Whether you’re a high school quarterback, retired golfer, or just feeling the wear and tear of age—if you have pain, you want to see the orthopaedic or sports medicine specialists at JCMG. Orthopaedics & Sports Medicine focuses on injuries and diseases of the musculoskeletal system, including joints, bones, tendons, muscles, ligaments, and nerves.

Featuring physicians who trained at multiple institutions currently ranked in the top 10 nationally by US News and World Report, JCMG Orthopaedics & Sports Medicine specializes in sports injury treatment, joint replacement surgery, fracture care, hand surgery, and minimally invasive surgical options.

Our team works to preserve and restore musculoskeletal system structures that have been affected by age, traumatic injury, and athletic activity. Conditions treated include arthritis, fractures, sports injuries, and carpal tunnel syndrome. Treatment may include medical and surgical options.

We provide advanced approaches to joint replacement surgery (including outpatient joint replacement surgery), arthroscopic surgery, and hand surgery, as well as offer an array of regenerative sports medicine and stem cell therapies. Our goal is to treat pain and restore quality of life for our patients.

Common Procedures Performed Include:

• Shoulder (including shoulder instability surgery, rotator cuff repair, meniscal surgery, and ligament reconstruction)
• Knee Arthroscopy
• Hip Arthroscopy
• Cartilage Preservation and Restoration Procedures
• Total Joint Replacement
  • Reverse and Anatomic Shoulder Replacement
  • Knee Replacement
  • Hip Replacement (Anterior Approach)
• Tommy John Surgery (UCL Reconstruction)
• Orthopaedic Trauma Surgeries (Fracture Care Procedures)
• Minimally Invasive Procedures for Complex Sports Injuries (knee, shoulder, hip)
• Carpal and Cubital Tunnel Surgery

UNDERSTANDING SPINE SURGERY

Spinal Fusion

Spinal Fusion is a surgical procedure used to correct problems with the bones of the spine (or vertebrae). A fusion essentially “welds” or joins two or more vertebrae of your spine together.
During the procedure, your surgeon may place bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws, and rods may be used to hold the vertebrae together, helping them to heal into one solid unit. Most surgeries can range from 2-8 hours depending on how many levels of your spine are involved.

Spinal fusions are done for various reasons, but are most commonly done to treat:

• Spinal stenosis (narrowing of the spinal canal) causing pain
• Abnormal curvatures of the spine
• Weak or unstable spine
• Injury or fracture to the spine

Types of Fusions

Anterior Cervical Discectomy and Fusion (ACDF)

Your surgeon will remove a herniated or degenerative disc in the neck area of the spine. The incision is made in the front (anterior) of the spine through the throat area. After the disc is removed, a bone graft is inserted to fuse together the bones above and below the disc space.

Lumbar Interbody Fusion

Your surgeon will first remove an intervertebral disc (disc between two connecting vertebrae) of the spine, and in that space, an implant (such as a spacer or cage) is inserted to help maintain normal alignment of the spine. Additionally, a bone graft (real pieces of bone used to stimulate bone growth) or a bone graft substitute (natural or synthetic) will be placed in the space made between neighboring vertebrae to help them fuse together. Your surgeon will choose the best way in which to access your lumbar spine:

Posterior Spinal Fusion (PSF)

Your surgeon makes an incision in the middle of your back (posterior). The spinal surgeon will protect the nerve roots and safely remove the material (bone spur, cysts, etc) pressing on the nerve. After the pressure is relieved from the nerve, a bone graft is placed along the back of the spine, allowing the two vertebrae to grow together as one solid unit (fusion).

Other Spine Surgeries

Laminectomy

Also known as decompression surgery, a laminectomy involves removing the lamina, the back part (or “roof”) of the vertebra that covers your spinal canal. By removing the lamina, the procedure increases the space for your spinal canal and relieves pressure on the spinal cord and/ or nerves. While a Laminectomy is the complete removal of the lamina, a Laminotomy involves only partial removal.

Discectomy

Surgical removal of herniated disc material that presses on a nerve root or spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by pressing on the spinal cord or surrounding nerves.

Foraminotomy

An operation used to relieve pressure on nerves that are being compressed by the intervertebral foramina (the passageway between two vertebrae through which nerve bundles exit from the spinal cord to the body).

Corpectomy

A surgical procedure that involves removing all or part of the vertebral body (the large, front part of the vertebrae), usually as a way to decompress the spinal cord and nerves. A corpectomy is often performed in association with some form of decompression.

Osteotomy

A surgical procedure in which a portion of the spinal bone is cut and removed. Spinal osteotomies are usually needed for the correction of rigid deformities or scoliosis (abnormal curving of the spine), where bone is cut, the spine is realigned, and then hardware is used to keep the spine in proper alignment.

Thank you for trusting Dr. Worley and JCMG Orthopaedics with your spine surgery.

