Dealing with a Torn Achilles Tendon

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What is a torn Achilles tendon?

An Achilles tendon rupture, better known as a torn Achilles tendon, is a very common injury, but requires attention from a doctor. It occurs when the tendon connecting the calf muscle to the heel bone is severed or torn. Men are seven times more likely to tear their Achilles tendon than women, and 75% of the time, the injury occurs from playing a sport or being active.

Achilles Tendon pain

Some antibiotics or cortisone injections actually increase the likelihood of injuring your Achilles tendon. Flouroquinolone antibiotics like Cipro and Levaquin, which are used mostly for respiratory urinary tract, and other bacterial infections, increase your chances of tearing a tendon or getting tendinitis. These medications disrupt certain cells in your body from replicating because they are fighting an infection. As a result, your tendons have a harder time repairing themselves and can swell or tear much more easily while you are exercising.

The Achilles tendon is the largest tendon in the body, so if you injure it, it is very important that you see a doctor. Two of our surgeons, Dr. Richard Jackson and Dr. Steven Herbst, perform Achilles tendon operations.


The Achilles tendon rupture is a traumatic injury and causes sudden pain behind the ankle. So you will know something is wrong! Patients often describe hearing or feeling a “pop” or “snap” sensation in their ankle or calf. Others say it feels like they have been kicked in the heel.

You may have difficulty pointing your toes downward, since the Achilles tendon pulls the foot. Swelling and bruising around the ankle or calf is also likely.

There are other Achilles tendon injuries that aren’t as serious as a ruptured Achilles tendon. If your pain isn’t as serious, you may have Achilles tendinitis or Achilles tendinosis.

Achilles tendinitis is swelling and tenderness of the tendon. This is mostly a result of overuse and can be easily treated.

Achilles tendinosis is a degenerative process where the tendon begins to break down and get small tears. This is mostly as a result of overuse, calf tightness, or a heel bone spur.

See the differences below:

torn Achilles tendon

Diagnosis: Thompson Test

To find out if you have a torn Achilles tendon, your doctor will likely perform the Thompson test.

You can also try this at home:

  • – Lie face-down on the exam table, with your feet extended past the table/bed.
  • – Doctor squeezes the calf muscle.

Achilles tendon tear test

If your Achilles tendon is fine, your toes will point downward, as the Achilles tendon pulls the foot.

If your Achilles tendon is injured, your foot will not move.



More minor Achilles tendon injuries will not usually require surgery. However, these injuries can take a long time to heal, so be patient. In order to protect and speed up the healing process, you should:

  • – Rest. Don’t try to do any strenuous activity until you are cleared by a doctor.
  • – Ice your leg for 20 minutes every 1-2 hours.
  • – Compress your leg with an elastic bandage to manage swelling.
  • – Elevate your leg with a pillow.
  • – Take anti-inflammatory medications.
  • – Wear a heel lift or boot, if your doctor recommends that.
  • – Stretch and strengthen your muscles – but only if your doctor or physical therapist recommends it!


If your injury is severe, you may need to undergo surgery to repair your Achilles tendon. However, you will likely return to your favorite activity or sport faster than if you went the non-surgical route! Surgery may also make you less likely to re-rupture your Achilles tendon. There are always surgical risks to any surgery, but the procedure is highly successful.

If you have further questions, please contact us!

What is hip bursitis?

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Many people come into our clinic every day with chronic hip pain. While many of our patients have osteoarthritis and require a hip replacement or reconstructive surgery, others are diagnosed with the most common cause of hip pain – hip bursitis.

What is hip bursitis?

“Bursitis” means the inflammation of the bursae. So what are bursae? Bursae are fluid sacs located all around the body that act as cushions to prevent friction between bones and soft tissue.

The hip has two major bursae that can become inflamed or irritated. The most common area for bursitis to develop is located by the greater trochanter, the bony point on the side of the hip bone. If this becomes inflamed, patients are diagnosed with “trochanteric bursitis.” The other major bursa in the hip is located on the inside of the hip, by the groin. If this becomes inflamed, patients are diagnosed with “ischial bursitis.”

