Revision Joint Replacement

Most people who undergo a total knee replacement get back to an active life that is free from the debilitating chronic knee pain. However, in some rare cases, the procedure may fail to yield the expected results. In these types of situations, surgeons recommend a second surgery called a revision knee joint replacement.

The objective of a revision surgery is same as the primary total knee replacement. The technique, though, is more complex because the primary implant will have grown into the bone around the knee and has to be carefully removed. Besides, removal of this prosthesis means some part of the bone is also lost, leaving the surgeon with lesser bone to work on.

Revision knee replacement surgery therefore is a challenging procedure that requires specialized tools and implants along with more detailed planning for the procedure to succeed.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

How Does a Revision Surgery Work?

Revision knee replacement surgery can be of different types. In some patients, the surgeon will revise only one part of the prosthesis; in others, all the three parts – the tibial, femoral, and patellar components have to be replaced along with a rebuilding of the bone around the knee using augments or a bone graft.

If there is significant damage to the bone, the standard knee implants cannot be used for a revision surgery. In cases such as this, the surgeon will use special implants that come with a thicker and longer stem that can fit deeper into the bone to give extra stability and support.

Procedure of Revision Knee Replacement

Revision knee replacement surgery is a very challenging and complex process and may take about 2 to 3 hours time to complete.

The surgeon will first make an incision along the older incision from the primary total knee replacement surgery. The new incision may extend farther in order to allow removal of the old components.

The surgeon then moves in to place the tendons and kneecap aside and reveals the knee joint. They will look for signs of infection in the soft tissues around the knee, and also examine the plastic and metal parts of the prosthesis to check which part has grown loose or worn out or moved out of its intended position.

Any cement that was used in the primary surgery is removed and retaining as much bone as possible, the surgeon will remove the original implant. Next, they will prepare the bone surface to receive the revision implant. Any deficit in the bone around the knee is made up using platform blocks and augments.

In some rare cases, bone grafts may be required to rebuild the knee, and they may be sourced from your own bone or from some donor. Once the bone is adequately prepared, the surgeon inserts the revision implant and any damage to the surrounding soft tissue is repaired before carefully testing the new joint’s movement.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Back Pain Treatment

The spinal column is among the most important and complex systems in the human body. It is the body’s primary support structure and comprises of 33 different bones or vertebrae. These together make up the spinal column and can be divided into cervical, thoracic, lumbar, sacral, and coccygeal.

An intricate knowledge of several different disciplines is required for the medical treatment of spine related diseases and injuries. Most spinal treatment providers focus on pain management, prevention, and function restoration. They are also dedicated to controlling costs for developing back pain treatments.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Spinal Pain and Epidural Injections

Epidural spinal injections contain steroids, which is directly injected around the nerve root sac, called the dura. This sac contains the cerebrospinal fluid. The injection helps in reducing inflammation that accompanies most spinal issues, like disc herniation, spinal stenosis, and degenerative disc disease.

Inflammatory proteins are flushed out from the spinal structure, that may have been causing pain. Epidural injections go a long way in relieving lower back pain in almost 50% patients. They are beneficial in allowing patients to manage pain in a better way and move towards rehabilitation.

Understanding Minimally Invasive Options for Spinal Surgery

Minimally invasive spinal surgery can help if your chronic back pain doesn’t respond to noninvasive treatments. The procedure is unlike open spine surgery. It combines state of the art technological advances to reduce the incision size and downtime.

More than one spinal condition responds in a positive way to minimally invasive spinal procedure. There are fewer risks associated with the procedure as compared to open spine surgeries.

Understanding Artificial Disc Replacement or ADR

ADR or Artificial Disc Replacement is an alternative option for lower back pain. It is used mainly instead of lumbar fusion since it helps in preserving the normal functioning of the spine. The results of the surgery can vary significantly. Artificial or synthetic disc is used in place of the damaged or worn disc material between the vertebrae.

