Shoulder Replacement

Shoulder Replacement

Shoulder Replacement Surgery

Thousands of traditional total shoulder replacements are carried out every year successfully in the US for patients suffering from shoulder arthritis. However, this type of surgery is not beneficial in patients with large rotator cuff tears, which have caused cuff tear arthropathy.

Conventional total shoulder replacement may not be able to alleviate the pain or increase motion for these patients. In fact, reverse total shoulder replacement is a far better option for these patients.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

How Does Reverse Total Shoulder Replacement Work?

Conventional shoulder replacement devices mimic your shoulder’s normal anatomy. In this type of surgery, a plastic cup like device is fitted to the glenoid or shoulder socket. A metal ball is then attached to the top of the humerus or upper arm bone.

Conversely, in reverse total shoulder replacement, the metal ball and socket are reversed. The plastic cup is fixed to the humerus while the metal ball is attached to the glenoid. This surgical procedure works better on patients with cuff tear arthropathy. This is because it makes use of different muscles for moving the arm.

Rotator cuff muscles in a healthy shoulder help power and position the arm for a wide range of motions. Rotator cuff muscles are used by conventional replacement devices to function properly. Patients with cuff tear arthropathy and large rotator cuff tear do not have these muscles in working order. Reverse total shoulder replacement relies on using the deltoids to position and power the arm instead of the rotator cuff.

Who is a Candidate for the Surgery?

Reverse total shoulder replacement surgery may be recommended in the following scenarios:

  • Cuff tear arthropathy
  • Irreparable or completely torn rotator cuff
  • Second surgery after an unsuccessful shoulder replacement surgery
  • Difficulty lifting the arm
  • Severe shoulder pain
  • Complex shoulder joint fracture
  • Chronic shoulder dislocation

What to Expect During the Pre-operative Stage?

You should wear button-front shirt and loose-fitting clothes on the day of the surgery when you go to the hospital. You may not be able to use your arm extensively since it would be placed in a sling after the surgery. You will be admitted on the surgery day and taken to the preoperative area. This is where you will meet with the anesthesiologist.

You will be given general anesthesia or a regional anesthesia depending on the operation. General anesthetic will help you sleep during the entire operation while regional anesthetic will numb the surgical area. You may be given a combination of the two as well.

Understanding the Surgical Procedure

Shoulder replacement procedure doesn’t take more than two hours. Your surgeon will make a small incision at the top or front of your shoulder and use it to remove the damaged bone. They will then reposition new components for restoring function.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Revision Joint Replacement

Revision Joint Replacement

Most people who undergo a total knee replacement get back to an active life that is free from the debilitating chronic knee pain. However, in some rare cases, the procedure may fail to yield the expected results. In these types of situations, surgeons recommend a second surgery called a revision knee joint replacement.

The objective of a revision surgery is same as the primary total knee replacement. The technique, though, is more complex because the primary implant will have grown into the bone around the knee and has to be carefully removed. Besides, removal of this prosthesis means some part of the bone is also lost, leaving the surgeon with lesser bone to work on.

Revision knee replacement surgery therefore is a challenging procedure that requires specialized tools and implants along with more detailed planning for the procedure to succeed.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

How Does a Revision Surgery Work?

Revision knee replacement surgery can be of different types. In some patients, the surgeon will revise only one part of the prosthesis; in others, all the three parts – the tibial, femoral, and patellar components have to be replaced along with a rebuilding of the bone around the knee using augments or a bone graft.

If there is significant damage to the bone, the standard knee implants cannot be used for a revision surgery. In cases such as this, the surgeon will use special implants that come with a thicker and longer stem that can fit deeper into the bone to give extra stability and support.

Procedure of Revision Knee Replacement

Revision knee replacement surgery is a very challenging and complex process and may take about 2 to 3 hours time to complete.

The surgeon will first make an incision along the older incision from the primary total knee replacement surgery. The new incision may extend farther in order to allow removal of the old components.

