General Orthopedics, Total Knee Replacement and Total Hip Replacement, Sports Medicine and Arthroscopy, Rotator Cuff Repair, Anterior Cruciate Ligament (ACL) Reconstruction, Neurosurgery, Minimally Invasive Spine Surgery (MIS), Surgery for Spinal Stenosis, Surgery for Herniated Disks, Surgery of the Brain  
  General Orthopedics, Total Knee Replacement and Total Hip Replacement, Sports Medicine and Arthroscopy, Rotator Cuff Repair, Anterior Cruciate Ligament (ACL) Reconstruction, Neurosurgery, Minimally Invasive Spine Surgery (MIS), Surgery for Spinal Stenosis, Surgery for Herniated Disks, Surgery of the Brain

National Orthopedic and Neurosurgery
3618 Lantana Road Suite 100
Lake Worth, FL 33462
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Orthopedics FAQ's

General Orthopedic FAQ
What is the difference between x-rays, MRI, and CT scan?
Should I apply ice or heat to an injury?
What is physical therapy?
What is a tendon? ligament? cartilage?
What is a cortisone/corticosteroid injection?
What is viscosupplementation? aka "the chicken shots"
What are NSAIDs and how do they work?
What is glucosamine / chondroitin?

Joint Surgery FAQ
What is an orthopedic surgeon?
What is arthroscopic surgery?
What is joint replacement surgery?
How long do artificial joints last?
When should I have a joint replacement?
Who should I choose to perform my surgery?
What is minimally invasive joint replacement?

Before and After FAQ
Do I need to do anything special the day or night before surgery?
When should I arrive at the hospital/surgery center?
What should I wear the day of my surgery?
How long will surgery take?
What kind of anesthesia will I receive?
How long will I stay in the hospital/surgery center?
What are the most common complications of orthopedic surgery?
What medications should I stop taking prior to surgery?
What happens after surgery?

Common Injuries & Conditions
What is the difference between a sprain and a strain?
What are muscle spasms?
What is a torn meniscus?
What is tendinitis?
What is bursitis?
What is arthritis?
What is a stress fracture?

What is the difference between x-rays, MRI, and CT scan?
X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.

Organs and tissues within the body contain magnetic properties. MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate these magnetic elements and create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems.

A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine much better than MRI, so they are more useful in diagnosing conditions affecting the vertebrae and other bones of the spine.

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Should I apply ice or heat to an injury?
Ice should be used in the acute stage of an injury (within the first 24-48 hours), or whenever there is swelling. Ice helps to reduce inflammation by decreasing blood flow to the area in which cold is applied. Heat increases blood flow and may promote pain relief after swelling subsides. Heat may also be used to warm up muscles prior to exercise or physical therapy.

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What is physical therapy?
Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport. Physical therapy is critical to your recovery from joint replacement surgery.

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What is a tendon? ligament? cartilage?
A tendon is a band of tissue that connects muscle to bone. A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint. Cartilage is a soft, gel-like padding between bones that protects joints and facilitates movement.

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What is a cortisone/corticosteroid injection?
Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis. In the arthritic joint, cortisone injections may be used over continued intervals for as long as the relief is reliable. There is no "3 shot rule" for cortisone injections of an arthritic joint.

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What is viscosupplementation? aka "the chicken shots"
Products such as Synvisc, Supartz, and Hyalgan are derivatives of cartilage produced from the combs of chickens. When injected into the arthritic joint, they may reduce pain by restoring the natural viscosity to the protective joint fluid. Large randomized trials have not demonstrated an improved performance over cortisone. Patients may experience a temporary irritation of the joint following injection and those with allergies to poultry or sulfa may not receive this treatment.

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What are NSAIDs and how do they work?
Non-steroidal anti-inflammatory drugs (NSAIDs) are prescription and over-the-counter pain relievers such as Advil, Motrin, and Aleve. They are popular treatments for muscular aches and pains, as well as arthritis. They work by blocking the cellular mediators of inflammation which produce pain after injury or from arthritis.

NSAIDs not only relieve pain, but also help to decrease inflammation, prevent blood clots, and reduce fevers. They work by blocking the actions of the cyclooxygenase (COX) enzyme. There are two forms of the COX enzyme. COX-2 is produced when joints are injured or inflamed, which NSAIDS counteract. COX-1 protects the stomach lining from acids and digestive juices and helps the kidneys function properly. This is why side effects of NSAIDs may include nausea, upset stomach, ulcers, or improper kidney function.

