News Archive (2011)

Bionic Knees - Advances in knee replacement implants and surgical and rehab techniques help speed recovery

John C. Lincoln Network, HealthBeat Newsletter
July - August 2011

Glendale resident Cheyrl Pound, 66, readily admits she should have had her knee replacement 10 years ago. “My right knee was very painful. I got gel and cortisone injections, and they didn’t work.”

Pound’s next step was a visit to Scott Siverhus, MD, an orthopedic surgeon on the medical staff at John C. Lincoln Deer Valley Hospital. After examining her right knee, he told her that arthritis had taken its toll; she needed a knee replacement. He performed the surgery on her right knee in December 2009 at the Deer Valley Hospital. In January 2011, he replaced her left knee joint.

“I was in the hospital four days the first time, three days the second time,” Pound said. “I walk fine now, with no cane. I’m still working on stairs; eventually, I’d like to not need the railing. But I can climb in and out of our motor home without pain now. And my range of motion is great.”


Less Tolerance for Painful

Joints As baby boomers age, the number of knee replacement surgeries is rising. “The fastest growing segment is 45- to 65-year-olds,” Dr. Siverhus said. “Patients today are less tolerant of pain and arthritic conditions. People are living longer and leading more active lives. As technology and surgical techniques have improved, patients’ and surgeons’ thresholds for worn-out and diseased joints have lessened. We can fix those joints.”

Implant technology improves  continually, he said, giving patients greater range of motion and function with a more natural feel. The metal and plastics are basically the same as 10 years ago, but companies are making the plastics more durable by removing oxidation through a variety of techniques. Most artificial joints will last 20-plus years.

“In round numbers, we’ll have to replace 2 percent at 10 years and 20 percent at 20 years,” Dr. Siverhus said. Is knee replacement surgery less invasive than 10 years ago? “When you’re putting half a pound of metal and plastic in a person, it’s really  never minimally invasive,” Dr. Siverhus said. “A typical incision today is four to six inches long. What we are able to do now is spare more of the soft tissues of the knee, including muscles and tendons.”

Computer Navigation Boosts Accuracy

In addition to implant improvements, surgical techniques have advanced in recent years. Dr. Siverhus is skilled in the use of computer navigation for knee replacement surgery.

“Computer navigation gives us a fixed point of reference above and below the knee,” he said. “An LED unit sends an infrared signal to a point at a designated distance from the operating table. Another LED light shows the parameters around the knee joint and at the ankle. Computer algorithms use this information to calculate the implant size and help us rebalance ligaments for the patient on the table.”

He noted that patients with arthritic knees often become bow-legged or knock-kneed because of pain. “We can realign those ligaments with the help of the computer and boost the accuracy of the installation.”

A small percentage of  patients, usually those who are younger, can be candidates for partial knee replacements. “This type of surgery has been around for 40 or 50 years,” he said. “Finding the right candidate for it is the challenge.” When only one of the knee’s three compartments is diseased or damaged, an orthopedic surgeon can choose to resurface that compartment only.

Pain Control and Rehabilitation

Dampening pain is another big advance for today’s knee replacement patients. “We now have a cocktail of different medications that we inject in the knee at the time of surgery. It provides lots of relief one to two days postsurgery, when pain typically is the greatest,” Dr. Siverhus said. With additional pain management protocols, patients get up and get moving sooner, lessening recovery time.

“The final challenge of knee replacement surgery, rehab, is typically down to six to eight weeks of physical therapy visits instead of three months, the norm 10 years ago,” Dr. Siverhus said.

Patients can continue to do required exercises at home to strengthen the knee and increase range of motion. Pound is more than pleased to be moving well again. “I’m much more mobile now,” she said. “I can be on my feet longer. Knowing what I know now, I would have done this much sooner.”

For more information, visit https://www.honorhealth.com/medical-services/orthopedics.

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"by Lesley Wright, The Arizona Republic.
May 6, 2011"

NFC kit lets patients leave hospital earlier and monitor their return to health from home

by Christopher Brown, Near Field Communications World
May 19, 2011

A new NFC solution from Gentag and The CORE Institute is designed to reduce healthcare costs by providing patients with a way to self-monitor their recovery after an operation so they can be discharged earlier from hospital.

GENTAG: Reducing healthcare costs with NFC by allowing earlier discharge

Patients sent home after operations will be able to self-monitor their return to health thanks to a new medical grade wireless monitoring kit designed to be used with NFC-enabled mobile phones.

