Adam Driesman, MD

Products And Services

• Non-Operative

  Non-operative treatment modalities make up greater than 80% of Dr. Driesman's practice. It is his philosophy that surgery should only be used as a last resort, when all non-operative treatments have been exhausted. Physical Therapy Dr. Driesman works closely with physical therapy colleagues to help his patients return back to their feet. He believes strongly that manipulations and strengthening exercises can help individuals restore normal biomechanics so they are no longer in pain. If identified correctly in the office exam, these poor habits can be quickly remedied in therapy without extensive treatment. Corticosteroid Injection Corticosteroid injections have been used for decades to temporarily relieve pain and inflammation in joints and soft tissues, and to relieve systemic inflammatory reactions. The advantage to injecting corticosteroid medication rather than taking it orally is that it is delivered more quickly to the affected area and often has more effective results. Corticosteroid injections are routinely used to reduce the pain and swelling of bursitis, tendonitis and arthritis. Corticosteroid injections are often given as part of rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection typically lasts from 1 week up to 1 year. A typical positive response may last for 3 months. Corticosteroid injections can also be of diagnostic value in pinpointing the regional source of the pain. Corticosteroid injections are usually administered in an outpatient facility under the guidance of fluoroscopy or ultrasound to verify that the medication is reaching the inflamed location. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is usually not painful, although the patient may feel pressure at the injection site. The injection procedure takes only a few minutes. Although the steroids themselves are not analgesics, they alleviate pain as a result of reducing inflammation. In most cases, the patient experiences immediate pain relief from the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid reduces inflammation, the patient should feel a significant, if not total, reduction in pain. The patient can usually resume normal activities the day following the procedure. Viscosupplementation Dr. Driesman frequently utilizes viscosupplementation, which refers to the injection of a hyaluronan preparation into the joint. This is a natural substance normally present in joint fluid to assist with lubrication. This allows for smooth movement of cartilage covering the joint spaces. A single injection directly into the joint can replenish dimished synovial fluid and enhance its lubricating properties. Platelet Rich Plasma (PRP) Platelet Rich Plasma is a relatively new method for the treatment of orthopedic conditions. It utilizes the patient's own growth factors and platelets to assist in healing. To perform, Dr. Driesman draws about 20 cc of blood and spins it down to create a mixture containing high concentrations of your own healing factors. This then can be injected into the affected area to provide an anti-inflammatory response and pain relief. This is not indicated for all patients, and Dr. Driesman will be quick to provide honest review of its efficacy in your condition Connective Tissue Progenitor Cells Some providers like to call these "stem cells therapy", but in reality in is tissue that can be isolated from the patient to proliferate into various connective tissues. While individuals like to state they can be used to "restore, heal and regrow damage tissue", at this point they have yet to prove that potential. Again, Dr. Driesman will have an honest conversation regarding the benefits and drawbacks of this therapy. Still, they have been shown to be symptom modifying in some patients, reducing inflammation and improving pain. Dr. Driesman can perform this therapy on select patients. The first step therefore depends on determining if you are a good candidate.

  Link: Non-Operative

• Joint Reconstruction and Replacement

  Because joints are in constant use, they often wear out over time due to overuse or aging. Joint reconstruction or replacement may be required to relieve the resulting pain and restore function. Most joints in the body, including the neck, shoulders, elbows, wrists, hands, hips, knees, ankles and feet, are synovial, permitting movement and articulation. When these joints suffer traumatic injury, or when the cartilage that normally protects them wears away, surgical repair or replacement may be necessary. Reconstruction and Replacement Surgeries Depending on the extent of the damage, there are several surgical options to repair or replace joints, varying in complexity, durability and recovery time. Joint Replacement Surgery Joint replacement is a complicated procedure, usually performed on the hip, shoulder or knee. Prosthetic joints used in the process are made of plastic and/or metal and are designed to move the same way natural joints do. Joint replacements may be cemented or uncemented. Cemented prostheses are often used in older patient whose bones are weaker and who are less active, while uncemented prostheses are used in younger, more active patients. The procedure with the uncemented device takes longer to heal because it requires growth of the patient's bone, but it results in greater mobility. In either case, the artificial joint typically lasts for 10 to 15 years, so the surgery may have to be repeated. In the case of younger patients, it may have to be repeated two or more times. Arthroscopy Arthroscopy is a minimally invasive procedure that is diagnostic as well as reparative. It is performed with a device called an arthroscope which enables the surgeon to magnify, as well as visualize, the site on a video monitor. The arthroscope is inserted through tiny incisions at the site through which the doctor can also make minor adjustments, such as trimming cartilage, removing bone spurs or releasing tight ligaments. Osteotomy Osteotomy is a procedure during which a section of bone is cut in order to realign the damaged joint. This procedure is typically performed on the knee or hip for younger patients who do not want to have joint replacement surgery yet. Resurfacing Surgery Most commonly performed on the hip, resurfacing is helpful to young patient and patients with medical conditions that make a hip replacement inadvisable. During resurfacing, only damaged cartilage is removed and a metal cap is placed over the ball portion of the hip. Although the surgery is less complex than hip replacement, resurfacing does not have as long a track record and so far it appears to be associated with a higher risk of complications. Arthrodesis Arthrodesis, commonly known as joint fusion, is a surgical procedure during which the surgeon uses various wires, pins, screws and plates to position the bones correctly until they fuse. This fusion will prevent painful movement. If there has been significant bone loss, a bone graft may be necessary. The bone to be grafted may be taken from another area of the patient's body, obtained from a donor bank, or may be made of synthetic material. Small Joint Surgery If joints in the hands or feet become so badly damaged that everyday activities are unmanageable, they may be replaced. In such cases, the goal is to restore enough mobility for the patient to resume performing simple tasks like using utensils or putting on shoes. Joint reconstruction and replacement have provided great relief to patients suffering from chronic severe pain. By restoring movement as well, joint surgeries enable patients to lead more active, productive and comfortable lives.