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What is glucosamine / chondroitin?
These substances are found as components of normal healthy cartilage. They are prepared by many manufacturers as a food product, not a medicine, and can be purchased "over the counter". They have few side effects and do not typically interact with any prescription medication. Positive benefits have not been verified by any studies despite intense attempts to do so. However, many patients report relief with their use.

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What is an orthopedic surgeon?
An orthopedic surgeon is a medical doctor who has received up to 14 years of education in the diagnosis, treatment, rehabilitation, and prevention of injuries and diseases of the musculoskeletal system (bones and joints, muscles, ligaments, tendons, and cartilage).

Some orthopaedic surgeons practice general orthopaedics, while others specialize in treating certain body parts such as the foot and ankle, hand and wrist, spine, knee, shoulder, or hip. Some orthopaedists may also focus on a specific population such as pediatrics, trauma, or sports medicine.

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What is arthroscopic surgery?
Arthroscopic surgery is one of the most common orthopaedic procedures performed today. Through the use of small instruments and cameras, an orthoapedic surgeon can visualize, diagnose, and treat problems within the joints.

One or more small incisions are made around the joint to be viewed. The surgeon inserts an instrument called an arthoscope into the joint. The arthoscope contains a fiber optic light source connected to a camera that allows the surgeon to view the joint on a television monitor and diagnose the problem, determine the extent of injury, and make any necessary repairs. Other instruments may be inserted to help view or repair the tissues inside the joint.

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What is joint replacement surgery?
Joint replacement surgery is performed to replace an arthritic or damaged joint with a new, artificial joint called a prosthesis. The knee and hip are the most commonly replaced joints, although shoulders, elbows and ankles can also be replaced.

Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Cartilage may be damaged through normal wear, injury, or illness and produce pain in the affected joint. Most people have joint replacement surgery when they can no longer control the pain with medication and other treatments, and the pain is significantly interfering with their lives. The only true indications for joint replacement surgery are pain and disability. Your age is not generally a consideration if you and your surgeon determine that other options are not practical.

Joint replacement surgery by most clinical measures is over 97% successful in relieving pain and restoring normal function when performed by a qualified surgeon.

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How long do artificial joints last?
On average, artificial joints have a lifespan of 10 to 20 years. Factors such as body mass, activity level, surgical technique, and the type of implant used may affect the lifespan of your joint replacement.

The experience of your surgeon plays a critical role in not only the durability of your new joint, but also in the degree of risk from a complication. Surgeons who are Fellowship Trained in joint replacement surgery and perform more than 100 replacements per year are proven to provide a more reliable outcome with a lower risk of complications.

New technologies such as alternative bearing surfaces made from metals or ceramics, rather than plastics, may dramatically increase the durability of your joint replacement. Metal on metal bearings allow for a more durable implant with a greater range of motion for the more active patient.

Patients whose joint replacements develop symptoms of wear and tear may require a "revision" or repeat joint replacement. Due to his expertise in treating patients who suffer from failure of their initial joint replacement, Dr. Kugler has become a center for referral of patients from all over the South East.

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When should I have a joint replacement?
The decision to have a joint replacement is determined by the patient after an informed discussion with a qualified surgeon. The decision may safely be delayed as long as the patient is satisfied with their function and the pain is tolerable. These factors are as individual as each patient.

Reasonable measures for conservative management of pain and disability are typically exhausted prior to joint replacement surgery. These include medicines, injections, activity and body weight modifications, and lifestyle considerations specific to each patient.

In general, your health and activity level are the primary consideration. Age is not a determinate factor for proceeding with joint replacement surgery.

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Who should I choose to perform my surgery?
All joint replacement procedures are performed by orthopedic surgeons. Some surgeons have completed additional training in joint replacement surgery called "Fellowships". Many joint replacements are performed perfectly by surgeons without this extra training, however, the most experienced surgeons are both Board Certified and Fellowship trained. In addition, your surgeon should seek to educate you about the procedure, be attentive to your questions, open to a second opinion, and produce a feeling of confidence in your choice.

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What is minimally invasive joint replacement?
Dr. Kugler is an expert in minimally invasive surgical techniques. He has developed implants specifically designed to facilitate these procedures and serves as an instructor for other surgeons in training.

