Mark Blaszczyk was remodeling his deck on a recent day in Wheatfield. A few months ago, that didn't look like it would be possible.
His right ankle was in constant pain from rheumatoid arthritis, limiting his mobility.
Then his podiatrist, Dr. Brian Damitz, told him about a new procedure that might be able to help: an ankle replacement. Damitz said the recovery times and outcomes were better than the traditional treatment, an ankle fusion.
On March 8, Blaszczyk became the first person to have his ankle replaced in Porter County.
Six weeks later, he was walking again. By late spring, he was hitting the links and revamping his house. "To see me and know me, you wouldn't know anything was wrong with me," said Blaszczyk, 64, who recently retired from his factory job. "I'm active. I golf. I bowl."
Ankle replacement is one of the innovative orthopedic treatments being done in the Region. Orthopedists say the spine, back, limb and joint care in Northwest Indiana rivals that of academic medical centers in big cities.
"I don't want my patients to have to drive all the way to South Bend or Chicago," said Damitz, who is on staff at Porter Regional Hospital and Lakeshore Bone & Joint Institute.
Less invasive surgery
One orthopedic trend in the Region is the increasing number of minimally invasive, outpatient procedures. Thanks to improved technology and surgical technique, patients who used to spend nights in a hospital recovering from surgery now go home the same day.
"From an orthopedic standpoint, there's been a movement to do more minimally invasive procedures with quicker recovery for patients and decreased hospital stays," said Dr. Nitin Khanna, a spine surgeon with Orthopaedic Specialists of Northwest Indiana in Munster. "Many patients now by two weeks are dramatically better after spine surgery, many are off all pain medication. Whereas before, it would have about a six- to nine-month recovery after these procedures."
One reason is the focus on multimodal pain management. Pain prevention now begins the day before surgery and uses regional nerve blocks and shorter-acting painkillers.
"Patients don't feel like they were run over by a truck after they wake up," said Dr. Dwight Tyndall, a spine surgeon at Orthopaedic Specialists of Northwest Indiana. "And with all the focus on opioid addiction, we want to make sure the anesthesia we use is not going to be problematic for someone in the future."
Dr. Gregory McComis, of North Point Orthopaedics in Munster, does a minimally invasive hip replacement. Called an anterior total hip arthroplasty, McComis goes in through the front of the joint rather than the side or rear. He says this method improves recovery times, cuts down on postoperative pain and reduces the chance of infection.
"We've done a 16-year-old, and we've done a 90-year-old," he said. "Our patients stay about one day. They're up and walking the day of the surgery."
Dr. Zeshan Hyder, a spine surgeon with Bone & Joint Specialists in Merrillville, said outpatient surgeries are less risky because patients aren't in the hospital around sick people. The procedures also don't require blood to be transfused, opening up them to groups that eschew transfusions such as Jehovah's Witnesses. The cost is also about a third of that of inpatient surgeries.
"If you ask me where the future of orthopedics is going, I think you're going to see more and more outpatient procedures. We're just seeing the tip of the iceberg right now," Hyder said. "It's cheaper for patients. It's safer in many ways. With health care costs just going crazy, it's the best way to go."
'All sorts of tools'
Dr. Nikhil Pandhi, an orthopedic surgeon with the Franciscan Physician Network, has been doing cartilage transplant procedures, using the patient's own cartilage cells or cartilage from a cadaver. He utilizes 3D printers to make patient-matched implants. He also noted the trend toward so-called "biologics," injecting stem cells and platelet-rich plasma to help patients heal.
"For orthopedics, we have all sorts of tools at our disposal these days," he said.
Still, he noted, joint preservation often comes down to the simple and old school: keeping your weight down and exercising.
Dr. Mark Jones, a podiatrist with Methodist Hospitals, was the first doctor in Indiana to put in a new implant for big toe arthritis. That toe is the foot's end point of contact when walking, making the condition painful.
Previous treatments consisted of fusions or implants in which the surgeon had to remove the joint. This new implant allows for dramatic improvements in pain, functionality, range of motion and recovery, Jones said.
"I have been doing joint implants for 16 years, and it's maybe every 10 years we have something this exciting that comes along," he said.
Dr. Vineet Shah, director of the total joint program at Methodist Hospitals, said another new offering is cementless knee replacements.
"There is no cement used to fix the metal components onto the bone," he said. "As there is no need for the cement, there is no need to turn on the tourniquet to stop blood flow. As a result of that, patients have less thigh pain after surgery." He said the procedure also allows surgeons not to have to remove bone during future revisions.
In addition, Shah and his counterparts at Methodist use a two-surgeon approach to improve outcomes.
"The benefits are you have two people looking at the placement of the components, you have two people participating in the surgical technique," he said.
A new concept, Xpress Ortho Care, arrived in the Region in March. The clinic, open evenings and weekends, provides urgent care specifically for people with orthopedic injuries.
Dr. John Diveris, a Merrillville orthopedic surgeon and partner in the new clinic, said those individuals have traditionally gone to the emergency room for injuries that weren't true emergencies, racking up expensive bills.
"Orthopedic urgent care is an attempt to diminish waiting times, to have you seen by people trained in orthopedics, have direct access to orthopedic surgeons on call, and allow for expedient follow-up," he said.
Dr. Joseph Schwartz, an orthopedist with Bone & Joint Specialists, said modern innovations include reverse shoulder replacement—reversing the traditional order of the procedure for improved pain relief and range of motion—and reconstructing, rather than repairing, ligaments, allowing for immediate stability and faster return to functionality.
His colleague, Dr. Michael Knesek, pointed to hip arthroscopies as a recent advancement. The minimally invasive, outpatient joint preservation method fixes problems including tears and bony anomalies.
"It's treating the younger, athletic population that has hip and growing pains and getting them back to doing what they want to do," he said.
He also mentioned patient-specific implants for shoulder replacements, nitroglycerine patches for tendon injuries, and robotic orthopedic surgeries.
Dr. Robert Coats, an orthopedist with Community Healthcare System, noted such innovations as neuromonitoring, in-office diagnostics and an injection to treat Dupuytren's contracture, a condition that affects the fingers.
"The biggest thing in orthopedics is people are trying to figure out how to repair or restore cartilage," he said.
People in the Region are now getting joint replacements at younger ages because of the improved longevity of the implants, said Dr. Scott Andrews, an orthopedic surgeon at Bone & Joint Specialists.
"A common refrain we hear from patients is they wish they would have had surgery earlier," he said. "They do so well that all of a sudden in retrospect they wish they have considered it earlier."