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Hip Arthroscopy for the Treatment of Femoracetabular Impingement

Hip arthroscopy is a minimally invasive surgical procedure that is performed through 2-3 small incisions to treat a variety of hip conditions. A small camera, called an arthroscope, is inserted into one of the incision sites which projects an image up on the screen to allow us to fully evaluate the hip joint. Small instruments are inserted through the incision sites to correct the hip pathology.

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Dr. Stewart performing hip arthroscopy Image of a labral tear repaired arthroscopically


One of the more common hip conditions that hip arthroscopy is used to treat is femoracetabular impingement (FAI). Femoracetabular impingement is a deformity that develops at the hip joint from abnormal pressure and friction between the ball and socket of the hip joint which results in pain and hip dysfunction. There are two types of femoracetabular impingement, CAM type and pincer type. CAM type of impingement is when there is excess bone growth on the head of the femur. Pincer type of impingement is when there is excess bone growth along the rim of the acetabulum. Femoracetabular impingement is the most common cause of a labral tear, which is the cartilage that is located at the edge of the acetabulum. Untreated femoracetabular impingement can lead to an early development of osteoarthritis and the need for hip replacement.

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CAM Type Impingement Pincer Type Impingement


Hip arthroscopy is an outpatient surgical procedure and therefore, patients go home the same day as their surgery. The hip arthroscopy procedure generally takes 1-2 hours. Patients will typically need assistance for the first 1-2 days postoperatively. Our patients begin outpatient physical therapy the day after their surgery. Supervised physical therapy is continued for up to 12 weeks postoperatively. All of our patients take naproxen twice daily for 21 days after surgery to reduce the risk of excess bone growth at the surgical site, called heterotopic ossification. Our patients are also put on aspirin postoperatively to reduce the risk of developing a blood clot. Generally, our patients use crutches for the first 2-3 weeks postoperatively. After hip arthroscopy, patients are able to return to light duty work 2-4 weeks after surgery. In general, patients can return to heavy duty work 4-6 weeks after surgery. However, every patient recovers at a different pace and therefore, return to work status is addressed at the 2 week postoperative follow up appointment.

Hip Injection

Hip Intraarticular Cortisone Injections

We often encourage patients to exhaust several conservative treatment options, including intraarticular cortisone injections, prior to being scheduled for total hip replacement surgery. Cortisone is a strong anti-inflammatory medication that if injected into the affected joint may provide substantial pain relief for weeks to months. These injections are very helpful both from a therapeutic and diagnostic standpoint as often times patients have more than one source of their pain. Undergoing an intraarticular cortisone injection helps to differentiate whether the majority of a patient’s symptoms are emanating from within the hip joint or an extraarticular source (back, tendon, etc.). If a patient has dramatic improvement in their symptoms within the first few hours after undergoing an intraarticular cortisone injection, this confirms that those relieved symptoms were originating from hip joint pathology.   The intraarticular cortisone injections are performed in our Altoona office on Tuesday afternoons and Wednesdays. The injections are performed in the office using ultrasound guidance and are minimally invasive; patients will be able to drive themselves home following the procedure. Diabetics should monitor blood sugars more frequently for several days after undergoing a cortisone injection as the cortisone may increase glucose levels temporarily. Additional side effects may include insomnia, headache, dizziness and soreness at the injection site. Intraarticular cortisone injections can be repeated as often as every three months. Hip Injection Diary

Knee Pain

X-Ray image of a knee with knee pain

SYMPTOMS

Common symptoms relating to knee pain, injuries, and other problems Many of our patients come to our office for evaluation of a specific symptom, such as knee pain or instability. It is our responsibility and privilege to obtain an accurate history, physical examination and obtain any necessary imaging studies including x-rays and/or MRI to determine a diagnosis for the knee pain or other symptoms. We then collaborate with our patients to create an individualized treatment plan that meets each of their needs. Listed below are several symptoms we often see patients for in our clinic:

• Knee pain

• Instability

• Catching

• Buckling

• Leg pain

 

 