The procedure is designed to help with chronic back pain while regulating normal motion of the spine. ADR has been performed in the United States with successful results since 2004. There is a 89-97% chance of excellent results in ADR surgery.

Should You Get a Back Surgery?

Back pain is a common occurrence and everybody faces it at some point or the other. However, surgery is not required for every back issue. Your physician should understand the extent of your pain issues and take a call whether surgery is required or not.

Back pain can pass away on its own with rest within a few weeks or months. However, you should still consult a doctor to understand the extent of damage. It is usually better to explore all conservative and non-invasive treatment options before going ahead with surgery.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Fracture Treatment

Fracture of the scapula or shoulder blade is common in vehicle collisions and accidents that involve falling from a height. While most such fractures can be treated by non-surgical methods such as the use of a sling and ice and pain medications, surgery may be required in a few rare cases of severe damage.

The scapula is surrounded by a protective covering of several muscles. An injury that fractures this bone is often likely to damage to other adjoining parts such as the collarbone, head, ribs, spinal cord, and lungs.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Symptoms of Scapular Fracture

Half of the patients who present with a scapula fracture come in with a fracture of the main body of the shoulder bone. About one-fourth of patients show fracture of the neck of the scapula. The common symptoms of a scapular fracture include:

• Severe pain when you attempt to move the arm
• Swelling in the area behind the shoulder
• Scrapes around the damaged area

Once you notice the symptoms of a shoulder blade fracture, it is vital you seek treatment at the earliest to ensure the damage does not increase.

Non-Surgical Modes of Treatment

The most commonly used non-surgical treatment for scapular fracture is a simple sling. This helps to hold the shoulder in place while the bones heal. Within one week, the doctor will advise you to begin mild shoulder movements to avoid stiffness of the shoulder and the elbow.

After you find a reduction in the pain, the surgeon will ask you to remove the sling and start performing passive stretching exercises. Either the surgeon or a physical therapist will guide you with the exercise which you must continue for about six months to one year until your shoulder regains its full range of motion.

Surgery for Scapula Fracture

Scapula fractures that are more complex will require surgery for treatment. Some cases when this is recommended are:

• Scapular neck fracture accompanied by noticeable angulation
• Glenoid articular surface fracture with bone displacement
• Fracture that affects the acromion process, resulting in impingement syndrome

In a scapular surgery, the surgeon first aligns the fragments of the bone into the correct position. Using metal plates and special screws, they attach the fragments together and to the outer surface of the bone. After a period of rehabilitation, the shoulder will regain its normal function.

Pain Management in Scapular Fracture

Scapular fractures cause a significant amount of pain and your surgeon will prescribe pain medications to deal with it. Most doctors advise the use of a combination of NSAIDs, opioids and local anesthetics to combat the pain. This combination helps reduce the dose of the opioids which must be used strictly according to the doctor’s instructions.

To avoid chances of an overdose or dependency, your surgeon will stop your opioid medication after your pain abates. Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada.

Rotator Cuff Repair

Rotator cuff tear may manifest itself due to normal wear and tear of the shoulder tendon with age, or it may be caused by an acute injury. Conservative treatment of this condition includes the use of rest, ice, and physical therapy to facilitate healing.

The type of tear, its size, and the activity level of the patient are factors that determine whether this kind of non-surgical treatment modes will be effective in relieving the symptoms.

When conservative therapy does not yield the desired results, surgeons recommend a surgical procedure called rotator cuff repair. This surgery may be performed using three different techniques: conventional open repair, mini open repair, and arthroscopic repair.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Conventional Open Rotator Cuff Repair

In this form of surgery, the surgeon makes an incision that is about 6 cm to 10 cm long. This allows a clear view of the torn tendon and the surgeon works through this incision to repair the damaged tendon and reattach it to the bone.

Many surgeons consider this to be the most effective of techniques for rotator cuff repair. While the surgery itself is straightforward, the large size of the incision may make the recovery period more painful and longer.