Hip bursitis doesn’t cause joint pain, so if you fear your pain is coming from your joint, you should see a doctor.

Trochanteric Bursitis


Pain and tenderness are the primary symptoms of hip bursitis. So if your pain mimics any of these below, you should see a doctor:

  • – Pain usually extends from the point of the hip to the outside of the thigh area.
  • – It is often sharp and intense in the early stages of bursitis
  • – May turn into a dull ache all across the hip area.
  • – Pain is usually worse at nice, when lying on the affected hip.
  • – Getting out of a chair irritates your hip
  • – Prolonged walking, climbing, or squatting irritates your hip

Where does it come from and who is at risk?

Anyone can develop hip bursitis, but it is more common in women, middle-aged, and elderly people.

Most cases of hip bursitis arise from overuse from a sport or activity, which is often caused by some biomechanical abnormality, like a leg-length discrepancy or weakness in the hip abductors. However, other cases often arise from an injury to the hip, like a fall, bone spurs, or rheumatoid arthritis. 


Medical doctors diagnose hip bursitis by doing a physical examination. Some may do an x-ray to rule out any joint or bone problems. They will check for tenderness and pain in the areas that cause the most discomfort.



Fortunately, most cases of hip bursitis don’t require surgery! People who suffer from it primarily need to rest, use anti-inflammatories, and ice the area. Much of the pain will usually resolve within a week, and then they can return to their activity – but take it easy at first!

However, if pain persists after resting, icing, and taking NSAIDs, people may need physical therapy, steroid injections, or use of an assisstive device, if the pain is debilitating.

If your doctor is concerned that you may have an infected bursa, he or she may want to aspirate the bursa fluid in your hip and sent it to a laboratory for further testing. However, infected bursitis is somewhat rare.


Surgery for hip bursitis is rarely necessary. However, if you have tried all non-surgical treatments and are still having significant trouble, you may need to have surgery to remove the bursa. Today, this can be done arthroscopically, so the procedure is not very invasive and allows for a fast recovery.

Can you prevent hip bursitis?

The short answer is no, you cannot prevent hip bursitis. However, there are things you can do to keep inflammation down:

  • -Avoid repetitive activities that put stress on the hips
  • -Lose weight if you need to
  • -Get proper shoe inserts if you have leg length discrepancy or you overpronate when you walk/run
  • -Keep your hips strong and flexible

If you are concerned that you have hip bursitis or other hip problems, please call our office to schedule a consultation.

Meet Grant Foley, Executive Director

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Meet Grant Foley, Executive Director

Welcome the newest member of the MCJR team, Grant Foley, our Executive Director!

Grant Foley

Grant has 20 years of management experience in orthopedic physical therapy. He received a bachelor’s degree in Business Marketing at Marian University and an MBA in Business Administration from Indiana Wesleyan. Grant provides overall business management and leadership for the practice and is always looking for ways to spread the unique mission of MCJR.

Grant grew up in Hanover, Indiana, where he first met Dr. Berend, who was then attending undergraduate school. They shared similar philosophies on life, business, and had a desire to serve people, so they are eager to work together in this capacity. Grant loves the family-like culture of the office and looks forward to being a part of MCJR’s future growth.

When he is not working, he loves spending time with his wife of over 15 years and their three children. Together, they enjoy being active outside, participating in youth sports, and supporting their local church.

We are excited to bring Grant into the MCJR family!

Meet the rest of our team.

