Devon Moore can throw a baseball 100 miles per hour. Formerly a first baseman, Devon, a sophomore at Lincoln Land Community College, has been a pitcher for only a year and a half. Yet his talent is getting noticed by the big leagues, and he’s already got notions of going pro, having at tended training camps with the Yankees, Phillies, and Orioles. His bright future was sidelined in September, however, when he began having medial elbow pain after throwing 80 to 95 pitches each game. The pain didn’t go away, and so he was advised to see an orthopaedist. “Dr. El-Amin got me in right away,” says Devon, who was fielding recruitment calls from a number of colleges. “I couldn’t pitch, so it was hard to talk to the colleges. I was eager to find out what was wrong.” Saadiq El-Amin, III, M.D., Ph.D., assistant professor of surgery and director of shoulder and sports medicine, evaluated Devon and determined the problem was really in his shoulder — a weak rotator cuff was overstressing the elbow ligament when he threw. “It’s a mechanics problem from throwing improp erly,” says Dr. El-Amin. While this type of injury could result in what’s known as a “Tommy John” surgery (ulnar collateral ligament reconstruction), Dr. El-Amin prevented that surgery by prescribing physical therapy and a throwing regimen to strengthen the muscle and teach Devon how to hold his shoulder in the correct position when throwing. Six weeks after his first visit to SIU, Devon has refined his pitching. “I don’t notice the pain anymore.” He has signed a contract to play with Indiana State University and returned to the pitcher’s mound in early February — just in time for spring training.
Whether a 20-year-old pitcher getting back to the pitcher’s mound or a 70-year-old woman who can kneel again to hug her grandchildren, the SIU Division of Orthopaedics follows a widespread philosophy, a mantra you’ll hear from every SIU orthopaedist: “We want to get you back to doing the things you love to do.”
Professor and Chair Khaled Saleh, M.D., leads the passionate and skilled surgeons and staff of the Division of Orthopaedic Surgery who are incorporating a variety of standard and innovative meth ods to help their patients get back to their preferred way of life. Dr. Saleh joined SIU School of Medicine in 2009, bringing with him not just innovative methods and ideas, but a plan to provide a comprehensive approach to orthopaedic care where excellence is standard. “The current standard is not good enough – our patients deserve better. The academic environment at SIU is a perfect environment to support this way of thinking.”
The Division of Orthopaedic Surgery combines exceptional technical skill with visionary ideas, cutting edge technology, and a philosophy of caring for patients as individuals. These skilled surgeons understand that physical movement often defines how we identify ourselves and how we contribute to our families, work, and communities. This means helping athletes throw properly, ensuring parents and grandparents have healthy shoulders and hips to toss their children or grandchildren into the air, and helping patients kneel to continue their daily prayer rituals.
Treating newborns through seniors, the division takes a three-pronged approach: teaching patients about preventive care, effectively treating all stages of any orthopaedic disease, and taking a multidisciplinary approach that includes trainers, physical therapists, physician assistants, surgeons, generalists and sports medicine physicians. “We’re not here to reproduce what’s already being done,” Dr. Saleh says. “We’re here to take it to the next level and raise the standard to excellence.”
The division is bringing minds skilled in advanced procedures not previously available in the area. Specialty focuses of the division include: diabetic foot and ankle clinic, neuromotor clinic, pediatrics clinic, amputee clinic, upper extremity services, orthopaedic oncology services, joint arthritis reconstruction, joint preservation, spine, trauma, fracture care and sports medicine/arthroscopy care.
“We have implemented the STEEP initiative: Safe, Timely, Efficient, Patient-Centered Care,” says Dr. Saleh. STEEP, part of the Institute of Medicine’s report to President Obama, makes recommendations to the entire country. “And we’re working with referring providers to ensure conservative therapies first.”
The division is streamlining care from all angles: wait times for appointments have slimmed from three months to three days; improved efficiency in the department means that patients can get answers within one or two hours, instead of spending a half day or whole day at the doctor’s office.
“We have integrated clinical service, education, and research related to the prevention, diagnosis and treatment of bone and joint related diseases to shape musculoskeletal healthcare delivery,” notes Dr. Saleh. “We are complementing new technologies and cutting-edge procedures such as hip arthroscopies, chilactomies and joint preservation surgery to keep patients active.”
