Currently browsing: Physician/Surgeon

Wedged Insoles for Knee Arthritis? Point/Counter Point

8/22/13: It was reported yesterday that a review of the literature by meta analysis concluded that lateral wedged insoles have only a potential placebo effect for patients with medial compartment osteoarthritis of the knee. Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis; A Meta-analysis. JAMA. 2013;310(7):722-730. doi:10.1001/jama.2013.243229. Counter Point: The necessary factor for shifting of axial loads away from the meidal compartment of the knee were not present in the studies. The essential inclusion criteria for effective use includes the patient having a compliant subtalar motion plus compliant passive laxity of the medial knee joint capsule and ligamentous structures. See for illustrations of such testing. If the foot and ankle cannot be passively moved into eversion (turned out) position then there would be no angulation force transmitted up the leg to the knee by the use of a lateral wedged insole. If the inner structures of the knee are tight and not compliant to allow the the transmitted axial force up the leg to open the medial aspect of the knee, there would be no physical change to the force on the medial compartment of the knee. The medical literature supports the effectiveness of a reduction in force across an arthritic joint to result in architectural structural changes in the bone next to the joint and grow cartilage on a joint surface. Look at Another factor for success of wedged insoles is the nature of the material to maintain its integrity to transmit the force without significant deformation of the material.

Redefining Value in Healthcare: Why Providers need to take back their OR

Click the link to read “Redefining Value in Healthcare: Why Providers need to take back their OR” Read it here:

Sushi Lessons for Physicians

3/6/2013:  I think there is value in this article  for physicians.  The 7 steps outlined by the sushi chef may be overlooked in our present culture. He clearly outlines 7  “take home messages” critical for aspiring physicians and surgeons.

Health Care Greed

2/22/13: Health Care Greed: The high cost of health care in America is easily explained in recent Time magazine article.  This article is worthy of one’s time.  Read more: While most critics point to the doctors as the problem, the doctors account for 17% of the health care dollar.  Doctors do contribute to the high expense by practicing defensive medicine; ordering laboratory and radiological tests.  Doctors also contribute by performing unnecessary procedures which is well established in other publications. So who and what else contributes to the high cost.  Where is the rest of the money going or where is it being spent. The Time publication points out the so called non-profit hospitals make large profits.  The administrators make millions in wages, far more than the doctor’s incomes.  The American Hospital Association spent $1,859,041 on lobbyists in 2012 and this is just the federal level.  The trail lawyers’ lobby makes sure there is no tort reform. Independently, I learned with an initiative I made to reduce health care costs in Michigan, that the insurance company is not interested.  You might think insurance companies have an interest in reduced premiums, but that is not so since the get a percentage of premiums.  Higher premiums mean increased income to the insurance company. Perhaps the take home message of the Time article is to learn what the hospital calls their “chargemaster list prices” and that if you are hit with these unjustifiable costs, there are advocates mentioned in the article whose business it is to help negotiate such.

References: Presidential Guest Speaker Lecture. International Society for Hip Arthroscopy