Outpatient joint replacement surgery benefits everyone involved

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In recent years, physician research has shown that outpatient joint replacement surgery benefits everyone involved – from the patients to the physians and clinicians. Patients recover better when they return home after surgery, instead of staying in the hospital or a rehabilitation facility. Below is a summary of the data that Dr. Berend and his SurgCenter Development colleagues from across the country have developed about the benefits of outpatient surgery:

Post-Acute Care After TJA: There is No Place Like Home

Perhaps the most significant developments in joint replacement surgery in the past decade have been in the area of multimodal perioperative management reducing pain, nausea, and length of stay leading to outpatient joint replacement surgery with recovery at home.1,2,3  The surgical procedures included in the outpatient program have expanded from Partial Knee Arthroplasty to Primary TKA, Primary THA4, and selected revision cases.  Emerging data demonstrate safety, reduced cost, and reduced resources.5

Since 2011 we helped develop and implement an outpatient program as part of 76 participating physician-owned ambulatory facilities in 19 states.  19,415 joint replacements have been performed.  The cohort included 6,146 TKA, 5,102 THA, 7,227 partial knee replacements, and 940 revisions and TSA.  Patients had a mean age of 58 years and 50% of the patients were female.  97% of patients were discharged same day, the deep infection rate was 0.2%, and the readmission rate was 0.3%.

The outpatient program centers on the patient needs, family engagement, essentials of home recovery, preoperative education, efficient surgery, and a surgeon controlled environment with highly standardized care.  This is a distinct shift in today’s healthcare environment, which has seen the expansion of regulatory demands; focus on Electronic Health Record (EHR), and distractions from real discussions of demonstrated value creation.  The future is bright for both ASC and hospital development of successful outpatient joint replacement program for patients and surgeons alike.



  1. Lombardi AV Jr, Barrington JW, Berend KR, Berend ME, Dorr LD, Hamilton W, Hurst JM, Morris MJ, Scuderi GR. Outpatient Arthroplasty is Here Now. Instr Course Lect. 2016;65:531-46.
  2. Berend ME, Berend KR, Lombardi AV Jr. Advances in pain management: game changers in knee arthroplasty.  Bone Joint J. 2014 Nov;96-B(11 Supple A):7-9.
  3. Berend, ME, Lackey, WG, Carter, JL. Outpatient TJA:  “Drive-Thru” Surgery – Affirms, JBJS-B. CCJR proceedings.
  4. Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH Jr, Hamilton WG, Hozack WJ. Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty.  Clin Orthop Relat Res. 2017 Feb;475(2):364-372.
  5. Edwards, et al. Avoiding Readmsisions – Support Systems Required after  Discharge to Continue Rapid Recovery.  J Arthoplasty 2015.

Outpatient Joint Replacement Surgery Effective for Hip and Knee Patients

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In years past, people in need of a joint replacement expected to stay immobile in a hospital for a week or more after their surgery. Recovery would be arduous, leaving many people stationary and off work for several months. Today, it’s a different story. Here at MCJR, over 60% of our patients get to experience outpatient joint replacement surgery and recover in their own homes.

So how do we do it here at MCJR?

Outpatient Joint Replacement Surgery

Innovative Techniques

Our surgeons at MCJR use advanced anesthesia techniques and a multi-model approach to pain control. Our modern instruments and less invasive techniques – such as the anterior approach to hip replacement – have made hip and knee replacement surgery safer and less invasive.


We perform most of our outpatient procedures at an outpatient facility specifically designed for orthopedic surgery, Midwest Specialty Surgery Center, which is conveniently located on our first floor. Because the surgery center is specialized and separate from a hospital, it is efficient, clean, and not exposed to diseases.

Patient satisfaction of the surgery center has been rated “good” to “great” with 98% of our cases in the last two years. We are confident that you receive the utmost care at Midwest Specialty Surgery Center.

Surgeons used to recommend that patients NOT move their legs directly after surgery, but it is now the complete opposite! We have found that to keep your leg still for days after surgery actually makes your recovery harder. It is better to move your joint to prevent it from getting stiff over time. Because of this, we get you up and walking after you have woken up from your surgery. The nursing team will teach your to walk with a walker, and you may have a brief physical therapy session.


We have found that people recover faster and more smoothly when they are in the comforts of their own home, instead of in a hospital. Because of that, we want you home! We still order lots of rest and time off work. However, they walk every day on their new joint and can do physical therapy at home. Many people feel good enough to return to work at 6-8 weeks, depending on their occupation.

Our MCJR team wouldn’t recommend outpatient joint replacement surgery unless we believed it really works! Our outpatient patients generally recover quickly  and without major complications. They regain the ability to walk up and down stairs, be active, and live without the nagging pain of arthritis.


