Probably the most common reason for poor function after a knee replacement is related to the way the surgeon aligned the knee replacement.  The most common way knee replacements are aligned is using MECHANICAL alignment.  Most surgeons are trained to place knee replacements this way.  Navigation and Robot assistance has attempted to increase the accuracy of MECHANICAL alignment in an effort to improve outcomes ie patient satisfaction however studies have not shown either navigation or robot use to improve outcomes. Mechanical alignment historically has been promoted with the tho ..read more

WHAT TO EXPECT AFTER TOTAL HIP REPLACEMENT: DAY 0-1: REBOUND PAIN WHEN THE SPINAL WEARS OFF.  IF you are not having pain, you don’t have to take the narcotics given – stop narcotics if you’re having nausea/vomiting/dizziness. YOU START THE MULTI-DRUG PAIN PROTOCOL. YOU START YOUR HOME EXERCISE PROGRAM: FIRST 2 WEEKS – FOCUS IS LIMITING STEP COUNT and SWELLING MANAGEMENT NOT STRENGTHENING: EVERY HOUR WHILE AWAKE SHOULD INCLUDE: 30-40 minutes of ICING and LEG ELEVATION.  ICING CAN BE DONE 24/7 AS LONG AS THE SKIN IS PROTECTED FROM FREEZER BURN.  THIS SHOULD BE DONE 30-40 minutes p ..read more

STEP 1: MAKE DECISION for TOTAL KNEE REPLACEMENT (TKR) also called TOTAL KNEE ARTHROPLASTY (TKA) When quality of life is impaired by knee arthritis, make the decision for total knee replacement.  Identify a co-pilot to read the blog. STEP 2: MEET DR. GALLAGHER IN CLINIC Meet with Dr. Gallagher to discuss TKA and pick a date for your surgery. Surgery days are Mondays, Thursdays, sometimes Wednesday PMs. MOST TKAs are done as SAME DAY OUTPATIENT surgery, usually in a surgery center (PINNACLE SURGERY CENTER).  However, sometimes patients require a hospital setting (ASCENSION SETON MEDIC ..read more

WHAT TO EXPECT AFTER TOTAL KNEE REPLACEMENT: DAY 0-1: RE-HYDRATE!  WATER/ELECTROLYTE DRINKS! REBOUND PAIN WHEN THE SPINAL WEARS OFF.  IF you are not having pain, you don’t have to take the narcotics given – stop narcotics if you’re having nausea/vomiting/dizziness. Occasionally,  FOOT DROP (unable to move foot upward) can happen if the numbing medicine from the nerve block leaks around a nerve in the back of the knee.  THIS RESOLVES WHEN THE NUMBING MEDICINE WEARS OFF – USUALLY BY THE NEXT DAY. YOU START THE MULTI-DRUG PAIN PROTOCOL. YOU START YOUR HOME EXERCISE PROGRAM: FI ..read more

RE-HYDRATION ELECTROLYTE DRINKS: PEDIOLYTE VS HEB ELECTROLYTE VS GATORADE ETC.  Helpful for dehydration that occurs with surgery and with fasting prior to surgery.       A “FANCY BANDAID” (4″x10″ Island Border Dressing) covers the incision for 7 days.  Patients should purchase 1 or 2 of these dressings to use at home if the first one becomes 50% saturated, or use gauze and medical paper tape.     Press ‘n’ Seal Seran Wrap is used to cover this “waterproof” bandage during showers to prevent any moisture from getting on the incision.       Hibi ..read more

Week 0-6: 1st postop visit 10-14 days postop – wound check – no sutures or staples to take out – all are dissolvable.  usually we get PT setup now if patients are ‘guarding’ their knee. 1. Aggressive swelling management: ICE, ELEVATION, NSAID therapy. 2. No resistance exercises.  Active ROM only: walking, stationary bike, bending and straightening. 3. Ween crutches when not limping. 2nd postop visit 5-6 weeks postop – check progress with Range Of Motion (ROM).  Goal for 6-8 weeks postop is to have near full ROM.  Start formal PT if none started for CLOSED CHAIN RESISTANCE O ..read more

Targeted Cold Therapy: An Innovative Way to Manage Pain   Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention. John B. Tran, Philip W. H. Peng, Karen Lam, Ehtesham Baig, Anne M. Agur, Michael Gofeld.  Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M.  Reg Anesth Pain Med. 2018 May;43(4):407-414. doi: 10.1097/AAP.0000000000000778. PMID: 29557887. Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Contr ..read more

JOIN US Complimentary Patient Education Seminar and Scanning Event If carpal tunnel symptoms such as numbness, pain, tingling or weakness keep you away from every day activities, you’ll want to join us for this complimentary education program with Dr. Benjamin Amis. Sign Up Today! or RSVP by phone 512-960-4590 I needed a total hip replacement for which Dr. Gallagher has been superb. Diana S. - Facebook Dr. Gallagher is thorough, smart, and attentive! I’m lucky to have him as my surgeon! Karen R. - Facebook Great docs with a friendly staff. I would certainly recommend seeing the ..read more

Carpal Tunnel Syndrome What is Carpal Tunnel Syndrome (CTS)? Affecting more than 12 million people, CTS can cause pain, numbness and tingling in the hand and arm. It occurs when the median nerve, one of the major nerves in the hand, is compressed as it travels through the carpal tunnel in the wrist. Traditional Carpal Tunnel Release Surgery CTS may be treated surgically through a procedure called carpal tunnel release (CTR), which relieves pressure on the median nerve by cutting the transverse carpal ligament. Traditional CTR procedures can remedy the condition but may result in large and some ..read more

4x per day, sets of 10-15.  PHONE ALARM reminder recommended. GLUTEUS MEDIUS STRENGTHENING – 45 degree HIP ABDUCTION STRENGTHENING STANDING or SIDE LYING Theraband not needed until able to do 15 with ease. FORM IS IMPORTANT when standing – must keep torso and pelvis level Leg Should be directed back at a 45deg angle   HIP FLEXOR STRENGTHENING – STRAIGHT LEG RAISES (SLRs) SEATED OR LYING BENT KNEE HIP FLEXOR STRENGTHENING sitting or lying Also, please look at videos by Bob and Brad: https://www.bobandbrad.com/total-hip-replacement-program ..read more