The surgeon then moves in to place the tendons and kneecap aside and reveals the knee joint. They will look for signs of infection in the soft tissues around the knee, and also examine the plastic and metal parts of the prosthesis to check which part has grown loose or worn out or moved out of its intended position.

Any cement that was used in the primary surgery is removed and retaining as much bone as possible, the surgeon will remove the original implant. Next, they will prepare the bone surface to receive the revision implant. Any deficit in the bone around the knee is made up using platform blocks and augments.

In some rare cases, bone grafts may be required to rebuild the knee, and they may be sourced from your own bone or from some donor. Once the bone is adequately prepared, the surgeon inserts the revision implant and any damage to the surrounding soft tissue is repaired before carefully testing the new joint’s movement.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Hip Replacement

Hip Replacement

Hip replacement surgery is recommended for patients with painful arthritis in the hip joint. In this procedure, the surgeon removes the affected joint and replaces it with a prosthetic one made from plastic and metal components. A successful hip replacement surgery gives the patient relief from pain in the hip and makes walking easier.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Direct Superior Hip Replacement Technique

Total joint replacement surgery is a field with new technologies evolving at a steady pace. In the field of hip replacement surgery, the latest surgical technique which is minimally invasive is called the Direct Superior Approach.

This newer technique of hip replacement uses an antero-lateral hip approach which is a modified form of the older anterior and posterior techniques. The surgeon makes a single incision in the region near the buttock and works around the muscles surrounding the hip joint.

This results in minimal trauma to the soft tissue in the area. Once the implant is in position, the surgeon repairs the capsule of the hip and the skin to prevent the hip from dislocating, and allow it to heal.

In this approach, the hip does not have to undergo the classical dislocation. This means there is minimal stretching of the capsule, tendons and muscles while removing the femoral head of the joint. As a result, there is less bleeding and also, even less pain than in the other surgical techniques of hip replacement.

Also, because the attachments of the anterior and posterior capsule to the femur are unaffected, the hip stays as perfectly stable as possible. Only one deep muscle structure called the piriformis tendon has to be released during this direct superior technique, and it is easy to repair during the closure.

Patient Benefits From Direct Superior Approach

When a surgeon uses the direct superior approach for hip replacement, it has distinct advantages for the patient such as:

  • Smaller size of incision
  • Lesser damage to the tendon and muscle
  • Decreased blood loss
  • Lower rates of dislocation
  • Lesser possibility of extremity twisting because leg stays in a near-natural position during the surgery
  • Fewer precautions required post-surgery
  • Lower level of pain post-surgery, resulting in reduced usage of pain medication; pain may respond well to mere over-the-counter medication, too
  • Earlier discharge after surgery, even on post-operative first day
  • Lower risk of complication

Precautions to Take Post- Hip Replacement Surgery

Before you are discharged from the hospital, your surgeon will provide you with instructions to make your life easier post-hip replacement surgery. These may include the following:

  • Sit upright in a straight-back, firm chair and do not use recliners.
  • To avoid bending too far and putting pressure on the hips, use a raised toilet seat.
  • Avoid climbing stairs.
  • Keep the floor free of clutter to reduce the possibility of a fall.
  • Refrain from strenuous activities such as physical exercise, driving and sexual activity until your doctor gives you the go-ahead.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Back Pain Specialists

Back Pain Treatment

The spinal column is among the most important and complex systems in the human body. It is the body’s primary support structure and comprises of 33 different bones or vertebrae. These together make up the spinal column and can be divided into cervical, thoracic, lumbar, sacral, and coccygeal.

An intricate knowledge of several different disciplines is required for the medical treatment of spine related diseases and injuries. Most spinal treatment providers focus on pain management, prevention, and function restoration. They are also dedicated to controlling costs for developing back pain treatments.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Spinal Pain and Epidural Injections

Epidural spinal injections contain steroids, which is directly injected around the nerve root sac, called the dura. This sac contains the cerebrospinal fluid. The injection helps in reducing inflammation that accompanies most spinal issues, like disc herniation, spinal stenosis, and degenerative disc disease.

