Atlantic Orthopaedics’ Dr. Tyler Welch Introduces State-of-the-Art Operating Table “The Guardian” at York Hospital

Dr. Tyler Welch was accepted into the International Society for Hip Arthroscopy, and Atlantic Orthopaedics & Sports Medicine will be introducing the hip arthroscopy procedure at York Hospital with a state-of-the-art operating table called the Guardian.

The Pivot Guardian System is a device produced by one of the nation’s lead medical suppliers, Stryker. The Guardian is specifically designed to mitigate complications, as it limits the amount of force applied to a patient’s hip during surgery. The Guardian also enables the surgeon to obtain better visualization of the hip during surgery compared to other operating tables.

The system’s boots enhance patient comfort and safety during surgery, and the surgeon can make precise range of motion adjustments during hip surgery with the Guardian.

The demand for hip arthroscopy is increasing every year, and surgeons in the US are projected to perform 271,000 hip arthroscopy procedures by the year 2021. This will be a compounded annual growth rate of 18.5%, compared to a 3.9% projected growth in shoulder arthroscopy and 1.6% projected growth in knee arthroscopy by the same year.

Atlantic Orthopaedics & Sports Medicine is a leading practice on the Seacoast for orthopaedics and sports medicine. They have offices in Portsmouth, New Hampshire and York, Maine and physicians have full medical staff privileges at both Portsmouth Regional Hospital and York Hospital.

Dr. Sastry to Chair Stryker’s Robotic Surgery Conference

SEPTEMBER 12, 2018—Dr. Akhil Sastry, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, has been asked to Chair Stryker’s National MAKO Program later this month. He will head the conference in Mahwah, NJ as the leading surgeon there and teach MAKO courses in partial knee, total knee, and total hip surgery to other attending surgeons.

Stryker is one of the world’s leading medical technology companies, and their MAKO system is a surgeon-controlled robotic arm that enables accurate alignment and placement of implants.

Sastry began using the MAKO Robotic-Arm Assisted Surgery System in 2016 and was the first surgeon in New Hampshire and Maine to perform a robotic assisted knee replacement. Sastry has been participating in their educational programs throughout the country teaching the full knee replacement on the robotic platform. Though he has taught many courses for Stryker, this will be the first time he will chair a conference for them.

Sastry is also the premier robotic-assisted orthopaedic surgeon at Atlantic Orthopaedics and Sports Medicine and has said the robot allows for a level of precision that enables a quick recovery and fewer issues for the patient once fully rehabilitated.

Dr. Sastry Shares Expertise by Teaching Mako Total Knee Course for Other Surgeons

AUGUST 23, 2018—Dr. Akhil Sastry, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, recently taught a MAKO total knee course for Stryker in Mahwah, NJ.

Stryker is one of the world’s leading medical technology companies. Their MAKO system is a surgeon-controlled robotic arm that enables accurate alignment and placement of implants, and Sastry has been participating in their educational programs throughout the country teaching the full knee replacement on the robotic platform.

Sastry began using the MAKO Robotic-Arm Assisted Surgery System in 2016 and was the first surgeon in New Hampshire and Maine to perform a robotic assisted knee replacement.

“Planning is a major component,” Sastry said. “The patient has a CT scan of the knee and the MAKO system will create a patient-specific 3-D model to pre-plan the knee replacement.”

Following the personalized pre-operative plan, the surgeon guides the robotic-arm during bone preparation to execute the pre-determined surgical plan and to position the implant. By selectively targeting only the part of the knee damaged by osteoarthritis, surgeons can resurface the diseased portion of the knee while helping to spare the healthy bone and ligaments surrounding the knee joint.

“Our patients get customized procedures, tailored specifically to them,” Sastry said. “Sensors are placed on the bones and signals are sent to the robot. If the surgeon strays just one millimeter from the specific measurements, the robot will stop.”

Sastry, who is the premier robotic-assisted orthopaedic surgeon of Atlantic Orthopaedics and Sports Medicine, said the robot “allows us creative license to reposition the implant in any direction we want to achieve consistent range of motion.”

