We present to you excerpts from our conversation with Dr. Jonathan Glashow, a leading orthopaedic surgeon for over 23 years, who is widely respected for his precision and application of groundbreaking surgical techniques. For his superior patient care, Dr. Glashow has been awarded numerous distinctions. Castle Connolly a major healthcare research company has ranked him one of America’s Best Doctors, New York Magazine has featured him in numerous annual Best Doctors issues, and he has been listed as one of New York Metro Area’s Best Doctors every year since 2000. Texas Medical Concierge asked him a few important questions on the latest in joint replacement surgeries, exciting developments in stem cell therapy and prevention strategies to avoid joint trouble.
Q1. In the field of orthopaedic medicine, new technologies, instruments and related advances in navigation, robotics and bone substitutes are expected to lead to less-invasive and more physiologic surgical interventions. Please explain to our readers the advantages of the latest innovations and current state-of-the-art techniques in the field of orthopaedics.
Dr. Glashow: “There are many advantages that come along with the latest innovations we currently use in Orthopaedic medicine. One of the most innovative amongst the current cutting-edge technologies is the use of robotics to perform partial knee replacements. Patients who previously would have needed a complete knee replacement, which includes the removal of all ligaments and cartilage, even though some may not be damaged, may now undergo partial knee replacements. A “mini” approach replaces a segment of what’s worn out in the knee with a small piece of metal and plastic. However, the undamaged ligaments and cartilage throughout the rest of the knee is left untouched.
An even more exciting technology is that of growing cartilage in a laboratory to perform arthroscopic cartilage repair surgery and arthroscopic ligament reconstruction. We are seeing the use of Biologics and stem cells in many areas. Increasing the odds of success and increasing the rate of recovery after arthroscopic repairs of both the shoulder and knee, are just one of their many benefits. These innovations have brought about a significant change by returning patients to their daily routine, faster than ever before. These cutting-edge technologies and early treatment of patients at the onset of their issues can have patients back in their daily routine faster than ever. Not only that, but also return the patient to activity/sport at a higher functioning level than prior to injury.”
Q2). What are some of the biggest changes you have seen in orthopaedic surgery over the last five years?
Dr. Glashow: “One of the biggest changes Orthopaedics has seen in the past five years is the drive for a much more minimally invasive surgery. Using technologies such as Robotics and Biologics, we can now approach many issues on a drastically smaller scale, performing surgeries on an ambulatory basis with the smallest incisions and shortest downtime seen yet to date. Our philosophy in Sports Medicine Orthopaedics has shifted from waiting for smaller issues to become larger before addressing, to just the opposite! Today it is about addressing the smaller issues with precise technology. Tackling these issues before the problems of today becomes much worse, leaving fewer options for treatment tomorrow.”
Q3). What, according to you, are the primary causes of joint trouble?
Dr. Glashow: “Joint troubles are multifaceted and have different levels of complexity. For some people, the cartilage simply wears out sooner than others in the natural degradation of joints. We cannot control the natural deterioration of cartilage or joints but there are some factors that we can control. Early injuries during our teen or early adult years that involve cartilage or ligament damage often develop into problems that require joint reconstruction midlife. If we identify and repair these cartilages, ligament or tendon injuries early on, we can often prevent the progression of arthritis, which is far more difficult to address should one wait for treatment.”
Q4). Could you tell our readers about shoulder instability and when to use bone grafting around the shoulder?
Dr. Glashow:”The shoulder is comprised of what we call a ball and socket joint and is the most movable joint in the body. Because of this constant use, the shoulder is subject to overuse injuries, such as shoulder instability. The shoulder is also the most frequently dislocated joint in the body, this is in part due to the fact that the “ball” the Humerus, is very round and the “socket” the Glenoid is very flat. Numerous dislocations and postponing medical treatment for a dislocation can often lead to damage of the Glenoid and Humerus and can make for a very challenging soft tissue reconstruction. I often recommend medical treatment for shoulder instability issues after the first or second injury to prevent bone damage. It is only after severe bone damage has occurred, where at least 20% of the Anterior Glenoid Rim is affected or that of a Hills-Sachs Lesion, that I suggest bone substituting procedures such as bone grafting and bone transfers such as that of a Latarjet. Performing these procedures through the use of Arthroscopy or by a very limited open approach, I find bone grafting and transfers to be treatments of choice. This is especially true for the high-level, high risk, collision athlete such as those of the National Football League (NFL).”
Q5). Could you please share some exciting developments in using stem cell therapy to treat orthopaedic health issues?
Dr. Glashow: “We are learning more everyday about what therapeutic effects stem cells are capable of, in the field of orthopaedics. There are several recent peer-reviewed articles that suggest the value of stem cells in the treatment of early to moderate arthritis in the knee and now shoulder as well. We now know through limited liposuction like techniques, we can generate enough stem cells to centrifuge and then install what’s been gathered into the joint. These innovative technologies may prevent the need for joint replacement surgery in early stages of arthritis. In the near future, I am personally attending a stem cell conference where I will be joining an IRB (Institutional Review Board) to study and observe the continuing advancements. Aside from it being a minimally invasive and a forward procedure, I have learned through my use of stem cell therapy in my patients, that there is great promise for this treatment with little to no down time.”
Q6). And finally, could you tell our readers some of the steps that they can take to avoid or delay joint replacement surgery?
Dr. Glashow: “As briefly touched upon earlier, the most effective way to prevent the need for a full joint replacement later in life is by the treatment of cartilage injuries or ligament problems before they become much larger and complicated. “If you feel something, say something” Addressing small issues today, prevents issues from being worse tomorrow. Keeping one’s weight and fitness on track are also very helpful keys in keeping both those ligaments and muscles strong and joints healthier. When genetics play their role in bone and muscle health, which we cannot control, it is best to seek medical advice early as there are alternatives to traditional invasive joint replacement, in forms of partial replacements and surface replacements. These procedures offer patients a far less invasive experience, often slow the progression of arthritis and prevent the need for full joint replacement.”
Texas Medical Concierge is delighted to provide priority medical access and advisory services with the Co-Chief of Sports Medicine Orthopaedics at New York’s Mount Sinai Medical Center, Dr. Jonathan Glashow through our Concierge Services in various international cities.