Category: Orthopedics

  • Health and Care of Bones Across the Lifespan Part 2: Are there any good habits for the care of bones?

    Last week, I discussed what bone is and why calcium matters. For my final installment in this series, I shed light on exercise, calcium and vitamin D daily recommendations, and DEXA scans.

    Exercise is important

    My mantra is “exercise is medicine.” In fact, the stress associated with exercise plays a key role in keeping our bones in shape. Exercise positively influences bone density by augmenting mineral deposits, which fights osteoporosis.

    The American College of Sports Medicine suggests 10 to 20 minutes of weight-bearing exercises twice daily, 3 to 5 days per week. Some good activities include walking, jogging, stepping, jumping rope, or stair climbing. Resistance exercises performed with manageable weights are likewise favorable. A good exercise plan keeps us agile, which in turn makes us less susceptible to falls and fractures.

    Calcium and Vitamin D

    To further promote the care of bones, the National Osteoporosis Foundation recommends a daily level of 1,000 milligrams (mg) of calcium for women age 50 or younger as well as for men age 70 or younger. However, a daily amount of 1,200 mg is recommended for women older than age 50 and for men older than age 70.

    Note that women are encouraged to increase their calcium intake at a younger age than men because estrogen levels drop during menopause. Estrogen is considered a fairly strong osteoprotective hormone. It inhibits osteoclasts from outpacing osteoblasts in the normal cycle of bony remodeling. However, too little levels of testosterone in men can end up being anti-osteoprotective, and therefore lead to bone loss.

    As for sufficient amounts of vitamin D, 400 to 800 international units (IU) are needed per day for adults age 50 and younger. At 51 years of age, 800 to 1,000 IU per day are recommended. The best source of vitamin D comes from direct conversion in the body due to sunlight exposure. However, both fish and eggs offer their own unique sources of this vitamin. And while all dairy foods contain calcium, the Food and Drug Administration ensures that fluid milk (and breakfast cereals) are vitamin D fortified.

    DEXA Scanning

    The gold standard for testing bone density is DEXA scanning. This test is simple to conduct using a special x-ray machine, as well as comfortable and extremely safe for individuals to undergo. DEXA stands for dual energy x-ray absorption. Although an initial scan evaluates the likelihood for developing osteoporosis, scans repeated every two years will assess steps taken to improve your bone density. If necessary, adjustments in your overall approach can always be made. Knowledge is a powerful motivator.

    The National Osteoporosis Foundation recommends DEXA scans for women who are age 65 or older, men who are age 70 or older, and for men or women if a bone is broken after age 50. In addition, DEXA scans are specifically warranted if a bone break or a bone loss, or both, is mentioned after a regular x-ray of your spine. Finally, results from DEXA testing are useful if you lose 1 inch of height within 1 year or 1.5 inches of your maximal height during your lifetime.

    With a physician referral, a radiology technologist from Imaging Services at Fisher-Titus Medical Center will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss.

    About Kevin

    Kevin Wininger is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. With an appropriate physician referral, a radiology technologist in Fisher-Titus’ Imaging Services will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss.

  • Health and Care of Bones Across the Lifespan Part 1: What is Bone? Is Calcium Important?

    Bones protect our organs and offer pivotal support for our muscles. Two types of bony tissues make up our skeletons. The first tissue type is called cortical bony tissue, which is strong and dense. The second type is trabecular bony tissue, which is flexible and much less dense. It is this unique pairing which gives each bone its strong, lightweight nature. In fact, I never grow tired of people’s reactions after they learn that ounce for ounce, bone is stronger than steel. What is more, our bones remodel at a fairly rapid pace. Every 10 years we acquire an entirely new skeleton. The cells carrying out this process are called osteoblasts and osteoclasts.

    Bone remodeling and growth

    Although osteoblasts lay out new bone matrix, it is osteoclasts that either remove old bone or perform maintenance for new bone growth. Repair of a fractured humerus – the long bone of the upper arm – is a good example.

    First, osteoblasts secrete a substrate that fills the space between the broken pieces. Little finesse is exhibited by these cells, however, as they normally overproduce matrix at the injury site. The result conjures up an image of the two halves of the fractured bone stuck in a handful of clay, but this is only the first step. Lastly, osteoclasts chisel off the excess material and create a smooth transition from new bone to old bone. We may imagine this effort as one similar to an artist sculpting a masterpiece with exquisite detail.

    How important is calcium?

    Despite the incredible benefits of bony remodeling throughout our lifetimes, wholesome ingredients for our skeletons are critical during formative years. This means getting the right nutrition to ward off the growth of soft bones when we are younger (i.e., rickets) and the onset of porous, brittle bones when we are older (i.e., osteoporosis).

    For starters, calcium and vitamin D are important. The role of vitamin D is vital because it helps transport the calcium found in dairy products and other food sources through the lining of our intestinal tract and into our bloodstream. At this stage, calcium travels within the circulatory system, with most of it en route for storage in our bones. Stored calcium is in a crystalline form that provides bone strength. In fact, over 99% of the total calcium found in the body is in teeth and bones. But there is much more to calcium than meets the eye.