“The new knee feels more natural,” Sastry said. “This level of precision allows for quicker recovery and the likelihood of fewer issues for the patient once fully rehabilitated.”

Sastry is certified in both partial and total robotic-assisted knee replacements.

“By using this new technology, it results in a home run every time,” Sastry said.

Dr. Sastry to Speak on the Benefits of MAKO

Akhil Sastry, MD of Atlantic Orthopaedics & Sports Medicine is this month’s speaker at Portsmouth Regional Hospital’s Orthopedic Wellness Lecture, to take place on Tuesday, March 27th at the Seabrook Public Library on 25 Liberty Lane in Seabrook from 5-6PM.

Dr. Sastry is New Hampshire’s first MAKO robotic surgeon, as well as a MAKO instructor for leading orthopedic surgeons around the world. He will discuss the benefits of using this advanced technology for anatomical mapping using the MAKO Robotic Arm, which allows for surgical precision in total and partial knee as well as total hip replacements. This precise implant placement leads to faster healing and recovery time for patients.

The event is free of charge and light refreshments will be served. To reserve your space, call 1(888) 421-1080 or visit https://portsmouthhospital.com/calendar/?session_id=a0s39000005y5jsAAA.

York Hospital Using New Shoulder Replacement Technology

YORK, Maine – Dr. Mayo Noerdlinger looks up at a computer screen above his head during a shoulder replacement surgery one recent morning at York Hospital. A 3-D image of the patient’s shoulder system floats on the screen, an image that has been created preoperatively and allows him to decide in advance how he wants to proceed during surgery.

Soon, a GPS probe is placed in the patient’s bone, picking up the contours of her shoulder and matching that to the image taken before surgery. As Noerdlinger works to put the pins in the bone to hold the replacement piece in place, he is guided by the probe to place them precisely where they need to go, down to the millimeter. No chance they will be put in “cockeyed.”

Noerdlinger said the technology represents the next and important step in the evolution of shoulder operations. York Hospital is the first hospital in the Northeast to offer this kind of technologically-guided surgery, and has been offering them since June.

“I definitely think there’s value in having a doctor who has experience and who has done a lot of surgeries,” said Noerdlinger, an orthopedic surgeon with Atlantic Orthopaedics and Sports Medicine in Portsmouth. “But even a person who does a lot of them may have an off day. A lot of experienced surgeons look at this technology and say, ‘Yeah, yeah, you’re not going to get better than surgical experience.’ But I think that there’s a little hubris in that.”

Noerdlinger certainly qualifies as an experienced surgeon. He has been a practicing physician for 15 years, and in the Seacoast area is the go-to-guy for shoulders. He said shoulder surgery has seen advances over the years. Where once there were one-size-fits-all components, today components are size-specific for each patient. This “has indeed led to getting good to excellent results for 15 to 20 years. But can we do better?”

He said when he was shown the equipment created by the company ExactechGPS, which allows those pins to be placed accurately in the bone, he saw the next logical step in perfecting patient outcome. “I’ll be honest with you. I’m not sure that putting in the components perfectly will make a difference. But it makes common sense,” he said, that perfect placement of the pins could allow the replacement shoulder to last five to 10 years longer. “I think this is a game changer.”

Shoulder problems are typically caused when the cartilage that protects the shoulder bones has worn down due to years of motion and pressure. This causes arthritis, most typically osteoarthritis, but also rheumatoid arthritis. Patients also can be suffering from bursitis.

Not all people with shoulder issues are candidates for total replacement. Many issues can be repaired through arthroscopic surgery, Noerdlinger said. For instance, most people he sees have a rotator cuff tear that can be handled through a shoulder arthroscopy. Many patients choose cortisone or similar treatments that will stave off the pain for a period of time, rather than go through surgery at all.

He said he sees people in their 30s and 40s who have shoulder issues, but can deal with it through a variety of treatments including cortisone – and yoga. “Staying flexible is key,” he said. “But by the time they’re in their 50s and 60s, they’re tired of it. They say, ‘I don’t want to live with it and I’ve had all the cortisone injections I want to have.’”