DIAGNOSES

Common conditions that we treat.   There are also instances when patients will be referred to our office by another practitioner seeking treatment for a specific condition relating to their knee pain. Below is a list of conditions we commonly treat:

• Osteoarthritis of the knee

• Failed knee replacement

• Infected knee replacement

• Meniscus tear

• ACL tear

• MCL strain

• Tibial plateau fracture

• Patellofemoral tendonitis

• Patellar dislocation

• Patellar fracture

• Quadriceps tendon tear

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Lectures

Lectures

Below you will find various educational materials that are available for your review. Dr. Stewart has written several articles for HealthyViewpoints which is an informative and educational handout published by Oakleaf Surgical Hospital and distributed to the local community each year. All of Dr.Stewart’s Healthy Viewpoints articles are listed below for you to review. Additionally, all of his powerpoint presentations from various lectures he has given over the past few years are listed below.

 

Here is a link to the Oakleaf Surgical Hospital website that has a video of Dr. Stewart discussing Mako Robotic Assisted Total Hip and Total Knee Arthroplasty.

Locations

Feel free to contact us with any questions.

Our goal is to make your experience with Dr. Stewart and his procedures the best it can be. We pride ourselves in being quick and responsive to any questions that come about. We are only a call or click away.

 

CONTACT INFORMATION

Call For An Appointment  icn-phone


715.832.1400
1.800.322.1747 (Toll-Free)

Send An Email  icn-email  


info@orthostewart.com

Locations & Clinics  icn-location


Sacred Heart Hospital

900 W. Clairemont Ave.

Eau Claire, WI 54701

715.717.4121

(1st, 3rd, 5th) Monday AM/PM

St. Joseph’s Hospital

2661 Co. Hwy I

Chippewa Falls, WI 54729

715.723.1811

(2nd, 4th) Monday AM

Diagnostic Radiology

1024 N Main Street

Rice Lake, WI 54612

715-234-8151

(2nd,4th) Monday PM

CVOSM Chippewa Falls Clinic

757 Lakeland Drive, Ste A Chippewa Falls, WI 54729

715.723.8514

Tuesday AM

CVOSM Clinic

1200 OakLeaf Way, Ste. A Altoona, WI 54720

715.832.1400

Tuesday PM

Wednesday AM/PM

OakLeaf Surgical Center

1000 OakLeaf Way

Altoona, WI 54720

715.831.8130

Thursday AM/PM

Friday AM/PM


SEND US AN EMAIL

LOCATION MAP

Mako Robotic-Arm Assisted Technology for partial knee replacement

We understand that making sure you know what to expect from your joint replacement experience is important to you. As you are reading through this material, if you have additional questions please reach out to us to discuss. Each patient is unique and can experience joint pain and arthritis for different reasons. It’s important to talk to us about the reason for your knee pain so you can understand the treatment options available to you. Pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. It is common for patients to try medication and other conservative treatments to treat their knee joint pain and knee arthritis. If you haven’t experienced adequate relief with those treatment options, you may be a candidate for Mako Partial Knee replacement, which may provide you with relief from your knee pain and arthritis.    

How Mako Technology works

Mako Robotic-Arm Assisted Technology provides you with a personalized surgical plan based on your unique anatomy and arthritis affecting your joint. First, a CT scan of the arthritis diseased knee joint is taken. This CT scan is uploaded into the Mako System software, where a 3D model of your knee is created. This 3D model is used to pre-plan and assist your orthopedic surgeon in performing your partial knee replacement. In the operating room, your surgeon follows your personalized surgical plan while preparing the bone for the implant. The surgeon guides the robotic-arm within the pre-defined joint replacement area and the Mako System. The orthopedic surgeon guides the robotic-arm within the pre-defined area and the Mako System helps the surgeon stay within the planned boundaries that were defined when the personalized pre-operative plan was created. This helps to provide more accurate placement and alignment of your implant.  
  • Mako Robotic-Arm Assisted partial knee replacement is a treatment option for adults living with early to mid-stage osteoarthritis (OA) that has not yet progressed to all three compartments of the knee. Depending on where the arthritis affects the knee, patients may have an implant inserted in any of the following areas:
  knee replacement surgery  

