Joint Replacement Q&A with Dr. Theodore Manson

Theodore Manson, MD is an Orthopaedic Surgeon at the University of Maryland Medical Center and an Associate Professor of Orthopaedics at the University of Maryland School of Medicine.

Dr. Manson specializes in hip and knee replacements and orthopaedic trauma. Below he answers the most common questions about joint replacement.

 

Q. What advances have there been in joint replacements including new technologies, changes in patient-management and rehabilitation?

A. One significant advancement in the last 10 years has been around pain management and early recovery protocols. The goal is to minimize the amount of narcotics patients require after surgery. Today, we manage pain through many different types of medicines in addition to narcotics. There’s been a lot of success recently with joint (intra-articular) injections of anesthetic around the hip or knee joint at the time of surgery. This injection limits the amount of pain patients have when they first wake up from surgery. We know that if you limit that first pain sensation, it helps with the whole pain management process going forward.

Another significant advancement is infection prevention. Patients’ skin is now pre-operatively prepped with the antiseptic and disinfectant chlorhexidine both at home prior to surgery and at the hospital as well. In addition, we optimize patients’ nutrition and health pre-operatively. These two things have drastically cut down on infection rates. We did not use to address patient nutrition. Now, we assess patients’ nutritional status before surgery. If a patient is at a higher risk for nutritional deficiencies – those with chronic illness, diabetes or poor appetite, we then work in conjunction with a nutritionist so their infection rates are lower.

Borrowing from the aviation industry, there have been substantial improvements to patient safety in the hospital postoperatively as well.  Standardized protocols, safety checklists and quality control monitoring have dramatically reduced untoward events in joint replacement patients.

Q. What new innovations in joint replacement surgery (hardware and techniques) are noteworthy and why?

A. There is a lot of marketing material on the internet regarding various joint replacement approaches, minimally invasive surgery, robotic surgery and use of custom hip and knee replacement parts.  It is important to realize that none of these things has been shown to be of any benefit. When considering joint replacement, choose a surgeon who performs a high volume of hip and knee replacement surgeries and who you get along with well on a personal level.

While there haven’t been any substantial innovations with implants in the last five years, we do have long-term data on our current implants and techniques that shows them to be functioning extremely well.

Q. Who should get a joint replacement? What factors should a person consider? How should a potential patient decide?

A. In general, joint replacement is an elective procedure. If the patient is falling due to their hip or knee arthritis, it can be a very dangerous situation, so falls are an indication they should go ahead with a joint replacement. If a person is no longer able to climb stairs, if the hip/knee pain keeps him/her up at night, or if s/he is constantly dependent on an assistive device like a cane, then I think they should strongly consider a joint replacement. For others with less severe symptoms, a joint replacement may still be of great benefit to them, but they should consider surgery when the time is right and shouldn’t feel pressured into a surgical option.

Q. What should a patient expect?

A. Once they have scheduled the surgery, most patients undergo pre-habilitation prior to the joint replacement. Many patients find it useful to go to a preoperative joint class at the hospital where they’re going to have the surgery. This helps to alleviate anxiety about the procedure and educate them on what is to come. For those who are substantially debilitated preoperatively, going to prehab (physical therapy) to strengthen the operative leg is helpful and helps us foresee any challenges that may arise postoperatively.

If you have a body mass index (BMI) of 40 or greater, you should delay joint replacement until you can get below 40. This is because infection rates increase substantially for people who have a BMI of 40 or greater.

Q. Does the type of implant used depend on patient activity and age? How?

A. In the past, different implants were used based on age, but for the vast majority of surgeons we use the same type of implants no matter the age. Occasionally patient with poor bone quality will require different implants, but usually we use the same regardless of age or activity level.

Q. What is the target recovery period and regimen for various categories of patients?

A. Patients see the majority of their improvement six to 12 weeks after surgery. They reach their maximum improvement six to 12 months after hip/knee surgery.

Q. What is the lifespan of replacement joints and do you expect the lifespan to grow longer soon?

A. The lifespan of replacement joints have a 1-percent-per-year failure rate, so with 20 years, you have a 20 percent risk of needing the joint replacement redone. I expect this will grow longer as we get better at preventing infection rates. If you are over 60 years old, the odds are you’ll probably never need to have the joint redone.

Q. Have risk factors (infections, failures, etc.) declined or increased (and for whom)?

A. Risk factors have declined because of more critical evaluation and optimization of risk factors for infection around the time of surgery.

