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MRI’s Explained – Open vs. Closed Operating Systems

Magnetic resonance imaging (MRI) didn’t start as the technology we now commonly know. Researchers Felix Bloch and Edward Purcell first discovered the magnetic resonance phenomena in 1946 and later harnessed the abilities of magnetic resonance to analyze chemicals, leading to their Nobel Prize in 1952. Later on, scientists discovered the same technique could be used to visualize different human tissues. By 1973, aided by the rapid technological progression of computers, researchers developed the MRI that we now use today. Then, in 2003, the MRI led to another Nobel Prize, this time awarded to researchers Paul Lauterbur and Peter Mansfield for developing MRI as a diagnostic tool.

What is an MRI?mri-2813912_1920

An MRI uses a strong magnetic field and directs the field at a specific area of the object or person of interest. As the magnetic field enters different tissues and fluids within the body, hydrogen atoms become excited similarly to how a smaller magnet becomes excited as a larger magnet inches closer. Depending on the tissue or fluid that the hydrogen atoms are in, the atoms return to a resting state at different rates as the magnetic field is turned on and off several times. This allows a computer to analyze the different rates and create an image that shows a contrast in the different tissues and fluids.

The process of turning a magnetic field on and off is repeated numerous times over each body part being imaged and is then completed in multiple planes of motion. Collecting images through each plane of motion allows a doctor the ability to see an injury, or lack thereof, from each viewpoint. Resultantly, a doctor would then be able to develop the most accurate diagnosis to create the most effective treatment protocol.

MRI’s differ from x-rays in that they are more effective at demonstrating abnormalities in tissue samples rather than bone samples. For example, a torn or degenerative meniscus may present a decreased joint space in the knee as apparent on x-ray, but an MRI would show the actual torn or missing tissue of the meniscus that causes the decreased joint space. Without the MRI the diagnosis would not be confirmed and an effective treatment protocol could not begin.

How does an MRI show an injury?Washington Orthopaedic Center open MRI

Trained health professionals can locate a severed or partially torn muscle, tendon (connects muscle to bone), or ligament (connects bone to bone) by comparing the shape of the tissue of interest to that of a normal, healthy tissue. For example, a torn anterior cruciate ligament (ACL) in the knee may appear frayed at one end if torn. The frayed image appears as fluid from the knee flows around the torn ACL to encompass the tissue and project different rates of hydrogen atoms returning to a resting state as explained above, leaving only the tissue to present a darker contrasting appearance.

Open vs. Closed MRI’s

There are two kinds of MRI systems, open and closed, which differ by just a few key points.

  • Comfort: As one might expect from the name, an open MRI offers a much more comfort. For someone who is injured, sick, or claustrophobic, an open MRI presents a greater amount of restfulness when compared to the cramped spacing of a closed MRI system. As a result, a patient who is able to remain calmer during MRI imaging often gets a better picture of the area of interest due to there being less movement during the process.  In addition, the open space allows imaging technicians to place patients into positions that improve the quality of images, something that can’t always be done in a closed MRI.
  • Imaging Power: On the other side, closed MRI’s have greater imaging power (1.5 Tesla in closed MRI compared to 0.3 Tesla in open). Larger imaging power can result in a clearer MRI image if scanning a deep tissue sample. However, in the case of orthopedics, an open MRI’s power of around 0.3 Tesla is sufficient to obtain clear images of bones, muscles, and ligaments.
  • Cost: A sometimes significant cost difference is found between open and closed MRI’s due to the larger magnets closed MRI’s. Less upkeep is needed to maintain an open MRI system and can result in a price decrease of 40-50% when compared to the cost of a closed system.

Washington Orthopaedic Center offers an on-site open MRI machine in Centralia to improve convenience and comfort. Our imaging technologists are even kind enough to play your music of choice during your MRI to improve your experience, as the process typically takes between 30 – 60 minutes. Washington Orthopaedic Center also contains an x-ray imaging center to accompany the MRI machine. For the greatest convenience, without the hassle of wandering through a hospital, turn to Washington Orthopaedic Center for your care.

By |November 20th, 2017|

Dr. Dujela Chapter on Evidence Based Bunion Surgery







IMG_3594 IMG_3595 IMG_3596 IMG_3597 IMG_3598

By |November 3rd, 2017|

Frozen shoulder: from freezing to thawing, a guide to repossessing your shoulder

If you’ve experienced shoulder pain, you know it can be one of the most debilitating forms of pain. A painful shoulder can make everyday tasks like picking up a cup to sleeping seem impossible. The dull toothache feeling of chronic inflammation in a shoulder is enough to make just about anyone go mad. Sometimes, as ongoing shoulder pain prevents someone from using his or her shoulder, the condition can turn into a disease called frozen shoulder.

