Total joint replacement can help relieve pain in your joints and enable you to live a more active life or complete activities of daily living. Generally, it is done after conservative treatment options, such as medications, injections, and physical therapy have not helped.
If joint replacement surgery is the best solution for you, the St. Charles Center’s orthopedic surgeons and support staff are ready to help you prepare for surgery and plan for a successful recovery. We offer the latest technology, including robotic-assisted surgery and outpatient total joint replacement.
Reverse total shoulder replacement is recommended for people who do not have a functioning rotator cuff. For these individuals, an anatomical total shoulder replacement can still leave them with pain and the inability to lift one’s arm past 90 degrees.
The design of this surgery is very innovative. As the name implies, the shoulder prosthesis does not recreate normal anatomy, instead the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. Patients receiving a reverse total shoulder replacement have a functioning deltoid muscle, which is the large muscle on the side of the shoulder, and a non-functioning rotator cuff, usually due to a large irreparable rotator cuff tendon tear. This procedure greatly improves the function of the shoulder by absorbing the some of the role of the absent rotator cuff. The prosthesis provides a stable and constant center of rotation, allowing the deltoid muscle to elevate the arm.
While this procedure does not make your shoulder normal, it does improve the function and reduces or eliminates shoulder pain. The prosthesis is non-atomic, but patients can expect to use the shoulder for light activities such as hunting, fishing, playing golf, riding horses, and doing lightweight training exercises in the gym. Most patients are able to drive within three weeks of surgery.
Once you and your orthopedic surgeon have decided to undergo surgery to reconstruct the anterior cruciate ligament (ACL) in your knee, you will need to choose which replacement graft to use. The torn ligament will not repair itself, nor can it be sewn together successfully. It must be replaced with a new tissue that will develop into a ligament over time. Choosing which graft is appropriate is not always an easy decision. There are pros and cons to each alternative. Your choices include your own tissue (autograft) or cadaveric tissue (allograft).
Autographs
The patellar tendon and hamstring autografts are the most common choices for ACL reconstruction. The patellar tendon runs from the knee cap (patella) to the lower leg bone (tibia). Surgeons have the most experience with this autograft and it is the most widely used. A vertical incision is made from the bottom of the patella to the top of the tibia. The middle third of the tendon is then cut, as well as the bony portions from the patella and tibia. The final autograft is made from the partial tendon and bones on either end. The bone on both sides allows for quicker healing of the graft.
Benefits
Orthopedic surgeons have the most experience with this procedure
Strongest graft concerning initial fixation
Quicker return to full athletic participation, typically 5-6 months
Risks
Increased chance of pain or discomfort while kneeling
More painful due to harvesting the tendon and bone portions
There is an extra incision where the graft is harvested
Increased risk for patellar fracture
Increased risk for patellar tendonitis
Although called the hamstring autograft, the tendons associated with this graft are not technically part of the hamstring. The semitendinosis tendon and the gracilis tendon are removed from a small incision just below and near the inside of the knee. This autograft has no bony portions and uses two tendons.
Benefits
Least amount of post-operative pain
Easier rehabilitation in regards to quadriceps activation
Quicker return to activities of daily living
No extra incision is required. The same incision is used to place the fixation hardware.
Risks
The fixation is not as strong initially. Caution is advised with rehabilitation.
Some hamstring weakness may be noted
Return to full athletic participation is slower, 6-7 months
There is no hamstring activation for at least four weeks to allow the harvest site to heal
Increased risk for hamstring strain/tenderness
Allografts
Allografts provide another option for ACL reconstruction. The tissue is harvested from a cadaver, so there are no complications from taking the tissue from your own body. The most common choices are Achilles tendond, quadriceps, anterior tibialis tendon, and patellar tendon. The decision on which allograft option to use is based on what is available and surgeon preference. Overall, the grafts are just as strong if you follow the specific rehabilitation protocol. Although donors are screened for communicable diseases, there is a risk of disease transmission associated with using graft tissue from a cadaver. There is a potential for viral transmission such as hepatitis or HIV.
Benefits
No pain or complications from harvesting the tissue
Fastest return to activities of daily living
Smaller incision on the medial tibia
Risks
Potential risk of viral transmission (chance of HIV transmission is 1 in 1.8 million)
Return to full athletic activities is generally 6-7 months
Higher re-tear rate in younger competitive athletes
Choosing which graft to use for ACL reconstruction is highly individualized for each patient. Discuss your lifestyle and the risks and benefits with your orthopedic surgeon to determine the best course of action to reach your goals.
