New Pain Reducing Procedure Studied by ONS Orthopedic Surgeons

GREENWICH ORTHOPEDIC SURGEON DR. PAUL SETHI AND THE ONS PRACTICE WERE FEATURED IN AN ARTICLE IN GREENWICH PATCH FOR USING A NEW PAIN-REDUCING PROCEDURE THAT CAN REDUCE OR ELIMINATE THE NEED FOR NARCOTICS.

In the article, Greenwich Surgeon Strives to Combat Opioid Epidemic with New Procedure, Greenwich Patch staff writer, Rich Scinto, wrote that oftentimes opioid addiction begins after surgery. 

Following is the article in its entirety:
Opioids post-surgery have become a double-edged sword in the wake of an increasing addiction epidemic. While they have great pain-reducing powers, they also carry the risk of addiction and the chance that pills can fall into the hands of an addict.

A group of orthopedic surgeons based in Greenwich are using a new pain-relieving method that helps reduce a patient’s reliance on opioids.

Dr. Paul Sethi with Orthopaedic and Neurosurgery Specialists recently has seen collegiate athletes in need of surgery who are willing to suffer great amounts of pain if it means staying off of opioids post-surgery.

“Young people are becoming more aware of how dangerous of a problem it is,” Sethi said about opioid addiction.

It is also frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to death or a lifelong battle with addiction, he said.

Sethi has been performing shoulder replacement surgeries with the use of Exparel, which is an injection of long-lasting liposomal bupivacaine that can last for three days post-surgery. Some patients have used no narcotics or a greatly reduced amount after the surgery, Sethi said.

Instead of prescribing 30 narcotic pills post-surgery generally there is only a need to prescribe 10, he said. That translates to less pills that could fall into an addict’s hands.

The prescription of opioid pain relievers has skyrocketed. In 2013 health-care providers wrote 259 million prescriptions, enough for every American adult to have a bottle of pills, according to the CDC.

About 70 percent of opioids used for non-medical reasons are obtained through family or friends and 18 percent through a prescribing doctor, according to the Substance Abuse and Mental Health Services Administration.

Sethi and others are conducting a peer-reviewed study about Exparel’s effectiveness in reducing pain after surgery.

Sethi and others at the practice plan to expand the use of Exparel to other types of shoulder surgery and there is potential to use it in operations such as ACL repairs. The injection has to be specifically tailored to each surgery in order for it to be effective, he said.

Surgeons should spend a good amount of time educating their patients about pain management and the potential for opioid abuse.

“In medicine we are pressed for time, but I think this is one of the most important things we teach our patients about,” he said.

The injection costs about $300 extra, which is a bargain if it can save a person from an overdose death or a long struggle with addiction, Sethi said.

For now narcotics still are prescribed in case pain comes back after Exparel wears off.

Double Shoulder Replacement Restores Mobility

SHOULDER REPLACEMENT REGAINS HIS ACTIVE LIFESTYLE JUST MONTHS FOLLOWING SURGERY. 

Arthritis had taken its toll on Dave’s shoulders. He was in constant pain. Sleeping was difficult and it was nearly impossible for him to take part in activities that he loves.  Then, two friends with similar shoulder issuesD.Hapke in Kayak referred Dave to shoulder surgeon, Dr. Seth Miller at ONS.  “When I met him, I immediately knew he was the doctor I wanted to care for me. He was thorough, thoughtful and patient. He has a great bedside manner and took the time to completely answer all my questions,” he recalled. 

Dave had his first shoulder replacement in January, 2013; the second one was done a year later. In both instances, the therapists had him doing exercises the day after surgery, which he continued at home within the week. Through a physical therapy program over the next few months, Dave was able to build muscle mass to help support his new shoulders.

Just 16 weeks after surgery, Dave was back on the water kayaking pain free. These days, he goes to the gym 2- 3 times a week and kayaks quite a bit on ponds, lakes and streams. He can even carry his  kayak.

“I am so grateful to have my active life back, thanks to ONS!” he said.

Shoulder replacement surgery and reverse shoulder replacement surgery is not for everyone. In many cases, treatment such as icing, anti-inflammatory medication and physical therapy can help get shoulder pain from arthritis under control. However, if pain persists, as it did with Dave, it may be time to consider a surgical option, notes Dr. Miller.

With arthritis and some fractures and injuries, the cartilage of the shoulder gradually wears away, creating a situation where bone is rubbing against bone. The resulting inflammation is extremely painful and makes shoulder mobility progressively more difficult. This condition typically develops later in life and gets worse over time.

The shoulder replacement procedure replaces the damaged joint with a highly-polished metal ball attached to a stem and a plastic socket. As long as a patient has an intact functioning rotator cuff, it can be an extremely successful procedure.