  • WomenWoman with pain in her shoulder on light background. Frozen shoulder
  • Adults of 40-60 years of age
  • Those with diabetes
Frozen shoulder most often occurs in a 3-step process.*
  • Freezing (6 weeks– 9 months): This phase begins with progressing tightness in the shoulder capsule as the tendons that comprise the shoulder movers become more stiff, scar tissue forms, and the amount of synovial fluid(lubricant for your shoulder joint) decreases. The freezing stage is typically the most painful stage.
  • Frozen (4-6 months): The shoulder capsule is extremely tight making daily activities very difficult. However, the pain experienced in the “freezing” stage is less severe.
  • Thawing (6 months – 2 years): The stiffness and pain in the shoulder slowly recede as daily activities become easier to complete.

As you can tell, recovery from a frozen shoulder is no quick fix.

Treatment, as always, begins conservative and progresses from there if treatments prove ineffective. The first stage of treatment involves the use of anti-inflammatory medications and gentle range of motion exercises. If this doesn’t do the trick, your doctor may recommend formal physical therapy for an extended period of time, a cortisone injection, or possibly an injection of sterile water into the shoulder capsule to help stretch the area, a process called joint distension. Normally, these treatments, along with time, do the trick. In special situations, surgery may be the last and only option left. If this is the case, consider the amount of treatments and time you’ve spent rehabbing your shoulder. Obtaining a second opinion may be beneficial as well.

Washington Orthopaedic Center’s physicians have over 40 years of experience treating frozen shoulders with great success. If you’ve been facing debilitating shoulder pain and immobility for an extended period of time, an orthopedic consultation with one of our four providers who treat frozen shoulder may provide an answer to your mysterious shoulder condition. Allow us to provide the tools you need to thaw your shoulder by giving us a call at (360) 736-2889 to set up your first consultation.

*Timeline according to the American Academy of Orthopaedic Surgeons

By |October 31st, 2017|

Unmatched Expertise: Dr. Scott Slattery

Dr. Scott Slattery Orthopedic Surgeron

Dr. Scott Slattery

Perhaps you know Dr. Slattery. As a small town doctor, you’ve likely run into him at the grocery store, seen him at local high school, sporting events, or maybe even ran into him at school-related activities. Dr. Slattery and his family have lived in Lewis County since 1999 and while he may seem like your average guy when you see him around the community, he’s more than average when it comes to his professional career and achievements.

He began by attending Loma Linda School of Medicine in California. After completing his medical education in orthopedic surgery and sports medicine through Loma Linda, he moved on to work as a surgeon at Langley Air Force Base in Virginia. Yet, he did more than work as a surgeon while at the base, he also served as Chief of the Department of Orthopaedics and Podiatry at 1st Medical Group Hospital. His time here provided for him opportunities to treat rare and complicated injuries.

He has lived in Lewis County, with his family, since 1999

He quickly used his expertise to assist the local high schools and Centralia Community College during sporting events and volunteered to be an on-site doctor for local recreational events throughout Lewis and Thurston counties.  Along with being appointed to the Sports Medicine Faculty of Providence St. Peter Family Practice Program and guest lecturing at numerous seminars for health professionals, he was invited to be a member of the American Orthopaedic Society for Sports Medicine, a prestigious organization that recognizes the academic and practical practices of sports medicine doctors. Out of the 802 board-certified orthopedic surgeons in the State of Washington, Dr. Slattery is 1 of only 58 members elected to this organization.

His time here provided opportunities for him to treat rare and complicated injuries.

In addition, he became one of the first orthopedists in the nation to hold a subspecialty certificate in Sports Medicine from the American Board of Orthopedic Surgeons.  Today, he is still the only holder of this certificate between Lakewood and Longview.

Dr. Slattery US Ski Team Doctor2009 proved to be a busy year for Dr. Slattery. 

With years of experience under his belt, and having been a well-recognized sports medicine specialist, Dr. Slattery was admitted into to what may be his exciting accomplishment yet, as part of the Team Physician Pool for the U.S. Ski and Snowboarding Association. With this he volunteers his time and resources to work with Olympic level athletes year after year.  To maintain his status in the Physician Pool, he is required to attend classes and attend events as the Team Physician yearly. 

