Garden State Orthopaedic Associates

15 professionals making a difference in health

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By Brooke Perry, Bergen.com

This year, (201) Magazine profiles a group of Bergen’s most committed health care providers, physicians, philanthropists and community advocates. Whether performing complex neurosurgical or craniofacial procedures on children, employing the latest technological innovations in the operating room, raising awareness about bullying and other social issues, volunteering in the community or helping patients recover from serious medical issues, these compassionate men and women are making a significant impact on the quality of life in our communities.

Dr. Kenneth Levitsky

Orthopedic Surgeon, The Valley Hospital and St. Joseph’s Regional Medical Center

Stand-Up Guys

Not so long ago, a patient with ankle arthritis had only one surgical option – a procedure that fused the bones together, rending the ankle motionless.

“Technology has improved dramatically, and times have changed,” says Dr. Andrew Brief, the orthopedic surgeon who performed Bergen County’s first total ankle replacement in 2009 at Holy Name Medical Center. “Rather than fusing the bones together, total ankle replacement preserves motion and offers the patient, in most cases, a much better quality of life.”

In 2010, Brief, who is affiliated with Ridgewood Orthopedic Group, teamed up with fellow orthopedic surgeon Dr. Kenneth Levitsky at The Valley Hospital to confront some of the more challenging foot and ankle reconstruction cases in the area.

“In our sub-specialty,” Brief says, “you need two working brains to play off of each other. He has years of experience, and I am closer to the training and clinical research. Our chemistry works well together.”

A long-time staff member of The Valley Hospital and a member of the teaching faculty at St. Joseph’s Regional Medical Center, Levitsky is associated with Garden State Orthopaedic Associates and regularly collaborates with Brief remotely. “Thanks to technology,” Levitsky says, “we can see patients in our offices and immediately consult one another.”

Both are forward thinkers inspired by innovation and technology, but their similarities don’t end there. They are both the sons of physicians, and both say they always knew they’d pursue careers in medicine. Brief’s father was a pioneering orthopedic surgeon in the 1980s who brought cutting-edge techniques such as arthroscopic surgery to local community hospitals. “Thirty years later, I’m doing the same with total ankle replacement,” Brief says.

The son of a pediatrician, Levitsky’s path to orthopedics was an “ah ha” moment. “I’d always loved working on my car, a Volkswagen Super Beetle,” he says, “and one day in my second year of med school, my advisor invited me into the operating room to observe a total knee replacement.” Levitsky saw all the saws, drills and hammers and thought, “This is fantastic!

“It dawned on me right then and there that this was what I wanted to do,” he says. “What we do shares many qualities with carpentry, but in a nice, sterile environment.”

Though ankle fusion surgery is still performed regularly – currently beating out total ankle replacement by almost 6-to-1 – the latter procedure is catching on fast, helped by the ever-advancing technology responsible for artificial joints, including the Salto Talaris Total Ankle Prosthesis, Brief and Levitsky’s artificial joint of choice.

Arthroscopy, Ankle Fusion, or Total Ankle Replacement. How to Decide?

admin — Fri, 18 Mar 2011 18:49:59 +0000

Kenneth A. Levitsky, M.D.
Garden State Orthopedic Associates

Although not as common as arthritis of the hip or knee, arthritis of the ankle is a painful condition manifest by swelling, stiffness, a limp, and loss of function. By definition, ankle arthritis is the loss of the normal joint cartilage of the ankle joint. This can occur from many conditions such as injury or fracture, rheumatoid arthritis, or osteoarthritis.

The non surgical treatment of arthritis of the ankle includes non steroidal anti-inflammatory medications, physical therapy, bracing, and injection therapy.

The surgical options for treatment include surgical “clean out” procedures (either performed arthroscopically or by standard incision), ankle fusion surgery, or total ankle replacement.

As with all medical procedures, each of the above surgical options has it’s pros and cons. The “clean out” procedure is the least invasive or the three choices above, but its success is limited and restricted to those ankles with mild and specific types of arthritis patterns.