If you have any questions about your upcoming spine surgery, please don’t hesitate to contact us:

Office: (573) 635-8000
Fax: (573) 556-1710
Patient Portal*: You may send a message to Sabrina Shoop (Dr. Worley’s RN)

* We highly encourage using the patient portal to better assist you. If you don’t have access please call our office for set up. In order for us to better assist you please do not leave numerous voice messages or portal messages as this only delays overall response time.

Pre-Operative Spine Surgery Instructions

Visit this page for a breakdown of information you should know prior to your spine surgery:
jcmg.org/spine-surgery-pre-operative-instructions/

Post-Operative Spine Surgery Instructions

Visit this page for a breakdown of information you should know about post-operative care and what you should know for after your spine surgery:
jcmg.org/spine-surgery-post-operative-instructions/

TOTAL JOINT REPLACEMENT

While preparing for total joint replacement surgery at the JCMG Surgery Center, there are a few things to keep in mind. Please read over this information carefully, as following all of these instructions is crucial for a safe and rapid recovery from surgery.

Preparations at Home

In preparation for your surgery, there are a few things you can do to get your home ready.

• Make sure that there are no loose throw rugs or cords on the ground that you could potentially trip over.
• If you have a very low toilet seat, you may want to consider getting an attachable elevated toilet seat to make getting up and down from the commode easier.
• If you have concerns about being able to stand in the shower immediately after surgery, you may want to rent or purchase a shower chair.
• While you will be able to put all of your weight on your leg after your surgery, you will need to use a walker for balance. If you do not already have one, please contact us and we will be happy to provide one for you.
• We recommend icing the area regularly after surgery. Ziploc bags of ice or frozen vegetables work just fine, but if you would prefer, you can purchase a polar care or ice chest machine either online or from our office.

Therapy Before and After Surgery

Physical therapy is extremely important in your recovery. We are going to have you do one or two sessions of physical therapy prior to your surgery where the therapist will instruct you on how to appropriately use the walker and give you some home exercises to work on. The therapist can also work with you on how to appropriately do stairs after surgery.

After the surgery, a physical therapist will come to your home within 48 hours to start working with you on your postoperative rehab. They will typically come to the house 3 to 4 times over the first couple of weeks, and then you should be ready to progress to outpatient physical therapy. Most patients will do physical therapy a couple of times a week for 6 to 12 weeks after their surgery.

It is important to do the home exercises and physical therapy after the surgery to avoid scar tissue and stiff joints.

Medical Clearance from Family Physician and Dentist

Prior to surgery, we would ask that you obtain medical clearance from your family physician and/or cardiologist. It is helpful to have them evaluate you and make sure that you are healthy and safe enough to have the procedure.

We also ask that if you have not seen the dentist in the last 6 to 12 months, that you see a dentist and have them check to make sure you don’t have any evidence of dental infection that could potentially cause an infection in the surgical site.

Ask your doctor, cardiologist, and/or dentist to send letters of clearance to our office.

Driving and Working After Surgery

After the surgery, we ask that you not drive until you are off of any narcotic pain medicine. If it is your right knee or hip that is replaced, you will need to have normal control of the leg and good reflexes before returning to driving.

We don’t have a set day that you have to return to work. On average, most people will take off of work approximately one month. You may ease back into activities as you feel safe and comfortable.

Labs and Anesthesia Before Surgery

Approximately two to three weeks prior to your surgery, we will have you do some lab work. You will also be given an appointment to meet with our anesthesiologist prior to your surgery. They will evaluate you and go over the anesthesia protocol with you. You will have a nerve block preoperatively which will help with your pain afterwards. Almost always, the surgery will be done under a spinal anesthetic.

Expectations Post-Surgery

While the joint replacement does immediately get rid of the arthritis, it is normal to have some swelling and pain afterwards.

Your pain should be well controlled with the oral medication that we will prescribe you. We will send in your prescriptions to the pharmacy of your choice the week before your surgery.

The surgery should eliminate the arthritic pain, but it will not make you 18 years old again. It is still possible to have inflammation in the soft tissue and still have occasional pain from other sources like tendinitis or bursitis.

Most studies show that approximately 80 to 85% of patients are satisfied with their joint replacement; however, JCMG Surgery Center feedback reports our outcomes are over 95% favorable. It is important to us that you feel safe and comfortable throughout this process.

CALL US AT (573) 635-800 WITH QUESTIONS

TOTAL HIP REPLACEMENT

JCMG Orthopaedics & Sports Medicine offers total hip replacement surgery, performed in an outpatient setting at the JCMG Surgery Center.

In the video below, Dr. Jonathan Craighead, an orthopaedic surgeon with Jefferson City Medical Group, covers all you need to know about getting a hip replacement surgery performed at the JCMG Surgery Center.

Why might you need a hip replacement surgery?

The most common reason to have hip replacement surgery is poorly controlled hip pain caused by arthritis. Arthritis is the medical term for damage to the cartilage of the joint. Cartilage is tissue that provides the cushion between the bone.

In a healthy hip, the ball and socket moves smoothly. In an arthritic hip, the joint space between the ball and socket is gone, with deformed bone-on-bone contact. Hip replacement surgery removes the bone-on-bone connection, replacing it with an artificial joint that restores healthy alignment.