Q. Are revision surgeries more or less common these days and why? Do you expect that to change? How and why?

A. Revision surgeries are more common these days simply because of the number of people who have gotten a joint replacement is increasing, and the number of baby boomers having joint replacement is increasing. I expect the number to continue to go up just because the number of people having a joint replacement is going up.

To make an appointment with Dr. Manson or one of our other orthopaedic specialists, please call 410-448-6400.  For more information on joint replacement or other orthopaedic issues, check out the University of Maryland Orthopaedics’ website.

University of Maryland Ear, Nose & Throat Team Preparing, Fundraising for Annual Volunteer Medical Mission

The University of Maryland Ear, Nose and Throat (ENT) team is gearing up for their next volunteer medical mission trip – and they’re hoping you can help them help more people. The team, led by head and neck surgeons Rodney Taylor, MD and Jeffrey Wolf, MD, has begun fundraising for their March 2017 medical mission to Ho Chi Minh City, Vietnam.

Fiji Team

The ENT Team during last year’s mission trip to Fiji

Every year, the ENT team travels to different under-served parts of the world to provide their services free of charge. The crew is dedicated to providing world-class care to those in need. They pay 100 percent of their own way, including airfare, shipping costs for their equipment and the cost of purchasing additional supplies not available onsite.

This year, the funds raised will also pay for patient transportation. While there is one hospital in Ho Chi Minh City, many Vietnamese citizens living in the rural hills don’t have easy access to health care. In fact, some of them have never even been to a hospital. This year, the ENT team will be covering the funds to get patients from their homes to the hospital to receive the care they need.

In Vietnam, Dr. Taylor says there is a higher rate of cleft lip and cleft palate, so they expect to see a lot of patients suffering from those conditions. The team also is planning to treat many patients with goiters (enlarged thyroid), parotid tumors (in the salivary glands), sinal nasal masses and even some cancers.

“It’s an area where we can make the biggest impact during our time there,” Dr. Taylor said. “We will also get the chance to soak in the culture, and learn valuable lessons from the patients we serve.”

Another huge win for the team, and the patients in turn, is the addition of a pediatric anesthesiologist to this year’s crew. That means the team will able to operate on children needing surgery, not just adults.

The ENT team is working with the Project Vietnam Foundation, a nonprofit humanitarian organization working to create sustainable pediatric health care in Vietnam, while providing free health care and aid to impoverished rural areas across the country.

All of the ENT mission trips are made possible through donations. If you cannot make it to the happy hour, donations are welcome on the Maryland ENT Mission website: http://www.marylandentmissions.org/donate.


­­­­Last year, the team traveled to Fiji for their annual medical mission. They performed 15 surgeries and saw 150 patients before the island was rocked by Cyclone Winston. Learn more here.

Remembering Dr. R Adams Cowley: A Revolutionary & Pioneer of Trauma Medicine


Dr. Cowley in the old CCRU

Dr. Cowley (center) instructing in the old CCRU

Dr. R Adams Cowley passed away 25 years ago today, but his contributions will live on forever in the form of thousands of lives saved.

R Adams Cowley, MD, a cardiothoracic surgeon, was the founder of United States’ first trauma center, University of Maryland R Adams Cowley Shock Trauma Center, and the Maryland EMS System. He revolutionized trauma medicine and is responsible for the development of the “Golden Hour” concept. As Dr. Cowley explained in an interview: “There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.”


Drs. Gens and Cowley

Dr. Cowley (left) with fellow trauma surgeon Dr. Gens in 1983

“R Adams Cowley was a pioneer, a man of immense vision and the father of American trauma care systems,” Dr. Thomas Scalea, Shock Trauma Physician-in-Chief, said. “At a time when we take organized trauma care for granted, it is important to remember that none of this would have happened without him and a few others who refused to take no for an answer. They fought the political and medical battles to demonstrate that organized trauma care saves lives. I am privileged to continue his legacy.”


Open Heart Surgery

A Baltimore Sun photo shows Dr. Cowley performing open-heart surgery on a 2-year-old boy

After many years of research and discussion, in 1958, the Army awarded Dr. Cowley a contract for $100,000 to study shock in people. He developed the first clinical shock trauma unit in the nation; the unit consisted of two beds (later four beds). By 1960, staff was trained and equipment was in place.

In 1968, Dr. Cowley negotiated to have patients brought in by military helicopter to get them to the shock trauma unit more quickly. After much discussion with the Maryland State Police, the first med-evac transport occurred in 1969 after the opening of the five-story, 32-bed Center for the Study of Trauma.

