Orthopaedic Services


Obesity can cause big orthopedic problems

Obesity can lead to a variety of different illnesses, but it can also do structural damage to our bodies. Orthopedic surgeon Dr. Michael Necci, of Alliance Institute of Musculoskeletal Medicine (AIMM), said obesity can weaken bones and damage joints -- sometimes leading to the need for surgical replacement.

Necci said in the early 1970s, 3 percent of all total joint replacements were caused primarily by obesity, but today, that number has increased sevenfold, to more than 20 percent. He said most joint replacements he performs are on obese patients, but they are performed for a variety of reasons. However, he said even though obesity is not always the primary cause, it is often a factor. "Obesity is playing into accelerating the arthritic processes," he noted.

When it comes to our joints, Necci said obesity affects them in two ways. First, in a purely mechanical way, he said more weight going through a joint leads to increased wear and tear. Second, which he said is probably more important, obesity tends to lead to a more sedentary life with less exercise and less movement, which also affects the joints.

"The cartilage inside our joints does not have a blood supply in and of itself. It gets nourishment from moving the joints and circulating the fluid throughout the joint," he said. "So, when you're more sedentary, that fluid isn't being moved around, the cartilage is not being replenished and nourished, therefore it's not as healthy and can deteriorate quicker. You add that with the extra weight and you can see how obesity and arthritis is becoming more and more of a factor here in America."

He said in addition to helping burn calories and possibly lose weight, exercise helps replenish the joints and also increases the muscle tone around the joints, which helps protect them. "When you have increased muscle tone around the joints, the muscle takes the brunt of the force going through the joint," he explained.

While you can't reverse the damage already done to the joint, specifically the arthritis that sets in, Necci said exercise can help slow down the deterioration. "If for years and years you were leading a sedentary lifestyle and you were overweight and putting an increased load (on your knees), the cartilage itself is going to be less healthy, but it has the ability to become healthy or stay healthy from that point on by circulating that joint fluid and building up the muscles around the joints to take the load off of them," he explained.

Obesity and a sedentary life affect bones in a similar way, Necci said. According to Wolff's Law, he explained, when bone has compression across it from activity, it increases its density, which strengthens the bone. "Patients that are not as active tend to have poorer bone densities than active patients. So, not only is exercise and activity good for the joints, but it's good for the bones as well," he said. "When we are active and putting weight across the joints and the bones, it increases bone density and increases bone health."

Necci said low bone density increases your risk for future fractures, which he said are especially common in the elderly population. He said having good bone density and stronger bones can help prevent these breaks from happening in some cases.

"If you sustain a fall hard enough and you land the right way, you're going to break no matter how healthy your bone is, but if you can build up your bone density and make it as strong as you can for your age, then that's just one more thing you can do to prevent these kind of injuries," he said.

Necci said an exercise program can help with the health of joints and bones. He recommends things that are easier on joints for those with arthritis, such as swimming, aquatic exercises, elliptical machines or a stationary bike.

"The easiest thing to do -- and you don't need a doctor, a physical therapist or an athletic trainer -- is to just walk. We walk all the time, every day, just living life," he said. "So, the easiest thing to do starting out is just increase your walking. Once you get to a certain point and you want to start doing more exercise and whatnot, definitely talk with your primary care physician about starting a program that may be more strenuous then walking, specifically for people with heart or lung problems. Therapists, athletic trainers, your local gyms, those are all good resources for getting on an exercise program."

Necci acknowledged that becoming more active can be a difficult change for some people. "The hardest part when someone has been accustomed to a sedentary lifestyle is getting started, and then maintaining it," he said. "Any patient that I have that falls into this category, I tell them to just take baby steps."

He advises these people to start small, sometimes with walking laps in their house or up and down their driveway for five to 10 minutes a few times a day. Once they are able to do that easily and are ready, they can increase it from there.

"The key is making small changes over a period of time so that way the things stick," he said. "It's the same thing as people who do extreme dieting. If you want to lose weight, the thing that's not smart to do is just stop eating because it's not realistic that you're going to continue that for an extended period of time. It's the same thing when changing your lifestyle -- and that's what it really is, it's a lifestyle change. Just make baby steps."

Patient up and walking four hours after local doctor performs 600th two-incision hip replacement surgery


"I'm amazed," 55-year-old Rick Areddy said as he ambled down the Alliance Community Hospital hall Nov. 1 -- just four hours after having his left hip replaced by Dr. Roger Palutsis.

