ABOVE: Dr. Dominic J. Peters, an orthopedic surgeon specializing in hip and knee replacement is the chairman of the surgery department at Salem Regional Medical Center. TOP: From left, Emily Petro, registered nurse, first assistant; John Ricci, Mako plasty product specialist; orthopedic surgeon Dr. Ken Jones; and surgical technician Karen Ward demonstrate how to use the mako robotic-arm to assist in a knee replacement at Trumbull Regional Medical Center. Mako robots are also used by Youngstown Orthopaedics at the Orthopaedic Surgery Center and St. Elizabeth Boardman Hospital.

EDITOR’S NOTE: This content originally appeared in the All About Health magazine inserted in The Vindicator on Thursday. It is being rerun today to correct the name of Dr. Dominic J. Peters, chairman of the surgery department at Salem Regional Medical Center, whose name was listed incorrectly in the magazine story and photos.

If you’ve ever broken a wrist, sustained a sports injury or if you’re aging — and you should be — chances are you have had or will one day be in need of orthopedic care.

“Orthopedics is kind of one of those areas in medicine that is always going to be needed because we haven’t found a way to stop the aging process, and as people age, the musculoskeletal system wears out,” said Dr. Thomas A. Joseph, president of Youngstown Orthopaedic Associates.

“You’re always going to have bone injuries, and orthopedics is the specialty that deals with those kinds of injuries as well.”

Orthopedics is the treatment of the musculoskeletal system — bones, muscles, joints and ligaments. It is a wide-reaching field that can treat anything from the neck down. The field includes many subspecialties, such as sports medicine, orthopedic oncology — the removal of orthopedic tumors — and orthopedic foot and ankle, just to name a few.

HIP AND KNEE REPLACEMENT

One of the most common subspecialties of orthopedics is adult reconstructive surgery, which usually focuses on the repair or total replacement of hips and knees.

“Total joint replacements are some of the most successful operations that are done — not only nationally but around the world — in terms of patient satisfaction, improvement and quality of life,” said Dr. James P. Jamison, a Youngstown Orthopaedic Associates surgeon specializing in adult reconstruction.

Patients who benefit from joint replacement procedures include those suffering from osteoarthritis and avascular necrosis, or those that have suffered a sports injury or other type of traumatic joint injuries, according to information from Trumbull Regional Medical Center in Warren. People often turn to joint replacement when they have exhausted other treatments, such as supplements, over-the-counter medication and joint injections.

In the past, joint replacement had been a solution only for adults older than 60 because of the limited lifespan of implants. Joint replacement is now an option for some younger patients as well, Jamison said.

“Implants are expected to last 20-plus years, without question, provided there aren’t any unforeseen problems,” Jamison said.

Adults as young as 40 are candidates for joint replacement.

“We have patients who are coming to surgery at younger ages, which returns them to a more productive life,” he said.

Poland native Dr. Dominic J. Peters, chairman of the surgery department at Salem Regional Medical Center, brought the practice of anterior hip replacement to the area five years ago. The process, practiced by about 20 percent of orthopedic surgeons across the country, involves replacing the joint by entering through the front of the hip. Studies show the minimally invasive procedure leaves patients with less pain and a quicker recovery time.

“I tell people the art of joint replacement has been evolving since its beginning almost 50 years ago,” Peters said.

Peters estimates that in a year, he performs around 600 total joint replacements at Salem’s Orthopaedic Bone and Joint Center — many of which are anterior hip replacements — and another few hundred partial hip and knee replacements and revisions.

SPINE CARE

Hips and knees are not the only parts of the body treated in orthopedics. A more specialized concern is the spine, in which surgical procedures are sometimes needed to correct cervical — or neck — fusions, lumbar fusions or herniated discs.

Southwoods Health has grown from an outpatient surgery center in 1996 to an acute care hospital in 2009, and has developed an expansive orthopedic program which includes spine care, according to chief operating officer Steve Davenport.

“We’ve started recruiting additional spine surgeons into town,” Davenport said. He added that orthopedic spine surgery has become an integral part of their operation.

The Southwoods Pain and Spine Center in Boardman focuses on tackling chronic pain. The center treats adult scoliosis, back pain, degenerative disc disease, neck pain, osteoarthritis and sciatica, among other conditions.

“We have conservative measures,” Davenport said of the center. “We might start with physical therapy, medical management, and go all the way up to and including a physical medical rehabilitation program — going up into spine surgery almost as a last result.”

Still, Southwoods boasts “all the latest and greatest spine surgeries,” Davenport said — from laminectomies (the removal of a portion of vertebral bone) to kyphoplasties (restoring vertebra fractures to their proper placement).

SPORTS MEDICINE

Salem Regional’s Dr. Jason A. Boyd treats yet another subset of orthopedic issues. As a sports medicine specialist, Boyd treats young athletes, whether that be high school students or people injured in a game of pickup basketball. The past year has been atypical for athletics, but Boyd still spent some time helping out Salem High School’s varsity football team.

Boyd treats meniscal tears, damaged rotator cuffs and injuries to the anterior cruciate ligament, better known as ACL.

“ACL is probably the most talked-about injury in sports medicine,” Cleveland native Boyd said.

He uses a technique called a quadriceps graft, in which the quadriceps tendon is harvested and used to repair the ACL. Boyd believes the quadriceps graft is the future of ACL repair, and most surgeons may be adopting it in the next five to 10 years.

“ACL reconstruction has been done for a long time. Any procedure that’s been around for a long time, we’re always improving it,” Boyd said.