    Including its role in bone health, calcium is one of the most important elements in the body. This claim stems from calcium’s presence within our heart and skeletal muscles. Here it is required for proper functioning. Calcium is also necessary for proper nerve function. If the levels of free, circulating calcium in the blood are low, then this mineral is tapped from its bony storage sites. However, when the appropriate levels of unbound calcium are reached, the bony reserves are restocked. The entire process is akin to a finely-tuned, highly-efficient feedback loop. Other minerals with important roles for good bone health include phosphorus, magnesium, potassium, and boron.

    Next week I will explain good habits for the smart and feasible care of our bones.

    Kevin Wininger is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. With a physician referral, a radiology technologist in the Imaging Services department at Fisher-Titus will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss. Talk to your doctor about referrals for these services if you think you might benefit.

  • Introducing the Mako System: Advancing Joint Replacement at Fisher-Titus

    In July of 2020, Fisher-Titus became the first hospital in the region to offer hip and knee replacements with Stryker’s Mako System. Through our partnership with NOMS Access Orthopaedics in Norwalk, Dr. David Pocos and Dr. Jason Brown perform total hip, total knee, and partial knee procedures with the assistance of the Mako robotic arm.

    Michelle Adams was the first patient to have a procedure with the Mako System at Fisher-Titus.

    In June of 2020, Michelle was on vacation in North Carolina when her knee suddenly gave out going down a flight of stairs. Although she didn’t fall, she was in so much pain that she wasn’t able to walk to the beach the rest of her stay.

    “I had trouble with my knee in the past,” Michelle said. “I had gotten injections at NOMS Access Orthopaedics, which helped, but this was different. It was more painful, and I knew something had to be done.”

    When she returned to Ohio, she scheduled an appointment with Dr. Pocos. They did x‐rays and determined she would need to have surgery to replace the knee.

    Along the way, she learned that she would be the first to have her procedure done with the assistance of the Mako System.

    “I was all for it. It’s something new and Dr. Pocos had been preparing for a year to operate with it,” said Michelle. “I’m very glad that I ended up having it done that way.”

    The Mako System provides each patient with a personalized surgical experience based on their specific diagnosis and anatomy. With the system, the surgeon can use a virtual 3D model of the joint, from a CT scan, to create a surgical plan before surgery. This plan helps them determine the implant size, orientation, and alignment based on the patient’s specific needs.

    How it works is with Mako’s AccuStopTM technology. The pre‐op plan defines an area in which the surgeon can operate. The technology keeps the robotic arm within the planned boundaries and guides direct, accurate cuts. Although the Mako system is often referred to as a robot, it cannot move on its own. The surgeon guides the robot’s arm to perform the surgery, and the surgeon can adjust the pre‐op plan if needed once they are in the operating room. The surgeon has full control of the instrumentation during the entire procedure.

    “The key to Mako is the reproducibility and planning,” Dr. Pocos explained. “A preoperative plan is generated based upon CT evaluation. I review the plan, and I am essentially doing the surgery before the actual surgery. Prior to Mako, I would template preoperative x‐rays to identify proposed size of implants and alignment. I would then rely on alignment jigs, feel, and experience in the operating room to
    accomplish the procedure. With the Mako, I am able to reproduce the preoperative plan with precision.”

    Dr. Pocos adds, “The interesting thing about Mako is that the procedure is the same and the end goal remains the same. The steps are the same. How we analyze the information is different.”

    In addition to creating a better surgical experience for surgeons, case studies suggest robotic arm assisted joint replacement may also be associated with decreased pain, improved early functional recovery, and reduced hospital stays for patients. There is also evidence suggesting patients required less opioids for
    pain following surgery. Both of these benefits are likely due to the fact that robotic arm assisted joint replacement reduces bone and tissue trauma since operating is limited to the pre‐determined boundaries based on the damaged bone.

    “Less retraction results in less trauma to the surrounding tissues,” Dr. Pocos said. “Patients have been pleased with their procedures thus far. The tissues have seemingly responded better. I have been very pleased with the outcomes. I am now using Mako on the majority of my hip and knee replacements.”

    Michelle said her recovery has been relatively easy. She had her surgery on a Tuesday and went home the next day to stay with her son and his family. After three days of mostly staying in bed to rest, she was able to get up and walk with a walker and start in‐home therapy by Friday.

    “It’s amazing that you can walk on a knee that was just replaced!” Michelle noted.

    Michelle credits a lot of her recovery to her kids, grandkids, the therapists, and the robotic‐assisted procedure.

    “A friend of mine is looking into having surgery,” said Michelle. “I told him, the robotic thing is the way to go.”

    Michelle was back to work in accounts payable just one month after her surgery. Now she’s looking forward to spending time with her three kids and five grandkids–especially watching them play sports.

    “That’s why I wanted to get it fixed,” Michelle explained. “I wanted to be able to go and watch them in the stands at their games.”

    About Orthopedic Surgery at Fisher-Titus

    Our surgical team performs many types of specialized orthopedic surgery, including:

    • Procedures on knees, hips, shoulder, and elbows
    • Total joint reconstruction (arthroplasty)
    • Fractures
    • Hand and wrist surgery, including carpal tunnel
    • Foot and ankle surgery
    • Orthopedic trauma
    • Pediatric orthopedics
    • Sports medicine

    Our partnership with the surgeons at NOMS Access Orthopaedics offers each patient:

    • Five-star patient satisfaction
    • Total joint replacement expertise
    • Complete care close to home

    For more information, please visit fishertitus.org/ortho.