

Dr. Khabie says, “While it might take a full year for Secretary Kerry to completely heal, with advances in surgical procedures, he should be up and walking with crutches the same day as the surgery to repair his broken leg.”

Options to fix the femur
“While there are two options, it really only comes down to one option, and that is surgery. The other option would be to remain bedridden for six weeks as the broken bone heals, but that is not a good idea. People can develop bed sores, blood clots, and even pneumonia if they stay in bed that long. This should be fixed surgically by stabilizing the bone with a rod, plates, or screws, depending on the pattern of the fracture,” says Dr. Khabie.

How long will it take to heal?
Dr. Khabie says, “Typically, the broken bone will take six to eight weeks to heal, and a year for a full recovery.”

What is to be expected when it is time for physical rehabilitation?
“This injury will require months of physical rehabilitation,” says Dr. Khabie. “The muscles in the leg will atrophy, meaning they will wither and shrink in size. When the bone is healed, he will begin a more aggressive rehabilitation to include strength training. It’s a good thing he likes bicycling. He will start rehab using a stationary bike in about six weeks.”

Are there added concerns since Secretary Kerry had hip surgery on his right side as well?
“That previous surgery on his right hip makes this surgery more delicate,” says Dr. Khabie. “Care must be taken that the rods and screws used to fix his femur fracture do not interfere with his prior procedure. It is wise that he is having the same team of doctors perform both surgeries.”

Editor’s Note:
Dr. Victor Khabie, MD, FAAOS, FACS is a member of the Somers Orthopedic Surgery and Sports Medicine Group. Dr. Khabie received his medical degree from Harvard Medical School and completed his fellowship in sports medicine at the world-renowned Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California, where he served as assistant team physician to professional sports teams including the LA Lakers, Dodgers, Kings, Mighty Ducks, LA Sparks, and the USC Trojan football team.