The kit, which checks for pressure and temperature variations that indicate swelling, will realise significant reductions in healthcare costs and improved outcomes for patients, say co-creators Gentag and The CORE Institute.

"The technology is based on an ultra-linear NFC-MEMS [Micro electro-mechanical systems] hybrid chip with 1mm mercury (Hg) precision and 0.1°C temperature accuracy developed during the past year by Gentag and its partners under the specifications and medical guidance of a team of US orthopedics surgeons, lead by Dr David Jacofsky and Dr Roy Sanders, chairman of The CORE Institute and President of Florida Orthopedic Institute respectively," the companies explain.

"The combined effort has created a completely new, minimally invasive, low cost way to measure in situ pressure and temperature in surgery areas, minimizing length of stay and decreasing complications through earlier diagnosis," they add. "The technology is covered under worldwide issued and pending patents."

Applications include compartment syndrome monitoring, post orthopaedics surgery monitoring, back pressure and bed sore monitoring as well as monitoring for excessive pressure in casts. Other medical applications are under development.

Users will be able to take readings from the monitor kit with an NFC phone. The technology is now available for limited post-surgery trials, with commercial production expected to start in 2012 with units for monitoring pressure in casts.

The announcement is the latest in a series of medical applications unveiled by Gentag, which specialises in low-cost, wireless sensor technologies based on cell phones.

Earlier this year, the company successfully demonstrated a diagnostic test platform that combines NFC and immunoassay technology to enable self-testing for pregnancy, fertility, pathogens, Aids, drugs, allergens and even certain types of cancers. In February, the company unveiled a low cost mobile phone — developed in collaboration with chip manufacturer NXP — able to handle both NFC and RFID applications.

"Gentag's work to bring the technology to low-cost cell phone markets offers great potential to the telemedicine applications," said NXP's Charles Dachs. "NFC will allow healthcare professionals to monitor their patients' health remotely, introducing over-the-counter technologies directly to consumer cell phones."

LEARN MORE — Topics: , , , , , , NFC trials and live services:

Read more: www.nearfieldcommunicationsworld.com

"by Lesley Wright, The Arizona Republic.
May 6, 2011"

First Cell Phone Based Post-Operative Orthopedics Surgery Monitoring Kit Announced by GENTAG, Inc. and The CORE Institute

Information contained on this page is provided by companies via press release distributed through PR Newswire, an independent third-party content provider. PR Newswire, WorldNow and this Station make no warranties or representations in connection therewith.


A completely new, minimally invasive, low cost way to measure in situ pressure and temperature in surgery areas, minimizing length of stay and decreasing complications through earlier diagnosis

After hospital discharge, patients can self-monitor with cell phones for excessive swelling, which will decrease readmissions

WASHINGTON and PHOENIX, May 17, 2011 /PRNewswire/ -- GENTAG, Inc., Third Technology Capital Investors, and The CORE Institute are pleased to announce the first fully integrated medical grade wireless monitoring kit for post-surgery applications compatible with the new generation of Near Field Communications (NFC) cell phones.  The kit allows patients to self-monitor for excessive swelling in the surgery area or inside casts with their cell phones after hospital discharge (compartment syndrome monitoring).

Significant post-operative orthopedics costs savings and improved outcomes for patients are expected.

The technology is based on an ultra-linear NFC-MEMS hybrid chip with 1mm mercury (Hg) precision and 0.1 C temperature accuracy developed during the past year by GENTAG and its partners under the specifications and medical guidance of a team of US orthopedics surgeons, lead by Dr. David Jacofsky and Dr. Roy Sanders, Chairman of The CORE Institute and President of Florida Orthopedic Institute respectively.  The combined effort has created a completely new, minimally invasive, low cost way to measure in situ pressure and temperature in surgery areas, minimizing length of stay and decreasing complications through earlier diagnosis.  The technology is covered under worldwide issued and pending patents.

Applications include compartment syndrome monitoring, post orthopedics surgery monitoring, back pressure and bed sores monitoring, and monitoring for excessive pressure in casts.  Other medical applications are under development.

The technology is available for limited post orthopedics surgery trials.  Commercial production is expected in 2012, starting first with pressure monitoring in casts. The technology will be fully compatible with Google, BlackBerry, Nokia, Samsung and other brand NFC cell phones integrating the NFC chip and can also be bundled with low cost custom NFC cell phones (e.g. GENTAG's GT-601) as low cost hospital discharge wireless monitoring kits.  FDA approval will be required for some applications.