Plantar fasciitis is the most common cause of foot pain, radiating from the bottom of the heel throughout the foot. The plantar fascia is the strong band of tissue in the arch of your foot, which runs from your heel to toe and absorbs strains and stress placed on the foot each time it is in use. Plantar fasciitis occurs when that supporting tissue becomes irritated and inflamed. Signs of plantar fasciitis include heel pain, pain with first initial steps after rest, and pain with extended exercise.
About 90% of plantar fasciitis cases heal successfully with conservative treatment options, but the longer it goes unaddressed, the longer it will take to heal and more complications can arise.
Symptoms of plantar fasciitis
The symptoms of plantar fasciitis typically develop gradually over time and may include sharp or stabbing pain in the heel, especially with the first steps in the morning or after prolonged periods of sitting or standing. The pain may also worsen after physical activity. The bottom of the foot may feel tender or inflamed, and the arch of the foot may feel tight or stiff.
In some cases, swelling may be present in the heel or arch. The pain and discomfort associated with plantar fasciitis can interfere with daily activities and make it difficult to exercise or walk for extended periods of time. It is important to seek medical attention if symptoms persist or worsen over time. Early treatment can help reduce pain and prevent further damage to the plantar fascia.
Risks of untreated plantar fasciitis
Plantar ruptures: Plantar ruptures can happen if plantar fasciitis is not addressed and you continue to place heavy impacts on the plantar fascia. These activities include running, sports, or even standing for long periods of time.
You likely have ruptured your plantar fascia if you hear a loud popping noise followed by intense pain, bruising, and swelling in the foot. If you believe you have ruptured your plantar fascia, seek medical help immediately. You may be required to wear a boot or use crutches for a period of time.
Plantar tears: When plantar fasciitis is left untreated, the plantar fascia can become inflamed and cause small micro tears. Many don’t notice these small tears as they arise until the pain becomes gradually worse. If left untreated, these tears can grow in size and numbers, causing further complications.
Heel Spurs: Heel spurs are a common response to plantar fasciitis left untreated. In order to protect the arch of your foot from damage, your body generates calcium. Over time, these calcium deposits create sharp protrusions that push against the fatty part of the heel causing pain with each step. Heel spurs can often be avoided if treated early.
Plantar Fibromatosis: Plantar Fibromatosis is a condition where benign nodules grow slowly along the plantar fascia. These often are undetected in the early stages until they suddenly begin to grow more rapidly. Over time as the nodules continue to grow, walking may become painful and uncomfortable.
If you’re suffering from plantar fasciitis pain visit one of our foot and ankle specialists for treatment.
Treatments for plantar fasciitis
The treatment for plantar fasciitis is aimed at reducing heel pain, inflammation, and improving the flexibility of the plantar fascia. The treatment options for plantar fasciitis may include rest, ice, compression, and elevation (RICE) therapy to reduce swelling and pain. Over-the-counter pain medications such as acetaminophen or ibuprofen may also provide relief.
Stretching exercises and physical therapy helps to improve flexibility and strength in the plantar fascia and surrounding muscles. Orthotic shoe inserts or heel cups may be recommended to provide additional support and cushioning for the foot. Surgery is typically a last resort and is only considered in severe cases that do not respond to other treatments. It is important to seek medical attention from a foot and ankle specialist early to receive a proper diagnosis and develop an appropriate treatment plan that addresses the patient’s specific needs.
In this quick video, foot and ankle specialist, Dr. Anthony Hinz, explains his treatment for plantar fasciitis
Body
What is a neurosurgeon?
Neurosurgeons or neurological surgeons specialize in the treatment of medical problems affecting the brain, spine, neck, back and central nervous system. These conditions can include stroke, brain injuries, spinal cord injuries, aneurysms and diseases of the brain and spine. With the region’s only pediatric neurosurgeon, the St. Charles Center for Orthopedics & Neurosurgery is also committed to caring for all types of pediatric brain and nervous system conditions.
St. Charles' board-certified neurosurgeons practice a conservative approach, using a wide variety of non-operative treatment options. When surgery is necessary it is performed in the least invasive way to shorten recovery times and reduce pain. Using state-of-the-art diagnostic tools, they develop and implement care plans that are as individualized as the patients being treated. Our neurosurgeons are committed to getting patients better and back to doing what they love.
