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Game-Changing Orthopedic and Sports Health Care

Norton Healthcare program aims for exceptional holistic care

LOUISVILLE A new care approach is emerging in sports medicine and Ryan J. Krupp, MD, is happy to see it reflect game-changing elements of orthopedic care. Krupp is an orthopedic surgeon with Norton Orthopedic Institute, as well as executive medical director of Orthopedics and Sports Health and Shoulder Reconstruction for Norton Healthcare.

“The focus is shifting from traditional injury treatment to the overall health and well-being of athletes,” says Krupp. “This holistic approach recognizes athletes are complex individuals who require comprehensive care.”

Krupp explains that across multiple targeted programs and services, Norton Healthcare works to deliver first-rate orthopedic and related care that goes beyond sports alone. It is about meeting the overall care needs of patients who may run the gamut from weekend warriors to Silver Sneakers members, to high level athletes.

“This is for anybody. The level someone operates at doesn’t matter,” he says. “Our goal is to treat every person as an individual, and help every patient maintain their best level of health and optimal performance.”

Comprehensive, Innovative Care

Within the broad areas of orthopedics and sports health, various Norton Healthcare departments and teams strive to deliver exceptional care across various parameters.

Patients range in age from adolescence to their 90s, which makes for a diverse range of clinical presentations. Conditions that Krupp and the rest of the shoulder team treats run the gamut from shoulder instability or dislocations in younger patients to proximal humerus fractures among older patients. The practice’s arthroscopic work involves many rotator cuff and labral repairs along with a variety of other interventions.

The team, which also includes Justin Givens, MD, Joshua J. Christensen, MD, Nyagon G. Duany, MD, and Chad E. Smith, MD, treats “teens and tweens,” but their care sometimes calls for coordination with other departments and care teams. For example, a case involving a 12-year-old might ultimately be referred to a pediatric orthopedic surgeon. Conversely, one of his pediatric orthopedic colleagues might refer a 16-year-old with an extensive labral tear. “There’s a lot of care overlap, and we work together to provide the best care and outcomes possible for every patient,” says Krupp.

Early Love of Sports Sparks “Fixer’s” Medical Career

Ryan J. Krupp, MD, Nyagon G. Duany, MD, and Justin Givens, MD, are three members of the shoulder surgery team at Norton Orthopedic Institute

In his leadership role within the shoulder surgery realm, one key thing Krupp likes about his work is helping people enjoy their lives and get the most from their experiences at any age. He says, “Keeping people mobile and active really resonates with me.”

A look at Krupp’s background leaves little doubt as to what drew him to orthopedic and sports medicine. He is proud to come from a “working class” family and enjoyed playing multiple sports in high school.

In high school, he suffered an open tibia fracture while playing basketball. He was impressed by the surgical procedures that he underwent, including placement of an intramedullary nail. Undergoing surgery and the follow up physical therapy and rehab struck him as important work that helps athletes and others recover from serious injuries.

Interacting with surgeons, physical therapists, and other caregivers resonated with the young patient who saw himself as “a fixer.” The physician-in-the making had always liked analyzing things, finding answers, and developing action plans.

“Orthopedics really appeals to me and my personality,” he says. “I’ve always liked being able to define problems and find solutions for them.”

Krupp and his brother were the first members of their extended family to attend college. Krupp briefly participated in the football program at the University of Dayton. He loved the experience but was attending the Ohio school on an academic scholarship and decided his chemical engineering and pre-med courses had to come first. He holds a degree in chemical engineering but knew early in his education and work journeys that sports and medicine were in his blood. “It’s something I’ll always enjoy,” he says.

The love of sports is a Krupp family trait. Both his son and daughter are competitive athletes. “It’s a lot of fun that we enjoy together as a family,” says Krupp, who sees his personal experience with athletics as an advantage in his work. It helps him understand the impact of training or muscle overuse. It allows him to relate with patients, sometimes including their parents, and treat them more effectively.

After college, Krupp worked briefly as a chemical engineer and in pharmaceutical sales before starting medical school at the University of Louisville. He completed an orthopedics residency at UofL followed by a sports medicine and shoulder reconstruction fellowship at the Steadman Hawkins Clinic of the Carolinas. Krupp joined Norton Orthopedics in 2008.

Aside from providing direct patient care, Krupp plays a key role in the business side of his practice. He also carves out time for clinical research. Research is critically important to the ever-changing treatment of orthopedic injuries — something in which the team, and Krupp especially, is involved.

“I’m involved with companies developing the next generation of implants and procedures we use for surgery,” he says. “I even do some work on projects looking at robotics, artificial intelligence and those types of things.”

