UCSF arthritis and joint replacement center will deliver comprehensive care

By Maureen McInaney on September 30, 2003

UCSF has opened a new Arthritis and Joint Replacement Center—a joint effort between the departments of rheumatology and orthopedic surgery. The center expands the UCSF Medical Center’s services for the treatment of more than 100 different types of arthritis.

“The goal of arthritis treatment is to reduce joint pain and inflammation, while improving or maintaining joint function,” said Michael Ries, MD, an orthopedic surgeon with the new Center.

In this comprehensive Center, orthopedists and rheumatologists will work together to provide a wide range of treatments for patients with degenerative and inflammatory joint disease. Treatment may include lifestyle changes, medication, bracing, physical therapy, or surgery and is tailored to best manage the condition of each patient, said Ries. Orthopedic specialists at the clinic will address joint disease in hips, knees and shoulders. In the future, a podiatrist will join the team to treat arthritis of the foot and ankle.

One of the most common types of arthritis is osteoarthritis (OA), also known as degenerative joint disease. It affects more than 15 million Americans and is most closely related to aging. OA is associated with the breakdown of cartilage, which functions as a cushion between the bones of the joints. Surgery may be indicated for patients with OA, according to Harry Jergesen, MD, a Center orthopedic surgeon, who specializes in total hip and knee replacements and revisions of these procedures.

The newest advances in orthopedic surgery include minimally invasive techniques, computer assisted surgery, and advanced implant options, explained Center orthopedic surgeon Kevin Bozic, MD. For patients requiring total joint replacement of the knee and hip, minimally invasive techniques offer the potential to shorten the recovery phase. Less invasive techniques can reduce blood loss, post-operative pain, duration of hospitalization, and time to full functional recovery, he said.

In minimally invasive surgery, computer assisted surgical navigation tools provide important benefits. These technologies enable physicians to improve their accuracy in positioning implants and minimize the size of surgical wounds. Bozic and Ries are among several surgeons in the country studying the impact of these techniques on patient outcomes.

According to Bozic, early results are encouraging. “Patients who undergo minimally invasive total hip replacement have been able to leave the hospital after two or three days, versus the traditional four-six day length of stay. Furthermore, patients are returning to normal function more quickly, enabling them to enjoy the quality of life gained by total knee replacement sooner.”

Other new techniques include partial knee replacement, also called unicompartmental knee arthroplasty, explained Ries. In a total knee replacement, all three compartments of the knee are fitted with a prosthetic implant. In a patient with arthritis isolated to a single compartment of the knee, the partial knee replacement offers the possibility to remove and resurface only the most damaged areas of cartilage, he said. The partial knee replacement is done through a smaller incision and requires less disruption to the muscles than a traditional knee replacement. This allows for a quicker recovery time for patients and allows them to regain their motion and function in less time, he explained.

UCSF orthopedic surgeon Benjamin Ma, MD, a shoulder specialist with the center, is investigating the possibility of using minimally invasive techniques for shoulder replacement. Shoulder replacements are currently completed with more traditional techniques. Though shoulder replacements have received less attention than hip and knee replacements, the long-term results are comparable, according to Ma.  Ma will also treat sports-related injuries to the shoulder (including arthropscopic repairs for dislocations and rotator cuff tears) and perform arthroscopic ligament and cartilage repairs for the knee.

Though surgery is indicated for some patients, it is not indicated for all, according to Ries. “Our rheumatology colleagues at the Center offer special expertise because many arthritic conditions are difficult to diagnose and treat.”

“We use a variety of strategies, including state-of-the-art medications to manage rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis and tendonitis,” said Kenneth Sack, MD, a rheumatologist at the Center.

John Davis, MD, a center rheumatologist, along with Sack, and UCSF rheumatologist Jennifer Gorman, MD, recently published a study in the New England Journal of Medicine that spurred FDA approval for a new drug to treat a painful and disabling spine condition called ankylosing spondylitis (AS). The immune-blocking drug called Etanercept (trade name Enbrel) already approved and used for rheumatoid arthritis, is now approved to treat AS, according to Sack.

This research was partially funded by the Rosalind Russell Medical Research Center for Arthritis. Founded in 1978 to support the advancement of arthritis research, the Center has served as a critical funding resource for UCSF researchers.  Currently, the Center is helping to support the work of nine leading scientists as well as young faculty members and fellows. These teams are asking many of the fundamental questions that must be answered to find the causes of arthritis.

Physicians affiliated with the UCSF Arthritis and Joint Replacement Center include:


Orthopedics:

* Harry Jergesen, MD, UCSF professor of orthopedic surgery
* Michael Reis, MD, UCSF associate professor of orthopedic surgery
* Kevin Bozic, MD, UCSF assistant professor of orthopedic surgery
* Benjamin Ma, MD, UCSF assistant professor of orthopedic surgery


Rheumatology:

* Kenneth Fye, MD, UCSF professor of rheumatology
* Kenneth Sack, MD, UCSF professor of rheumatology
* John Davis, MD, UCSF assistant professor of rheumatology


The Center is located on the Plaza level of the UCSF Ambulatory Care Center at the UCSF Medical Center. To make an appointment with a rheumatologist call 415-353-2497. To make an appointment with an orthopedic surgeon call 415-353-2808.

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