The ExactechGPS system begins to work at his office, he said. Patients who decide on replacement will get a CAT scan, which the company turns into a 3-D image. With this image, Noerdlinger can come up with a game plan specifically geared for the individual patient. He said this is particularly helpful when preparing for a reverse shoulder replacement – when the ball at the end of the humerus bone is cut off and a metal ball is attached to the upper arm bone – essentially reversing the shoulder system. This is done when there is a large rotator cuff tear. Rather than the rotator cuff, the deltoid muscle will power the arm.

Armed with patient-specific information, he goes into surgery, where he places a probe into the shoulder blade that will allow him to place the ball component exactly in the right place and pin it into the bone precisely. And it’s all on the computer screen in front of him.

He said creating the hole for the probe, or tracker, “does add to surgical time, and that’s more anesthesia. But I’ve found the typical increase in surgical time is four minutes. That’s worth it to put those pins in perfect position. I started performing these at the end of June, and this is my ninth. There have been no negative outcomes. Everyone is doing well.”

Noerdlinger credits York Hospital President Jud Knox and the hospital Board of Trustees for listening to him when he approached them about acquiring the machine. “It’s an expense that the hospital took on themselves, and they do not pass on to the patient,” he said. “Our practice has a great relationship with the hospital, and they always said, if you want something let us know. This was the first time I went to the hospital, and they listened to me.”

Noerdlinger said he is waiting for Portsmouth Hospital, where he is Chief of Orthopedic Surgery, to get the same machine, but because the hospital is part of a larger, for-profit corporation, “there’s a lot of machinations. York Hospital made a decision in a week. This hospital said, ‘Why not do it?’”

This is not the first high-tech machine that the hospital has acquired. Since early 2016, the hospital has offered knee replacement surgery using a similar technological system that marries preoperative images with operation images. In both cases, York Hospital was the first in the region to offer these technologies.

Knox said much of the hospital’s decision-making comes down to the relationship with the doctor and the outcome for the patient.

“I don’t think being the first in the region is a risk for us if, one, we have a great relationship with the physician who’s promoting the technology and, two, if the evidence is available to show the efficacy of the technique,” he said. “And whatever we’re talking about, we try to figure out if it has value for patients.”

Unlike knee replacement surgery – estimated by the American Academy of Orthopaedic Surgeons at some 900,000 a year nationwide – only about 56,000 shoulder replacement surgeries are performed annually. “It’s a non-weight-bearing joint, unlike knees and hips,” said Noerdlinger. “The question is, how much money should be spent to make someone’s life better? That analysis is above my pay grade. I believe this will allow people to have a better long-term outcome. I can’t monetize that value. But I do feel passionate about this.”

“When you look at the disability caused by shoulder problems, it’s huge. When people can’t put on their shirt or tie their shoes, that’s an issue,” said Knox. “We won’t do as many shoulders as knees, but the numbers don’t mean those shoulder operations are not important. There is not a single number of frequency that we use to measure whether we do a procedure or not.”

According to Noerdlinger, York Hospital is among a rarified few that have embraced this technology. There are only five major medical centers that have this machine in operation or are in the process of setting it up, including Stanford University Medical Center, the Cleveland Clinic and the Hospital of Joint Disease at New York University. It is also widely used in Spain, France, England and Australia. Few small hospitals are using the technology.

“The significance is York Hospital’s relationships with patients and their physicians,” said Knox. “Hopefully that’s our strength and hopefully that’s what helps us be a success in the land of medical care giants. All hospitals are trying to do a good job. All hospitals are asking what is the right technology to do the best thing for our patients.”

“I do not see these technologies as economic lifesavers. I don’t think that works,” he said. “When all is said and done, it’s going to be whether people believe York Hospital is doing the right thing for their well-being.”

–

As of November 2017, Portsmouth Regional Hospital has obtained the GPS technology a allowing patients access to the same benefits in Portsmouth.

To view the article on Seacoast Online, visit http://www.fosters.com/news/20170828/york-hospital-using-new-shoulder-replacement-technology.