In addition to advanced technologies, the orthopaedic division of surgery considers the whole patient both in and out of the operating room. With younger patients getting more active and older adults staying active, improved orthopaedic care and a better understanding of patients needs are required. “We want Springfield to become nationally renowned as a place that offers not only the standard offerings of orthopaedic procedures but goes beyond what we know to design something even better. I’m proud of SIU and the uniqueness we bring to the area,” Dr. Saleh declares.
Such passion of the faculty and support staff is undeniable. “We turn away no patient, no diagnoses. I’m tremendously proud of what we do and can do. It’s rare we feel the need to refer patients to St. Louis or Chicago,” says Keith Gabriel, M.D., who has been with SIU since 2002.
Here are just a few of the phenomenal ways the orthopaedic division is achieving a new standard of excellence.
You can count on one hand (with fingers leftover) the number of pediatric orthopedic surgeons available south of Illinois’ Interstate 80— and two work at SIU School of Medicine: Associate Professor of Surgery Keith Gabriel, M.D., and Assistant Professor of Surgery Jasmin McGinty, M.D. They treat a multitude of ailments in infants, children and teenagers, everything from sports medicine to multiple physical challenges, from neuromuscular to genetic disorders. SIU stands as one of the few places in the region that offers pediatric orthopedic care.
With the rise of childhood athletics and competition, surgeons are seeing more broken bones, sprained wrists, and ligament injuries in children. Repetitive injuries such as the “little leaguer’s shoulder and elbow are important to treat correctly because the injuries and treatment can affect the child’s growth. A young gymnast, for example, can injure the growth plate at the wrist, analogous to a stress fracture. “If you intervene early enough, you can prevent long-term injury just by enforcing rest and non-operative care such as physical therapy,” Dr. Gabriel explains. The surgeons take great care in selecting treatments that will repair the problem and minimize impact on growth plates and prevent or delay the need for surgery.
Last summer, Aubree Whited of Mahamot, Ill., 13, was hit by a car and now suffers from a painful stress fracture in the vertebrae called spondyliothesis. According to the American Academy of Orthopaedic Surgeons, spondyliothesis is the most common cause of low back pain in adolescent athletes. “Spondyliothesis has really affected my life,” Whited says. “I had to stop doing sports and running around. I had to be as still as possible for a long time.” The stress fracture weakened the bones, causing the vertebrae to shift out of place and causing pain. Aubree has tried three types of braces with a hip/leg attachments for months, but her back pain has not ameliorated. “The braces helped a little bit but not as much as I was hoping for,” Aubree says. “I can do cheerleading now, but only the basics.” On a visit with Dr. Gabriel in November, she and Dr. Gabriel discussed her options: more physical therapy or surgery. “We want to get you back to doing what you want to do,” Dr. Gabriel tells the cheerleader and softball player. Surgery would mean four days in the hospital, then six months of recovery and therapy before she could return to her sports. Aubree hesitates. “If you can live with the pain, it may not get worse,” Dr. Gabriel says. “It’s your decision.” Nearing Christmas, Aubree hadn’t decided about the surgery. “But I love Dr. Gabriel,” she says. “I love how he explains my issues in a language my family and I can understand. He is very patient and always makes me laugh when I get scared or sad.”
For his young patients, Dr. Gabriel advocates stopping problems before they start. Diet, he says, is critical to prevent orthopedic problems for children. “Treatment and prevention of osteoporosis and osteopenia — which in adults leads to fractures and ultimately short life —begin in childhood,” he says. His advice? Drink milk. “Every day I talk with patients and families about the importance of calcium and Vitamin D. Children tend to drink heavily sugared beverages. Teenagers especially shy away from milk. The body only accumulates bone mass until you’re 26 years old, then we all start to lose bone mass. “Getting enough calcium and vitamin D during active growing years is vital to bone health and will make a difference when you get to be middle aged to prevent insufficiency fractures and arthritis.”
SIU surgeons also treat a multitude of congenital and development and neuromuscular spinal deformities, including scoliosis (curvature of the spine). SIU now offers the ScoliScore™ Test, the first and only genetic test that analyzes 53 different genes to develop a numerical score to accurately predict the possible progression of scoliosis. “This allows us to counsel families very effectively,” Dr. Gabriel notes. “Previously the patient would have to have spinal radiographs (X-rays) done every four to six months. We had no way to predict how high a risk the patient was for scoliosis progression.” Just a little saliva can allow physicians to design personalized care for scoliosis patients.
