Joint Preservation Institute of Iowa specializes in procedures and techniques that preserve your natural knee and shoulder joints. We are committed to providing comprehensive, high-quality care by improving or maintaining joint function. Joint preservation techniques are often less invasive than traditional treatments with shortened recovery times, giving patients the opportunity to enjoy a healthy and active lifestyle sooner.
- Surgery may be used to treat a torn rotator cuff if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently
Surgery to repair a torn rotator cuff tendon usually involves:
- Removing loose fragments of tendon, bursa and other debris from the space in the shoulder where the rotator cuff moves (debridement)
- Making more room for the rotator cuff tendon so it is not pinched or irritated. If needed, this includes shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing)
- Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus)
- Arthroscopic surgery is the most common technique, but some cases may require open-shoulder surgery, which requires a larger incision
Superior Capsular Reconstruction is a new surgery used to treat “unfixable” Rotator Cuff Tears. Previously, patients with massive, unfixable Rotator Cuff Tears either had to live with the pain or have a Reverse Total Shoulder Replacement, a very extensive surgery that removes the entire shoulder joint. While this is a good procedure for older, less active patients, it is not usually appropriate for younger patients, athletic individuals, or Laboring Workers.
Dr. Goding performed the nation’s first Superior Capsular Reconstruction using the Dermaspan graft from Zimmer/Biomet. Dr. Goding worked with the Orthobiologics division at Zimmer/Biomet for over 1 year to develop the Dermaspan graft in a form that is usable for the Superior Capsular Reconstruction.
Dr. Goding has authored the Surgical Technique for his modification of this highly successful surgery. This technique will be distributed to surgeons as educational material in order to help them perform Dr. Goding’s unique version of the Superior Capsular Reconstruction. Dr. Goding designed the technique to make the surgery less technically difficult and therefore able to be performed by more surgeons.
The Dermaspan Graft is a graft of thick skin from a human donor which has had all of the DNA removed so that it is biologically inert and the body will not reject the graft. The previous version of the graft was too stiff to be used in Superior Capsular Reconstruction surgery. Zimmer/Biomet was able to create a graft that would be amenable to use in this surgery.
Mihata et al. were the first to report using fascia lata autograft for SCR. In their series of 24 shoulders, 83% had intact grafts by postoperative imaging at an average follow-up of 34 months. Mean active elevation increased significantly from 84° to 148° (P < .001) and external rotation increased from 26° to 40° (P < .01). Acromiohumeral distance (AHD) increased from 4.6 ± 2.2 mm preoperatively to 8.7 ± 2.6 mm postoperatively (P < .0001). There were no cases of progression of osteoarthritis or rotator cuff muscle atrophy. Twenty patients (83.3%) had no graft tear or tendon retear during follow-up (24 to 51 months). The American Shoulder and Elbow Surgeons (ASES) score improved from 23.5 to 92.9 points (P < .0001).
Burkhart et. Al Have recently reported good early results using the Human Dermal Allograft (Arthrex) in 100 pts.
Dr. Goding is strongly philosophically opposed to performing a reverse Total Shoulder Arthroplasty in a patient without glenohumeral arthritis, but who has a massive Rotator Cuff Tear. Reverse Total Shoulder takes away tremendous bone during the procedure and renders revisions nearly impossible in the case of a failure. This is a surgery Dr. Goding reserves for the older, low demand population. The Superior Capsular Reconstruction shows tremendous promise as a long term alternative with very good early and midterm results. Failure of Superior Capsular Reconstruction does not take away any bone, or preclude other surgeries including Reverse TSA if necessary in the future.
- Mihata T., Lee T.Q., Watanabe C. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459–470. [PubMed]
- Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Repair. Arthrosc Tech. 2016 Dec 12;5(6):e1407-e1418. doi: 10.1016/j.eats.2016.08.024. eCollection 2016 Dec.
Standard Total Shoulder Replacement performed for arthritis of the shoulder is a highly successful operation. There are , however, reasons to believe that an alternative type of replacement is more appropriate for more active individuals, younger individuals, and Laboring Workers who will put significant stress on the implant.