Dr. Slattery one of only 200 physicians nationwide with these credentials.   

In the same year, Dr. Slattery was also recognized on the national level by receiving the award for America’s Top Orthopedist.  An honor that highlights his experience, training, professional associations, and board certification.  Dr. Slattery was also recognized this year by Beckers Orthopedic Review as an “Orthopedic Surgeon to Know   

Undoubtedly, we are fortunate to have Dr. Slattery here at Washington Orthopedic Center.  He continues to bring a quality of service you would like only find in the most prestigious city hospitals to our small communities.  Maybe you haven’t found the right orthopedist for you or an answer to an orthopedic problem you’ve been trying to solve. Dr. Slattery, may have the expertise you require. Call Washington Orthopaedic Center at 360-736-2889 to schedule an orthopedic consultation with Dr. Slattery.

By |October 18th, 2017|

Washington Orthopaedic Center – Patient Reviews

General Reviews

– Everyone has been great. Every phone call email and visit has made me feel valued as a client. I’m not sure if I can explain it clearly. Each person I have encountered has shown this and has made sure all of my needs were met. Just simply amazing! Customer service must be a priority and a value!
– All staff were professional and friendly to both me and my family.
– I have received the best care
– I’m quite pleased with the progress!
– Great staff! washington orthopaedic center group doctor photo with dr mark morishige, dr keith birchard, dr scott slattery, dr keith anderson in front of centralia clinic
– The MA Kelsey Moorecraft did a wonderful job today first time I have had her at an appointment here.

Keith V Anderson M.D. Reviews

– Very good doctor
– Clearly Dr. Keith Anderson is the best orthopedic surgeon in and out of the operating room. Very respectful very thorough and is very honest and upfront about choices and procedures. He always tries the least invasive surgeries first. I’m very satisfied with my procedure. Thank you very much Dr. Anderson.
– I was very impressed with his positive attitude and the amount of time he took to patiently explain things to me and the time he took to show me the x-rays.
– I’ve been going to him off and on for several years. I am very comfortable talking to him and respect his opinion regarding my health. I’m always in good care with Dr Anderson and his staff.
– Excellent Experience
– I love everyone at WA ORTHO THIS PLACE IS GREAT
– My surgery went very well and I am very pleased with his staff and and Dr Anderson
– I think Dr. Anderson is great at listening (everything) to make it short !

Keith R Birchard M.D. Reviews

– I was happy with the whole procedure and with the results
– Truly a professional! Throughout my care dating back to June Dr. Birchard discussed all options clearly and included me in decisions. I have never felt so involved in my care. He has set the bar very high for all others.
– Thank you did excellent
– Got us in quickly

Michael D Dujela D.P.M. Reviews

– Dr. Dujela has performed both of my ankle fusions and I have been very happy with his care and humanity as a Dr. I would recommend him to anyone having issues with their feet and ankles
– “Very professional yet personable & caring. Realistic approach about care by offering several ways to handle it. He didn’t immediately jump to the “”let’s operate”” as the only remedy.”
he is the best specialist i have ever had i respect him totally
– Very personable professional great people skills
– “Just a “”Down to earth Doctor””! I feel he knows and has helped me out so many ways in the past. Dr. Dujela has kept me walking. I will forever be thankful for him. ”
– He has always done right by me and will always be my doctor.
– Dr. Dujela is a very compassionate person i feel he really cares about me as a patient. I would recommend him to anyone that needs to be scene!
– Care was excellent. Could have used more precise written instructions with post-op visits regarding what I should/should not do to hasten recovery from surgery. Although I was aware that he was behind in his schedule I felt like I received his undivided attention and concern.