About one in 1,000 patients will need surgical treatment for a spinal deformity. Should an operation be needed, the faculty offer all types of operative care, including spinal fusion surgery. “Children embody what orthopaedics is about, says Dr. McGinty. “The surgical procedures we do really impact the rest of their lives.” She has expertise in limb alignment, a procedure done slowly with ring external fixators to slowly correct the malformation of the bone as it grows. “Children can have their whole lives affected by the realignment of their limb.”
More than 4,000 babies (about 1 in 1,000) are born with clubfoot in the United States each year and SIU surgeons provide the best care available to treat it. “We use a nice, gentle technique of stretching and casting that corrects the deformity in five to six weeks,” Dr. McGinty explains.
Better treatments and therapies mean that youngsters can get back to their lives — whether that means hanging on the monkey bars or playing high school quarterback. “We sometimes underestimate the impact that these activities have on children, not just physically, but socially, too,” says Dr. McGinty. “If it defines who they are, we don’t want that taken away from them. We will do everything we can to ensure they get back to what they want to do.”
Many of those young patients are athletes like Devon Moore, and SIU orthopaedists recognize the need for this specialty care. “With increased participation in coached sports, young people really do have serious sports injuries,” notes Dr. McGinty. She hopes to implement programs to help with ACL injury prevention. A few athletes already are learning how to throw properly and how to land to prevent injuries.
In an unprecedented partnership for central Illinois, Dr. Saleh and Family & Community Medicine Chairman Jerry Kruse, M.D., joined forces to bring the care and expertise of Sports Medicine family physician James Daniels, M.D., to the orthopaedic division. Dr. Daniels and Orthopaedic Surgeon Saadiq El-Amin, M.D., Ph.D., care for athletes of all varieties, from the weekend warriors to semi-professionals.
“As an orthopaedic surgeon, I rely on the family physician like Dr. Daniels to help treat more medically- based conditions such as an athletes’ asthma, diabetes, or any cardiac concerns,” says Dr. El-Amin. “Dr. Daniels can help us address the entire patient, which may affect performance. Together, we can decide on the best care for the athlete.”
Before joining SIU School of Medicine, Dr. El-Amin was assistant team physician for the New York Knicks and St. John’s University. Under the guidance of Dr. Answorth Allan and family physician Dr. Lisa Callahan, he came to understand the importance of working together to facilitate patient-centered care. Through that experience, he realized that rehab, education and prevention are valuable options. He joined SIU in July 2010 and already has developed a rehabilitative throwing program for athletes to get pitchers back on the mound faster and prevent future injuries. “I tell my patients, ‘I want you to keep what God gave you.’ But if it’s necessary to operate on a knee, hip, or shoulder, we can explore that option .” He approaches every patient like a professional athlete. “We may have to do treatment or therapy at a lower intensity, but they will get the same care that I gave to professionals.”
Dr. Daniels appropriately uses a sports metaphor to explain the team approach. “I think of it like Dr. Saleh is the coach, Dr. El-Amin is the quarterback, and I’m the receiver.” He foresees that this could be the beginning of a new model of medicine. “Primary care physicians and specialists may overlap more. Orthopaedics is becoming more holistic in thinking, and primary care can become more technical, embracing new technologies.”
The surgeons say they are seeing traumatic sports injuries in younger athletes – injuries that can turn those athletes into arthritic adults in time. “I’ve seen sports injuries in children as young as six years old,” Dr. Saleh says. “The more trauma that accumulates, the earlier arthritis can start.”
The division offers a compendium of care for arthritis: protecting the healthy joint through exercise and activity to avoid injury. “Many people will have varying degrees of arthritis by age 65,” says Dr. Saleh. Other centers, Dr. Saleh says, may jump right to replacement as the patient’s only option. SIU faculty offers prevention, treatments, and therapies as viable options for their patients.
“The surgical components of arthritis and osteoporosis disease may comprise 80 percent of what we do as orthopaedic surgeons,” Dr. Saleh says. “But we are optimizing joint preservation so we don’t have to do replacements as often as surgeries done nationally.”
The pediatric specialists emphasize prevention of arthritis. Dr. McGinty focuses on limb realignment and hip dysplasia treatments that include the periacetabular osteotomy, which contours the socket in the pelvis for better distribution of weight bearing surface on the hip to prevent arthritis for a longer period of time. Dr. McGinty, who joined SIU in August, trained in this innovative procedure, as are Dr. Gabriel and Dr. McAndrew. This expertise is difficult to find elsewhere in central Illinois.