In 1970, Dr. Cowley expanded his dream, feeling that not a single patient should be denied the state-of-the-art treatment available at his trauma center in Baltimore. He envisioned a statewide system of care funded by the state of Maryland available to anyone who needed it.

Airport Drill

Dr. Cowley leads a drill at the airport

His dream became a reality with the intervention of former Governor Marvin Mandel. Governor Mandel became interested in Dr. Cowley’s program when a close friend was severely injured in a car crash. In 1973, the Governor issued an executive order establishing the Center for the Study of Trauma as the Maryland Institute for Emergency Medicine. The order simultaneously created the Division of Emergency Medical Services. Dr. Cowley was appointed as director.

Maryland had the first statewide EMS system, and it, like the Shock Trauma Center, has become a model worldwide. Countless lives have been saved due to Dr. Cowley’s vision.

r-adams-cowley-studentsWe thank you, Dr. Cowley, and will always remember your legacy.

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Taking Treatment & a Half Marathon, Together, One Step at A Time

The relationship between a cancer patient and their care provider is a special one.  Between radiation therapy appointments, hours of chemotherapy, and even sometimes surgery and recovery, there’s not much that can strengthen this bond, besides running a half marathon.

Dana and Tiffani

But Tiffani Tyer, a nurse practitioner in Radiation Oncology at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC), and Dana Deighton’s journey started long before this year’s Maryland Half Marathon & 5K.

About 3 years ago Dana was diagnosed with stage IV esophageal cancer.  At 43 years old with 3 young children, it was, in Dana’s words, “unfathomable.” She traveled up and down the East Coast looking for a treatment plan that would give her the most hope. Many acted like she was naïve and unrealistic for even seeking out treatments beyond palliative chemotherapy.

After much deliberation, Dana settled on a plan of 8 cycles of chemotherapy at one local hospital. During this treatment, a friend introduced Dana to Mohan Suntha, MD, a radiation oncologist at UMGCCC.

Within an hour of getting Dana’s information, Dr. Suntha gave her a call. While he agreed the appropriate preliminary step was chemotherapy, he did not close the door on her like many others.  Dr. Suntha and Dana continued to check in with each other throughout her chemotherapy treatments to see how things were going.

In December 2013, after Dana finished chemotherapy, she learned she would not be considered for radiation or surgery by the hospital where she was initially treated. She was told that the data did not support it. She was devastated. Dana returned to UMGCCC, where Dr. Suntha and Tiffani were always willing to reassess her situation and provide guidance when obstacles seemed insurmountable.  Knowing that every case is different, he agreed to reevaluate her.

tiffani dana and dr sunthaAfter careful consideration and determining that her distant disease had indeed resolved, he offered her local treatment with chemotherapy and radiation targeting the primary site in her esophagus.  While the local treatment helped, the primary site still showed evidence of persistent disease at the end of her treatment.  To try to avoid major thoracic surgery, an endoscopic mucosal resection was attempted, but was unfortunately unsuccessful. Dana was again devastated. She felt like it was just another blow to her journey to health and she was running out of options.

Dr. Suntha and Tiffani encouraged Dana to stay hopeful. They agreed along with many other providers that indeed she was in a difficult position. After many tumor board discussions and repeat imaging studies to confirm her extent of local disease thoracic surgeon Whitney Burrows, MD, was consulted. He discussed surgical salvage to address her only site of cancer.  Albeit risky, with no guarantee of a survival benefit, it was her only remaining local treatment option.  Recognized as a long shot with a real possibility of acute complications related to such a long and complicated surgery, she willingly consented to undergo the esophagectomy. From Dana’s view the benefit far outweighed the risk. She believed in her team and her surgeon, whose expertise is well established in post chemoradiation patients. It proved to be a good choice and offered a huge reward.  Dana recovered well and was cancer free and feeling great–until July 2015.

It was then that a routine interval scan revealed a new lymph node mass in her Axilla (near the armpit) was biopsied and confirmed to be recurrent esophageal cancer.  Dana had resigned herself to more draining rounds of chemotherapy after another surgery could not remove all of the cancer.  But again, Dr. Suntha, Tiffani, and medical oncologist, Dan Zandberg, MD, always made sure all options were presented and considered.

tiffani zandberg and sunthaDana’s case was represented to  their colleagues at a tumor board meeting on the Friday before she was supposed to start chemotherapy.  Drs. Suntha and  Zandberg called her that evening to  recommend  immunotherapy, which harnesses the power of a  patient’s immune system to fight cancer.  After a sleepless night, Dana agreed.   She now receives treatments of Nivolumab every 2 weeks for at least a year.

