General Orthopedics


Arthritic joints are swollen, or inflamed, usually because the smooth cartilage around them has been damaged in some way. Patients with arthritis suffer from pain, stiffness and swelling in the affected area(s).

Cartilage Repair | Arthritis Treatment  | Total Joint Replacement | ChattanoogaNearly one in three adults suffers from arthritis or other chronic joint symptoms. Arthritis is the most common chronic ailment among the elderly, although it can affect people of any age, including children.

There are over 100 different types of arthritic diseases. The most common is osteoarthritis, a degenerative joint disease in which the cartilage protecting the bone ends wears away. At first, discomfort results from inflammation in the joint. Then, as the condition progresses, the worn bones rub together with painful friction whenever the joint moves. Osteoarthritis frequently affects weight-bearing joints such as the spine, hips and knees.

Rheumatoid arthritis is a chronic condition in which the body's own immune system attacks the joint lining. This autoimmune disorder usually affects the hands and feet and can cause pain even when the joint is not being moved.

A diagnosis of arthritis is made after an evaluation of symptoms, a physical examination and one or more diagnostic imaging tests.

Unfortunately, most types of arthritis are currently incurable – but today's treatment options can be very effective. Treatment typically involves a combination of anti-inflammatory medication and devices to relieve stress on the joint (canes, crutches or splints). Regular exercise, weight loss for overweight patients, and cortisone injections may also be helpful. In severe cases, orthopedic surgery such as joint replacement may be the only way to improve or restore function and relieve pain.

Total Joint Replacement

Sometimes the best way to relieve pain and restore function to a joint is to replace all or part of it with a prosthesis (an artificial joint). Prostheses are intended to restore function to the joint and relieve pain associated with arthritis, other chronic conditions, or traumatic injury.

Cartilage Repair | Arthritis Treatment  | Total Joint Replacement | ChattanoogaProstheses are designed to move like a regular joint. They are made of durable plastic and metal parts that fit together snugly but glide smoothly (as opposed to the painful friction associated with the worn cartilage of arthritic joints). The pieces are shaped like the structures they replace – for example, the damaged bones in a ball-and-socket joint of a hip or shoulder are replaced with a metal ball and plastic socket. They are held to the surrounding bone either with a locking mechanism or with a special bone cement.

Cartilage Repair | Arthritis Treatment  | Total Joint Replacement | ChattanoogaThe length and difficulty of recovery depend on the location of the joint replaced as well as the patient's age and overall health. Hip or knee surgery typically requires temporary use of a cane or walker. Some pain and stiffness following surgery is normal. Gradually the weakened muscles regain strength and flexibility as the patient becomes accustomed to using the joint. The physician will discuss when it is safe to return to any athletic activities. Once in place, prostheses usually perform well for up to a decade or longer.

Which joints can be replaced?

The hip and knee are the most frequently replaced joints, although it is possible to treat many others. Procedures include:

  • Shoulder Joint Replacement
  • Elbow Joint Replacement
  • Wrist Joint Replacement (Arthroplasty)
  • Hip Resurfacing
  • Total Hip Replacement (THR)
  • Total Knee Replacement
  • Ankle Joint Replacement

Fracture Care

A fracture is a break or crack in a bone that occur when the bone cannot withstand outside forces, often as a result of trauma or disease. Fracture, break and crack all refer to the same thing. Fractures can range from a small crack in the bone to complete separation. They are often caused by a fall, motor vehicle accident or sports injury. Normal activities can also cause fractures for people at a higher risk, including those with low bone density (osteoporosis), bone tumors, cancer or brittle bone disease (osteogenesis imperfecta).

Some of the different types of fractures include:

  • Stress Fracture - A stress fracture occurs as a result of overuse. Because of repeated use, the bone becomes weak and cannot absorb the shock that is put on it. It is common in the lower leg or foot and especially among athletes.
  • Compression Fracture - A compression fracture occurs as a result of old age. People with osteoporosis are at high risk for this type of fracture because their bones lose calcium. The weakened bones, usually in the spine, can crumple under the force of gravity.
  • Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaIncomplete (Greenstick) Fracture - A greenstick fracture occurs when the bone bends but does not completely break. This occurs most often in children, who have high levels of calcium in their bones.
  • Comminuted Fracture - This occurs when the bone cracks into several fragments. It occurs as a result of high impact trauma or osteoporosis.

A bone fracture causes pain, swelling and sometimes bruising of the affected area. Applied weight or pressure causes even more severe pain. They are usually easy to diagnose, but treatment requires precision and care by experienced professionals.

Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaWe offer specialized knowledge and care for the treatment of fractures. Our doctors will treat your injury every step of the way until it is completely healed. Bone fractures can be diagnosed by physical examination and an X-ray or CT scan. Immobilizing the area is often helpful in relieving pain before proper treatment begins. Treatment for bone fractures depends on the location and type of fracture, as well as the patient's medical history. We take all of these factors into account when developing a treatment plan.