However, there is a group of patients that not only have significant cartilage damage in their shoulder, but also have a torn rotator cuff that is beyond repair. The rotator cuff is a group of muscles that run from the shoulder blade to the upper arm and allows patient to elevate their arm. Twenty years ago, treatment options were limited. In 2004, the FDA approved a reverse shoulder replacement procedure that was being used successfully overseas.

The surgery takes about two hours and involves a small incision, usually about three to four inches in length. Patients can expect to stay in the hospital somewhere from one to three days. Further, patients will be released with their arm in a sling, and undergo exercises to reestablish range of motion with the joint.

Between four and eight weeks after surgery, patients should be able to raise their arms above their heads without pain. Three to four months after surgery, patients are gradually resuming the activities of daily living. Many patients remark after recovery that they feel like they’ve been given their life back.

ONS’ Dr. Seth Miller was one of the first in the metropolitan area to perform reverse shoulder replacement surgery. He will take part in a Joint Replacement Symposium at Greenwich Hospital with ONS colleagues and joint replacement surgeons Drs. Frank Ennis and Brian Kavanagh.

The event will be held on Wed. May 11 starting at 6 p.m.  To register, call 203-863-4277 or online.

Surgeons to hold Special Seminar on Shoulder Pain and Shoulder Replacement Surgery at Greenwich Hospital

On Thursday, December 8 at 1:30 p.m., orthopedic surgeons Seth Miller, MD and Paul Sethi, MD will present a free community health talk about the latest solutions for shoulder pain. The talk takes place in the Noble Conference Center at Greenwich Hospital on Perryridge Road. Registration is requested; call (877) 585-0125 to register.

“Severe shoulder arthritis and chronic shoulder pain can make daily-life activities, like combing hair, reaching for a lamp or putting on a sweater extremely difficult,” says Dr. Miller who is also a shoulder specialist and one of the foremost shoulder experts in the New York Metropolitan area. “If you can’t do the simple things you once did, you may be suffering from a shoulder condition. There are reliable solutions for chronic shoulder pain. It is important to learn about your options in order to make the best decision for you.”

Orthopaedic Surgeon Dr. Seth Miller of ONS

Many people are familiar with hip or knee replacement to treat chronic pain caused by advanced arthritis.  In the last 25 years, shoulder replacements have been used by a select group of skilled orthopedic surgeons to help their patients with chronic shoulder pain, restore mobility and stop pain. Dr. Seth Miller and his colleague Dr. Paul Sethi have performed over 1000 shoulder replacements at Greenwich Hospital in the past 20 years, earlier than at any other hospital outside New York City. For their patients this means regaining the mobility they thought was permanently lost.

Doctors recommend shoulder replacement for patients with severe shoulder arthritis, who have not achieved pain relief from conservative treatments, or who have had a severe fracture. In the procedure, the surgeon replaces the damaged or arthritic joint surfaces with a highly-polished metal ball attached to a stem, and a plastic socket. In cases where the patient’s own ball is severely fractured and the socket is normal, the surgeon may replace only the ball.

In addition to being a staff orthopedic physician at Greenwich Hospital, Dr. Seth Miller serves as Clinical Associate Professor of orthopedic surgery specializing in shoulder surgery at the Hospital for Joint Diseases at NYU Medical Center. He is also assistant Attending Physician in orthopaedic surgery at New York-Presbyterian Hospital.

Dr. Seth Miller is a graduate of Mount Sinai School of Medicine in New York. After his residency at New York Columbia-Presbyterian Medical Center, he completed a research fellowship at the Hospital for Special Surgery in New York and a shoulder surgery fellowship at Columbia-Presbyterian Medical Center. He has been an orthopaedic consultant to the New York Mets for more than eight years.

Paul Sethi, MD is a Board-certified orthopedic surgeon with sub-specialty training

Orthopaedic surgeon Paul Sethi, MD

in sports medicine and the shoulder and elbow. Dr Sethi graduated with honors from Cornell University. He received his medical degree from Mount Sinai School of Medicine and performed his internship and residency at Yale University. He completed a sports medicine fellowship at the Kerlan Jobe Orthopaedic Institute in Los Angeles, CA. His research on athletic performance while a resident surgeon at Yale, his studies on professional basketball players and his own experience as a college varsity athlete have provided Dr. Sethi with first-hand experience, and an invaluable perspective in understanding sports-related injuries and conditions.

Dr. Sethi is a former orthopedic consultant to the Los Angeles Dodgers baseball team and former assistant team physician of the Los Angeles Lakers basketball team, Los Angeles Kings hockey team, the Los Angeles Dodgers and University of Southern California football team.

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