Mark Morishige M.D. Reviews

– Excellent Doctor. Very knowledgeable and explains things in a way I can understand.
– This was my first exam/treatment by this new doctor. I was extremely happy with the care & treatment that he provided. I will consider him worthy of high recommendation and will certainly see him in the future for any joint issues. His bedside manner & his communication skills rank up at the very top of the scale for me. Very pleased!!
– Dr. Morishige explained my condition in an easy to understand way so I knew what was wrong with my shoulder.
– Dr. Morishige was not only nice he explained (and gave me great news!) exactly what the issue was and the next steps needed. I felt well taken care of and would definitely recommend him and this practice to anyone in need. Thank you!
– He was great & listen to me. Great doc. Not many listen to patients anymore.
– Very appreciative
– Very professional and knowledgeable conveyed that to this patient

Scott S Slattery M.D. Reviews

– Dr Slattery took the time to explain exactly what my options were what the surgery would be and what I could expect both long and short term. He also did an excellent job with the surgery. The staff at WA Orthopedics are always friendly and bend over backwards to be helpful. I will highly recommend both Dr Slattery and WA Orthopedics!
– Was a happy place to go.
– Specifically I appreciated the way he continued to work through the issue with my knee and didn’t stop at the first blush. By doing this he uncovered what the initial X-rays and MRI didn’t uncover. Very grateful again for the efforts of WOC!
– Excellent all around!
– Looking forward to being fixed and total recovery from my torn rotator cuffs.

By |October 11th, 2017|

Cortisone: A Quick Relief Guide to Orthopedic’s Most Common Injection

Levi Bale Intern

Article by Levi Bale

I injured my hip entering my sophomore year of high school. I was a top ranked discus thrower and although I managed to get off one great throw during an early in the season meet, my distances quickly diminished after reinjuring my hip in practice. Running became difficult, and soon enough, I was hardly able to train due to the discomfort in my hip. My primary care physician referred me to Dr. Slattery at Washington Orthopedic Center, and after exploring different options Dr. Slattery and I decided to move ahead with a cortisone injection. Now I won’t say the injection was a miracle worker; I didn’t make state that year in discus nor did my pain vanish. However, the cortisone did give my body the advantage it needed to overcome the chronic inflammation in my hip and make a return to full sport participation in the following years. That’s what cortisone does; it provides a kick-start of sorts to prevent an overactive recovery system.

To understand what a cortisone injection does, you first need to understand inflammation.

Perhaps the most popular term in health sciences right now, inflammation in the product of damage done to your body’s tissues. Every injury results in inflammation. Exercise causes inflammation. Even eating food triggers inflammation. Typically inflammation is a good thing. It results in increased blood flow to an area to stimulate recovery by providing essential nutrients and by bringing white blood cells, cells that fight off foreign invaders and clean up waste products, to the injured site. Over time, the waste products are disposed of naturally by your body and the blood flow returns to normal. Yet, as in the case of my hip, sometimes the body’s inflammations response is too efficient, which may result in chronic inflammation that produces the discomfort felt a day after an event like an ankle sprain, but over the long term.

This is where a cortisone shot jumps into action. A cortisone shot typically contains a corticosteroid, a strong anti-inflammatory, and a local anesthetic to be administered directly to the area of interest. The injured area may feel immediately improved thanks to the effects of the local anesthetic, but may be more painful after the anesthetic effects wear off since the body reacts to a needle entering the tissue. Yet, after 3-4 days, you may begin feeling the beneficial effects of the corticosteroid, which leads to less inflammation and pain. Cortisone shots are administered at most four times per year, however, many orthopedists prefer to use the shot less frequently. Here are the advantages and disadvantages of cortisone shots:

Advantages:cortisone injection syringe
• Fast and strong reaction to inflammation
• Easy to administer
• Cheaper than alternatives like synthetic joint injections or surgical procedures
• High success rate
• Minimal side effects

• Possible shrinkage and/or lightening of skin at the injection site
• Post injection soreness at the injection site
• Elevated blood sugar for those with diabetes
• Possible, but very unlikely, avascular necrosis (dying blood vessels), acne, or osteoporosis

Cortisone shots may benefit people of nearly any age or activity level given the right circumstances. The shot is one of the most rapid and dependable ways to overcome long acting pain and inflammation, and can be as easy as a quick visit to your doctor. Specifically, an orthopedist, with their specialized knowledge of anatomy and prior experience using these shots on a regular basis, can provide the best opportunity for success.

Do you think you need a cortisone shot in Centralia or Olympia? Luckily, Washington Orthopedic Center has you covered. With five doctors and four physician assistants on staff, we have the experience and availability to meet your specific health needs. Call us today at 360-736-2889 to schedule an appointment with one of our providers and learn more about how a cortisone shot may improve your long-term discomfort.