Body
Orthopedic Surgery
Orthopedic surgery is a medical specialty that deals with the treatment of injuries, diseases, and disorders of the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. The St. Charles Center is dedicated to providing the highest quality of care to its patients and is staffed by experienced and highly skilled orthopedic surgeons who are committed to achieving the best possible outcome for each patient.
The St. Charles Center for Orthopedics & Neurosurgery is the premiere location in Central and Eastern Oregon for orthopedic injuries and conditions. With offices in Bend, Redmond, Prineville, La Pine, Madras, Sisters, Burns and John Day, the St. Charles Center offers a full range of orthopedic services, including both surgical and non-surgical options. From diagnosing and treating common conditions such as osteoarthritis, sports injuries, and fractures, to performing complex joint replacements and hand surgeries, the Center’s team of experts are equipped to handle all types of orthopedic needs.
In addition to a five-year residency after medical school, each of our orthopedic surgeons are board certified and completed additional fellowship training in their respective areas of subspecialty such as foot and ankle, hand and upper extremity, shoulder, knee, minimally invasive joint replacements, arthroscopic surgery, pediatric orthopedics, and sports medicine. In addition, many of our surgeons have completed additional board certifications or participate in ongoing research and clinical trials.
At the St. Charles Center, our orthopedic surgeons are committed to getting patients better and back to doing what they love.
For patients with osteoarthritis or that have experienced trauma to their hip, a total hip replacement can restore function and decrease pain. This is done by replacing the damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip joint. The most commonly utilized total hip replacement is the posterior approach (through the back of the hip), which has been performed successfully for decades. The anterior approach (through the front of the hip) has been utilized as long as the posterior approach but its popularity has grown in the US over the past 10-15 years.
If you are considering a total hip replacement, this guide will help compare the two approaches and give you information to discuss with your surgeon. There are risks and benefits to each type of approach. In addition, be prepared to ask your surgeon about their experience, complications, and overall outcomes. Orthopedic surgeon, Dr. Connor King, explains the differences between these two approaches in the video below.
Hip Replacement Surgery
Posterior approach
Posterior hip replacement, the traditional approach to hip replacement surgery, involves accessing the hip joint from the back of the body. Surgeons perform this approach by cutting through muscles and tendons to reach the hip joint. Despite its longer recovery period, posterior hip replacement remains a reliable technique, particularly for patients with complex hip conditions or prior hip surgeries.
The majority of patients are a candidate for this type of surgery.
The patient is positioned on his or her side during surgery.
The surgeon makes a 4-6 inch incision just behind the hip, along the buttock area.
The surgery takes 60-70 minutes.
It is the most common approach and provides the greatest patient safety.
Anterior approach
Anterior hip replacement involves accessing the hip joint from the front of the body. Surgeons perform this approach through a smaller incision and by carefully navigating between muscles and tendons. This muscle-sparing technique aims to minimize damage to surrounding tissues, potentially leading to faster recovery and improved early stability of the hip joint.
Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy.
The patient is positioned on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery.
The surgeon makes a 4-6 inch incision on the upper thigh.
The surgery takes 90-100 minutes.
This is a technically challenging procedure. Patients should find a surgeon very experienced in this approach.
Intraoperative visualization and precision
Both anterior and posterior hip replacements can be performed using various techniques and surgical approaches. Surgeons may utilize minimally invasive techniques, computer-assisted navigation, or robotic assistance to enhance precision and outcomes. The choice of technique depends on factors such as the patient’s anatomy, the surgeon’s experience, and the availability of technology in the operating room.
Posterior approach
Technique allows the surgeon full visualization if the hip cup and femur.
No intraoperative x-rays needed.
Very low risk of fracture due to easier exposure.
When performed with the Mako Robotic-Arm there is a high-degree of precision of implant placement to recreate the patient’s natural anatomy.
Anterior approach
Technique allows excellent visual exposure of hip cup, but challenging exposure of femur requiring muscle and capsule release.
Higher risk of femur fracture due to more difficult exposure.
Intraoperative x-rays are often used to confirm placement of the implant due to less visual exposure.
Muscle preservation
One of the distinguishing features of the anterior approach is its emphasis on muscle preservation. By accessing the hip joint through natural muscle intervals, surgeons can minimize damage to surrounding tissues, potentially leading to faster recovery and improved function. In contrast, posterior hip replacements typically require cutting through muscles and tendons, which can result in longer recovery times and temporary weakness.