Through his practice, Krupp sees a wide spectrum of shoulder issues among patients from their teens to their golden years. Among different age groups common problems can range from instability to dislocations to proximal humerus fractures.

Krupp does a significant amount of arthroscopic work, plus open surgeries as needed for rotator cuff or labral repairs. He also performs many total and reverse shoulder replacements as well as a variety of additional arthroscopic and open surgeries, which can include proximal humerus fractures, clavicle fractures, acromioclavicular joint separations, and various other instability operations.

“We’re really a tertiary referral center, so we get a lot of difficult cases sent in from outside,” says Krupp.

Despite a busy practice schedule, Krupp and his colleagues provide coverage for community programs and events. Over the past 15 years they have covered everything from high school and college sports to Iron Man competitions.

Team’s Newest Member Specializes in Advanced Shoulder, Elbow Care

Justin Givens, MD, is excited to join Norton Healthcare’s Orthopedic Institute. As the team’s newest member, he welcomes opportunities to provide patients with advanced, innovative shoulder and elbow care.

Givens grew up in southcentral Kentucky and graduated from Lindsey Wilson College with a surgical residency at the University of Louisville. He completed a shoulder and elbow fellowship at the Florida Orthopedic Institute, and recently completed a special sports fellowship that involved extra training.

Chad E. Smith, MD, and Joshua J. Christensen, MD, are also members of the shoulder surgery team at Norton Orthopedic Institute.

He expects to treat many young patients for shoulder problems or dislocations related to trauma, sports injuries or overuse. Givens is one of only a few specialists in Kentucky able to perform pyrocarbon hemiarthroplasty, an innovative partial humeral replacement technique for those with intact rotator cuffs.

The FDA only recently approved this procedure for use in the US. Its use in Europe has shown promising results that help patients avoid full shoulder replacement and stay active with fewer restrictions on what they can lift.

Among his cohort of older patients, Givens treats injuries related to rotator cuff tears or arthritis. He sees hardworking people who have endured years of pain because they were told nothing could be done for them. “I’m not saying we have an answer for every problem, but we have a lot of options in our toolbox,” he says.

For example, Givens cites allograft reconstruction as an innovative procedure that can allow replacements in the setting of severe bone loss and deformity when there were previously no answers for this issue.

Muscle transfers, another relatively new development, are proving to be game-changers for treating shoulder pain and loss of function. The procedure involves moving a working muscle or tendon to replace one that is non-functioning. Most of the muscle transfers the Norton Orthopedic Institute team performs involve rerouting part of a patient’s trapezius muscle to function in a new way.

Platelet-rich plasma injections are another useful tool to help patients suffering from “borderline injuries.” For instance, a patient might have a partial cuff tear or a painful shoulder that does not call for full reconstructive surgery. PRP injections are a non-operative option that can help relieve pain and stimulate healing.

Subscapularis-sparing surgery is another innovative procedure Norton Orthopedic Institute experts can offer candidates for shoulder replacement. It allows surgical reconstruction of the shoulder while leaving the muscles of the rotator cuff intact. Givens is well versed in this procedure, which typically involves a shorter healing time than traditional shoulder replacement techniques.

“Our experience doing subcap-sparing surgery makes us one of only a few places in the country doing this procedure,” says Givens. “It allows the patient to be out of a sling in a couple of days instead of spending weeks in a sling waiting for your rotator cuff to heal.”

Striving for Exceptional Individualized Care

Emerging technologies continue to play a crucial role in the impressive work Krupp, Givens, and the rest of the team does to provide patients with their best possible outcomes. Both physicians see the value of having a wide portfolio of options available to meet their patients’ individual care needs.

“You might say we’re always looking for a better mouse trap,” Krupp says with a laugh.

Both Krupp and Givens agree this is an exciting time to look at different ways to add technology like robotics or artificial intelligence to their work. They continue to see great promise in today’s emerging technologies and better processes like the improved longevity of today’s shoulder replacements. Due to improved coatings and other advances, modern-day implants may be able to last well beyond 15 to 20 years. They also promote stronger bone-growth bonds.

“Our aim is always to provide the best individualized care we can to every patient,” says Krupp. “We strive to treat every patient the way we want our own families to be treated.”

Ultimately, the doctors and their teams work from the concept that exceptional care is built on meeting each patient’s unique needs using the right individualized approaches, resources, and tools. It is important, Krupp points out, to avoid the well-known adage that warns if the only tool you have is a hammer it is tempting to treat everything as if it were a nail.