References: Presidential Guest Speaker Lecture International Society Hip Arthroscopy Boston,MA September 28, 2012 Johnson LL. Arthroscopic Surgical Principles and Pracatice: C.V. Mosby. 1986 McCarroll, H. Relton. Unexpected Roads to Greatness. J Bone Joint Surg Am. 1959;41:546-552. Johnson, L. L.: Needlescope. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 36-43.St. Louis, C. V. Mosby, 1978. Johnson, L. L.: Joints Other than the Knee. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 249-260.St. Louis, C. V. Mosby, 1978. Johnson, L. L., Becker, R. L.: Role of the Assistant in Arthroscopy. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 274-281.St. Louis, C. V. Mosby, 1978. Johnson, L. L.: Comprehensive Arthroscopy of the Knee.St. Louis, C. V. Mosby, 1977. Johnson, L. L.: Diagnostic and Surgical Arthroscopy of the Shoulder.St. Louis, C. V. Mosby, 1993. Detrisac, D. A., Johnson, L. L.: Arthroscopic Shoulder Capsulorrhaphy using Metal Staples. Arthroscopy and Related Surgery, 1993; 24(1):71-88. Johnson, L. L.: Sports & Medicine – Who is Influencing Whom? 1990 John C. Kennedy Lecture. Am. J. Sports Med., 649-654, 1990. Johnson, LL. Arthroscopic Abrasion Arthroplasty: A Review. Clin Orthop. 2001: 391S; S306-S317. Johnson, L.L. The Outcome of a Free Autogenous Semitendinosus Tendon Graft in Human Anterior Cruciate Reconstructive Surgery: A Histological Study.  Arthroscopy 1993;9(2):131-142. Johnson, L. L.: A Rationale for Systematized Record Keeping and Improved Documentation, “Twenty Years at the Bed Side, Doc”.  Arthroscopy 1987; 3:258-264. Johnson LL, JohnsonAL, Colquitt JA, Simmering MJ, Pittsley AW. Is it possible to make an accurate diagnosis based only on a medical history? A pilot study on women’s knee joints. Arthroscopy 1996; 12:709-714. Johnson, L. L., Becker, R. L.: An Alternative Health Care Reimbursement System-Application of Arthroscopy and Financial Warranty-Results of a Two Year Pilot Study. Arthroscopy. 1994;10(4):462-470. Johnson, L. L.: Arthroscopic Abrasion Arthroplasty Historical and Pathological Perspective:  Present Status.  Arthroscopy Journal, 2:54-69, 1986. VanDyk GE, Dejardin LM, Flo G, Johnson, LL. Cancellous Bone Grafting of Large Osteochondral Defects: An Experimental Study in Dogs. Arthroscopy 1998;14:311-320 LIVING IN THE PRESENT Johnson LL, Delano MC, Spector M, Jeng L, Pittsley A, Gottschalk A. The biological response following autogenous bone grafting for large defects of the knee: Index surgery through 12-21 years’ followup. cartilage. 3 (1) Jan; 85-98. First published on August 16, 2011 as doi:10.1177/1947603511413568. Johnson LL, Verioti C, Gelber J, Spector M, D’Lima D, Pittsley A. Pathology of the end-stage osteoarthritic lesion of the knee: Potential role in cartilage repair.  Knee. 2010; 18(6). 402-406.   Guyton GP, Brand RA. Apparent spontaneous joint restoration in hip osteoarthritis.  Clin Ortho Rel Res 2002, #404;pp.302-307. Zhang D, Johnson L, Hsu, H-P, Spector, M. Cartilaginous Deposits in Subchondral Bone in Regions of Exposed Bone in Osteoarthritis of the Human Knee:  Histomorphometric Study of PRG4 Distribution in Osteoarthritic Cartilage. J Ortho Res. 2007; 873-883. Milgram JW: Morphologic alterations of the subchondral bone in advanced degenerative arthritis. Clin Orthop 173:293-312, 1983. EYE TO THE FUTURE Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD, Shive MS, Buschmann MD. Drilling and Microfracture Lead to Different Bone Structure and Necrosis during Bone-Marrow Stimulation for Cartilage Repair. J Orthop Res. 2009 Nov;27(11):1432-8. Garg AK: The use of platelet rich plasma to enhance the success of bone grafts around dental implants. Dent Implantol Update 11:17, 2000. Reeves KD, Hassanein K: Randomized prospective double blind placebo controlled study of dextrose prolotherapy of knee osteoarthritis with and without ACL laxity. Alt Ther Hlth Med 2000;6(2):37-46. Reeves KD, Hassanein K: Randomized prospective double blind placebo controlled study of dextrose prolotherapy of osteoarthritic thumbs and finger (DIP, PIP and trapeziometacarpal joints) Evidence of Clinical Efficacy. Jnl Alt Compl Med 2000;6(4):311-320. Reeves KD, Hassanein K: Long term effects of dextrose prolotherapy for anterior cruciate ligament laxity: A prospective and consecutive patient study. Alt Ther Hlth Med 2003;9(3)58-62. Dumais R, Benoit C, Dumais A, Babin L, Bordage R, deArcos C, Allard J, Belanger. Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study. Pain Medicine  2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print] Jayaprakasam B,VareedSK, Olson LK, Nair MG. Insulin secretion by bioactive anthocyanins and anthocyanidins present in fruits. J Agric Food Chem. 2005 Jan 12:53(1):28-31 Johnson LL, vanDyk, GE, Green JR III, Pittsley AW, Bays B, Gully SM, Phillips JM. Clinical Assessment of Asymptomatic Knees: Comparison of Men and Women. Arthroscopy 1998:14(4):347-359. Johnson LL, JohnsonAL, Colquitt JA, Simmering MJ, Pittsley AW. Is it possible to make an accurate diagnosis based only on a medical history? A pilot study on women’s knee joints. Arthroscopy 1996; 12:709-714.   Gray CL.  Battle for America’s Future. Healthcare, the culture war and the future of freedom.                  

Couple of short, good reads

9/18/12  It is not common for me to either read books or recommend them, but with weather change last couple of days I read two books worthy of others attention.  I never like to get a book thicker than 1/2 inch nor recommend the same.  They both fall into that category. Gray CL. The Battle for America’s Soul; healthcare, the culture war and the future of freedom. Eventide publishing.  This reviews the history of the various world views and nothing is new since Plato.  Now the increasing divide in America is based upon the two opposing world views.  He outlines the results depending upon which one prevails. The other is: Hill Craig. Five Wealth Secrets 96% of us do not know.  Family Foundations International PO Box 320 LIttleton, CO 80160  This is a very simple practical outline of basic money management and the consequences thereof. Both can be found on the Internet.  Inexpensive and worthy of your attention.

Football Head Trauma: How to Stop it!

9/14/12  There must be a stop put to the head trauma in football.  Several years ago I wrote the NFL about this, suggesting a simple solution that I thought everyone would understand; No hitting with the head and no hitting in the head.  I did not get a response.  The problem continued and now has escalated and surfaced publicly.  Still the practice goes on at all levels.  The practice of “Spearing” is illegal, but rarely penalized.  It is common practice and probably is taught to “put your helmet on the ball” so as to cause a fumble. The risks are to both player’s head and neck in this type of collision.  The player rendering the blow cannot be so naive to think the laws of physics have been suspended when he hits with his helmet.  “For every force there is an equal and opposite force.”   His head and brain are inside that battering ram.  It is not just the helmet stupid, it is your brain or spinal cord. Since nothing has worked so far, a stronger penalty must be instituted for this action.  Since instant replay is so available and there is precedent for identifying “irrefutable evidence” by video in football, I suggest the following method of penalizing such action. THE SOLUTION:  A video referee will monitor all plays where a player hits with his head to another player’s head throughout each quarter of the game.  Since there is a hiatus in play at end of each quarter and the game, this referee announces one penalty point subtracted from the team’s score for each such incident.  At the end of a close game the outcome will be known in matter of seconds.  Another method would be to have the penalties and score adjustment instantaneously projected on the scoreboard. Since this suggested rule would affect the score,  the practice of hitting with the head will stop.  15 yard penalties and game ejection has not been enough.  It will be a passive restraint to such action.  when introduced it will stop the practice of hitting with the head from being taught.  It will instill blocking and tackling methods that avoid such incidents.  In my profession this suggestion would be considered PREVENTIVE MEDICINE.