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Kentucky Orthopaedic and Hand Surgeons

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LEXINGTON In the era of consolidation and sub-specialists, Kentucky Orthopedics and Hand Surgeons (KOHS) remains successful by staying with its founding formula of specialists and general orthopedics.

KOHS was founded in 1981 by Dr. G.J. Sweeney, Jr. and Dr. David Stevens. The practice continues today after joining with three other Central Kentucky private orthopedic practices to form Ortho Kentucky. That four group merger occurred in July 2010 when KOHS joined Orthopaedic Consultants, Kentucky Bone & Joint Surgeons and Lexington Orthopaedic Associates. Ortho Kentucky was profiled in M.D. UPDATE, April 2011.

The mission of KOHS remains intact says senior partner Mark E. Einbecker, MD, “by providing outstanding patient care by fellowship trained sub-specialists and a general orthopedist who can handle everything and anything that comes our way.” Patients come to the Lexington office in Central Baptist’s medical campus from West Virginia, southern and northern Kentucky and west to Frankfort.

Einbecker says his commitment to a life of providing medical care began when he was a medic in the US Army Green Beret Special Forces, 1974–1977. “For a young man, with a little bit of college and no direction, it was a great experience and exposure to a lot of medicine,” recalls Einbecker.

Einbecker attended medical school at Northwestern University and took residency at the University of South Florida. Einbecker was fellowship trained in hand and upper extremities at the Christine M. Kleinert Institute for Hand and Microsurgery in 1991 before joining KOHS.

Today, Einbecker says the majority of his practice is “hand, elbow and wrist surgeries on working adults, who are too young to retire but whose aches and pains make working a daily challenge.” Repair and replacement surgeries for tennis elbow, medial epicondilitis, nerve entrapment, Duputhren’s Contracture and, “the big one, carpel tunnel syndrome” keep Einbecker’s surgery schedule full, as well as consultations for his rheumatoid and osteo-arthritic patients.

Though hand transplant surgeries garner the media buzz, it’s the outpatient procedures that motivate Einbecker. “With an eight to 10 minute operation, we can relieve pain and preserve use and feeling in hands and fingers that might otherwise be lost through lack of awareness.”

As an example, Einbecker points to a common hand replacement procedure, arthritis at the base of the thumb joint. He replaces the arthritic joint with a pyro-carbon ball that restores mobility and pain-free use of the affected thumb joint. “It’s so simple and common that I carry the pyro-carbon ball in my pocket to show patients,” he says, pulling the ball out. It’s the size of a small gumball.

Foot and Ankle: Prevention and Replacement

Lisa T. DeGnore, MD, says she is “a tertiary sub-specialist known among referring physicians for salvaging and repairing foot surgeries that have previously failed.” Yet prevention of diabetic foot disease is her most passionate cause.

Diabetic neuropathy interrupts the protective nature of pain sensation, states DeGnore. “Patients who suffer from diabetic neuropathy will walk around with a hole in their foot and not feel a thing,” she says, so prevention of diabetic ulcers is the key. DeGnore educates her patients on her four step prevention regimen: moisturize their feet every night to prevent the dryness that leads to cracking and infection; sand calluses every day; use custom inserts in shoes for problem feet; and no smoking, plus a tight rein on glucose in their diet. DeGnore recommends that primary care physicians regularly examine their diabetic patient’s feet for warning signs of infection.

Ankle repair systems lag behind other joint replacement hardware in DeGnore’s view, so she is reluctant to use them on her patients, who are primarily middle age to early seniors and are heavy. The thin tibia and fibula struggle to withstand the intense downward pressure of walking when they are compromised with arthritis and the insertion of metal and plastic hardware, says DeGnore. When ankle surgery is needed, she prefers fusion over replacement.

Correcting rheumatoid foot deformities and straightening spastic foot deformities in stroke or head injury patients are the more gratifying surgical procedures that DeGnore performs because her “patients are free of pain and can walk again,” she says. Additionally DeGnore treats complex genetic foot deformity, Charcot –Marie Tooth disease, while her mainstay procedures are removing bunions and performing corrective toe surgery.

DeGnore graduated from the University of Michigan’s six-year college and medical school program, took her residency at UNC Chapel Hill, a fellowship at Vanderbilt, and was on faculty for five years at UK before joining KOHS in 1998.

General Orthopedist: The Go to Guy

A graduate of the seven-year combined medical school and doctoral program in biochemistry at UK, plus a five-year orthopaedic residency and specialty at UK prepared Mathew A. Nichols, MD, for a career in academic medicine. But that was not to be.

Instead, Nicholls joined KOHS in 2004 and brought his interest in improving best practices for medicine and hospitals with him. Nicholls is widely published and works consistently within his specialty and hospitals to advance patient care. He stresses pre-and post-operative patient education and processes. Among his efforts are a curriculum that educates patients on post operative expectations; modifying anesthesia for orthopedic patients for faster post-op recovery; and initiating physical therapy within hours of surgery whenever possible. “Same day physical therapy shows definite improvement in reducing blood clots and allows the patient to leave the hospital faster,” says Nicholls.

As a general orthopedic surgeon, Nicholls is trained in the management of a wide array of operative and non-operative musculoskeletal problems from carpal tunnel syndrome to primary joint replacement and revision surgeries. He enjoys the challenge of staying up to date on the latest in treatment of the wide array of orthopedic problems. During any given week he may find himself operating on the shoulder, knee, ankle or any one of the joints in the upper or lower extremities.

Joint revision surgery intrigues Nicholls because it demands more pre-op planning and thought. The most important factor, he says, is determining why the primary surgery failed. Was it the result of infection, bone fracture, lack of proper therapy, or implant failure? Determining the reason why an implant failed is critical in devising a solution that will work. “When you operate on a failed total joint, you may have to have a back-up plan and a back-up plan to the back-up plan,” he says.

Nicholls’ PhD in biochemistry included extensive study in the use of MRI. He continues to rely heavily on imaging in his orthopedic practice. He is a strong advocate for reading his patient’s MRIs himself in addition to simply reading the radiology report. “We use computers and cameras to make our surgeries smarter,” he says, this allows him to see the three dimensional fields and how joints and soft tissue align.

Addressing patient post-op expectation is part of the educational process that Nicholls embraces. He reminds patients that the replacement joint will not be as good as their God-given one. And joint replacement may relieve their pain, but may not allow them to do everything and anything they want to do. “Joint pain is sometimes your body’s way of telling you to do something different,” he says to his patients.

Doing the right surgery for the right problem is Nicholls’ mantra. “I frequently joke with my patients that I have plenty of surgeries that will make them worse off, but we are only going to find the one that will make them better. The more patients engage in the decision and post-op therapy process, the better they do.”

(Editor’s note: Dr. George Boucher, physiatrist joined KOHS in 2011. He specializes in the non-surgical treatment of bone, joint and muscle pain associated with fibromyalgia and was profiled in MD Update, March 2012.)

For patient referral, contact Kentucky Orthopaedic and Hand Surgeons at (859) 278 3481. Located at 1780 Nicholasville Rd, Suite 501, Building B, Lexington KY 40504