Posterior approach
The main incision goes through the gluteus maximus and will heal without repair.
Muscles that are used to externally rotate the hip are detached during the procedure and later reattached to bone and will heal without complication.
Anterior approach
This procedure is not entirely muscle sparing. Due to risk of nerve damage, the incision enters the compartment of the tensor fascia latae muscle to expose the hip safely.
The indirect head of the rectus femoris is released to allow entry into hip.
External rotator muscles are cut and are not reattached during this approach.
Most surgeons cut and do not repair the joint capsule.
Nerve damage
Nerve damage is a potential complication of both anterior and posterior hip replacements, although the risk may vary depending on the surgical approach. In anterior hip replacements, the femoral nerve is at risk due to its proximity to the surgical site. Surgeons must exercise caution to avoid damaging the nerve, which can lead to weakness or numbness in the leg.
In posterior hip replacements, the risk of nerve damage is generally lower, as nerves are less exposed during surgery. However, damage to the sciatic nerve, which runs close to the hip joint, is still possible and can result in pain, weakness, or sensory changes in the leg.
Posterior approach
Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery.
Anterior approach
Higher risk of injury to the lateral femoral cutaneous nerve, which may cause numbness in the outer thigh.
Precautions
Patients undergoing anterior or posterior hip replacement surgery must follow specific precautions to optimize their outcomes and minimize complications.
Posterior approach
Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement.
Discuss with your surgeon – some do not have post-operative precautions with this procedure.
Anterior approach
Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement.
Dislocations are usually anterior and can occur with external rotation of the leg during any activity.
Post-operative experience
After hip replacement surgery, the majority of our procedures are conducted on an outpatient basis, primarily at Bend Surgery Center and Cascade Surgicenter, unless patients are deemed unfit for ambulatory surgery. In some cases, joint replacement surgeries performed at St. Charles also facilitate same-day discharge whenever possible.
Patients will gradually increase their activity levels under the guidance of a healthcare professional, starting with gentle exercises and progressing to more strenuous activities as tolerated. Regular follow-up appointments with the surgeon will monitor the healing process and address any concerns or complications that may arise.
Posterior approach
At the St. Charles Center for Orthopedics & Neurosurgery, this procedure is most often performed in an outpatient setting (returning home the same day) at Cascade Surgicenter or Bend Surgery Center.
Postoperative complications are the same for both approaches, including risk to structures, blood clots, infection, death, anesthesia risks.
The medical equipment required for recovery for both approaches is the same. You may need a front-wheeled walker, cane, leg lifter, grab bars and an elevated toilet seat.
Anterior approach
This procedure is also most often performed at an outpatient surgery center such as Cascade Surgicenter and Bend Surgery Center.
Postoperative complications are the same for both approaches, including risk to structures, blood clots, infection, death, and anesthesia risks.
The medical equipment required for recovery for both approaches is the same. You may need a front-wheeled walker, cane, leg lifter, grab bars and an elevated toilet seat.
What is the difference between inpatient and outpatient surgery?
Orthopedic surgeon specializing in total hip replacements, Dr. James Hall, talks about the benefits and risks of outpatient total joint replacement in this video.
Return to activity
The timeline for returning to activity following hip replacement surgery varies depending on the surgical approach, the patient’s overall health, and the presence of any complications. In general, patients undergoing anterior hip replacement may experience a faster recovery and earlier return to normal activities due to the muscle-sparing nature of the procedure.
Patients undergoing posterior hip replacement may have a longer recovery period, as they may need more time to regain strength and mobility after the surgery. However, with diligent rehabilitation and adherence to postoperative precautions, most patients can expect to resume their favorite activities within a few months of surgery.
Posterior approach
Sedentary work – 2 weeks
Light activity (walking, stationary bike, etc.) – 6 weeks
Physical Work – 6-16 weeks
Sports – 3 months
Anterior approach
Sedentary work – 2 weeks
Light activity (walking, stationary bike, etc.) – 4-6 weeks
Physical Work – 6-16 weeks
Sports – 3 months
Typically discontinue the use of walking device 1-3 weeks sooner than posterior approach.
Anterior and posterior hip replacements are two commonly performed surgical approaches for treating hip arthritis and injuries. Each approach has its own set of benefits and considerations, and the choice between them should be made in consultation with a qualified orthopedic surgeon.