Smoking causes worse outcomes in joint replacement

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Most people know that smoking can cause significant damage to a person’s lungs and heart – but did you know that smoking can also damage a person’s joints? Because of this, smoking causes worse outcomes in joint replacement surgery. Patients who fail to quit smoking before joint replacement surgery are far more likely to need a revision down the road.

smoking causes worse outcomes in joint replacement

Smoking causes joint damage

Smoking is still the number one cause of preventable death. According to OrthoInfo, more than 440,000 people in the U.S. die from tobacco-related diseases each year! Some damage done from smoking cannot be repaired, but other negative effects on your body can be reversed – or at least reduced – simply by quitting smoking. One of those risks that can be reduced is incurring joint damage. Quitting smoking allows your joints to regain strength and reduces your risk of fractures.

Below are some examples of what smoking does to your joint and bone health:

– increases your risk of developing osteoporosis, which weakens your bones and increases your risk of fractures

– nicotine slows the production of bone

– decreases absorption of calcium from your diet. Without calcium, your bones become brittle

– breaks down estrogen, which is necessary in maintaining a strong skeleton – both in men and women

Because of these damaging effects, smokers are nearly twice as likely to suffer tendon tears and overuse injuries. They are also more likely to develop rheumatoid arthritis and low back pain as they age.

Smoking makes joint replacement recovery harder

If you are a smoker and think you need a joint replacement, our surgeons will recommend that you quit smoking before you have surgery. Studies have shown that joint replacement patients who continue to smoke before and after surgery are 10 times more likely to need a joint revision surgery than non-smokers. They are also more likely to have complications, including blood clots, irregular heartbeat, and kidney failure.

This is because smokers’ bones cannot heal well and cannot grow into the porous metal of the joint implant. According to Dr. Adolph Lombardi, president of Joint Implant Surgeons in New Albany, Ohio, “smokers may be getting as much as 25 percent less blood to the wound than nonsmokers.”

What if I can’t quit?

We understand that quitting is hard. But we also know that quitting will make your quality of life so much greater. Many of our patients who continue to smoke end up with serious complications, fractures, or the need for additional surgeries because their bones are brittle. We want to make your recovery as pain-free as possible – for everyone involved.

If you have more questions about this, please call our office to speak with a clinician. 317-455-1064.

Foot and Ankle Specialist seeing patients at MCJR

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Meet Dr. Steven Herbst

More than anything, MCJR is dedicated to making the healthcare experience more accessible and comforting for our patients. One of the ways we strive to do that is by meeting as many of your orthopedic needs as we can. Our MCJR surgeons specialize in hip and knee pain, but we also have a foot and ankle specialist, Dr. Steven Herbst, who see patients in our office for your convenience.

foot and ankle specialist


Dr. Herbst is a foot and ankle surgeon who works primarily at Central Indiana Orthopedics in Muncie, IN, but has been coming to MCJR twice a month to see patients and perform outpatient surgery at MSSC. Herbst graduated from the Indiana University School of Medicine, then completed his residency training in orthopedic surgery at the University of Iowa Hospitals and Clinics in Iowa City, IA. After his residency, Dr. Herbst moved to Baltimore, MD to train in foot and ankle surgery.

He has been in practice with Central Indiana Orthopedics since 2002.

Dr. Herbst treats patients with a variety of foot and ankle problems, including arthritis, foot/ankle deformities, and flat feet. Some of his most common procedures include Achilles tendon repairs, flatfoot reconstruction, midfoot and ankle fusions, posterior tibial tendon repairs, and fracture care.

To schedule an appointment with him in our office, call his main office at (765) 284-7738.

Carpal Tunnel Syndrome: Management and Surgical Options

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According to the National Institute for Neurological Disorders and Stroke (NIH), carpal tunnel release is one of the most common surgical procedures in the United States. It occurs in your hands when “the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.” The median nerve gives feeling to your fingers on the palm side of your hand.  