Boyd also does his fair share of the third-most common reconstructive orthopedic surgery — shoulder replacement.

Like hip and knee replacement, shoulder replacement is typically a successful surgery, Boyd said. Shoulders commonly need to be replaced due to osteoarthritis or rotator cuff arthropathy, which typically stems from a chronically neglected rotator cuff tear.

Patients getting a new shoulder, hip or knee at Salem go through a presurgical joint class and consultation designed to make them comfortable and prepare them for their surgeries.

Boyd often uses computer navigation technology to make sure he is placing joints as accurately as possible. He compared the technology to a video game.

“In addition to standard X-rays, I will typically be ordering a CAT scan of the shoulder. I take that information and I’m able to build a 3D model of the shoulder,” Boyd said. “It allows me to look at their anatomy and figure out what their exact deformity is and what my implant selection and positions should be.”

Boyd attaches an antenna to the patient’s shoulder and that syncs with a computer program that guides drilling and implant insertion.

“I’m able to watch in real time and verify that I’m executing the plan and surgery that I’ve already planned out,” Boyd said.

TECHNOLOGY

Other technology also lends a hand in modern orthopedic surgery. Most local orthopedic facilities make use of advanced imaging and robotic technologies to improve diagnostic abilities and perform more precise surgeries.

A major aspect of orthopedics is diagnostics, which makes imaging technology like MRI (magnetic resonance imagining) and CT (computerized tomography) scans and X-rays vitally important. Facilities at Youngstown Orthopaedics, Southwoods and Salem Regional are equipped to get high-resolution images prior to surgery.

Another technique used locally for both diagnosis and surgery is arthroscopic surgery, also called arthroscopy. The minimally invasive technique involves using fiberoptic cameras inside the joint so surgeons can view the area to be operated on without seeing it directly, according to Joseph.

Youngstown Orthopaedic Associates also has the ability to do Mako robotic-arm assisted surgeries at St. Elizabeth Boardman Hospital and the Orthopaedic Surgery Center.

“You use robotic assistance when you’re performing a joint replacement to improve the precision and accuracy,” Joseph said.

With Mako robots, surgeons can make smaller incisions, which means patients can recover faster and have smaller scars. Procedures done with the Mako show less implant wear and loosening and reduced blood loss, according to information from Trumbull Regional Medical Center, which also has a Mako.

Joseph said the recovery process for patients is also more advanced than it once was. The use of biologics — drugs derived from living organisms — accelerate the healing process and can lessen scar tissue and inflammation.

One commonly known biologic is stem cells, which come from human bodies or from embryonic fluid. Another biologic is platelet gel, which is obtained by taking blood from a patient and spinning it in a centrifuge to get platelet-rich plasma with growth factors. The platelet gel is then injected back into the patient to facilitate healing. Platelet gel has been around for about 10 years, according to Joseph, and is used at Youngstown Orthopaedics.

QUALITY CARE

Innovative techniques, specialized technologies and the wide range of expertise in Mahoning and Columbiana counties mean that orthopedic patients need look no further than their back door for quality care.

Davenport said Southwood’s spine center “keeps patients from needing to go to either Pittsburgh or Cleveland for those kinds of surgeries.”

In addition to spine care, Southwoods has the capacity to treat a range of orthopedic problems, from a sprain to reconstructive surgery. The hospital also has specialists in sports medicine and upper extremities, or hands, elbows and shoulders. It boasts very low infection rates and good outcomes across the board.

“We call it the Southwoods way,” Davenport said, adding that the three components that make up Southwoods are first and foremost the patients, then the physicians, and the staff.

“The staff here see a lot of patients in a given day. They treat everybody like an individual. That’s what makes the whole mystique of Southwoods as effective as it is,” Davenport said.

In the past five years, Salem Regional has revolutionized the way it approaches orthopedics with state-of-the-art facilities and a focus on enhancing patient experience and outcomes, all while maintaining its small “family feel.”

“People come from New York State, Pittsburgh, Cleveland and Columbus for anterior hip replacement,” Peters said. The team at Salem has all grasped the concept of raising the bar, he said.

Salem’s orthopedic team works closely and shares data with researchers at places like Johns Hopkins University. Peters also corresponds with implant companies and gives input, looking at performance of the implant in patients.

Youngstown Orthopaedic Association is the area’s largest orthopedic group, with 10 surgeons and one physiatrist who takes care of non-operative musculoskeletal pain. The entity has offices in Canfield, Boardman and Howland, and has its own MRI machine, physical and occupational therapy, and DME bracing, or durable medical equipment bracing. Surgeons are trained in subspecialties, allowing Youngstown Orthopaedics to treat the whole spectrum of orthopedics in “one-stop shopping,” Joseph said.

Youngstown Orthopaedics also works closely with the Orthopaedic Surgery Center, an ambulatory surgery center in Youngstown, and has urgent care facilities in Howland and Canfield that are focused on orthopedic emergencies.

Joseph, born and raised in Boardman, said Youngstown Orthopaedics is “truly local” and has a “hometown feel.” Seven of the group’s 10 physicians come from this area.

“We think that we’re providing good service to the area,” Jamison said.

Subspecialties

• Adult reconstructive — hip and knee replacements

• Sports medicine — treatment of sports injuries, typically shoulder and knee

• Orthopedic oncology — removal of orthopedic tumors

• Pediatric orthopedics — treatment of musculoskeletal system in children

• Orthopedic foot an ankle — typically more comprehensive treatment than podiatry

• Hand and upper extremity

• Spine

SOURCE: Youngstown Orthopaedic Associates