Orthopedic Services

Specializing Institutions

Orthopedics is the study of the musculoskeletal system. Orthopedists specialize in the diagnosis and treatment of problems with bones, joints, ligaments, tendons, muscles and nerves. There are a lot of professions that offer non-surgical treatment alternatives for many orthopedic conditions, such as chiropractic, podiatry and occupational therapy. The most common conditions in orthopedics are musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors and congenital disorders. Currently, more than one in four Americans suffer from a musculoskeletal impairment, with back and knee being the most prevalent.

Patients looking for excellence and innovation in orthopedic procedures will find it at the South Texas Medical Center. Some of our institutions have nationally recognized orthopedic care services, Joint Replacement Clubs and support groups, pediatric and geriatric orthopedics, and rehabilitation. Procedures available to patients at the South Texas Medical Center include total knee and hip replacement, shoulder care, spine surgery, orthopedic trauma care and orthopedic rehabilitation.

Some of the best orthopedic physicians and specialists in south central Texas work and research at the South Texas Medical Center to bring patients the best and latest in sports medicine, cartilage restoration, orthopedic reconstruction, joint replacement and advanced spine procedures. Specialists are also available to help patients recover after surgery through a friendly rehabilitation process. The South Texas Medical Center is also home to the Acute Rehabilitation Center, which is accredited by The Joint Commission and The Commission on Accreditation of Rehabilitation Facilities, to assist patients during every step of the rehabilitation process.

Orthopedic Articles

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: http://bmj.co/1zCnywT Annals of the Rheumatic Diseases, online December 4, 2014.

  • Review finds best exercises to prevent women's knee injury

    By Madeline Kennedy

    (Reuters Health) - Some training methods are better than others at preventing knee ligament injuries in young women, researchers advise.

    Based on 14 previous studies, the researchers say training programs that focus on strengthening the legs and hips and stabilizing the abdomen are the most effective for preventing injury to the anterior cruciate ligament (ACL), and doing more than one type of exercise is also important.

    "We know neuromuscular training can reduce ACL injury in female athletes, but we were not sure what exercises are the best to attain the maximal prophylactic effects," said Dai Sugimoto of The Micheli Center for Sports Injury Prevention and the Boston Children's Hospital Orthopaedics and Sports Medicine department, in Massachusetts.

    The ACL is the key stabilizing ligament in the knee, and is most often injured during sports that involve quick turns or pivoting movements.

    ACL injuries are very serious and can take a long time to heal, the researchers write in the British Journal of Sports Medicine. College athletes with ACL injuries lose more time on the field than athletes with ankle or traumatic head injuries, according to the researchers.

    Young women facing the greatest risk are those who play sports involving a lot of pivoting, such as soccer, basketball, lacrosse and handball, according to Sugimoto. He added that the most common age for women to be injured is around 14 to 17 years.

    Grethe Mykelburst, who outlined the risks involved with ACL injury in an email, said, "it takes you out of your sport for 6-12 months, and some don't succeed to return to their previous level." She added that the risk of getting osteoarthritis, a degenerative condition, in the knee is high after injury.

    Mykelburst, a sports physical therapist and associate professor at the Oslo Sport Trauma Research Center in Oslo, Norway, was not involved in the review.

    Sugimoto's team analyzed 14 studies of exercise intervention programs, looking specifically at four different exercise approaches including balance, jump training, abdomen stabilizing exercises and strengthening of the legs and hips.

    Training programs that aimed to build strength in the back of the legs and in the hips significantly reduced the number of ACL injuries when compared with programs that did not. That was also true of programs that focused on strengthening and developing more control of the abdomen.

    Programs that included more than one type of exercise were significantly more effective than those using only one type. "Neuromuscular training has to incorporate many exercise modes," Sugimoto told Reuters Health. "Performing only one exercise mode seems ineffective."

    The researchers note that while balance and jumping exercises were somewhat helpful in reducing injury, they were not effective unless combined with other exercises.

    The study lists a number of specific helpful exercises, including Russian hamstring curls, sit-ups, pushups and bench press. Sugimoto emphasized the hamstring curls in particular, as they work both to strengthen the legs and hips and require abdomen control.

    "With inclusion of these exercises as well as a variety of exercise modes, athletes can attain the fullest benefit from neuromuscular training and prevent ACL injury," Sugimoto said.