Step 1. Knee CT Scan

Step 2. Knee Personalized Planning


It’s important to understand that the surgery is performed by an orthopedic surgeon, who guides the robotic-arm during the surgery to position the implant in the knee joint. The Mako Robotic-Arm does not perform joint replacement surgery, make decisions on its own, or move without the surgeon guiding the robotic-arm. The Mako System also allows your orthopedic surgeon to make adjustments to your plan during surgery as needed. Dr. Stewart serves patients in the Eau Claire, Altoona and Chippewa Falls area who are experiencing joint pain and arthritis.  Contact him with questions today at 715-832-1400.



IMPORTANT INFORMATION

Partial knee replacement

General indications: Partial knee replacement is intended for use in individuals with joint disease resulting from degenerative and post-traumatic arthritis, and for moderate deformity of the knee.

Contraindications: Partial knee replacement surgery is not appropriate for patients with certain types of infections, any mental or neuromuscular disorder which would create an unacceptable risk of prosthesis instability, prosthesis fixation failure or complications in postoperative care, compromised bone stock, skeletal immaturity, severe instability of the knee, or excessive body weight.

Common side effects of knee replacement surgery: As with any surgery, knee replacement surgery has serious risks which include, but are not limited to, peripheral neuropathies (nerve damage), circulatory compromise (including deep vein thrombosis (blood clots in the legs)), genitourinary disorders (including kidney failure), gastrointestinal disorders (including paralytic ileus (loss of intestinal movement)), vascular disorders (including thrombus (blood clots), blood loss, or changes in blood pressure or heart rhythm), bronchopulmonary disorders (including emboli, stroke or pneumonia), heart attack, and death.

Implant related risks which may lead to a revision of the implant include dislocation, loosening, fracture, nerve damage, wear of the implant, metal sensitivity, osteolysis (localized progressive bone loss), and reaction to particle debris. Partial knee implants may not provide the same feel or performance characteristics experienced with a normal healthy joint.

The information presented is for educational purposes only. Speak to your doctor to decide if joint replacement surgery is right for you. Individual results vary and not all patients will receive the same postoperative activity level. The lifetime of a joint replacement is not infinite and varies with each individual. Your doctor will help counsel you about how to best maintain your activities in order to potentially prolong the lifetime of the device. Such strategies include not engaging in high-impact activities, such as running, as well as maintaining a healthy weight. Ask your doctor if robotic-arm assisted surgery is right for you.

Stryker Corporation or its other divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Mako, Stryker. All other trademarks are trademarks of their respected owners or holders.

References
  1. Bell, Stuart W., Anthony, Iain, Jones, Bryn, MacLean, Angus, Rowe, Philip, and Blyth, Mark. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty. The Journal of Bone and Joint Surgery. Volume 98-A: Number 8. April 20, 2016. pp 627-35.

MKOHMT-PE-3_Rev-1_13841 Copyright © 2017 Stryker Corporation



Mako Robotic-Arm Assisted Technology for total knee replacement

Tired of Dealing with Knee Pain? Want to Know More About Your Options?

We understand that making sure you know what to expect from your total joint replacement experience is important to you. As you are reading through this material, if you have additional questions please reach out to us to discuss.

 

Each patient is unique and can experience joint pain for different reasons. It’s important to talk to us about the reason for your knee pain so you can understand the treatment options available to you. Knee pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. It is common for patients to try medication and other conservative treatments to treat their knee pain. If you haven’t experienced adequate relief with those treatment options, you may be a candidate for Mako Total Knee replacement, which may provide you with relief from your knee pain.



How Mako Technology works

Mako Robotic-Arm Assisted Total Knee replacement is a treatment option for adults living with mid to late-stage osteoarthritis (OA) of the knee. Mako provides you with a personalized surgical plan based on your unique anatomy. First, a CT scan of the diseased knee joint is taken. This CT scan is uploaded into the Mako System software, where a 3D model of your knee is created. This 3D model is used to pre-plan and assist your ortopedic surgeon in performing your total joint replacement.