Early that morning, Areddy became Palutsis' 600th patient to go under the knife using the two-incision technique of minimally invasive hip arthroplasty. Though some of the excitement has worn off since he first did the procedure on an 80-year-old woman seven years ago, Palutsis is still amazed at the speed of the recovery compared to the traditional hip replacement.

The Alliance orthopedic surgeon has always known the benefits of "minimally invasive" surgery even before the term was popular. Having been trained in the traditional method, he slowly began making smaller and smaller incisions on his own to make it easier for patients to recover.

Already having cut down the size of his incisions from 6 to 4 inches, Palutsis admits he was skeptical when he first heard about the 2-inch procedure making waves in the world of orthopedics.

"I still remember asking my daughter what two and two is," Palutsis recalled. "What's the difference between two 2-inch incisions and one 4-inch incision?"

Palutsis said he wasn't sure how confident he was that the new procedure made much of a difference compared with what he was already doing. Even after training and learning the procedure himself, he had his doubts.

"Actually, after the first four or five surgeries, since it was a lot tougher, I was going to quit," he recalled. "But then these people came back and they started telling me what they did in the six-week period of time. I didn't tell them. They were just doing things because they could. That's why I kind of stuck with it."

Despite the extra work and difficulty in doing the procedure, Palutsis could no longer deny the benefits to the patients.

The difference in the two-incision hip surgery versus the traditional method is in the procedure itself. The hardware remains the same, but rather than cutting muscles, the surgeon separates the muscles in a procedure that is all about precision.

"With this you can actually be more precise even though they're little incisions because we use about eight seconds of fluoroscopy (a type of imaging that shows a continuous X-ray image on a monitor) during the case and so you know exactly where the position is, you know how big the hip is, the leg length -- all of that's as precise as you can get it," he explained. "So, we can take as much as we can of the guesswork out of it."

Because of the method used, patients are back on their feet, walking and doing many normal daily activities within 24 hours. Other benefits include no formal physical therapy, no blood thinner and a reduced risk of blood clots and pneumonia due to the ability to be mobile so quickly. Approximately 92 percent of the patients are discharged by the physical therapist within 24 hours of the procedure.

When seen back at Palutsis' office for a postoperative visit 10 days later, approximately 10 percent of patients are using a walker, 70 percent use a cane, and 20 percent are walking unassisted. Patients are allowed to drive between 10 and 21 days after surgery, and go for a final visit six weeks after the surgery. They can transition from walking with assistance to without assistance as tolerated, and can return to work at their own pace.

Despite all the positives for the patients and the fact that there is a constant increase in hip replacement procedures performed in the U.S. each year, Palutsis remains one of only a handful of surgeons in the country who perform the minimally invasive surgery, which has brought a lot of patients from all over Ohio and several other states who are looking for an easier method and recovery.

"I was in the second group to train in the country and at that time I was doing about 10 to 12 hips a year, which is about the average for most people," he said. "And now I do over 100 a year."

Most of the patients come to him by word of mouth or through their own research, which is what brought Areddy from his hometown of Aurora to Palutsis' office in the Carnation Clinic on Arch Avenue.

Areddy said he had suffered through three or four years of hip pain from "bone on bone arthritis" and was struggling to walk around a golf course when he began a conversation with a golf friend who told him about the minimally invasive procedure. Another friend mentioned a Youngstown area golf pro who had the procedure done by Palutsis and was giving lessons three days later.

Areddy said he did a lot of research and spoke with patients who had the surgery before making his decision to schedule the surgery at ACH, which he said surprised many of his friends and family.

"One of the bizarre things being a Clevelander -- living in Aurora -- everybody looks at you, 'You're not going to the (Cleveland) Clinic? You're not going to (University Hospitals)?'" Areddy admitted. "We have the world-class hospitals up in Cleveland and they don't do this procedure. There isn't a doctor at the (Cleveland) Clinic that does this procedure."

As an active person and competitive golfer, Areddy was thrilled with the fact that the procedure would prevent him from being immobile for long.

"I had been delaying getting the work done altogether because I'm already bored and I've been here four hours," Areddy admitted while in his room at Alliance Community Hospital. "So, the concept of three months of doing this, I would have accepted a lot of pain for a long time before I would have done this."