On the Cutting Edge: Seacoast Surgeon Trains Others in Use of Latest Technology in Knee Replacement

PORTSMOUTH – Recent advancements in robotic technology will help patients achieve better results during total knee replacement, says a surgeon who is training his peers on new methods.

Dr. Akhil Sastry, of Atlantic Orthopaedics and Sports Medicine in Portsmouth, was one of the first surgeons to try the Mako Total Knee with Triathlon Knee System for Stryker, one of the largest developers and manufacturers of total knee replacement systems in the world. When the company began selling their newest technology for total knee replacements last year, Sastry started teaching surgeons in the United States and around the globe how to use it.

“Now, 5,000 robotic assisted total knees have been performed by over 200 surgeons worldwide. The projected number of surgeons will be almost 1,000 by the end of next year,” Sastry said.

Sastry trained the first surgeon to use the technology in Germany, and during the last week of September, he will be traveling to India to teach surgeons there how the newest Mako robot works.

The concept of robotics being used in knee surgery has been around since 2006, but patients still have only a 75- to 80-percent satisfaction rating post-operation, Sastry said. He believes the latest technology will improve that because surgeons can take into account a knee’s complete range of motion when planning and performing their procedures.

“We can fine-tune the positioning of the implants to not only take account for the static positioning of the knee, but the dynamic position of the knee,” Sastry said. “So, it creates a perfect plan each and every time.”

Sastry performs total knee replacements at Portsmouth Regional Hospital and York Hospital in Maine.

In Laconia, surgeon Arnold Miller says he is using the newest Mako robot for total knee replacements. Miller started using robotics five years ago for partial knee replacements and hip replacements.

“I have been impressed with the results, and patients seem very happy with their outcomes,” Miller said.

Miller works at the Laconia Clinic, and performs total knee replacements at Lakes Region General Hospital in Laconia.

Dr. Jeremy Hogan also uses Mako robots during his surgeries at Lakes Region General Hospital. He works at Advanced Orthopaedic Specialists in Gilford.

Hogan was first exposed to Mako robots seven years ago. He says he has been using them at the hospital for five years.

Hogan says using robots has enhanced his accuracy.

“I can measure single degrees and millimeters, which is super human, and the robot assist ensures that I carry out my patient specific plan precisely,” Hogan said. “The goal is always a ’forgotten joint’ where the patient does not notice the presence of a replacement. A patient that had a traditional total knee by me a few years ago and recently underwent a robot assisted total knee feels that the rehab process is easier this time.”

In a video created for the Mako Total Knee with Triathlon Knee System, Stryker’s Chief Executive Officer Kevin Lobo says the new technology is a great example of modern collaboration and innovation.

“The health care landscape is consistently evolving. Stryker is committed to partnering with our customers to bring innovative solutions for our patients,” Lobo said.

Stryker’s global headquarters are located in Kalamazoo, Mich.

Experts project that total knee replacements in the United States are expected to increase 673 percent by 2030.

Article seen in the New Hampshire Union Leader.

Dr. Noerdlinger of Atlantic Orthopaedics Leads the Northeast in Shoulder Surgery

York, ME – Dr. Mayo Noerdlinger, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, recently became the first surgeon in the Northeast to perform a shoulder replacement surgery using ExactechGPS-guided technology, an innovative new procedure for shoulder replacement. Already one of the top shoulder surgeons in the Northeast, Dr. Noerdlinger and his patients will benefit even more with this new technology, a major advancement in shoulder replacement. Dr. Noerdlinger performed his first surgery of this procedure at York Hospital, the first hospital in the Northeast to purchase ExactechGPS. This was the premier surgical case north of the Mason-Dixon line of the Mid-Atlantic.

ExactechGPS shoulder replacement, also called ExactechGPS Shoulder Application, improves the precision and predictability of shoulder surgery from preoperative planning to real-time execution. This new technology helps the surgeon better understand his or her patient’s anatomy before entering the operating room, and while during surgery ExactechGPS provides a real-time view of the implant placement process and guides the surgeon toward any necessary adjustments.