The Symptoms

When the median nerve is pinched, you may experience some of these symptoms:

  • -Numbess, tingling, burning sensation in your palm or fingers
  • -Swelling
  • -Loss of grip strength
  • -The need to “shake out” your hand
  • -Inability to tell between hot and cold by touch

If you have carpal tunnel and are looking for a solution, Dr. Richard Jackson and our newest team member, Dr. Sebastian Peers would be happy to see you for a consultation and possibly for a minor procedure, carpal tunnel release. Though surgery may not be necessary, they would provide helpful tips for combating your carpal tunnel.

How do I know if surgery is the best option for me?

  • -Your symptoms have lasted for more than 6 months, surgery is usually recommended
  • -You’ve tried non-surgical treatments
  • -You want a quick, effective recovery

About the surgery: Carpal Tunnel Release

To address your carpal tunnel syndrome, a surgeon gets to the root of the problem – the median nerve. In this surgical procedure, the surgeon severs the tissue putting pressure on the median nerve to relieve pain and reduce pressure directly affecting the nerve.

This procedure is done under local anesthesia and the patient can go home the same day! After surgery, your ligaments will grow back and allow more space than there was before. Often, surgery will immediately relieve your symptoms, but a full recovery period may take several months.

Tips to Manage the Pain

  • -Take anti-inflammatory medication, like aspirin or ibuprofen. This can relieve the pressure on the median nerve.
  • -Get a corticosteroid injection, such as prednisone or lidocaine.
  • -Exercise! Stretch out your wrists and hands as often as possible. Strength training is also beneficial, but is most effective when done with a physical/occupational therapist to work on movements directly related to your symptoms.
  • -Do yoga. Yoga has been proven to reduce pain and improve grip strength in those suffering from carpal tunnel.
  • -Wear a wrist brace to keep your wrist straight.
  • -Wear fingerless gloves to keep your hands warm and flexible.

 Give us a call at 317.455.1064

Upper extremity surgeon to see patients at MCJR

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Meet Dr. Sebastian Peers

We have some exciting news – MCJR is partnering with a hand, wrist, elbow, and shoulder specialist, Dr. Peers, to see patients in our office! Dr. Peers is from Reconstructive Hand to Shoulder of Indiana (RHSI) in Carmel, but will begin to see patients out of our office several times a month in order to reach people in the south-central area of Indiana who suffer from upper extremity joint pain. His first day in clinic at MCJR is Friday, March 31.

If you are interested in scheduling an appointment with him here, call his office at 317-249-2616!


Dr. Peers was raised in Goshen, Indiana, then went on to study chemistry at Wabash College where he also helped found the college’s first competitive cycling team. Then, he attended Indiana University School of Medicine where he became interested in orthopedic surgery. After medical school, Dr. Peers completed a five-year orthopedic surgery residency program at William Beaumont Hospital in Detroit.

After residency, Dr. Peers had the privilege of completing a two-year hand, elbow, and shoulder fellowship at Cleveland Clinic. During his two years in Cleveland he trained with world-renowned experts in all areas of the upper extremity. He has particular interest in minimally invasive shoulder procedures, including arthroscopic shoulder repairs and total shoulder resurfacing replacement surgery. Because Dr. Peers lives an active lifestyle, he therefore takes pleasure in getting his patients back to their own active lifestyles as quickly as possible.

When he is not working, Dr. Peers enjoys spending time with his family. He and his wife, Mary, enjoy taking their two children outside every chance they get. He also enjoys cycling, trail running, and tennis.

MCJR featured in Faces of Indy

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Faces of Indy: The Face of Outpatient Joint Replacement

Indy’s local mag Indianapolis Monthly featured our Midwest Center for Joint Replacement surgeons in their second annual Faces of Indy publication. IM’s goal for publishing this edition every year is to feature the people behind some of the best businesses around town. Often, we forget to look past a billboard or TV ad to consider the people dedicated to the businesses that make up Indy. But it’s the hard-working people behind our businesses that make our city thrive, which includes our wonderful surgeons!