  Link: Joint Reconstruction and Replacement

• Anterior Hip Arthroplasty

  Traditionally, hip arthroplasty, commonly known as hip replacement, has been performed by accessing the joint through the rear of the leg. Recent advances in technique, however, have made an anterior approach, during which the surgeon accesses the hip joint through the front of the leg, a more desirable option for most patients. An anterior approach offers a number of advantages. Whereas during traditional hip replacement surgery, muscles had to be cut and subsequently reattached, using the anterior approach, these muscles need only be moved aside. Moreover, an anterior hip replacement provides the surgeon with the opportunity to clearly visualize the entire hip socket and to implant a variety of necessary devices. The minimally invasive anterior approach also lowers the risk of dislocation common in other hip replacement procedures. By maintaining the integrity of the muscles and the hip capsule, this procedure also provides the stability to keep leg lengths equal and so avoids the need for leg lengthening. Since less muscle damage takes place, anterior hip replacement often enables the patient to be hospitalized for a shorter period of time and to recover more quickly. In many cases, patients are walking without assistive devices 2 to 3 weeks after the operation. Low impact forms of exercise are recommended immediately after anterior hip replacement, and high-impact activities are typically only prohibited for 3 months. The anterior hip arthroplasty is not equally well-suited to all patients. Patients who are not suitable candidates for anterior hip replacement include: Those with previously implanted devices Extremely muscular individuals Obese patients Whether an anterior approach to hip replacement is a viable option is determined after careful evaluation of the individual patient.

  Link: Anterior Hip Arthroplasty

• Bilateral Total Knee Arthroplasty

  Bilateral knee arthroplasty is the replacement of both knees during the same period of time. This procedure can be simultaneous, with both knees operated on during the same surgery, or staged, with separate surgeries performed on each knee a few days or weeks apart. Bilateral knee arthroplasty is performed on patients disabled by severe arthritis in both knees. While the bilateral procedure is longer and more complex than a single knee arthroplasty, the pain relief after surgery is much greater and the overall rehabilitation time is shorter. There is some debate about whether the simultaneous procedure is preferable to the staged operations and also about whether bilateral arthroplasty is always more beneficial than two widely spaced operations. Advantages of the Simultaneous Bilateral Procedure There are several important advantages to a bilateral total knee arthroplasty, including: Single administration of anesthesia Shorter hospital stay Reduced costs More efficient correction of bilateral bone deformities The great majority of patients who have had the bilateral procedure say that they were pleased with the results and, if given the choice, would choose this method again. Once the immediate postsurgical pain abates, they experience relief in both knees. In addition, they only have to undergo one surgery and one period of rehabilitation. Risks of Simultaneous Bilateral Procedure While total knee arthroplasty is considered a safe operation, it carries the risks of any surgical procedure, including excessive bleeding, blood clots, infection and adverse reaction to medication or anesthesia. The rate of these complications is approximately the same for bilateral or singular operations. For some patients, early rehabilitation may be more difficult after the bilateral surgery since there is not an unaffected leg to use for support. Bilateral total knee arthroplasty is not usually recommended for patients who are over 80 years of age or patients who have serious underlying medical conditions. In these situations, bilateral surgery may present a greater risk since it is a larger, more traumatic event than smaller, more widely spaced procedures. Patients in these categories are at greater risk of developing cardiopulmonary and neurological complications or of requiring blood transfusions.