Dr. Goding uses the Arthrosurface Ovo system which he believes is the best implant for these high activity patients. The reasons for this belief are founded in the unique design elements of the system. The humeral head is preserved rather than cut off. This in and of itself is a significant advantage over standard or even stemless humeral head implants, both of which remove significantly more bone than than the Ovo system.
Standard Total Shoulder Replacement:
Humeral head (ball of shoulder joint) is removed.
Onlay Glenoid (socket of shoulder joint) is used.
Humeral head preserved
Rim of bone preserved around Glenoid component.
The advantage of maintaining the humeral head include having significantly more bone to work with if the implant fails decades down the road and revision surgery is necessary. The screw in fixation method of the head resurfacing has also been shown to be more stable than standard press fit stemmed shoulder implants.
On the glenoid side, the differences are even greater , and Dr. Goding truly believes that the inlay Glenoid is truly a game changer for patients. By maintaining a rim of bone around the implant, rather than completely covering the Glenoid the implant has tested to be 10 x more stable than any onlay type of glenoid. Edge loading is the most common reason for failure in Total Shoulder Replacement. The inlay Glenoid preserves a rim of bone around the implant.
Biomechanical laboratory testing has shown that all tested onlay type glenoids failed at 700-1100 loaded cycles when placed on a machine designed to simulate shoulder motion. The inlay glenoid was still intact at 4000 cycles, the predetermined endpoint of the experiment.
Patients have been able to return to athletics, heavy labor and even powerlifting after having the Arthrosurface shoulder resurfacing. Many surgeons are not able to perform this procedure due to its difficulty. Dr. Goding actively teaches this technique to other surgeons around the country in organized courses in major cities. Dr. Goding strongly believes that this is the best implant for younger, active individuals with shoulder arthritis.
Gagliano JR, Helms SM, Colbath GP, Przestrzelski BT, Hawkins RJ, DesJardins JD.
J Shoulder Elbow Surg. 2017 Jul;26(7):1113-1120. doi: 10.1016/j.jse.2017.01.018. Epub 2017 Mar 27.
- A newer procedure, the reverse total shoulder replacement is suitable for people with painful arthritis in their shoulders and damage to the muscles around the shoulder. In this procedure, the surgeon removes the damaged bone and smooths the ends, then attaches the new joint piece to the shoulder bone and replaces the top of the upper arm bone
The most common shoulder injury affects one of the major stabilizing ligaments attached to the labrum of the shoulder socket. It is formally called a Bankart tear, which occurs as the result of the shoulder dislocating
- Surgery to repair a Bankart tear can be performed via arthroscopic surgery or the more traditional open surgery. The procedure reattaches the damaged labrum to the rim of the shoulder socket (the glenoid)
- Both techniques help prevent the chance of another dislocation. The advantages of arthroscopic surgery include less discomfort, it is minimally invasive and the surgeon can see around the entire shoulder to better assess the cartilage, rotator cuff and other structures
- Shoulder arthroscopy uses a tiny camera called an arthroscope to examine or repair the tissues inside or around the shoulder joint. The arthroscope is inserted through a small incision
The Collagen Meniscus Implant is the first FDA approved implantable device to address large tears in the Meniscus. Previously, there have been no options for large meniscal tears other than meniscal transplantation which is not indicated for most patients. The Collagen Meniscus Implant is , as the name implies, made of collagen, which is the same material that makes up the meniscus. Dr. Goding is one of the first surgeons in the nation to be trained on this implant and is now certified through the FDA process, and able to provide this procedure to his patients. The implant is indicated in patients who have large tears whether or not they have had previous surgery on the meniscus itself.
Removal of the meniscus causes a dramatic increase in the contact pressures between the Femur and the Tibia bones within the knee joint. This increase in in contact pressures can cause pain and lead to arthritis.
Despite being only recently approved by the FDA, the Collagen Meniscus Implant has a great track record in Europe with 10 year results reported as good to excellent in 83% of patients and 0 complications.