All four of our surgeons are honored to have been a part of the publication this year. You can either read our featured page below, or view a virtual edition of the Faces of Indy 2017  here.

MCJR's page in Faces of Indy

What is a Total Ankle Replacement?

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Procedure: Total Ankle Replacement

ankle replacement

Although our ankles bear as much body weight as our knees, they are much less likely to develop osteoarthritis – 9 times less likely, in fact! This is in part because ankle cartilage is denser and tougher than knee cartilage. However, just like any joint, it is possible to develop ankle osteoarthritis as you age, especially if you have had previous ankle injuries, surgeries, are overweight, or have other medical conditions that affect joint health. Although there are many different types of procedures that can be done to aid ankle problems, one of the most comprehensive is the total ankle replacement.

Symptoms of Ankle Osteoarthritis

If you develop ankle osteoarthritis, common symptoms include:

— stiffness

— swelling, warmth, and redness

— pain and tenderness when pressure is applied to the joint

— instability

— locking or buckling when you walk

If you are experiencing severe pain or trouble in your ankles, you may be a candidate for a total ankle replacement, or ankle arthroplasty. This procedure, similar to a hip or knee replacement, removes damaged bone and cartilage and replaces that with metal compartments.

The Procedure

The surgical cut for an ankle replacement is usually at the front of the ankle. The surgeon gently move tendons and nerves around in order to reach the bone. The surgeon then removes the damaged bone or cartilage and replace the damaged tibia and talus bones by gluing or cementing the metal parts designed to your ankle. Once the ankle is stabilized, he will sew up the incision.

For approximately 6 weeks, you will wear a cast or brace while your ankle heals.

A successful procedure will largely decrease or rid you of ankle pain and allow you to move your ankle up and down. After an arthroplasty, we recommend you avoid high-impact sports or activities, but you will most likely be able to perform lower impact activities, including swimming, hiking, and cycling after you have recovered.

You will likely need to be more aware of the kinds of shoes you wear. Some patients change their shoes several times a day in order to adjust the stress distribution on their ankle.

Here at MCJR, Dr. Richard Jackson and Dr. Steven Herbst (of Central Indiana Orthopedics) treat ankles and perform total ankle replacement surgeries. If you have concerns about your ankle pain, call our office to schedule a consultation with Dr. Jackson or Dr. Herbst.

6 Myths about Joint Replacement

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Avoiding a joint replacement?

We’re here to debunk some of the most common myths we hear from our patients.

myths about joint replacement


MYTH #1: “A joint implant will only last me 10 years”

FACT: There are a few reasons why a joint replacement may need to be revised, but the implant wearing out is incredibly rare. We see patients back in the office 25+ years after their knee replacements and the implants have not worn out one bit! In general, there is over a 90% chance that your joint replacement will still be performing well 20 years after your surgery.

MYTH #2: “I shouldn’t consider having surgery until the pain is unbearable”

FACT: Because our implants last well over 20 years, people can consider having a joint replacement at a younger age. You shouldn’t suffer through debilitating pain if you don’t have to! Pain often makes people less mobile, which can increase weight gain and an unhealthy lifestyle. These factors often make the pain worse.

MYTH #3: “I’m too young/old for joint replacement”

FACT: There is not an age requirement for joint replacement surgery. Younger patients can now have joint replacements because of our advanced implant systems and the likelihood of the implant lasting 25+ years. Older patients, depending on their health, can also withstand a joint replacement. Some 90-year-old patients are in better health than some 60-year-olds, so every case is different.

MYTH #4: “I won’t be able to maintain an active lifestyle”

FACT: It’s actually the exact opposite! We want you to return to an active and pain-free lifestyle after surgery. You will likely be able to begin performing low-impact activities like cycling, swimming, and hiking just 4-6 weeks after surgery. High-impact sports are typically not recommended for total hip or total knee replacements, but every case varies. Talk to your surgeon about your options.

MYTH #5: “I’ll be in the hospital for a week” 

FACT: In years past, patients did have to stay in the hospital for a week, but because of our advanced anesthesia techniques and multi-model approach to pain control, no one has to stay in the hospital for more than 2 days today. Over 60% of our patients go home the same day of their surgery. We have found that most people recover better and faster when they are recovering in the comforts of their own home.

