Category: Physician/Surgeon

Football injuries would be reduced by rule changes

11/11/2015: Football injuries could be reduced by 3 rule changes.

#1: “Spearing” or leading with the head and helmet to hit another player is technically outlawed. The institution of “targeting” or hitting with helmet to head or neck is now penalized. However the incidence of leading with the head and helmet still is prevalent. This is seen with attempts to cause a fumble. The impact on the players head and neck is still there with this fumble inducing technique. I have long proposed that the rule be more general; No hitting with the head and helmet or in the head or helmet. This should be understood by all parties.

#2: No slamming to the ground outside of normal tackling technique. This occurs most often on the quarterback after he has released the pass. The result is the quarterback is forced backward into the ground with his head the last to hit the ground with great acceleration. It is almost like a whip lash injury to the neck but more importantly the potential for brain concussion of some magnitude.

#3: Restore the rule on “No assisting the ball carrier”. What happens now is that the ball carrier is upright or nearly so and both teams are pushing on this rugby like scrum, which is short for scrimmage. The result is often an injured player laying on the field after all the pile is cleared. This is the source of knee and ankle injuries especially to the linemen pushing in the scrum.

Nice Award

I received the inaugural President’s Award today from the Arthroscopy Association of North America. It was given the person who, although never president of the organization, made “numerous contributions to the Association and to the advancement of Arthroscopic Education.”

Invited Speaker: AANA April 2015

12/4/2014: I was invited to give a Presidential guest lecture in April 2015 at Arthrocopy Association of North America. So I had to get recent photograph.

November 2014 Johnson Lanny

This is the requested Bio related to the lecture.

Dr. Johnson was one of the pioneers in arthroscopic surgery. He was probably the first in the USA to perform arthroscopy of the temporal mandibular joint, the shoulder, the elbow, the wrist, the hip and ankle in the 1970’s. He performed perhaps the first arthroscopic repair for shoulder instability in August 1982.

He is holder of more than 60 US patents, most related to arthroscopic surgery and tissue engineering. The most notable was perhaps the motorized instrumentation for arthroscopic surgery. 4,203,444: Surgical Instrument suitable for closed surgery such as of the knee (arthroscopy) 5/20/1980 and 4,274,414: Surgical Instrument (arthroscopic shaver) 6/23/1981.

He has a long interest in cartilage repair and healing. He may have been the first to promote such by arthroscopic means, the procedure known as Arthroscopic Abrasion Arthroplasty.

Although he concluded his clinical practice in 1995 he continues to do research and publications in the cartilage engineering space. The following two publications are long term follow ups on what previously would not have been expected; repair of articular defects with histological evidence of hyaline cartilage and a clinical benefit. Johnson LL, Delano M, Spector M, Gottschalk A, Pittsley A. The Biological Fate of Autogenous Bone Grafting for Large Volume Osteochondral Defects of the Knee: 13020 years follow-up. Johnson LL, Delano M, Spector M, Gottschalk A, Pittsley A. Long Term Clinical Assessment following Autogenous Bone Grafting for Large Volume Three Dimensional Osteochondral Defects of the Knee. ICRS, May 2009, Miami, FL.

The last several years have been devoted to R & D on phytochemicals and their biological effects. He has been issued US patent 8,263,069 Composition including anthocyanins and anthocyanidins for prevention and or treatment of articular cartilage associated conditions. September 11, 2012. His presentation will review his past experience as well as present more recent research concerning the discovery of osteoarthritic disease modifying reagents and novel broad spectrum antibiotic and wound healing promoting reagents.

He believes there is a new era coming in orthopedics will be in tissue engineering and disease modification based upon phytochemicals. He predicts that this will have a greater impact on orthopedic surgery than that of arthroscopy.

Late Stage Treatment for Government Run Health Care


This is an interesting read about a government further down the road than the USA on government run health care.

Prediction: Only Providers with low Infection rates will do total joint surgery

4/26/2014: Prediction. Only surgeons and hospitals with low infection rates will do total joint surgery.

The incidence of operative infection will control who will do surgery of this type in the future. The reason is that a surgical infection is very costly to treat as well as the morbidity, loss of work, even mortality.

Here are the numbers concerning infection and total knee replacement.

The relative incidence of operative infections was reported as 2.0% and 2.4% following total knee surgery.

The annual cost of infected revisions to U.S. hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. (Kurtz SM, et al Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep; 27(8 Suppl)

The average cost of the surgical revision of an infected total knee replacement was $116,383 in the years 2001 through 2007. (Kapadia BH, et al. The Economic Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center. J Arthroplasty. 2013 Oct 17).

Under the new rules for quality assurance under the affordable health care act (Obamacare) the hospital will eat this loss.

Another often overlooked factor for those not on Medicare have a higher deductible under Obamacare. No patient going through the prolonged treatment for post operative infection will be able to pay their deductible. It can be $1000 to $10000. This problem already exists in Germany. This is a burden on the patient if they pay. If they do not pay then the cost is shifted to the doctor and the hospital. (Haenle M. et al. Economic impact of infected total knee arthroplasty. Scientific World Journal. 2012; 2012:1 96515).

So the hospital gets the expense shifted to them. Cost shifting is major feature of government health care insurance public policy.

Therefore only hospitals and surgeons with no or very low infection rates will do total joint surgery.

Notice I said surgeons. The hospital will not be able to afford even a “large producer” who has infections. “Sorry Doctor SoandSo, we know you are a nice guy and a good surgeon, but we can not afford to underwrite the risk of your incidence of infection.”

Health Care Fraud: government style

11/4/13: Health care fraud occurs when billing is made for services not rendered. If the transgression is by a physician, there is a large financial penalty for every occurrence whether intended or not.

Would it not be health care fraud if an agency collected money for services not ever rendered?

The federal government is an example. ObamaCare authors knowingly wrote a law that charges women insurance premiums for pregnancy services when it could be known they are out of the child bearing age. Furthermore, consider those women who have already had a hysterectomy which is known by government databases. If the hysterectomy and or oophorectomy were for cancer, the woman is assigned to a higher premium pre existing condition group. The later reason is logical by actuarial accounting, but fraudulent when charging premium for a pregnancy service that could never be rendered.

Now that the law is passed it may be time for the American people to read this law to learn if the above is verified.

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.