Read more: www.nbc12.com

Orthopedic center may test health reform law

by Lesley Wright, The Arizona Republic
May 6, 2011

Banner Del E. Webb Medical Center administrators gathered hospital employees Friday to announce a joint venture with the CORE Institute that could be a early test of the health-care-reform law for patients and physicians.

By the end of the year, orthopedic patients will be treated at the Banner CORE Center for Orthopedics, a limited-liability company operating out of the Sun City West hospital.

The model calls for orthopedics patients to go through a seamless "continuum of care," from initial exam to postoperative rehabilitation. At the same time, the partners will learn how to co-manage healthcare costs during the three-year pilot period.

The center will give patients one integrated treatment and, eventually, bill for one payment under a new "bundled" reimbursement system. Even bonuses will be based on group performance.

CORE, the Center for Orthopedic Research and Education, approached hospital administrators in 2010, ready to pour $5.8 million into the venture. The center's board, co-managed by CORE and the hospital, will handle every aspect of orthopedic care at Del E. Webb.

David Jacofsky, CORE CEO and an orthopedic surgeon, said his company decided to partner with a hospital once he saw that health-care reform was heading toward integrated, standardized care.

"We will re-engineer patient expectations," he said.

Banner Del E. Webb CEO John Harrington summed up the new management trend in the first slide of his presentation: "The whole is greater than the sum of its parts."

Dr. Charlie Agee, chief medical officer for Banner Del E. Webb, said, "The next 10 years of medicine will probably be the most interesting of any decade in the past. This is where we need to be in the future."

New patient experience

The primary change in the care model will be the bundled payment system, where Medicare and other insurers pay a lump sum for the patient's treatment, instead of the fee for service that compensates medical professionals on a per-diem basis.

If a surgeon today has to operate on a patient five times because of complications, he or she is paid five times. That will stop under bundled care and should reduce the number of copays.

Medicare has rolled out pilot programs for bundled payments and intends to have it open for all states by 2013.

Arizona is not a pilot state, but Harrington said the center will apply to be a pilot program for its own bundled-payment system in 2012.

Banner wants to be ready to offer high-quality orthopedic care under the new health-care system, Harrington said. That means that all involved practitioners - from nurses to physical therapists -will have to consider the whole patient.

"With health-care reform, the dollars are going to be less and less at our disposal, so we have to be more efficient with our healthcare," Agee said. "We have to worry about putting together this care pathway."

Banner Del E. Webb has the second-highest volume of orthopedics patients in the Valley, just behind Scottsdale Healthcare.

Three orthopedic groups now practice at the hospital. Those in the new center will use the same methods and standards and have a metric system of goals to measure quality.

"To participate in our program, everybody is agreeing to do it the same way," Harrington said. "It is evidence-based practice."

Innovative methods

The CORE Institute opened in Sun City West in 2005 with three doctors. It now has 31 physicians, 19 physician assistants, four therapy centers and seven locations around the Valley. The institute includes 24 companies that research new equipment and treatments. In the future, patients can expect to see robots, radio frequency and Bluetooth technology incorporated into their care.

One of the new innovations piloted at Banner Del E. Webb is Secure Track, a ceiling-mounted support device for patients who have had hip joints replaced. Holding on to the device, they can practice walking without a fear of falling.

Patient Shirley Madkins, a 62-year-old Sun City West resident, said the track system made her feel secure as she walked at a relatively normal gait just one day after surgery.

"It's phenomenal," Madkins said.

Doctors, nurses and other staff will give patients more information about what to expect before they are admitted to surgery and after they leave.

The orthopedics center is growing, adding spinal surgery and the expanding treatment of sports injuries. The department performed 2,000 joint replacements this year, compared with 500 surgeries in 2005.

Jacofsky is excited about health-care reform because the old system was outdated. Standardization of care means that all professionals on a team follow proven protocol.

"We will continue to be national leaders in new technology," Jacofsky said.

Preparing for reform

Moving forward, Medicare will be looking for large practices that tie cost-efficiency with the best patient outcome.

Banner Del E. Webb and CORE administrators spent a year constructing the partnership between the non-profit hospital and the private institute. But they believe it will put them in a good position as health-care reform moves forward, with a management model that can be replicated at other Banner centers.

"The better the value, the more Medicare will want to be aligned with us," Agee said. "That is where we need to be in the future."

Harrington said that high quality and lower costs will help the country create its own style of accessible care.

"I think in the U.S. we will try everything possible to create an efficient system ourselves before national health insurance is forced on us," Harrington said.

Read more: www.azcentral.com

"by Lesley Wright, The Arizona Republic.
May 6, 2011"
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