Arthroscopy. 2011 Jul;27(7):933-43. doi: 10.1016/j.arthro.2011.02.018. Epub 2011 May 31.
Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ follow-up.
Now Offered at Joint Preservation Institute of Iowa
The Joint Preservation Institute of Iowa is now offering COOLIEF*, an advanced nonsurgical treatment for knee pain.
COOLIEF* from Dr. Richard Goding at the Joint Preservation Institute of Iowa is a minimally invasive treatment option that uses cooled radiofrequency energy to safely target the nerves that send pain signals to your brain.
COOLIEF* involves no incision, preserves the knee joint, reduces the need for pain medications and provides pain relief for up to 24 months. You can generally return to work and normal everyday activities within several days.
Request an Appointment
Call 515-381-3410 to schedule an appointment to see if COOLIEF* is right for you.
- This minimally invasive outpatient alternative to joint replacement shows tremendous promise in prolonging the life span of the patient’s own knee and significantly delays the need for a total knee replacement
- By injecting a calcium phosphate cement into the lesions of early arthritis, we treat the pain associated with early arthritis, and may be able to slow the progression of the disease
- See how subchrondroplasty works and could work for you below!
- Many techniques are used for cartilage restoration, but it may not be appropriate to address extensive arthritis in the knee
- This procedure involves replacing part of the knee rather than the whole knee if arthritis is localized in one area and the rest of the knee is healthy
- This relatively new surgical technique allows the surgeon to insert the same reliable knee replacement implants through a shorter incision while avoiding trauma to the quadriceps muscle, the most important muscle group around the knee
- This technique uses an incision that is typically only 3-4” in length and results in a shorter recovery time
- The less-traumatic nature of the surgical approach may also decrease post-operative pain and lessen the need for rehab and therapy
- Outpatient knee replacement is a surgical procedure removing the damaged knee and replacing it with an artificial knee implant
- Total knee replacement surgery is now conducted on an outpatient basis, allowing patients to go home the same day of the surgery
- Arthroscopic knee surgery is performed through small incisions to repair injuries to tissues such as ligaments, cartilage or bone within the knee joint area. The surgery is conducted with the aid of an arthroscope, a small instrument guided by a lighted scope attached to a video monitor
- Arthroscopic surgeries range from minor procedures such as flushing or smoothing bone surfaces or tissue fragments associated with osteoarthritis, to the realignment of a dislocated knee and ligament grafting surgeries
The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relive pressure on the median nerve in the wrist. Two approaches for this surgery include:
- Open Carpal Tunnel Release Surgery – Open surgery requires a longer recovery period and leaves a larger scar than endoscopic surgery,but there are fewer chances of other complications
- Endoscopic Carpal Tunnel Release Surgery – Recovery is quicker than open surgery. The scars heal more quickly, are smaller and tend to be less painful at three months after surgery, but, there may be a higher probablity of needing another surgery later
Cubital tunnel syndrome (CuTS) is an injury to the ulnar nerve in the arm that can result in moderate to severe pain and numbness in the elbow and ring and little fingers.
There are four main types of cubital tunnel surgery:
- Simple Decompression – One of the cubital tunnel ligaments is cut to reduce pressure on the nerve, which remains in the tunnel
- Subcutaneous Transposition – The ulnar nerve is moved out of the cubital tunnel to the topside of the elbow
- Submuscular Transposition – The ulnar nerve is moved out of the cubital tunnel and placed underneath the muscles around the elbow
- Medial Epicondyle – The bony medial epicondyle on the elbow is shaved down so the ulnar nerve can shift freely in and out of the cubital tunnel
- Tennis elbow is caused by making the same forceful arm movements over and over. It creates small, painful tears in the tendons in your elbow
- If you have open surgery, your surgeon will make one incision over your injured tendon andhe unhealthy part of the tendon is scraped away. The surgeon may repair the tendon using a suture anchor or stitch it to other tendons
- Tennis elbow surgery may also be done via arthroscope, scraping away the unhealthy part of the tendon