By understanding the differences between anterior and posterior hip replacements, patients can make informed decisions about their treatment options and work towards an improved quality of life.
We’ve put together a free guide to help you better understand joint replacement preparation, orthopedic surgery, and recovery. If joint replacement surgery is the best solution for you, the St. Charles Center’s orthopedic surgeons and support staff are ready to help you prepare for surgery and plan for a successful recovery.
Grand Rounds - January 10, 2025 "Human Trafficking: Hiding in Plain Sight"
Speaker: Kara S. Huls, MD. Pediatric Emergency Medicine, Child Abuse Pediatrics; Medical Director, Pediatric SANE; Medical Director, Sunrise Program, University of Alabama School of Medicine.
Objectives
Define sex trafficking, or commercial sexual exploitation, as described by US federal law.
Recognize at least 3 risk factors or possible indicators of trafficking.
Describe the potential role of non-provider staff members in identifying trafficking victims.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
Are you experiencing Anterior Tibialis Tendonitis?
Deep achy pain on the inner front of the ankle?
Loss of motion at the ankle?
Ankle weakness?
Swelling on the inner front of the ankle?
Increased pain in your ankle with increased activity?
These symptoms can be a result of Anterior Tibialis Tendonitis. A condition not very well known, but one that can have lasting affects if not properly diagnosed and treated.
The muscle that runs down the front of your shin is called the Tibialis Anterior muscle. This muscle works together with your Anterior Tibial tendon, located on the inner-front of the ankle to help your foot flex upward. This muscle and tendon rely on one another for proper foot and ankle function. When the muscle and tendon stop working together because of overuse or a traumatic ankle injury, Anterior Tibialis Tendonitis may occur.
Another condition that can occur in the ankle is Drop Foot. Drop Foot, also known as Foot Drop, can be caused when the Anterior Tibialis muscle and tendon stop working all together. Those with this condition experience difficulty lifting the front part of their foot, or their foot and toes drag on the floor when they walk. In most cases, this condition is treatable by addressing the underlying medical condition causing it.
In this short video, Dr. Anthony Hinz, orthopedic surgeon at the St. Charles Center, goes further into explaining the cooperative relationship between the Tibialis Anterior muscle and tendon.
St. Charles Health System is announcing today plans to open a pilot community pharmacy in Madras in late spring of 2025, helping to fill a critical health need and improving access to prescription medication for the region. Many community organizations came together to open this new pharmacy through funding and support, including Central Oregon Health Council, which provided $460,000 in funding for the project. The new pharmacy will be located at the site of the former Hometown Drug, near downtown Madras and only three blocks from St. Charles Madras.
“Recent pharmacy closures mean Madras has just two pharmacies and they are overwhelmed. Patients are driving outside of the area for services or sometimes going without their needed medications because getting them filled is too challenging,” said Michael Powell, chief pharmacy officer for St. Charles. “We know that when people don’t have access to necessary medications it increases their risk for hospitalizations and other poor health outcomes.”
“Our Mosaic Pharmacy in Madras has been at capacity every day since we opened a few years ago, and we’ve understood for a long time that there is a real need for additional pharmacy services in Jefferson County,” said Megan Haase, FNP and CEO of Mosaic Community Health. “We don’t have the space to expand our current pharmacy to meet the needs of the community and are fully in support of this new partnership to increase access to pharmacy services in Madras. We believe that this project will help lead to better health for all residents of Jefferson County.”
Powell anticipates demand for services at the new pharmacy will be high. Records show that the former Hometown Drug location was filling 10,000 prescriptions per month when it closed.
“We are thrilled to buck the trend and open a new community pharmacy to help provide needed access to our community,” said Dr. Leo Savage, a primary care doctor at St. Charles Madras Family Care who has worked as a physician in the community for 25 years. “Every day I talk with patients who are scrambling to get their prescriptions filled or even going without. This development will have an overwhelmingly positive impact on the lives of our patients.”
Once opened, the pharmacy will fill prescriptions (in store and via a drive-up window) and provide immunizations, medication management, injections for long-term care needs and retail sales for over-the-counter medicine and durable medical equipment (like crutches or walkers).
“I am thrilled St. Charles and our local partners are able to bring this vital service to the communities of Madras, Warm Springs, Culver, Metolius and beyond,” said Todd Shields, Vice President and Hospital Administrator for the Madras and Prineville hospitals. “Together we are helping improve the health of Central Oregonians.”