Dr. Suntha has always recognized that there’s something unusual about Dana’s case, and has often asked, “Is there something different about her biology? We don’t know.”

Dr. Suntha, he also believes that Dana’s strong will and clear ability to advocate for herself has facilitated part of the success of her care.

dana and tiffaniThroughout these three years, Dana describes herself as lucky enough to continue her usual regimen of walking, running, and exercising consistently.  She donated money to the Maryland Half Marathon & 5K to fund cancer research in the past, but feeling much healthier and up to a new challenge, she promised to run it in 2016. She has always ran 10 milers in her hometown of Alexandria, Virginia, but knew those 3 extra miles of hills in the Half Marathon would be challenging.
Despite her reservations, in a partnership with Tiffani, the Radiation Oncology Greene Street Dream Team was born. On May 14th, Tiffani and Dana ran the entire race together (even though, according to Dana, Tiffani could’ve run circles around her).  To date, they’ve raised more than $10,000. They’ve taken every step together in cancer treatment and every step in the half marathon & 5K – a true bond that will continue.

Fundraising for the Maryland Half Marathon and 5K that supports this Radiation Oncology Dream Team and their patients continues until June 30th.

You can donate to Tiffani & Dana’s team here.

Pediatric Residents at Univeristy of Maryland Reach Out and Read

A string of rainy days in Baltimore made Friday the perfect day to stay inside and read a good book. And thanks to the efforts of some hard-working Pediatric Residents at the University of Maryland School of Medicine, more than 200 students in Baltimore City had a new story to read!

Throughout the morning, the pediatricians-to-be visited several schools in the University of Maryland Children’s Hospital community, including James McHenry Elementary-Middle School and Franklin Square Elementary in West Baltimore. They spent time interacting with the students, with the hopes of promoting a healthy attitude toward development and literacy at a young age.

James McHenry students had a special visitor: Baltimore City Council President Jack Young handed out books and spent time reading to four classrooms of Pre-K and Kindergarten students.

The Maryland Book Bank and the Maryland Chapter of the American Academy of Pediatrics donated the 200 books that went home with students.

The day of reading was a part of a nationwide “ROAR: Reach Out and Read” effort, which is a non-profit that works to incorporate books and literacy into pediatric care.

Friday was also designated as a “Call to Action” Day by the American Academy of Pediatrics to F.A.C.E Poverty: promote Food Security, Access to Health Care, Community, and Education.

ENT Surgical Team Annual Volunteer Trip

Annual Volunteer Trip Takes UM Surgical Team to Fiji to Treat Patients with Head and Neck Conditions

Update (2/21/16): This past weekend, Fiji was devastated by Cyclone Winston.  All 12 members of the UM surgical team are OK and awaiting the international flight home.

Our thoughts and prayers go out to the people of Fiji as they struggle to rebuild, and we pray for the families who lost loved ones and whose homes were destroyed.

We are exceptionally proud of the courage and dedication of our mission team. They saw over 100 patients over the course of their stay and completed a large number of surgeries. The actions of these selfless individuals embody many of the reasons that individuals choose medicine as a career and many of the reasons that a number of clinicians volunteer for such medical missions.


University of Maryland head and neck surgeons Rodney Taylor, MD and Jeffrey Wolf, MD have seen first-hand how devastating cancer and other conditions of the head and neck area can be for some patients.  Not only do certain types of conditions undermine their health, but they can also be disfiguring and carry social stigmas.

Dr. Wolf

Dr. Jeffrey Wolf

Dr. Taylor

Dr. Rodney Taylor

“Many times people with head and neck conditions are ostracized from their communities and go into hiding. These conditions can be life-altering,” says Dr. Wolf. He and Dr. Taylor are associate professors of otorhinolaryngology-head and neck surgery at the University of Maryland School of Medicine who treat patients at the University of Maryland Marlene and Stewart Greenebaum Cancer Center.

The doctors are determined to help. Each year, a team of University of Maryland Ear, Nose and Throat (ENT) specialists (led by Drs. Taylor and Wolf) travel to a different under-served part of the world to provide their services free of charge. The team pays 100 percent of their own way, including airfare, shipping costs for their equipment and the cost of purchasing additional supplies not available onsite.

This year, the UM medical mission boasts 12 volunteers – surgeons, anesthesiologists, residents and nurses. This specialized ENT team will travel a total of 29 hours by plane, boat and car to Fiji’s second largest island, Vanua Levu. There they will operate out of the Mission at Natuvu Creek, a nonprofit model community that provides medical and educational services to rural people of Fiji.