By |September 26th, 2017|

What You Need to Know About ACL Tear & Repair

basket ball player jumping about to landFor athletes and “wanna-be” athletes alike, an anterior cruciate ligament (ACL) tear is one of the most feared injuries one can sustain. More common in females than males, and commonly seen in sports requiring quick changes of direction, the ACL is typically torn as an athlete plants their foot on the ground with an extended leg and rotates internally. Accidents involving falling from some height with an extended knee can also results in an ACL tear. The initial injury may be accompanied by a “snap” or “pop,” but often doesn’t keep an athlete from walking off the field under their own weight. In fact, some people may go an extended period of time, months to years, with lingering knee pain only to find out they actually tore their ACL long ago. Unlike other areas of the body that have self-repairing tissue, an ACL tear will not repair itself. Thus, the only corrective treatment for a torn ACL is found through surgery.

While the only real fix for an ACL tear lies within surgery, chances are you will get three different answers from three different orthopedic surgeons if you ask each of them how they repair an ACL. From the angles that surgeons drill, to the tissue that is used to replace the ACL, this is a heavily debated topic for those in the field. Here is some information on the different types of ACL repairs that are done.

The Tissue:

As you learned earlier, an ACL tear does not fix itself. Instead, the tissue is replaced with new tissue in the form of an allograft or an autograft, which calls for slightly different operative procedures.

  • Allografts are tissue samples taken from cadavers that are fitted specifically for the size of the injured knee. Since the graft is harvested for specific size, it is more expensive than an autograft. In addition, the graft may take a greater amount of time to adapt to one’s knee and may have an immune response. However, an allograft allows for a faster surgery since the graft is ready prior to the procedure and doesn’t require taking tissue from other areas of one’s body as an autograft does.
  • Autografts are tissue samples taken from other areas of an individual’s body. Since this procedure requires additional work to harvest tissue, the procedure does take longer than using an allograft, but the tissue often adapts more easily to one’s knee. There is more healing that needs to be done from this procedure, but in an athletic population, the results of a healed product are typically better than when an allograft is used. These are the most common areas used to create the autograft.
    • Hamstring (semitendinosus or gracilis) – Using the hamstring to create an autograft often leads to the least painful and quickest recovery to activities of daily living. Also, the incision used to harvest the tissue is the same incision used during the actual ACL repair. On the downside, taking tissue from the hamstring, a major muscle in any sport competition, requires more time immobilized at the hamstring to allow it to heal completely, which also increases the time it takes to reach sport participation with full power capabilities.
    • Patellar Tendon – This tendon is often referred to as the strongest option for ACL replacement. Additionally, harvesting from the patellar tendon increases the recovery speed and return to sport with full power capabilities. On the other hand, the initial rehabilitation from this graft is more painful than other options, may results in patellar tendonitis, and requires an extra incision site when compared to the hamstring graft.

Did you tear your ACL, or has someone you know torn his or her ACL? Know that there are several options available for treatment. Consider your lifestyle and the goals you have for yourself moving forward before committing to any method of operative treatment. Washington Orthopaedic Center has several surgeons that routinely complete ACL repair procedures near Olympia. Give us a call at 360-736-2889 to set up a consultation with one of our providers today.

Article by Levi Bale

By |September 22nd, 2017|

Life Can Be A Pain In The… Foot?

A guide to fixing the base of your big toe: 1st MTP arthrodesis

Life can be a pain in the foot, and trust me, you’ll quickly realize how much a painful foot can control your life once it really starts hurting. For some, myself included, it’s flat feet that lead to a host of complications, while for others the pain started when a weight was dropped on their foot. A common issue is found at the base of your big toe, officially called the first metatarsal-phalangeal joint.

Whether the pain at the 1st MTP joint is caused by a foot deformity, chronically wearing bad footwear, or from an acute injury, the pain can be significantly detrimental to one’s quality of life due to the natural push off from the big toe during activities like walking and running

What causes the pain?

Runner holding foot from MTP toe pain

No matter the origin of the pain, acute or gradual, the eventual chronic pain is caused by the wearing down of cartilage between the two bones that form the MTP joint. The lack of cartilage leads to inflammation in the joint, osteophytes (small bones fragments) that grind inside the joint, and the development of arthritis in and around the joint, which limits the 1st MTP’s range of motion and increases pain. The nature of the issue is typically progressive, meaning the longer the problem lingers the greater the formation of arthritis will be and the greater the pain will become.

Progression of treatment:

Conservative (non-operative) – Conservative treatments include employing stiff-soled shoes, sometimes accompanied by a Morton’s extension custom orthotic, to decrease the amount of movement required by the 1st MTP joint during activity without affecting normal gait, corticosteroids, and NSAID’s. Although these methods may limit the discomfort for a period of time, the injury will often progress to the point of needing to take more invasive action.

