Orthopedics is the branch of medicine that treats the bones, joints, muscles, tendons and associated tissues. The eight orthopedic surgeons at Cedar Valley Orthopedics care for patients with broken bones, sports injuries, arthritic or worn-out joints, sprains, strains, cuts and bruises, as well as diseases and congenital problems involving the musculoskeletal system.
The most common procedures performed include joint replacements of the hip, knee, shoulder and ankle; care for broken bones and joint dislocations with splints, casts or surgery; and arthroscopic joint surgery, carpal tunnel surgery, and trigger finger release surgery in the hand. Dr. Jim Crouse says the majority of the cases have to do with injuries and arthritis.
“Statistically, there are more people with arthritic hips and knees,” he notes. “The population is aging and people are tending to be heavier, putting more stress on their joints, which causes increased wear. With age comes aches and pains from arthritis, bursitis and tendonitis.”
As uncomfortable and inconvenient as any of these conditions or injuries may be, there have been advancements in the instruments and diagnostic and treatment techniques. Physicians are better-equipped to evaluate and treat bone and joint problems, leading to quicker and less-painful recovery times. Improved techniques and materials also offer a new hope of living more normally for people faced with fractured or degenerated joints, including the elderly, for whom a broken hip can lead to a sudden decline in lifestyle and overall health.
“One of the biggest advancements is the development of arthroscopy for joints,” Dr. Crouse says. “It’s a major tool used now, particularly for shoulder and knee cases. There are still cases that need open surgical procedures, but more are performed with a scope. The surgery is often easier to perform this way and means quicker recovery for the patient. It’s also more cost-effective because it can be performed as an outpatient procedure.”
This ties in with the trend of patients returning home sooner after hospitalization. Rather than needing to stay two weeks after a hip replacement, as was once the case, people may return home as early as the next one or two days. There is a movement to perform more replacements as outpatient procedures, which Dr. Crouse says requires a “concerted effort in getting people prepared and working with the family, physical and occupational therapists and others in managing post-operative care.”
He explains that the instruments used for arthroscopy and joint replacement continue to be refined. MRI and CT scans are used for improved diagnosis and treatment. Materials continue to be refined for joint implants as we learn over time what works and what does not work so well.
“We used to tell patients that a joint replacement would last maybe 10 years,” Dr. Crouse says. “Now, we say that most are going to last a lifetime. As a result, we are seeing much younger people with injury or stress to the joints having replacements, understanding they are more likely to have wear and loosening, which may require revision, as well as the possible complications associated with any procedure.”
Dr. Crouse explains that cobalt chrome materials and ceramics, which are very hard and don’t wear, are generally used for joint surfaces along with a highly developed polyethylene (plastic). For bone ingrowth surfaces, titanium is the material of choice because of its closer similarity to real bone.
“Bone can grow into it and bond more easily,” he says.
Medical research is constant. In the forefront is stem cell research concerning regeneration of cartilage, skin and tendons. The hope is to have normal cartilage rather than metal in replacement surgery. Small areas of cartilage loss have been treated with various procedures, including taking cartilage from a knee, sending it to a laboratory to grow, and re-implanting the cartilage. However, as with most breakthroughs, the practice is expensive, time-consuming and still being perfected.
Cedar Valley Orthopedics is also very focused on doing its part to keep costs as reasonable as possible. “Modern medicine is expensive, and we want to provide value for what we do,” says Dr. Crouse.
Many of their surgeries are performed as outpatient procedures in United Medical Park’s Surgical Center on West Ridgeway Avenue in Waterloo.
“It’s more convenient and is aimed at healthy patients who don't require major surgery and who can go home the same day, although overnight stays are possible. Most often this involves hand and foot surgeries, such as carpal tunnel and trigger finger release, and arthroscopic surgeries,” Dr. Crouse says. “As time goes on, I believe these procedures done in the Surgical Center will only increase. We now do partial knee replacements as outpatient procedures.”
The orthopedic surgeons at Cedar Valley Orthopedics travel to surrounding communities for clinical visits, including Waverly, Independence, Grundy Center, West Union and Sumner. In some cases they can perform outpatient surgery locally, but most of the inpatient operations are done at UnityPoint Health-Allen Hospital.
Cedar Valley citizens are fortunate that in the more rare and complicated cases, patients may be transferred to the University of Iowa or The Mayo Clinic; they both have a close relationship with CVMS.