 
In the operating room, your surgeon follows your personalized surgical plan while preparing the bone for the Triathlon Total Knee implant. With over a decade of clinical history, the Triathlon knee replacement is different than a traditional knee replacement because they are designed to work with the body to promote natural-like circular motion.  

The orthopedic surgeon guides the robotic-arm to remove diseased bone and cartilage within the pre-defined area and the Mako System helps the surgeon stay within the planned boundaries that were defined when the personalized pre-operative plan was created. In a laboratory study, Mako Technology demonstrated accurate placement of implants to a personalized surgical plan.

 

It’s important to understand that the surgery is performed by an orthopaedic surgeon, who guides the robotic-arm during the surgery to position the implant in the knee joint. The robotic-arm does not perform surgery, make decisions on its own, or move without the surgeon guiding the robotic-arm. The Mako System also allows your orthopedic surgeon to make adjustments to your plan during surgery as needed.

knee replacement joint plan surgery for knee arthritis



 
 

IMPORTANT INFORMATION

Knee replacements

General indications: Total knee replacement is intended for use in individuals with joint disease resulting from degenerative, rheumatoid and post-traumatic arthritis, and for moderate deformity of the knee.

Contraindications: Knee replacement surgery is not appropriate for patients with certain types of infections, any mental or neuromuscular disorder which would create an unacceptable risk of prosthesis instability, prosthesis fixation failure or complications in postoperative care, compromised bone stock, skeletal immaturity, or severe instability of the knee.

As with any surgery, knee replacement surgery has serious risks which include, but are not limited to, peripheral neuropathies (nerve damage), circulatory compromise (including deep vein thrombosis (blood clots in the legs)), genitourinary disorders (including kidney failure), gastrointestinal disorders (including paralytic ileus (loss of intestinal digestive movement)), vascular disorders (including thrombus (blood clots), blood loss, or changes in blood pressure or heart rhythm), bronchopulmonary disorders (including emboli, stroke or pneumonia), heart attack, and death.

Implant related risks which may lead to a revision include dislocation, loosening, fracture, nerve damage, heterotopic bone formation (abnormal bone growth in tissue), wear of the implant, metal sensitivity, soft tissue imbalance, osteolysis (localized progressive bone loss), and reaction to particle debris. Knee implants may not provide the same feel or performance characteristics experienced with a normal healthy joint.

The information presented is for educational purposes only. Speak to your doctor to decide if joint replacement surgery is right for you. Individual results vary and not all patients will receive the same postoperative activity level. The lifetime of a joint replacement is not infinite and varies with each individual. Your doctor will help counsel you about how to best maintain your activities in order to potentially prolong the lifetime of the device. Such strategies include not engaging in high-impact activities, such as running, as well as maintaining a healthy weight. Ask your doctor if the Triathlon knee is right for you.

Stryker Corporation or its other divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Mako, Stryker, Triathlon. All other trademarks are trademarks of their respected owners or holders.

References
  1. Mistry J, Elmallah R, Chughtai M, Oktem M, Harwin S, Mont M. Long-Term Survivorship and Clinical Outcomes of a Single Radius Total Knee Arthroplasty. International XXVIII.
  2. Designed to maintain collateral ligament stability throughout the range of motion. Stryker-Initiated Dynamic Computer Simulations of Passive ROM and Oxford Rig Test, Stephen Piazza, 2003.
  3. Wang H, Simpson KJ, Ferrara MS, Chamnongkich S, Kinsey T, Mahoney, OM. Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii. J Arthroplasty. 2006;21(8):1193-1199.
  4. Gómez-Barrena E, Fernandez-García C, Fernandez- Bravo A, Cutillas-Ruiz R, Bermejo-Fernandez G. Functional performance with a single-radius femoral design total knee arthroplasty. Clin Ortho Relates Res. 2010;468(5):1214-1220.
  5. Hampp E. et al. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy to Plan Compared to Manual Technique. Orthopaedic Research Society 2017 Annual Meeting, San Diego, CA. Poster No. 2412. March 20-22, 2017.