  Link: Bilateral Total Knee Arthroplasty

• Robotics and Enabling Technologies

  Robotics, computer navigation, and enabling technologies aid in the accuracy and precision of joint replacement. This allows Dr. Driesman to take a patient-specific approach when planning and executing hip and knee replacement. rea, allowing the radiologist to analyze it. The referring physician can then use the results to diagnose the problem and determine a course of treatment -- all before any surgery begins. Robotic Joint Replacement There are many different types of robotic assistance used for orthopaedic surgery. Fortunately, Dr. Driesman has trained with cutting edge technology and feels comfortable utilizing many of these systems. At his clinic, he utilizes a computed tomography (CT) scan before surgery. This three-dimensional imaging offers many advantages, including collecting more information before attempting the surgery, and to plan exactly how much bone should be removed and to aid in maximizing the accuracy of implant alignment. During the surgery, the robotic arm ensures that the plan is followed exactly Computer Navigation Computers can also be used to assist during an operation. While many utilize jigs and guides to make bone cuts, Dr. Driesman is trained in computer navigated systems. They aid in more predictably and reporducibly achieving optimal alignment through the use of infrared beams and shiny spheres. Although we do not need the computer, studies have demonstrated that accuracy is improved with this technology. Augmented Reality and 3D Printed Patient Specific Guides Continuing to stay up to date with the latest technology, Dr. Driesman has used both augment reality and 3D Printed Guides. With the 3 dimensional CT scan, we can recreate perfect location, size, and angulation of the components, specifically designed just for your knee. 3D Printed Patient Specific Guides are built off your personalized CT scan. With the plan in place, plastic models are created and sterilized into the operating room, so that they can be utilized as guides to make the perfect cuts just for you. These guides are unique for each patient and fit onto your anatomy like a glove, taking all the guess work out of the operation. In a similar fashion, augmented reality can also be utilized to use your native anatomy to create the exact unique orientation. This has the potential to limit outliers. Ask Dr. Driesman if any of these enabling technologies would be a good option for your situation.

  Link: Robotics and Enabling Technologies

• Knee Arthroscopy

  Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. During an arthroscopic procedure, a device known as an arthroscope is inserted into a small incision in the knee. Through this tube, a thin fiberoptic light, magnifying lens and tiny video camera are inserted, allowing the doctor to examine the joint in great detail. Arthroscopy may be a diagnostic procedure following a physical examination and imaging tests such as MRI or CT scans or X-rays. It may also be used as a method of treatment to repair small injuries in the knee. Knee Arthroscopy as Treatment Relatively minor knee damage is frequently treated using arthroscopic techniques. Most knee damage results from sports injuries or osteoarthritis. During an arthroscopic procedure, the surgeon may be able to treat: Loose bone or cartilage Meniscal tears Torn ligaments Synovitis (swelling of the joint lining) Misalignment of the patella (knee cap) Inflamed tissue In patients with osteoarthritis of the knee, arthroscopy is also used in the removal of dead tissue, a process known as debridement. Benefits of Knee Arthroscopy Because it is minimally invasive, arthroscopy offers the patient many advantages over traditional, more invasive, surgery. These include: No cutting of muscles or tendons Smaller incisions Less bleeding during surgery Less scarring Shorter recovery time Shorter and more comfortable rehabilitation Candidates for Knee Arthroscopy Knee arthroscopy is quickly becoming the ideal procedure for many conditions affecting the knee. Its minimally invasive advantages allow patients to receive fast and simple pain relief, increased range of motion and restored function, while avoiding or delaying the need for joint replacement surgery. Despite its many advantages, arthroscopy is not appropriate for every patient. Some patients, especially those with knee problems that are in difficult-to-see areas, may benefit more from conventional surgery. The Knee Arthroscopy Procedure Knee arthroscopy is performed on an outpatient basis under local or general anesthesia, depending on the type and severity of the condition, as well as the patient's personal preference. During the procedure, the surgeon inserts the arthroscope into the knee through a tiny incision. This instrument is used to identify any damage or abnormalities within the knee, or to confirm the diagnosis of a previous imaging exam. If damaged areas are detected, they can be repaired during the same procedure by inserting surgical instruments into additional small incisions. Recovery from Knee Arthroscopy After a knee arthroscopy , patients often experience swelling and pain for several days. These symptoms can be controlled by the usual home remedies: resting and elevating the leg, applying ice and taking over-the-counter painkillers. Patients are encouraged to get up and walk around as soon as possible after the procedure, although crutches or a cane may be needed for some period of time. Most patients can usually return to work within a week, but will need to undergo physical therapy in order to restore full range of motion to the joint. Most patients can resume light physical activities after a few weeks, although full recovery from knee arthroscopy may take 12 weeks or longer. Risks of Knee Arthroscopy While knee arthroscopy is considered safe for most patients, there are certain risks associated with any surgical procedure. These risks include: infection, blood clots, accumulation of blood in the knee, nerve damage or adverse reactions to medications or anesthesia. In the great majority of cases, the knee arthroscopy goes smoothly.

  Link: Knee Arthroscopy