The hip arthroscopy program, a minimally invasive surgical procedure that treats damaged joints or numerous orthopaedic conditions using an arthroscope, is a relatively new procedure done at SIU. Dr. Gabriel treats a disorder called impingement, which uses an arthroscope to repair ligament tears and contour the femoral head so that it matches the acetabulum and doesn’t pinch the hip socket — a cause of arthritis and hip pain.
After prevention, treatment, and therapies have run their courses, the skilled surgeons have leading-edge technologies to replace worn-out joints with the most innovative metal and plastic replacements to improve the performance and longevity of joint implant. “We’ve got better plastics, metals and ceramics that should improve the longevity of replacements,” Dr. Saleh explains. “Minimally-invasive and computer-assisted surgeries for knee replacement are new to the area, offering patients better results, allowing them to heal faster and become active sooner. Instrumentation has been optimized to decrease errors and essentially perfect operations.”
Hip and knee replacements are the No. 2 surgery in the U.S. (behind stent procedures). “Replacement knees used to only last 10 years, now they last 30 or more,” adds Dr. Saleh, who designed an innovative knee system recently approved by the FDA.
This prosthetic knee reconstructs the diseased knee joint tattered by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis. The VEGA knee system was approved by the FDA in July 2010, and allows a wider range of motion, flexing 165 degrees to mimic normal knees. It also contains a coating that doesn’t leach any ions and cause allergic reactions as have been noted in recent implant recalls.
Numerous patients rave about the quality of care by SIU orthopaedic surgeons. One former patient said, “Dr Saleh and his team finally got my knee right after three surgeries by other doctors.” Richard Wakefield was pleased with the care of his mother, Hazel. “It was a relief to have such good and high quality care delivered in a compassionate fashion to your family and loved ones. Dr Saleh and his team were outstanding to work with, and they took care of my mom’s knees. It’s a real blessing and a great resource to the community to have someone like Dr Saleh, who has a world reputation for joint replacement surgery, right here in our community. SIU is the best.”
A Team Commitment
The orthopaedics division offers an even wider spectrum of care. Other top-quality services include general orthopaedic services and rehabilitation (David J. Olysav, M.D.), trauma care (Mark McAndrew, M.D.), spine surgery (Per Freitag, M.D., Ph.D.), and foot and ankle care (John A. Shoudel D.P.M.) “These outstanding physicians bring a long track record of experience and expertise that helps us reach our mission and goals of supporting our community,” Dr. Saleh asserts. A highly-skilled staff of physician assistants and nurse practitioners enhance care as well.
“Our goal is to reconstitute quality of life and function — to restore people back to their lives,” says Dr. Saleh. “We want to expand and advance the field while meeting the needs of the community. We overlap with other providers in some respects, but we also pursue subspecialty expertise that goes beyond the current standards of care. We also educate the next generation of doctors and surgeons. That’s the advantage of working in an academic center.”
With such specialty and subspecialty care, patients don’t have to travel to Chicago or St. Louis. “We can do any of the spine techniques done in larger cities, and we have a more personal touch than big cities,” Dr. Gabriel says. “We are smaller and can spend more time with patient.”
True to that word, the pediatric orthopaedic surgeons have partnered with the Illinois Division of Specialized Care for Children, visit numerous smaller towns such as Mattoon, Salem, Champaign, and Carbondale multiple times a year. Typical patients include those with clubfoot, limb deformity, hip dysplasia, and scoliosis. Dr. McGinty grew up in a rural area in North Carolina. “It’s important that children have improved access to health care,” she says. The outreach work expands and improves access to care.
Many faculty also provide care to patients far from central Illinois to have an international impact. Dr. McAndrew visits Haiti; Dr. Gabriel helps Cambodians; Dr. Saleh spent time last summer in Palestine.
The closely-knit division understands that helping patients return to their ways of life strengthens not only joints, but families and communities. Patients attest to their impact. “You changed my life,” says one patient. “I can keep up with my grand kids. It doesn't hurt anymore, and I’ve stopped taking pain pills.”
Just as they repair or reconstruct hips, shoulders, knees and more, so the growing orthopaedic department strengthens its very core, resulting in rippling effects that include better academics for SIU, improvement for the community, and better care for patients — getting them back to doing what they love.