This visit will mark the first time Vanua Levu has been visited by ENT, head and neck surgeons, and the team is eager to start helping those in need. They expect to see a lot of patients with disfiguring conditions, such as cancer, and those with goiters (enlarged thyroids) and parotid tumors (on the salivary glands). The team will care for as many patients as they can during their week-long stay in Vanua Levu.

The trek will be long, and the medical team is hopeful the surgeries will be successful.

The team heads to Fiji on February 12.

Donations will help defray the cost of travel and other expenses. Learn more about how to donate here: http://www.marylandentmissions.org/donate

For more information on the Mission at Natuvu Creek, visit their website: http://natuvu.org/

March of Dimes Thanks UMMC During Day of Gratitude

The March of Dimes recognized the University of Maryland Medical Center during their Day of Gratitude, Wednesday, Jan. 6. Staff at the UMMC Neonatal Intensive Care Unit (NICU) received a plaque to commemorate their efforts to support the March of Dimes mission to improve the health of babies.

UMMC is one of 33 Maryland hospitals to earn banner recognition from the March of Dimes as part of its “Healthy Babies are Worth the Wait” campaign, which aims to reduce the number of elective births before a full term of 39 weeks. The March of Dimes partners with the Maryland State Department of Health and Mental Hygiene and the Maryland Patient Safety Center to award banners.

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Left to right: Katie Stover (MoD), Jennifer Tarr (MoD),  Treza James, Joan Treacy, Caroline McGinnis, Danielle Luers, Dr. El-Metwally, Jane Munoz, Dr. Bearer, Sara Bielecki (MoD), Penelope Shields

Thanks to our staff for all you do to keep babies healthy!

Learn more about the NICU at the University of Maryland Children’s Hospital or visit the Maryland March of Dimes website.

 

Double Listing: A Promising Option for Certain Patients

We recently participated in Mediaplanet USA’s “Hepatitis & Liver” campaign where industry professionals and associations came together to draw attention to the importance of liver health, while highlighting hepatitis awareness, testing education, and treatment to erase the stigma and judgments attached to the disease.

Dr. Rolf Barth, director of Liver Transplantation, was featured in an article about the types of patients who typically see results from double listing. He mentions patients with less threatening illnesses, who do not require immediate transplantation, can stand to gain more from a double listing, whereas the sickest patients are already at the top of the list, and do not necessarily benefit.

The campaign was distributed within the centerfold of USA Today and is published on a Mediaplanet original site. You can read the full article here: http://umm.gd/1NON6hs

Governor Larry Hogan Visits the Neonatal Intensive Care Unit

“Heading to my fifth round of five-day, 24-hour chemo this morning at the University of Maryland Medical System in Baltimore. As always thank you to everyone for your prayers and support during this journey!

Before my treatment I took some time to visit the brand-new, world-class Drs. Rouben and Violet Jiji Neonatal Intensive Care Unit at UMMS which officially opened on Tuesday. There I met families with children being treated at the NICU and listened to the stories of Baby Rebecca, Baby Ilyanna, and Baby Javion who are on the road to recovery following bouts with a range of health challenges such as infections, cardiac abnormalities, and abdominal complications. They are carefully cared for, with a balance of compassion and unparalleled clinical excellence!

The work these incredible doctors and nurses at the NICU do is amazing and they are saving lives every day! Please keep these families in your thoughts and prayers!”

-Governor Larry Hogan

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The ‘Seeker’ Gives Through a Living Kidney Donation

Matthew Taylor writes about “living an authentic life in a world of artifice” in his blog, “The Seeker.” This week, he posted a frank and engaging piece about donating one of his kidneys to his wife, who suffered from polycystic kidney disease.  Here’s an excerpt:

“After some soul searching, I decided to give her one of mine. It was not an easy decision to make since there were many factors to consider, but I am at peace with it now. In fact, I’ve come to appreciate some things about a kidney transplant that I never would have thought of before.”

Taylor, a writer who lives in Rockville, Md., gave the University of Maryland Medical Center, where his donation and his wife’s transplant were performed, permission to direct readers to his post,  “25 Ways to Appreciate a Kidney Transplant.”

The University of Maryland Medical Center is home to the second-largest kidney transplant program in the country. The surgeons involved in Taylor’s donation and his wife’s transplant were Michael Phelan, MD; David Leeser, MD; and Stephen Bartlett, MD.