“ExactechGPS gives us much more flexibility when it comes to treating shoulder pain operatively,” Dr. Noerdlinger said. “Without a doubt, surgeons will be able to operate more precisely thanks to the computer navigation, which will decrease complication and speed up recovery for our patients.”

Mayo Noerdlinger, MD, FAAOS, CIME, specializes in orthopedic, reconstructive and arthroscopic surgery; shoulder surgery and replacement; reverse shoulder replacement; treatment of torn tendons and ligaments; sports medicine and others. He is also the physician behind Seacoast Shoulder, which offers patients the latest in state-of-the-art treatment for shoulder ailments of all kinds. Visit www.seacoastshoulder.com for more information, or call 603.431.1121 or 207.363.3490.

Atlantic Orthopaedics & Sports Medicine is a group of Board-Certified physicians who utilize the latest concepts in orthopaedics and sports medicine, coupled with preventive and surgical techniques. For more information, visit www.atlanticorthopaedics.org, or call the Portsmouth clinic at 603.431.1121.

MAKO Event At Portsmouth Regional Hospital A Success

Portsmouth, NH – Atlantic Orthopaedics & Sports Medicine recently held an event with Portsmouth Regional Hospital to showcase the MAKO Robotic-Arm for orthopaedic surgery. Lead by Dr. Akhil Sastry, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics, the evening included a live demonstration of the MAKO Robot followed by an educational session in the hospital’s classroom.

MAKO is the newest addition to robotic surgery at Portsmouth Regional Hospital, and a groundbreaking technique worldwide. In his presentation, Dr. Sastry discussed the customizable procedure for knee and hip replacements, including the benefits of using MAKO. These include greater surgical precision than alternative technologies, a minimalized hospitalization period, and more rapid recovery for the patient.

The event was filmed and will soon be uploaded to the Atlantic Orthopaedics website. Approximately 60 people were in attendance, and engagement was high during the Q&A portion of the evening. Both Atlantic Orthopaedics and the hospital look forward to future events like this one to keep community members engaged with their health care.

Dr. Akhil Sastry, M.D., FAAOS is a Board-Certified and Fellowship-Trained surgeon with specialties in joint replacement, direct anterior hip replacement, and arthroscopic and robotic surgery of the knee. Certified in both Partial and Total Robotic-Assisted Knee Replacements, Dr. Sastry is renowned on the national and international level for robotic-assisted joint replacement surgery and surgical technique. He is the first physician in New Hampshire to offer total knee surgery using the MAKO Robot.

Dr. Welch Publishes Article in Orthopaedic Journal

Portsmouth, NH – Dr. Tyler Welch, a physician at Atlantic Orthopaedics and Sports Medicine, recently published an article in the Journal of Experimental Orthopaedics. It is titled The Effect of a Dynamic PCL Brace on Patellofemoral Compartment Pressures in PCL-and PCL/PLC-Deficient Knees.

The study examines the PCL, or posterior cruciate ligament, located in the back of the knee. One of four major ligaments of the knee, it connects the femur (thighbone) to the tibia (shinbone). In a controlled laboratory study, Dr. Welch and five colleagues explored a deficiency of the PCL leading to arthritis in the patellofemoral knee joint, and evaluated the hypothesis that dynamic bracing reduces pressure in the knee joint in PCL-deficient knees. Coauthors of the study were Thomas Keller, Ruben Maldonado, Melodie Metzger, Karen Mohr and Ronald Kvitne.

The Journal of Experimental Orthopaedics is an international journal that aims to bridge the gap between orthopaedic basic science and clinical medicine, and publishes works that examine the field of experimental orthopaedics. Each published article goes through peer review and is upheld to the high quality standards of the Journal.

Dr. Welch is a physician at Atlantic Orthopaedics who specializes in cartilage restoration, sports medicine, joint replacement, and arthroscopic surgery of the hip, knee and shoulder. He is the lead doctor of the clinic’s Cartilage Center, a place for patients experiencing joint pain and early arthritis. Dr. Welch is affiliated with the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, and the Arthroscopy Association of North America.