Operative Treatment – Luckily, operative treatment is very successful in managing 1st MTP pain and stiffness. The first line of defense comes in the form of a cheilectomy, which is the removal of bony spurs from bone that decrease a joint’s function and causes discomfort. Recovery from a cheilectomy is typically quick; often progressing to normal shoe after sutures are removed 10-14 days postoperative. The next treatment, in select cases, would be an emerging technology called Cartiva, a synthetic cartilage implant that replaces the worn out cartilage in the MTP joint. Cartiva may be a great option for more active individuals, as it allows weight bearing as tolerated immediately after surgery. The final line of defense, a 1st MTP arthrodesis, removes the joint surfaces and screws the two bones together to create a joint fusion, sometimes aided by an additional plate placed on top of the joint. Furthermore, bone graft can be placed on the joint surfaces to aid in the creation of new bone to fuse the joint even more.

Dr. Dujela performing surgeryDr. Dujela, our foot and ankle expert at Washington Orthopaedic Center, who also serves as national chairman for the Education and Scientific Affairs Committee for the American College of Foot and Ankle Surgeons, is a frequent international lecturer of the techniques above and teaches the procedures to surgeons around the globe. In addition, Dr. Dujela is currently writing a textbook chapter on the very topic of MTP treatment. Choosing to walk and move comfortably is a lifestyle choice for someone with pain at the base of his or her big toe. Get your foot checked out by Dr. Dujela, the doctor you want whether or not your toe pain requires surgical foot treatment.

Call Washington Orthopaedic Center at 360-736-2889
to schedule an orthopedic appointment at your convenience.

By Levi Bale

By |September 12th, 2017|

Have a Chronically Dislocating Kneecap? We Can Fix That!

Anyone can dislocate his or her kneecap, or patella, given enough torque. Young, old, muscle bound, or lean, it doesn’t matter much. The real difference maker is your anatomy. If you, or someone you know, have a chronically shifting patella, know that there is a safe and secure way to fix your knee and that Washington Orthopaedic Center has providers with years of experience doing just that.

knee joint image with tendons The knee joint primarily consists of three bones, the femur, tibia, and the patella. The fibula is more or less along for the ride here. The femur has two large condyles on either side of the knee, which is what you feel when you palpate the sides of your knees, and in between the condyles lies a groove called a trochlea. Naturally, the patella glides in the trochlea as the knee flexes and extends, fixed in the middle by the two opposing condyles. This is where things get interesting. With enough internal rotation under pressure with a knee flexed between 20 and 40 degrees, the patella can slip out of the trochlea.

For the most part, anyone with average knee anatomy won’t ever experience his or her patella shifting outside normal position. However, people exhibiting abnormal anatomy are at a greater chance of either dislocation, a complete shift of the patella often due to a tear in the medial patella-femoral ligament (MPFL), or a subluxation, partial dislocation of the patella due to a loose or partially torn MPFL.

If you find yourself with a dislocated knee, you’ll have it reduced by an emergency response team. Afterward, it’s not a bad idea to have it checked it checked out by an orthopedist in case there was more damage to your knee during the dislocation. Normally, however, nonoperative treatment like a light brace or physical therapy is recommended after only one dislocation. It’s a different story for a chronically dislocating knee. Multiple dislocations is typically a clear sign that there is abnormal anatomy or a torn MPFL, the ligament that holds your patella to the medial side of the femur, that is causing the patella to shift unnaturally. When this occurs, an orthopedist will take a look at your x-rays to assess for abnormal alignment and anatomy, physically test your knee for instability, and then recommend surgical intervention if the signs and symptoms are positive for chronic patellofemoral instability.

MPFL Surgery and Recovery:arthroscopic knee surgery by orthopedic doctors

Washington Orthopaedic Center has several providers who are well practiced in the reconstruction of the MPFL. MPFL surgery is arthroscopic, meaning the repair is done inside the knee without opening the leg up and lasts around one hour. After surgery, you are sent home, and you are walking, with a brace to stabilize your lateral motions, that same day without any restriction on your knee’s range of motion. After roughly four weeks, the brace is off, and light weight-bearing activities can be resumed with caution. For athletes, running is continued at around 10 weeks, and full return to sport takes place around four months.