For years, the “gold standard” operation for severe arthritis of the ankle that was resistant to nonsurgical treatment was considered to be an ankle fusion. This procedure removes the arthritic cartilage from the ankle joints and fuses the bones of the ankle together with metal screws, plates, or a combination of both so that the ankle bones grow together as one. This essentially eliminates the arthritic ankle joint, thus eliminating the pain from arthritis. This operation has and continues to be a reliable method for treatment. The disadvantages of this procedure include loss of normal ankle motion and the possibility of developing arthritis in other nearby foot joints that are called upon to ‘perform extra duty’. Irrespective of these considerations, ankle fusion continues to be a reliable and effective treatment for disabling ankle arthritis that has stood the test of time.

More recently, there has been renewed interest in Total Ankle Replacement. The early results from ankle replacement surgery in the 1970’s and 1980’s were disappointing and the procedure was essentially abandoned. However, recent advances in design, technology, and surgical technique have resulted in new interest and improved results with this surgical procedure. There are currently five FDA approved total ankle replacement designs available for implantation.

Although the long-term results of the procedure are yet unknown, the short-term results are encouraging. Recent research has concluded that relief of pain and walking ability is not significantly different when ankle fusion is compared to total ankle replacement surgery, however those patients with successful ankle replacements did demonstrate improved function.

Although the early results are quite promising and this exciting procedure can be a very good choice for some, as noted above, we still are awaiting the long-term results.

Snow Safety

admin — Mon, 28 Feb 2011 18:21:56 +0000

Preventing sports injuries to the foot and ankle!

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Kenneth Levitsky, M.D., orthopedic surgeon at Garden State Orthopedic Associates in Fair Lawn, maintains that there are four primary ways to avoid sports injuries. Dr. Levitsky, who specializes in injuries to the foot and ankle, says that taping and bracing, the use of orthotics, stretching, and rehab and proprioceptive training are the best ways to prevent injury when engaging in weekend warrior or other sports activities.

1. TAPING AHD BRACING

“The most common risk factor for ankle sprain in sports is a history of previous sprain.” Dr. Levitsky says. “Taping of the ankle has been shown to prevent ankle sprains despite the fact that it loosens within 10 minutes and provides little or no support within 30 minutes.”

Levitsky notes that, even when the tape loosens, it can be a constant reminder of the
previous injury and makes the athlete more conscious of the ankle or foot. Levitsky also
points out that the use of high-top shoes alone is ineffective. “The sneakers may give the appearance of offering additional support, but cannot be counted on to do the job. Taping and bracing are highly effective for athletes with previous injuries.”

2. USING ORTHOTIC DEVICES

A second strategy for preventing injury to the foot
and ankle is the use of orthotic devices. “There is positive evidence that orthodox devices diminish stress fractures and perhaps plantar fasciitis,” Levitsky says.

3. STRETCHING BEFORE AND AFTER PHYSICAL ACTIVITY

Orthopedic doctors agree that even though there is no conclusive evidence that stretching prevents sports
and other injuries, stretching before physical activity can reduce the risk of injury.
“Due to the paucity, heterogeneity and poor quality of the available studies, no definitive conclusions can be drawn as to the value of stretching for reducing the risk of exercise related injuries,” Levitsky says. “There is also no conclusive evidence that stretching diminishes the incidence of Achilles ruptures. Nonetheless, I maintain that stretching is an important element of any physical activity – prior to and following the activity.”

4. REHABILITATION AHD PROPRIOCEPTIVE TRAINING

Levitsky is enthusiastic
about the research that has been conducted qualifying rehabilitation and
proprioceptive training as strong regimens to prevent sports injuries.
Proprioception is the sensory feedback that the body provides regarding the joints position in space and its movements. Joint tendons and ligaments have proprioceptors which are presumably impaired with a sprain/injury.

“Exercises on a wobble board enhance both postural control and ankle muscle strength,” Levitsky says. “This is a regular part of a rehabilitation regimen when the ankle has been injured. It helps restore strength and balance and really gives the body a better sense of
itself in space.”

Levitsky says that conclusive medical studies have been conducted that document the effectiveness of proprioceptive training in the reduction and prevention of sports injuries.
“In one study of European handball players who used a wobble board as part of their training, there was an 80 percent decrease in the number of injuries caused by over-use and/ or trauma,” Levitsky says. ”Another study found soccer players with proprioceptive training had one-seventh the risk of ACL injuries. Athletes with a history of previous ankle sprains had a reduction in the rate of ankle injury during soccer practice and competition.”