However, minimally invasive is essentially a marketing term to describe techniques directed at performing joint replacement surgery through smaller skin incisions. Other than the smaller incision, the procedure is IDENTICAL to any other joint replacement. Large, randomized studies have proven NO DIFFERENCE in length of hospital stay, amount of blood loss, speed of recovery, or improvement of outcome. Conversely, the stuborn attempt by surgeons to reduce the length of skin incisions has been DIRECTLY linked to an increase in intra-operative and post-operative COMPLICATIONS such as nerve damage, torn ligaments, malpositioned implants, infections, increased blood loss and poor results.

Claims of dramatically reduced or "same day" hospital stays and minimal recovery periods have not been verified and should be viewed with skepticism and may even be considered dishonest.

The experienced and conscientious joint replacement surgeon will perform your procedure through the smallest practical incision to create your joint replacement perfectly.

Your recovery should be directed toward a perfect procedure, without complications, and functional for many years to come.

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Do I need to do anything special the day or night before surgery?
Someone from the surgery center or hospital will call you to discuss pre-operative instructions. They usually include the following:

  • Do not eat or drink anything, including water, after midnight the day of your surgery. You may brush your teeth, taking care not to swallow any water.
  • Follow your doctor’s orders regarding the taking of any medications the night before or the day of your surgery.
  • Refrain from smoking after midnight the day of your surgery.
  • Notify your surgeon if there is any change in your physical condition, such as a cold, fever or flu symptom.
  • If there is a chance you are pregnant, please notify your surgeon immediately.

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When should I arrive at the hospital/surgery center?
Arrive promptly at the time specified by the surgery scheduler. If you are having surgery at an outpatient surgery center, you will usually be asked to arrive one hour before your scheduled surgery. Times may differ if you will be admitted to the hospital prior to surgery. Most pre-operative blood, lab or paper work is preformed prior to the day of your surgery.

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What should I wear the day of my surgery?
Bathe or shower the morning of surgery but do not apply any makeup. Wear low heeled, comfortable shoes and loose, comfortable clothing such as t-shirts, button-down shirts, sweat pants or baggy shorts that will fit over bandages or dressings following surgery. Do not wear contact lenses or jewelry.

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How long will surgery take?
The length of surgery depends on the procedure being performed, the surgeon, and the method of surgery (e.g., minimally-invasive arthroplasty or a more invasive revision procedure). Your joint replacement will typically take between one and two hours.

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What kind of anesthesia will I receive?
The four main types of anesthesia include general, regional, monitored, and local. The type of anesthesia you will receive is influenced by one or more of the following factors:

  • The kind of surgery you are having
  • Estimated length and site of the surgical procedure
  • Your overall medical condition and health status
  • Medications you currently take
  • Your surgeon’s preference

With general anesthesia, you are completely asleep and unconscious with total loss of sensation.

In regional anesthesia, the anesthesiology provider injects you with an anesthetic to provide numbness or loss of pain or sensation to the area of the body requiring surgery. The injection is made near a cluster of nerves and is called a nerve block. The most common types are spinal, epidural, or peripheral. You may remain awake and alert or be sedated. This type of anesthesia is associated with decreased blood loss and a lower incidence of blood clots (DVT) for joint replacement patients.

If you are sedated during regional anesthesia, then you receive monitored anesthesia care, also known as MAC sedation or twilight sleep. Monitored anesthesia care involves the administration of drugs to produce sedation and analgesia (insensibility to pain without loss of consciousness). In addition, your surgeon will administer local anesthesia to the operative site.

Local anesthesia is an injection that provides numbness to a small area and is used primarily for minor surgery. It is often administered by the surgeon and does not require the presence of an anesthesiology provider.

You will meet with your anesthesiologist prior to surgery and will have an opportunity to discuss your anesthesia options. Your anesthesiologist will inform you of the advantages, side effects, and possible complications of each. Depending upon the factors above, you may be able to participate in the decision-making and choose which method you prefer.

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How long will I stay in the hospital/surgery center?
The time you spend in the hospital or surgery center will vary depending upon the type of surgery performed, the type of anesthesia that was given, and your individual needs. The typical length of stay for a joint replacement procedure is two to four days. Claims of same day surgery for joint replacement are dubious at best and not regarded by the experienced joint surgeon as safe. Remember, the emphasis is on an uncomplicated procedure with many years of durability not the length of time you spend in the hospital.

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What are the most common complications of orthopedic surgery?
Most patients will not encounter problems after joint replacement surgery. As with any surgery, however, there are potential risks, including: reaction to anesthesia, bleeding, infection, blood clots, nerve damage, lack of full range of motion, scar formation, or re-injury of the joint or soft tissue.