Dr. Noerdlinger Named One of NH Magazine’s Top Doctors

Portsmouth, NH – Dr. Mayo Noerdlinger, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, was recently named a Top Orthopaedic Surgeon in New Hampshire Magazine’s list of 2017 Top Doctors.

Dr. Noerdlinger joins 273 leading physicians in 55 specialties across New Hampshire, nominated by their peers in a wide range of medical needs, from pediatrics to surgical care. Health-care research and information company Castle Connolly Medical Ltd. conducted the survey process, whose research, screening and selection carefully chose top doctors for traits like medical specialty, educational and professional experience, and dedication to their patients.

“I’m so honored and humbled to be recognized among the state’s leading physicians,” said Dr. Noerdlinger. “I always hope my patients leave the practice feeling truly cared for, and that their needs were listened to throughout the treatment process. It’s what I love to do, and I’m glad my peers can see that shining through.”

Dr. Noerdlinger, MD, FAAOS, CIME, specializes in orthopedic, reconstructive and arthroscopic surgery; shoulder surgery and replacement; reverse shoulder replacement; treatment of torn tendons and ligaments; sports medicine and others. He is a member of the Department of Orthopaedic Surgery at Portsmouth Regional Hospital, the Medical Director of ProCare Physical Therapy & Hand Center and of Hampton Physical Therapy, and a Team Physician at Wells High School and the University of New Hampshire.

Dr. McMahon to Speak on Back Pain at York Senior Center

York, ME – Andrew McMahon, DO of Atlantic Orthopaedics & Sports Medicine will speak to members of the York Senior Center on back pain as part of a Lunch and Learn Program for the Center. He will be joined by Dr. Bryan Hoffman from Saco Bay Physical Therapy for the event, held Tuesday, May 2^nd, beginning at 10:30am.

Dr. McMahon will present information on chronic back pain, including common causes, methods to combat pain, and how to prevent it before pain strikes. In his practice, Dr. McMahon stresses the importance of identifying the underlying reason for injury in treatment – a key topic during the Senior Center program.

“By recognizing and correcting deficits in strength, flexibility, and the way we move our bodies, we heal quicker and we protect ourselves from future injuries,” he said. “In my mind, education, motivation and partnership with my patients are the keys to success.”

A Board-Certified physician at Atlantic Orthopaedics, Dr. McMahon specializes in sports medicine, musculoskeletal ultrasound and post-concussion management. He received his BS from the University of New Hampshire and his DO from the University of New England College of Osteopathic Medicine.

Total Knee Replacements with Dr. Sastry

YORK, Maine – Since January 2016, orthopaedic surgeon Dr. Akhil Sastry began performing partial knee replacements using the Stryker MAKO Robotic-Arm Assisted Surgery System at York Hospital.

He is now using the procedure on total knee replacements, and of the 150 knees he’s operated on since last January, 20 of them have been total knee replacements.

Sastry is the first surgeon on the Seacoast to use the MAKO system for a total knee replacement. He and York Hospital are one of only 25 providers worldwide to offer this innovative knee replacement procedure.

The MAKO system is a surgeon-controlled robotic arm technology that enables accurate alignment and placement of implants.

“Planning is a major component,” Sastry said. “The patient has a CT scan of the knee and the MAKO system will create a patient-specific 3-D model to pre-plan the knee replacement.”

During surgery, the surgeon guides the MAKO robotic-arm with surgical equipment based on the patient-specific plan. This allows for the removal of only the diseased bone, preserving healthy bone and soft tissue, and assists in positioning the implant based on the patient’s anatomy.

“The new knee feels more natural,” Sastry said. “This level of precision allows for quicker recovery and the likelihood of fewer issues for the patient once fully rehabilitated.”

Sastry is certified in both partial and total robotic-assisted knee replacements and has been selected to be one of 15 surgeons to teach this technology to other orthopaedic surgeons worldwide. Sastry will be participating in multiple educational programs throughout the country teaching the full knee replacement on the robotic platform.

“By using this new technology, it results in a home run every time,” Sastry said.