How Hip Replacement Surgery is Performed

Hip replacement surgery takes approximately one hour. We do an anterior approach to the hip, which means we are able to go between the muscles instead of cutting the muscles. This typically causes less pain and leads to a quicker recovery compared to a posterior or lateral approach to the hip.

During the surgery, we make an incision across the front of your hip and use special tools to remove the worn out ball of your hip. A metal prosthesis goes into the top of your thigh bone and a new ball is attached. Your worn out socket is reamed out and a new metal socket with a plastic liner is inserted. Now, instead of bone-on-bone, you have a new prosthetic ball and socket that no longer hurts when it is moved.

Potential Risks of Hip Replacement Surgery

The risk of the surgery in healthy individuals is low.

• The risk of infection is less than 1%. You will be given IV antibiotics during the surgery to help prevent any infection.
• The risk of nerve damage in your foot or ankle is less than 1%.
• The risk of blood clots is less than 1%. If you have no risk factors for a blood clot, after surgery, you will be placed on a baby aspirin twice a day for approximately 40 days. If you have a history of blood clots or are at high risk for one, you will be on a prescription blood thinner for 40 days after surgery.
• 10-15% of patients will develop a little dull or numb spot next to their scar. Sometimes this is permanent and sometimes it resolves. It usually doesn’t bother people, but we’d like for you to know about it ahead of time.
• The risk of fracture or dislocation, meaning that the ball pops out of the socket, is less than 1%.
• The risk of a leg length discrepancy is very low. We will take x-rays during surgery to try and ensure that the hips are the same length. Occasionally, patients can have other reasons for a leg length discrepancy. Some patients have scoliosis which causes the pelvis to tilt resulting in a leg length discrepancy, while others have one shin bone longer than another. If a leg length discrepancy occurs, it can usually be treated with a small shoe lift.
• The most common side effects of the surgery are some swelling and stiffness.

We will have you wear compression stockings immediately following surgery on both legs for approximately one month after surgery. This helps to prevent swelling, stiffness, and blood clots.

CALL US AT (573) 635-800 WITH QUESTIONS

TOTAL KNEE REPLACEMENT

JCMG Orthopaedics & Sports Medicine offers total knee replacement surgery, performed in an outpatient setting at the JCMG Surgery Center.

In the video below, Dr. Jonathan Craighead, an orthopaedic surgeon with Jefferson City Medical Group, covers all you need to know about getting a knee replacement surgery performed at the JCMG Surgery Center.

Why might you need a knee replacement surgery?

The most common reason to have knee replacement surgery is poorly controlled knee pain caused by arthritis of the knee. Arthritis is the medical term for damage to the cartilage of the joint. Cartilage is tissue that provides the cushion between the bone.

In a healthy knee, the bones are well-aligned and there is a healthy joint space between the thigh bone and shin bone where the normal cartilage is preserved. In an arthritic knee, the normal joint space has deteriorated, resulting in bone on bone contact and bowing of the knee. After knee replacement surgery, the artificial knee has restored the space between the bones and realigned the knee into proper position.

How Knee Replacement Surgery is Performed

Knee replacement surgery takes approximately one hour. During the surgery, we make an incision over the front of the knee and use special tools to remove the edge of the bone and the damaged cartilage. The metal implant is then cemented to the end of the thigh and shin bone and there is a plastic spacer in between. Now when you go to move the knee, it no longer rubs bone-on-bone and now rubs metal and plastic.

Most patients will be ready to go home within one to three hours after their surgery. We will make sure that you are able to safely walk, that you are medically stable, and that your pain is controlled before letting you leave the surgery center.

Potential Risks of Knee Replacement Surgery

The risk of the surgery in healthy individuals is low.

• The risk of infection is less than 1%. You will be given IV antibiotics during the surgery to help prevent any infection.
• The risk of nerve damage in your foot or ankle is less than 1%.
• The risk of blood clots is less than 1%. If you have no risk factors for a blood clot, after surgery, you will be placed on a baby aspirin twice a day for approximately 40 days. If you have a history of blood clots or are at high risk for one, you will be on a prescription blood thinner for 40 days after surgery.
• Everyone who has a knee replaced gets a little dull or numb spot on the outside part of the knee. Sometimes this goes away, but sometimes it is permanent. It does not usually bother people, but I’d like for you to know about it ahead of time.
• Artificial knees occasionally make noise. The metal and plastic are harder surfaces than cartilage, and you may occasionally feel a click or pop in the knee. This does not mean that something is broken or coming loose, and it is normal to occasionally feel or hear a noise in the artificial knee.
• The most common side effects of the surgery are some swelling and stiffness.
• Very rarely, patients will produce excess scar tissue which causes so much stiffness that it will require a manipulation in order to break it up.

We will have you wear compression stockings immediately following surgery on both legs for approximately one month after surgery. This helps to prevent swelling, stiffness, and blood clots.

CALL US AT (573) 635-800 WITH QUESTIONS