Inflammatory proteins are flushed out from the spinal structure, that may have been causing pain. Epidural injections go a long way in relieving lower back pain in almost 50% patients. They are beneficial in allowing patients to manage pain in a better way and move towards rehabilitation.

Understanding Minimally Invasive Options for Spinal Surgery

Minimally invasive spinal surgery can help if your chronic back pain doesn’t respond to noninvasive treatments. The procedure is unlike open spine surgery. It combines state of the art technological advances to reduce the incision size and downtime.

More than one spinal condition responds in a positive way to minimally invasive spinal procedure. There are fewer risks associated with the procedure as compared to open spine surgeries.

Understanding Artificial Disc Replacement or ADR

ADR or Artificial Disc Replacement is an alternative option for lower back pain. It is used mainly instead of lumbar fusion since it helps in preserving the normal functioning of the spine. The results of the surgery can vary significantly. Artificial or synthetic disc is used in place of the damaged or worn disc material between the vertebrae.

The procedure is designed to help with chronic back pain while regulating normal motion of the spine. ADR has been performed in the United States with successful results since 2004. There is a 89-97% chance of excellent results in ADR surgery.

Should You Get a Back Surgery?

Back pain is a common occurrence and everybody faces it at some point or the other. However, surgery is not required for every back issue. Your physician should understand the extent of your pain issues and take a call whether surgery is required or not.

Back pain can pass away on its own with rest within a few weeks or months. However, you should still consult a doctor to understand the extent of damage. It is usually better to explore all conservative and non-invasive treatment options before going ahead with surgery.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Malunion And Nonunion Fracture Treatment

Malunion And Nonunion Fracture Treatment

A fractured bone that takes on an abnormal position during the healing process is called as a malunion fracture. The bone or the limb in which it is present appears to have bent, and its function too gets impaired. A fractured bone that fails to heal even after 9 to 12 months is known as a nonunion fracture.

Both malunion and nonunion type of fractures are complex conditions which are very different from the original fracture. Having such fractures evaluated by an expert surgeon is important to identify the cause so that it can be treated to restore limb function.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

How is Malunion Different From Nonunion?

Malunion refers to a fracture that has healed, but not in the usual position. The healed bone takes up unusual positions which causes the affected limb to get twisted or bent or grow shorter.

In a nonunion, the bone does not heal at all, so realigning does not occur even a year after the fracture. This inability to heal may be due to the body having insufficient bone tissue to repair the break. It may also occur due to other factors such as the patient being a smoker or having diabetes.

Both malunion and nonunion fractures result in similar symptoms of pain, discomfort, bruising, swelling, and impaired function in the affected area. An expert orthopedic surgeon can diagnose the exact condition and treat it using non-surgical or surgical procedures.

Causes of Malunion and Nonunion Fractures

Infection that lingers around the broken bone is one of the causes for a malunion or nonunion, and it can be very challenging to treat. Reconstruction of the bone can start only after completely eliminating the infection.

Insufficient blood supply to the fracture area can lead to dead bone. During the surgery in such cases, the dead bone has to be removed to bring the living bone ends together.

Lack of stability in the affected area may also prevent fracture healing.

The patient’s biology and levels of important substances such as vitamin D, thyroid hormones, and minerals such as phosphorus, calcium and magnesium can also influence the healing process.

Treatment of Malunion and Nonunion Fracture

In some malunion fractures, if the limb function is not reduced, the doctor may advise some non-surgical treatment. In cases where the position of the broken bone is causing further damage, they will advise surgical treatment to remove the aberration. The most common form of surgery for malunion is called an osteotomy and it includes a lengthening, or shortening or realignment of the broken bones.

Nonunion fractures may be treated using braces or electric stimulation while others may require surgery. Surgery for a nonunion fracture involves a repair of the damaged bones and the tissues around them. Gaps in between bones may be filled with a plate and screw system to give stability to the bone. Sometimes, bone grafts are used to stimulate the bones to heal.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Fracture Treatment

Fracture Treatment

Fracture of the scapula or shoulder blade is common in vehicle collisions and accidents that involve falling from a height. While most such fractures can be treated by non-surgical methods such as the use of a sling and ice and pain medications, surgery may be required in a few rare cases of severe damage.

The scapula is surrounded by a protective covering of several muscles. An injury that fractures this bone is often likely to damage to other adjoining parts such as the collarbone, head, ribs, spinal cord, and lungs.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Symptoms of Scapular Fracture

Half of the patients who present with a scapula fracture come in with a fracture of the main body of the shoulder bone. About one-fourth of patients show fracture of the neck of the scapula. The common symptoms of a scapular fracture include:

  • Severe pain when you attempt to move the arm
  • Swelling in the area behind the shoulder
  • Scrapes around the damaged area

Once you notice the symptoms of a shoulder blade fracture, it is vital you seek treatment at the earliest to ensure the damage does not increase.

Non-Surgical Modes of Treatment

The most commonly used non-surgical treatment for scapular fracture is a simple sling. This helps to hold the shoulder in place while the bones heal. Within one week, the doctor will advise you to begin mild shoulder movements to avoid stiffness of the shoulder and the elbow.

After you find a reduction in the pain, the surgeon will ask you to remove the sling and start performing passive stretching exercises. Either the surgeon or a physical therapist will guide you with the exercise which you must continue for about six months to one year until your shoulder regains its full range of motion.

Surgery for Scapula Fracture

Scapula fractures that are more complex will require surgery for treatment. Some cases when this is recommended are:

  • Scapular neck fracture accompanied by noticeable angulation
  • Glenoid articular surface fracture with bone displacement
  • Fracture that affects the acromion process, resulting in impingement syndrome

In a scapular surgery, the surgeon first aligns the fragments of the bone into the correct position. Using metal plates and special screws, they attach the fragments together and to the outer surface of the bone. After a period of rehabilitation, the shoulder will regain its normal function.

Pain Management in Scapular Fracture

Scapular fractures cause a significant amount of pain and your surgeon will prescribe pain medications to deal with it. Most doctors advise the use of a combination of NSAIDs, opioids and local anesthetics to combat the pain. This combination helps reduce the dose of the opioids which must be used strictly according to the doctor’s instructions.

To avoid chances of an overdose or dependency, your surgeon will stop your opioid medication after your pain abates. Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada.

Orthopedic & Sports Medicine Procedures: ACL Reconstruction

ACL Reconstruction

The Anterior Cruciate Ligament (ACL) is one of the important ligaments of the knee. Tear of the ACL is a common injury encountered in sports such as football, basketball, soccer, and skiing downhill, that involve a sudden change in motion, direction, and jumping.

Mild ACL injury can be treated with rest and rehabilitation exercises. More severe forms of injury will require surgery to replace the torn ligament with a new one.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

ACL Grafts

To give you a new ACL, the surgeon will use part of a tendon – a tissue that resembles a ligament. This tissue is called a graft and ACL grafts can be of three types: hamstring tendon, patellar tendon, and donor grafts. Each type of ACL graft has its merits and limitations and the surgeon will recommend one type over the other based on the specifics of your injury.

Steps in ACL Reconstruction

ACL reconstruction is a surgical procedure performed on an outpatient basis by orthopedic surgeons. The steps in this surgery include:

Diagnostic Arthroscopy

In this first step, the surgeon inserts an arthroscope into the knee and examines the damage of the joint to confirm the ACL tear. If they find any damage of the meniscus and cartilage, they will treat these injuries too during the ACL reconstruction.

Harvesting and Preparation of the Graft

Harvesting involves obtaining a graft from either a donor or from another part of the patient’s body. The tissue to be used as the graft is prepared to meet the length and width requirements to convert it into the new ACL.

Creation of Tibial Tunnel and Femoral Tunnel

The surgeon then creates a space within the knee into which the ACL can be placed. Using a drill, they prepare a tunnel in the shin bone or the tibia. Through this tibial tunnel, the surgeon passes a drill down the middle part of the knee joint to develop another tunnel that extends until the thighbone or the femur. One end of the new ACL will be positioned in the tibial tunnel and the other end in the femoral tunnel.

Graft Positioning and Fixing

To position the new ACL, the surgeon uses a large pin with one end of the ACL attached to it. This is pulled into the femoral tunnel and that end of the ACL is attached to the femur. After the ACL is in position, it is secured in place using a screw that holds the graft within the tunnel.

After the femoral side of the graft is fixed, tension is applied to the graft end to make the graft tight. A similar procedure used to fix the tibial side of the ligament in place.

Recovery from ACL reconstruction surgery is a slow process. Patients have to wear a knee brace and move using crutches for many weeks after the surgery. They also require physical therapy to build knee strength and restore the knee’s entire range of motion.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada.

Orthopedic & Sports Medicine Procedures: Rotator Cuff Repair

Rotator Cuff Repair

Rotator cuff tear may manifest itself due to normal wear and tear of the shoulder tendon with age, or it may be caused by an acute injury. Conservative treatment of this condition includes the use of rest, ice, and physical therapy to facilitate healing.

The type of tear, its size, and the activity level of the patient are factors that determine whether this kind of non-surgical treatment modes will be effective in relieving the symptoms.

When conservative therapy does not yield the desired results, surgeons recommend a surgical procedure called rotator cuff repair. This surgery may be performed using three different techniques: conventional open repair, mini open repair, and arthroscopic repair.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Conventional Open Rotator Cuff Repair

In this form of surgery, the surgeon makes an incision that is about 6 cm to 10 cm long. This allows a clear view of the torn tendon and the surgeon works through this incision to repair the damaged tendon and reattach it to the bone.

Many surgeons consider this to be the most effective of techniques for rotator cuff repair. While the surgery itself is straightforward, the large size of the incision may make the recovery period more painful and longer.

Mini-Open Repair

This technique is a combination of an arthroscopic repair with an open repair but with a smaller sized incision. First, the surgeon uses an arthroscope to view the damaged shoulder and remove damaged tissue or bone spurs.

After this, they place a small incision that is about 3 cm long and through this, they reattach the tendon to the bone. Recovery is more rapid and less painful as compared to an open cuff repair because the incision here is smaller in length.

Arthroscopic Rotator Cuff Repair

In an arthroscopic repair, the surgeon makes tiny incisions to insert the arthroscope which streams images of the affected tendon through a small camera onto a TV screen. By viewing these pictures, the surgeon can perform the appropriate repair through the arthroscope.

This is a more recent technique and damage to the deltoid muscle during surgery is very minor compared to the other two techniques. However, arthroscopic repair is not useful in all types of tears and also, it involves a greater technical challenge that all surgeons may not be equipped to manage.

Shoulder Replacement Surgery

In patients who have significant rotator cuff tears for several years without receiving any treatment, the cartilage of the shoulder joint eventually wears out. These types of tears which usually involve at least two of the four tendons, are called massive rotator cuff tears.

This condition may be treated using special implants. In an innovative technique called a reverse shoulder arthroscopy, the surgeon installs an artificial ball and socket joint in such a way that the ball portion is positioned on the shoulder blade while the socket part is fitted onto the arm bone.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Shoulder Replacement

Shoulder Replacement

Arthritis of the shoulder joint can be painful, but it does not cause as great a disability as arthritis of the hip or knee. Doctors therefore prefer to treat it using non-surgical methods. Hip and knee replacement surgery are far more common than shoulder replacement surgery. However, shoulder replacement may be performed in patients who do not respond well to non-invasive forms of treatment.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Implants for Shoulder Replacement

In shoulder replacement surgery, an implant made of metal and plastic is used to replace the natural joint. The metal ball takes the place of the head of the humerus (arm bone) and the plastic cup replaces the glenoid (socket of the shoulder blade). After the surgeon has removed the faulty joint, the implant is accurately positioned and attached in place using cement.

What to Expect During Surgery?

Shoulder replacement surgery is done under general anesthesia. The surgeon may also administer a drug that blocks the nerves in the shoulder region to reduce the amount of pain you experience after the anesthetic effect wears off.

The surgeon first makes a 4 to 6 inch long incision along the front of the shoulder joint. Next, they remove the bone and cartilage affected by arthritis. Using special instruments, the artificial implant is set in place.

The actual replacement surgery will require about two hours; including the preparation and recovery period, the entire procedure may take about three hours.

Most patients will have to stay overnight in the hospital after the surgery. Although efforts are underway to carry out joint replacement on an outpatient basis, it requires extensive education of the patient before the surgery to help them learn how to cope after returning home.

Post-Surgical Rehabilitation

Rehabilitation begins soon after the surgery with a therapist meeting the patient to demonstrate and perform physical therapy. The sling the patient wears after surgery will have to be taken off during the therapy. Most surgeons allow their patients to undertake some movement right after surgery.

Patients generally resume their normal activities within about three months of the surgery. This is the time to begin exercise to strengthen the shoulder muscles and increase their movements.

Risks in Shoulder Replacement Surgery

As in any other surgery, there is the risk of infection after shoulder replacement surgery, too. An infection around the new implant can cause serious complications and so, you must follow the instructions of your doctor to avoid infection.

There is also a risk of breakdown of the bone near the shoulder implant due to contact with the metal and plastic parts or the bone cement used. Some patients may experience instability or dislocation of the implanted joint. In other patients, the implant may loosen over time. People who undertake excessive physical activity involving the shoulders after undergoing this surgery may suffer from a fracture of the implant.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Orthopedic & Sports Medicine Procedures: Partial Knee Replacement

Partial Knee Replacement

A total knee replacement surgery replaces the entire knee joint. A partial knee replacement, however, involves only one part of the knee. Based on which part of the knee is damaged, surgeons will replace the medial (inside), lateral (outside), or the kneecap portion of your knee.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Is Partial Knee Replacement Right for You?

Partial knee replacement is the method of choice for persons who are 60 years of age or older and have only partial knee damage. Surgeons also choose this technique if:

  • The patient is thin, older, and does not have a very active lifestyle
  • The knee deformity is minor only and the arthritis under the kneecap or the other side of the knee is not very bad
  • The range of motion in the patient’s knee is good
  • Knee ligaments are still stable

Persons with severe knee arthritis are not advised a partial knee replacement.

Procedure of Partial Knee Replacement

In a partial knee replacement procedure, the surgeon removes damaged bone and tissue from the knee joint. A prosthetic, which is an artificial implant, is used to replace the part which has been removed. The rest of your knee remains unchanged. Recovery from a partial knee replacement is faster because smaller incisions are used during the surgery.

Depending on your specific requirement, the surgeon will administer either general anesthesia or regional anesthesia. General anesthesia ensures that you sleep throughout the procedure. Regional anesthesia may be spinal or epidural type and only numbs the body parts below the waist. Your surgeon may also give you medication to make you drowsy or relaxed.

The surgery begins with a cut over the knee that is 3 to 5 inches (7.5 to 13 centimeters) in length. The surgeon then examines the joint to verify the extent of damage that has been shown by the pre-surgery diagnostic tests. In the rare event of finding a greater degree of damage than expected, the surgeon may advise a total knee replacement at this juncture.

During the actual procedure, the damaged part of the tissue and bone is removed. The replacement part made of a combination of metal and plastic is placed inside the knee and attached using bone cement. The surgeon then sutures the wound to close it.

Post-Surgical Recovery

Recovery is rapid in most patients and they report a significant reduction in knee pain after the surgery. People recover faster from a partial knee replacement than from a total knee replacement. You will be able to walk without support from a walker or cane within a month of surgery.

Most patients require physical therapy for at least 4 months following surgery. Your surgeon will advise you to avoid high-impact forms of exercise such as jogging and instead, choose activities such as swimming, walking, biking, golf, or tennis.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

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702.933.9393
9499 West Charleston, Suite 200
Las Vegas, NV 89117