MKOHMT-PE-3_Rev-1_13841  Copyright © 2017 Stryker Corporation

Meet Dr Stewart

Dr. Stewart, orthopedic surgeon specializing in hips and knee surgeries in Eau Claire and Altoona

Nathaniel Stewart, M.D.

Dr. Stewart is an orthopedic surgeon specializing in hip and knee surgery in Eau Claire, Altoona, and Chippewa Falls. As the most experienced hip arthroscopist in Western Wisconsin, Dr. Stewart began performing hip arthroscopy in 2000. Being an orthopedic surgeon at the forefront of arthroscopic treatment of femoroacetabular impingement, Dr. Stewart has published research in collaboration with the University of Wisconsin – Eau Claire on the relationship between sports participation and femoroacetabular impingement (FAI). Current research includes how FAI can lead to hip arthritis. As a member of the American Association of Hip and Knee Surgeons, orthopedic surgeon Dr. Stewart is dedicated to providing state of the art care for hip and knee patients in the Eau Claire, Altoona, and Chippewa Falls area.

Orthopedic Surgeon Altoona & Eau Claire

In December of 2013, Dr. Stewart began using the direct anterior (DA) approach for hip replacement surgery in the vast majority of patients. Currently, over 98% of his hip replacements are done through the direct anterior (DA) approach. While he changed to the direct anterior approach for faster patient recovery, his original research published in January of 2016(1) demonstrated the increased accuracy of component positioning of total hips done through the direct anterior approach as compared to the more commonly used posterior approach.

Hip & Knee Replacements

Dr. Stewart joined Chippewa Valley Orthopedics and Sports Medicine Clinic in 2003. As an orthopedic surgeon, he is grateful for the trust patients and referring physicians have given him over these years. He is also thankful to the hospital staff at OakLeaf in Altoona, Sacred Heart in Eau Claire, and St. Joseph’s Hospitals in Chippewa Falls. Their dedication and hard work allow Dr. Stewart and the other members of Chippewa Valley Orthopedics and Sports Medicine Clinic to provide exceptional orthopedic care to the Chippewa Valley. In his free time, Dr. Stewart enjoys spending time with his three children and two grandchildren and he also enjoys spending time outdoors hunting or at his hobby farm.

 

Accreditations

  • Medical Degree: University of MN School of Medicine, Minneapolis, MN
  • Medical Internship: Mayo Clinic, Rochester, MN
  • Orthopedic Surgery Residency: Mayo Clinic, Rochester, MN
  • Orthopedic Research Fellowship: University of Minnesota, Minneapolis, MN
 

Professional Affiliations

  • American Association of Hip and Knee Surgeons (AAHKS)
  • American Academy of Orthopaedic Surgeons (AAOS)
  • Wisconsin Medical Society
 

Hospital Affiliations

  • Sacred Heart Hospital, Eau Claire, WI
  • OakLeaf Surgical Hospital, Altoona, WI
  • St. Joseph’s Hospital, Chippewa Falls, WI

Our System

Information on Our Locations and Systems

Below you will find the contact and website information on our hospitals where we perform our procedures.

Please contact us by calling 715-832-1400 and we would be happy to answer your questions.

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OakLeaf Surgical Center

1000 OakLeaf Way

Altoona, WI 54720

715.831.8130

www.oakleafsurgical.com

9166d219d6085c3b1c505575fe12ded4

Northwoods Therapy

757 Lakeland Drive, Ste A

Chippewa Falls, WI 54729

715.723.5060

www.northwoodstherapy.com

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St. Joseph’s Hospital

2661 Co. Hwy I

Chippewa Falls, WI 54729

715.723.1811

www.stjoeschipfalls.com

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Sacred Heart Hospital

900 W. Clairemont Ave.

Eau Claire, WI 54701

715.717.4121

www.sacredhearteauclaire.org