Washington Orthopaedic Center has the world-class providers and assistants you need to succeed after a reoccurring injury such as a chronically dislocating patella. Dr. Slattery, a board certified sports medicine specialist, and Dr. Morishige, a fellowship trained sports medicine specialist, have specific training in this procedure and deliver a quality of medical expertise that we are blessed to have in our small community. Schedule an appointment to have your knee evaluated by one of our providers today by calling us at 1-360-736-2889.

-Article by Levi Bale

By |September 5th, 2017|

The Surgical Scheduling Process Demystified

Prior to working in a surgical setting, I always thought that once it is decided to have orthopedic surgery, you would be put on the next available surgery spot with your Surgeon, and that was that. Now I know it is not that simple. Nothing is ever that simple; there is a rather extensive process to even be on the surgery schedule. 

When I first started learning about this process, it seemed overwhelming to me. However, after a few deep breaths and getting to know the awesome staff at Washington Orthopaedic Center, I now know that the process is very manageable.  And just like me, you will have the wonderful staff at WOC to help guide you on your journey to wellness.

Senior woman with her hands on a painful knee while sitting on examination tableThe first step on this wellness journey is obviously coming to WOC with an orthopedic issue.

You will first be scheduled with a provider to assess any injuries and issues that can be treated by one of our orthopedic specialists.  In the clinic, the provider will look into non-surgical options first and work with you, the patient, to see what works best for your lifestyle. We always strive to do the least invasive option whenever possible for our patients. Once it is decided that the best possible option is surgery the process begins.

Every patient has a different journey, but they all follow the same general surgical path.  We always start with a review of insurance and the urgency of the procedure. If the procedure is deemed urgent by the surgeon or if you are double covered or have Medicaid or Worker’s Comp insurance, you will proceed directly to our ASC surgery scheduling department.

If you do not fall into either one of the categories listed above, you will proceed to our financial services representative, Traci.  She then contacts your insurance to review your benefits.  This process provides her with the amount of your co-insurance and any outstanding deductible amount.  Once you have reviewed your insurance benefits and amount responsible with Traci, our Surgery Scheduler will begin the insurance authorization process for your surgical procedure at our ASC.

Either Janet or Michele, our surgery schedulers, will also contact you and review a quick series of health history questions. Some questions you would be asked are, do you have a history of diabetes, or high blood pressure, or use diuretics. Based on your medical history and the procedure that you are having, then determines if you are one of the lucky individuals who will be meeting with one of our RN’s in the house for a preoperative teaching or if we are able to complete the teaching via telephone. 

The teaching takes place in the comfort of our education room at the surgery center. You will meet with one of our highly qualified RN’s and be asked additional health history questions, what medications you take, if you have any allergies, and past surgical history to name a few. Some patients may need to have certain lab draws or an EKG at this teaching as well.  An EKG is a simple noninvasive test that looks at the electrical activity in the heart. If there is an abnormal result, the test results are reviewed by our anesthesiologist.  After the questions are all finished, and tests were done, we review with the patient what to except for the upcoming surgery. You are encouraged to ask whatever questions you may have or review anything that may need to be clarified.  We want you to be as ready and prepared for the procedure as possible, therefore if you have any questions, no matter how irrelevant you might think it is, please be sure to ask.

Dr. Dujela performing surgery

We will discuss this with you during your teaching, but please note that for the safety of our patients, you must have someone to drive you home after surgery because of the anesthetic used during surgery.  To help our patients on their journey to recovery, we ask that they also have someone stay with them for at least the first twenty-four hours, and sometimes longer after the procedure.

I know this may seem a bit overwhelming at first, it definitely was for me, but the dedicated staff at WOC is here the entire way to make this journey as easy as possible for you to navigate through the 8 step program.   

Step 1: Make an appointment with a WOC provider.

Step 2: If surgery is the best treatment option, you may be directed to Traci.

Step 3: Traci contacts your insurance and reviews everything with you.

Step 4: Janet or Michele will start the authorization process.

Step 5: Janet or Michele will contact you to review your medical history and get you on the schedule.

Step 6: You will have your pre-operative teaching, either in person or on the phone.

Step 7: You will be contacted the business day prior to notifying you of what time to arrive at the ASC.

Step 8: Day of surgery!! Remember, no eating or drinking anything after midnight.

Now it’s time to start the process, be sure to give us a call and make an appointment with an orthopedic surgeon today at 360-736-2889 to get started on your journey to wellness!

-By Josie Dekoker