Mild fractures, including stress and greenstick fractures, usually only require the conservative treatment methods of ice, rest and anti-inflammatory medication. Moderate fractures may require splints or braces along with pain medication. The immobilization helps relieve pain and speed up recovery. More severe fractures may require surgical treatment, especially open fractures with wounds that need to be closed.

Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaAfter the proper treatment is performed, the rehabilitation process begins. It is important to care for your fracture while it heals. Full healing can take several weeks to several months. Your doctor will advise you on how to care for your fracture and helpful measures you can take to ensure a speedy and healthy recovery.

Osteoarticular Transfer System (OATS)

Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaThe Osteoarticular Transfer System, commonly known as OATS replaces damaged cartilage in the knee with healthy cartilage from another area of the joint, relieving pain and restoring movement and function to the joint.  A mosaicplasty is the name for a general procedure that treats severe cartilage damage, and the OATS procedure is one type of mosaicplasty.

Although cartilage is essential to smooth, painless movement of the joints, some areas have a more critical need for the support and cushioning provided by the cartilage.  During the OATS procedure, small plugs of healthy cartilage are removed from areas of the joint that are not in critical need, and transferred to the area of damaged cartilage.

The OATS procedure is ideal for patients with small areas of cartilage damage that can be easily repaired with a graft. Widespread cartilage damage cannot usually be treated with this procedure, since there may be insufficient amounts of healthy cartilage available.

After the OATS procedure, patients will need to undergo a lengthy physical therapy program in order to restore range of motion and relieve pain and swelling on the joint.  Most patients will be on crutches for 6 to 12 weeks after surgery before they can successfully bear weight on the joint again.  Long-term follow-up care will be required in order to maintain the results of this procedure.

Autologous Chondrocyte Implantation (ACI)

Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaAutologous Chondrocyte Implantation, commonly known as ACI, is a surgical procedure that treats cartilage damage caused by injury or degeneration.  This procedure is most often performed to treat the knee, although it can be used on other joints as well.  It is used after non-surgical treatments have failed and cartilage damage is severe.

During the ACI procedure, Dr. Sumida will use arthroscopy to identify the area of cartilage damage and remove a small sample of healthy cartilage cells.  These cells are sent to a lab, where they are duplicated over the next four to six weeks. Once enough cells have been grown, a second procedure is schedule, during which the new cartilage is implanted into the joint with the aid of a periosteal patch.

Fracture Care  | Autologous Chondrocyte Implantation (ACI)  | Osteoarticular Transfer System (OATS) | ChattanoogaAfter this procedure, patients will need to undergo a physical therapy program in order to restore full function to the treated area.  The ACI procedure is ideal for patients with only small areas of cartilage damage, who have significant pain and swelling, and who are not obese.  This procedure is considered safe for most patients, although there is a risk of scar tissue formation, infection and knee stiffness developing after surgery.

Fractures of the Foot and Ankle

A fracture is a break in a bone. It may be a crack in the bone (a stress fracture) or a complete break; the bones may shift out of place or break the skin. Fractures in the bones of the foot and ankle cause a variety of symptoms and require different treatments depending on the location and severity of the break as well as the patient's overall health.

  • Digits (toes/phalanges) and Metatarsals (long bones of the forefoot) – There are many different kinds of fractures that can happen to the bones of the forefoot and toes. They are painful but often heal without the need for surgery. The metatarsals are prone to stress fractures, or cracks in the bone. These are usually related to a recent increase or change in activity. The fifth metatarsal below the small toe may fracture if it is landed on badly or if the ligament of a twisted ankle pulls off a piece of the bone. Symptoms of a toe or metatarsal fracture include pain that gets worse when walking; swelling; and sometimes bruising.
  • Fractures of the Foot and Ankle  | Chattanooga Lisfranc Joint (midfoot) – Often caused by dropping something heavy on the top of the foot or by falling after catching the foot in a hole. Symptoms are similar to a sprain and include swelling and pain at the top of the foot; bruising; possible inability to bear weight; and pain when moving the foot while the ankle is held steady. If you think you have a sprain and it does not improve with rest and ice after one to two days, you may have a Lisfranc joint fracture and should see a doctor to prevent further injury.
  • Calcaneus (heel) – Usually the result of an automobile accident or fall from a great height. Symptoms include pain on the outside of the ankle or under the heel; inability to bear weight; swelling and stiffness. May be accompanied by back or knee injury due to the amount of force required to break the heel bone.
  • Fractures of the Foot and Ankle | Chattanooga  Ankle – Like severely sprained ankles, broken ankles are often caused by a fall, injury or car accident. Symptoms that one or more of the three bones that make up the ankle may be fractured are: severe pain in the ankle; swelling; bruising; tenderness; inability to bear weight; and deformity of the joint. May be accompanied by dislocation or ligament damage (sprain).


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