    Every year 350,000 people seek ACL reconstruction surgery in the United States, the authors point out.

    Sugimoto said that although surgery is the best available treatment, 24 to 30 percent of high school athletes who undergo the surgery tear their ACL again within the next several years.

    "That's why we need to prevent ACL injury in first place to avoid subsequent ACL injury and preserve a healthy knee joint," Sugimoto said.

    "The evidence is strong that neuromuscular training works," Mykelburst agreed. "As an athlete or a coach, you can't afford not using the prevention program and exercises that exist," she added.

    SOURCE: http://bmj.co/1wATVNF British Journal of Sports Medicine, online December 1, 2014.

  • Fractures are major cause of older women's hospitalizations

    By Kathryn Doyle

    (Reuters Health) - For U.S. women age 55 or older, bone fractures due to osteoporosis lead to more hospitalizations and greater healthcare costs than heart attack, stroke or breast cancer, according to a new study.

    "What we saw and what those of us in the bone heath field have known is that the burden of major osteoporotic factors is huge," said lead author Dr. Andrea Singer of MedStar Georgetown University Hospital in Washington, DC, and clinical director at the National Osteoporosis Foundation.

    More than five million people over age 50 in the U.S. have been diagnosed with the bone-weakening disease osteoporosis, including two percent of men and ten percent of women, according to the Centers for Disease Control and Prevention.

    "We really underestimate the importance of osteoporosis and fracture, and people underestimate their own risk," Singer told Reuters Health.

    She and her coauthors used inpatient data from more than 1000 hospitals nationwide.

    Between 2000 and 2011, 4.9 million women over age 55 were hospitalized for osteoporotic fracture of the hip, pelvis, arm, leg or spine, compared to 3 million for stroke, 2.9 million for heart attack and 700,000 for breast cancer.

    Osteoporotic fractures accounted for more than 40 percent of the hospitalizations, the researchers calculated, and led to an estimated hospital cost of more than $5 billion per year.

    Heart attack, stroke and breast cancer hospitalizations cost the healthcare system $4.3 billion, $3 billion and $500 million per year, respectively, according to results in Mayo Clinic Proceedings.

    Even these numbers likely underestimate the true cost of osteoporosis to the healthcare system, Singer said.

    "We've known for a long time that osteoporotic fractures are the source of a lot of expense and pain," said Dr. Ethel S. Siris, past president of the National Osteoporosis Foundation and director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center at New York-Presbyterian Hospital.

    "Since this is something that has a higher burden than other things that patients or providers worry about all the time like heart attack, stroke and breast cancer, then we ought to be doing something to ask the right questions," Singer said.

    A quarter of all people who suffer a hip fracture die within one year, which is much higher than the other diseases included in the study, she said.

    "Of the 75 percent who remain alive, many lose their independence and need assisted living," Singer said. "A lot of times people fear not necessarily dying, but being incapacitated, ending up in a nursing home. Those statistics are daunting."

    Most people who break a hip never return to their normal lives, said Siris, who was not involved in the new study.

    "Half the people who break a hip have previously broken something else, and instead of looking at that as a red flag, those people don't get evaluated, they don't get bone density tests," she told Reuters Health. "Somehow or other fractures are just not taken so seriously."

    But recognizing and treating osteoporosis after that first fracture could prevent more fractures later, Siris said.

    That can include maintaining a healthy lifestyle to prevent or slow bone loss, getting adequate calcium and vitamin D, and doing weight-bearing muscle strengthening exercise. Even people who have had a fracture already can do modified safe activities, and can take care with proper footwear, avoiding steps, and avoiding carrying heavy loads, and thereby prevent falls, Singer said.

    "In terms of building new bones and really getting to the best bone density level you can, that happens when you're young," but it's never too late to treat osteoporosis, Singer said.

    Used correctly, bisphosphonate drugs can be very effective at lowering fracture risk, Siris said.

    "There's little doubt of the benefit of treatment if you need it overwhelmingly," she said. "There are lots of good treatments."

    Older women may qualify for a bone density test, and should request one after suffering a fracture over age 50, Singer said.

    "I hope in some ways this paper serves as a call to action to providers and empowers women to think about their own bone health," she said. "If their provider isn't proactively asking, then they can ask about it."

    SOURCE: http://bit.ly/1uh2Nkb Mayo Clinic Proceedings, online December 13, 2014.