Mini-Open Repair

This technique is a combination of an arthroscopic repair with an open repair but with a smaller sized incision. First, the surgeon uses an arthroscope to view the damaged shoulder and remove damaged tissue or bone spurs.

After this, they place a small incision that is about 3 cm long and through this, they reattach the tendon to the bone. Recovery is more rapid and less painful as compared to an open cuff repair because the incision here is smaller in length.

Arthroscopic Rotator Cuff Repair

In an arthroscopic repair, the surgeon makes tiny incisions to insert the arthroscope which streams images of the affected tendon through a small camera onto a TV screen. By viewing these pictures, the surgeon can perform the appropriate repair through the arthroscope.

This is a more recent technique and damage to the deltoid muscle during surgery is very minor compared to the other two techniques. However, arthroscopic repair is not useful in all types of tears and also, it involves a greater technical challenge that all surgeons may not be equipped to manage.

Shoulder Replacement Surgery

In patients who have significant rotator cuff tears for several years without receiving any treatment, the cartilage of the shoulder joint eventually wears out. These types of tears which usually involve at least two of the four tendons, are called massive rotator cuff tears.

This condition may be treated using special implants. In an innovative technique called a reverse shoulder arthroscopy, the surgeon installs an artificial ball and socket joint in such a way that the ball portion is positioned on the shoulder blade while the socket part is fitted onto the arm bone.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Arthroscopy

Arthroscopy is an advanced, minimally invasive technique used to perform surgery of the joints such as the hip, knee, and shoulder. The orthopedic surgeon examines and treats the damage in such areas using an instrument called an arthroscope.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Shoulder Arthroscopy

The shoulder is an area that may undergo significant damage as a result of wear and tear due to age, injury or overuse. Shoulder arthroscopy is used to treatment different conditions that cause pain and damage of the articular cartilage, the labrum and rotator cuff tendons. This technique is also used to treat conditions affecting the soft tissues around the shoulder joint.

Some of the usual shoulder arthroscopic procedures are:

• Removal of bone spurs, loose cartilage, or inflamed tissue
• Repair or removal of the labrum
• Repair of ligaments, rotator cuff, and recurring shoulder dislocation

Other, less common uses of arthroscopy are:

• Nerve release
• Excision of cysts
• Fracture repair

Shoulder replacement, however, cannot be performed using arthroscopy.

Shoulder Arthroscopy Procedure

The first step is injection of a fluid into the shoulder in order to inflate the joint. Next, the surgeon makes a tiny, buttonhole-sized incision in the shoulder through which they insert the arthroscope. The inflation caused by the injection makes it easier for the surgeon to view the structures in the area with greater clarity through the arthroscope.

A continuous flow of fluid through the arthroscope ensures a clear view and also helps in control of any bleeding that may occur. The arthroscope images get projected on a video screen and the surgeon is able to view the actual condition of the patient’s shoulder.

Knee Arthroscopy

Knee arthroscopy is used to deal with conditions that cause damage of the cartilage and other soft tissues around the knee joint. These include:

• Removal of loose cartilage or bone fragments or inflamed synovial tissue
• Repair or removal of a torn meniscus
• Reconstruction of damaged anterior cruciate ligament
• Treatment of patella (kneecap) problem and knee sepsis (infection)
• Articular cartilage trimming

Knee Arthroscopy Procedure

The surgeon inserts the arthroscope into the knee joint and it begins to relay the images from there through a video monitor. Using this view, the surgeon guides miniature surgical instruments to the area to carry out the necessary treatment. As the tools and arthrosocope too are very thin, only a tiny incision has to be made. This is beneficial because patients experience less pain and joint stiffness and recover faster from the procedure.

Hip Arthroscopy

Hip arthroscopy uses the arthroscope to view and perform surgery for damage of the hip joint. It precludes the need for major incisions as in conventional hip surgery. Using the view projected by the arthroscope on a video monitor, the surgeon uses tiny surgical tools to perform the surgery in a minimally invasive manner.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada.