Menorah Medical Center
September 08, 2014

By Linda Cruse, The Kansas City Star

Excruciating pain. That's how Dave Gresko, Nora Gillespie and Ann Hodson described what they endured before undergoing orthopedic procedures.

Gresko, 65, said he was unable to turn over in bed at night without crying out from severe hip pain. "My wife complained that I was waking her up every night," he said. "The pain was excruciating."

After meeting with doctors, Grosko, of McLouth, Kan., learned that he needed to have his left hip replaced. He underwent joint replacement surgery in January at Shawnee Mission Medical Center and returned to work as a field sales manager for an appliance company two weeks later. Now he is sleeping through the night "I'm good as gold," he said.

Nora Gillespie, 61, said excruciating pain caused by what she later discovered was a spontaneous vertebrae compression fracture kept her from day-to-day activities. "I couldn't get out of bed, get off the coach or move in any way without pain," she said.

Doctors gave her a series of epidural back injections to treat what they thought was sciatica. But after the treatments proved ineffective, an MRI revealed she had a back fracture. Gillespie, of Kansas City, underwent a vertebroplasty procedure at Menorah Medical Center. She was back to her normal activities within a few days. "I went from excruciating pain to no pain," she said. "It was amazing."

Ann Hodson, Overland Park, fell in late July and fractured her back. Within several days she underwent a kyphoplasty procedure performed by the experts at Healient Physician Group in Leawood. She soon returned to her regular activities, including taking a trip to Canada to visit friends.

Hodson, who describes her age as 70-plus, was relieved at the procedure's simplicity. "I wasn't keen to go through back surgery, because I had done that in the past," she said. "But kyphoplasty was a very quick outpatient procedure. I was back home later that evening. I went in with pain and left without pain. I also could stand up straighter." She described the procedure as "a blessing."

Gresko, Gillespie and Gillespie have joined hundreds of thousands of other older adults living pain-free lives after undergoing orthopedic procedures.

"Today's older adults are more active than generations past," said Burrel Gaddy, an orthopedic surgeon with the Shawnee Mission Orthopedic and Spine Center, who performed Grosko's surgery. "They work, exercise, travel and play much harder," he said. "They are not willing to accept limitations. Basically, they don't want to slow down."

Joint replacements are occurring in record numbers in the United States. Knee replacements have more than doubled from 264,311 in 1997 to 621,029 in 2009,while total hip replacements totaled 332,000 in 2010.

Gaddy, who has been in practice 20 years, said that while he is performing minimally invasive joint replacement on younger patients, he is also performing the procedures on older patients, well into in their 80s.

David Burkhart, an interventional radiologist with Healient, said he has performed the kyphoplasty procedure to repair spinal fractures on patients more than 100 years old.

And Jason Himmel, an interventional radiologist at Menorah Medical Center, has performed kyphoplasty on patients in their mid-90s. "I wouldn't hesitate to treat even older adults if they are active," he said.

Orthopedic advances

Smaller incisions and better materials have made joint replacements available to more patients, Gaddy said. "Equipment technological advances have enabled us to reduce the size of the incision for both knee and hip replacements," he said. "That means less post-Operative pain, a shorter hospital stay and a faster recovery."

Improvements have also been made in the joint replacement materials, he added. "We're using better, denser plastics that don't have to be replaced as often, which makes the replacements last longer," he said.

Thanks to vertebroplasty and kyphoplasty procedures, many adults are finding relief for painful compression fractures. Undiagnosed, spinal compression fractures can lead to subsequent fractures and curvature of the spine, which makes walking, breathing, eating and sleeping painful and difficult, Burkhart said. Symptoms are a new, severe pain in the middle of the back making it difficult to move or breathe.

"Early treatment is vital," Burkhart said. "Untreated fractures can lead to subsequent fractures and life­ threatening conditions."

Vertebroplasty involves injecting bone cement into the spine to stabilize the fracture and restore vertebrae height. Kyphoplasty involves placing a needle into the spine, inserting a balloon into the needle and inflating the balloon. The balloon is then removed and bone cement is injected into the space, repairing the fracture and restoring vertebrae height.

Both procedures take about an hour and most patients are able to go home later the same day. Patients with severe pain are sometimes admitted to the hospital to provide better pain control, Himmel said.

Himmel said that spinal fractures due to osteoporosis are a growing concern for older adults. One in two women and one in four men age 50 and older in the United States will have an osteoporosis-related fracture in their lifetime. These figures are projected to double in the next 50 years when the population ages, according to the International Osteoporosis Foundation.

Burkhart said 85 percent or more of patients who undergo kyphoplasty find the procedure eliminates or significantly reduces pain. “We also spend time educating patients regarding the underlying causes and treatments for osteoporosis, which is the primary reason for compression fractures,” he said.

Don’t live with pain

While many patients realize there is help for their pain, some patients live years without seeking help, Gaddy said.

“I had a patient who was in so much pain she couldn’t walk,” he said. “Pain controlled every area of her life. After having both hips replaced she is a new woman. She was teary-eyed when she thanked me.”

Gaddy said many patients are amazed at how good they feel following orthopedic surgery. “They say things like, ‘I didn’t realize how good I could feel,’” he said. “They think pain is just part of getting older. But many times help is available.”

Gaddy said that he recommends patients try conservative measures before considering surgery. “Surgery is the last treatment modality,” he said.  “Some people can be treated with medication, therapy and modification of activities. If that fails, we explore surgical options.”

Burkhart and Himmel said compression fractures can sometimes heal themselves without significant pain. “But if the patient is not getting better with pain medication and reduced activity it’s time to consider other options, Burkhart said.