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What medications should I stop taking prior to surgery?
Your surgeon and anesthesiologist will determine what medications you should stop taking before surgery, when they should be stopped, and when you can resume taking them after surgery.

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What happens after surgery?
You will be taken to the recovery room and monitored for a period of time. After that you will be taken to a holding room (if in an outpatient surgery center) or to a patient room if you have been or are being admitted to the hospital.

If your operation was in a surgery center, a nurse will review post-operative home care instructions with you, as well as explain any special instructions provided by your surgeon regarding diet, rest, medications, when to follow up with your doctor, and how to use any durable medical equipment such as a sling or crutches your doctor may have ordered.

When you follow up with your doctor, he or she will discuss additional post-operative instructions such as rehabilitation, when stitches may be removed, when you can drive or return to work or school, how long you should use crutches or a sling, how long you should take pain medications, and more.

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What is the difference between a sprain and a strain?
A strain occurs when a muscle is stretched or torn. A sprain occurs when a ligament is stretched or torn.

Strains are often the result of overuse or improper use of a muscle, while sprains typically occur when a joint is subjected to excessive force or unnatural movements (e.g., sudden twists, turns, or stops). Sprains can be categorized by degree of severity:

• A first-degree sprain stretches the ligament but does not tear it. Symptoms include mild pain with normal movement.

• A second-degree sprain is characterized by a partially torn ligament, significant pain and swelling, restricted movement, and mild to moderate joint instability.

• In a third-degree sprain, the ligament is completely torn with mild to severe pain, swelling, and significant joint instability.

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What are muscle spasms?
When muscles become inflamed, they can also spasm, or contract tightly, as a response to injury. While they are the body’s way of protecting itself from further injury, they often produce discomfort. Muscle spasms are common following hip and knee surgery.

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What is a torn meniscus?
The medial and lateral menisci (plural of meniscus) of the knee are two crescent moon-shaped disks of tough tissue that lie between the ends of the upper leg bone and lower leg bone that form the knee joint. Meniscus tears commonly occur during sports when the knee is twisted while the foot is planted firmly on the ground. In people over the age of 40 whose menisci are worn down, a tear might occur with normal movement, minimal activity, or minor injury. These tears are called degenerative and are often the first hallmark of early osteoarthritis.

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What is tendinitis?
Teninitis is inflammation of a tendon, a band of tissue that connects muscle to bone. It is most commonly the result of overuse during physical activities. Repetitive motions can stretch and irritate the tendon, causing pain and swelling. Tendinitis may occur around any joint that sustains over use or injury.

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What is bursitis?
Bursitis is inflammation of a bursa or bursae (more than one bursa), small fluid-filled sacs that cushion areas of friction around joints. Bursae contain synovial fluid that lubricates the joints. Bursitis typically occurs as a result of overuse during physical activities or infection of the synovial fluid. If a bursa becomes infected or irritated from repetitive stress, it will cause pain and limited movement. Bursitis is most common in the shoulder, knee, hip, or elbow.

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What is arthritis?
The most common form of arthritis, osteoarthritis, can affect any joint in the body, but most often afflicts the knees, hips, and fingers. Most people will develop osteoarthritis from the normal wear and tear on the joints through the years, however, there are ethnic and genetic predispositions for osteoarthritis. Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As bones rub together, bone spurs may form and the joint becomes stiff after long periods of activity or inactivity.

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What is a stress fracture?
A stress fracture is a microscopic crack in a bone that occurs from overuse. Muscles normally absorb the shock of physical activities, but when they become too fatigued to do so, they transfer the stress to the bones which results in a hairline-sized fracture.

Stress fractures usually develop in the weight bearing bones of the feet and lower legs, often after a rapid increase in the duration or intensity of exercise.

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Orthopedic Services
General Orthopedics
Total Knee Replacement and Total Hip Replacement
Sports Medicine and Arthroscopy
Rotator Cuff Repair
Anterior Cruciate Ligament (ACL) Reconstruction
Neurosurgical Services
Minimally Invasive Spine Surgery (MIS)
Surgery for Spinal Stenosis
Surgery for Herniated Disks
Surgery of the Brain

National Orthopedics and Neurosurgery, P.A.
3618 Lantana Road Suite 100
Lake Worth, FL 33462
Tel: (877) 518-1188
Fax: (561) 969-6920

     

All Content Copyright 2011 National Orthopedics and Neurosurgery, P.A.