Though Palutsis said he has had plenty of stories, such as a father attending his son's high school football game four days later, a farmer planting crops before his 10-day postoperative visit and a minister standing at the pulpit preaching less than a week after the surgery, he doesn't want patients to try to do too much too soon.

"The biggest problem is a lot of people overdo it, and you have to almost caution them not to overdo it because they feel very, very well," he said. "I tell patients this is not a contest."

In all, Palutsis has been thrilled with the results of the 600 procedures, which have not only provided quick and easy recoveries, but also less complications than the traditional surgery. Of course, while the recovery has been impressive, Palutsis explained that it is the end result that is the important thing.

"It doesn't do you any good to do a fancy approach if the end result isn't as good. So, if you're having trouble with the hip at the end of it, I don't think there's an advantage to it," he said.

By the first 200 surgeries, Palutsis not only knew the procedure was worth it, but wrote a paper on the positive results.

Since those earlier days, he has grown so comfortable with the procedure that he has revised the surgery and redesigned and modified all the instruments he uses. He is also using a modular hip, which is semi-custom, to specifically fit the person's physical makeup -- taking the surgery "to the next level."

A week after the Nov. 1 surgery, Areddy reported that he was thrilled with his recovery so far. He said he left the hospital around noon Nov. 2 after learning how to walk up and down a flight of steps on crutches. He was able to easily negotiate the three flights of stairs at his home without any pain, which allowed him to sleep in his own bed.

By Nov. 3, he started to use a cane, and his pain was controlled by an occasional Tylenol. By Friday, he was able to celebrate his daughter's birthday at a local restaurant. On Saturday, Areddy said he carried the cane around to satisfy his wife, but by Sunday he took a walk without the cane.

"The entire hip replacement process has absolutely exceeded my expectations regarding the recovery process and the lack of pain," Areddy expressed in an e-mail update Monday. "I am heading to work this morning (my wife needs to drive) and plan to have a completely normal day and will do a follow-up visit with Dr. Palutsis on Thursday and expect to receive the okay to drive and be completely independent."

For more information on the two-incision hip arthroplasty, visit www.alliancehip.org or call Carnation Clinic at 330-821-0201.

Dr. David Mungo Joins ACMF
Alliance Community Hospital (ACH) is proud to announce the opening of the Alliance Community Medical Foundation, LLC (ACMF).

The ACMF is a partnership between Alliance Community Hospital and area physicians that is aimed at retaining the top clinicians and medical services in our region.  It will enable physicians to focus their attention on direct patient care, since daily business operations will be handled by the Foundation.

ACH is pleased that David Mungo, M.D., a Board Certified orthopaedic surgeon specializing in orthopaedic and sports surgery and David Kanagy, M.D., who is Board Certified in Otolaryngology and head and neck surgery, have chosen to become charter physician partners with the Foundation.

“Hospital/physician collaborations such as the ACMF have been formed in an effort to combat physician shortages brought on by skyrocketing malpractice insurance costs, plummeting reimbursement payments and increased cost for medical education throughout the U.S. in recent years,” said Dale Wells, MBA, CHCE and Senior VP of Finance/Operations at ACH.

Wells said that both Drs. Mungo and Kanagy have long been associated with ACH and that they and any other physicians ultimately joining the Foundation are equal partners in a business enterprise aimed at improving the quality of health care services offered through ACH.

“As always, our ultimate goal is to strategically plan for optimal growth of productive programs and services, so that we can continue to provide the best health care services possible to the community we serve through the most affordable means.  This is especially important at this economically-challenged time and our physician partners are key to achieving this objective,” said Wells. 

ACMF began operations on January 1, 2009.

Wells noted that, with the face of health care changing rapidly, ACH is committed to this partnership with local physicians “in order to retain the high-level of clinical expertise at our facility and in our service area.”

“ACH’s partnership with area doctors is mutually beneficial for all involved and, most importantly, for our patients and the community at large,” he said.

Dr. Mungo will now see patients at his new office in Suite 220 of the Professional Office Building at 270 E. State Street.   He can be reached at 330-596-6500.  The fax number is 330-596-6505.  Dr. Kanagy will continue to see patients in his office at 1401 S. Arch Avenue.  He can be reached at 330-596-6520.  The fax number is 330-596-6525.

For more information about Alliance Community Hospital’s programs and services, please visit our website at www.achosp.org.


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