MYTH #6: “I’ll have to go to a rehab facility afterward”

FACT: A small percentage of our patients may prefer to recover in a rehabilitation facility, either because their health concerns may require more monitored care, or because they wouldn’t have sufficient help around their home. However, most patients will do their full recovery at home.

Medical Missions

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Dr. Jackson and Steve Spry go to El Salvador

The week of January 21-29, Dr. Jackson and his nurse, Steve Spry went on a medical missions trip to El Salvador with Calvary Lutheran Church. The team set up medical clinics, built swing sets, and provided crafts for children.

In total, they traveled with a team of locals to six different locations and saw 100-200 patients each day in their clinic.

“The people of El Salvador were extremely grateful and made us feel at home, wherever we went,” said Dr. Jackson, who has traveled to El Salvador several times over the years. “I am so thankful to be a part of MCJR, where serving people all over the world is a primary and fundamental focus.”

Below are some photographs of Dr. Jackson, his wife Denise, Steve Spry, and the beautiful people of El Salvador.

From left: Dr. Jackson, Steve Spry, Denise Jackson

Steve administers a knee steroid injection

Dr. Jackson examines a woman’s knee

Painful Joint Replacement?

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Have you had a joint replacement and it’s been nothing but painful? Is your joint replacement years old and you’re worried it’s worn out?

Just like hips and knees can “go bad” (arthritis) and require a joint replacement, hip and knee implants can “go bad” and need to be redone.  The most common reasons for revision surgery include infection, fracture (broken bone) around the implant, and loosening of the implant.  These things can happen soon after a joint replacement or after decades of good function.  When we embark on a joint replacement with a patient we always warn the patient that, unfortunately, there is no such thing as a risk-free surgery.

At Midwest Center for Joint Replacement, our fellowship-trained joint replacement specialists perform revision surgeries all the time – from simple cases to the most complex of the complex. We are happy to meet with any patient who has a painful joint replacement that is performing poorly.  We see patients in our office every week from all parts of the state of Indiana, as well as surrounding states.

If you have a painful joint replacement, your first consultation with us will involve:

> X-rays

> Discussion of the history of the joint

> A physical exam 

> Further testing, such as lab tests, imaging, and testing the fluid from within the joint

We will then discuss whether further surgery is needed. In some cases, more surgery is unlikely to make the problem/pain better.

At MCJR, we believe that prevention is key.  Throughout our website, you can learn how MCJR is making joint replacement less painful through every step of the way, including preventing complications.

Misconceptions about the life of a joint replacement

A common misconception about joint replacement is that the implant will only last about 10-15 years.  This is not the case.  Of all the possible reasons that a joint replacement needs to be revised, the implant wearing out over time (like tread on a tire) is incredibly rare.  We see patients back in the office 25+ years after their knee replacement and the implants have not worn out one bit!  In general, there is >90% chance that your joint replacement will still be performing well 20 years after your surgery.

If you are concerned about your joint replacement pain, please call our office to schedule a consultation! Our office number is 317-455-1064.

Write a Review!

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We love to hear feedback about your experience at MCJR! If you are interested, write surgeon reviews online:

  1. Type your physician’s name in the search box
  2.  Hit “Search”
  3.  Click “Take the Survey” and fill out as appropriate
  4. To read others’ reviews of your doctor, click “Responses” beside the stars

  1. Locate your doctor in the top box search
  2. Click the patient review tab
  3. Click “Write a Review”
  4. To read others’ reviews, click “Read Reviews”


  1. If you have a Facebook, type in “Midwest Center for Joint Replacement” in the search box
  2. Select “Reviews” on the right hand side of our page
  3. Under “Tell people what you think,” select the number of stars you think MCJR deserves
  4. Once you select the stars, a box will pop up for you to write a review

Want to read or write surgeon reviews right now?

Find your surgeon and select the website below:

Dr. Michael Berend                                         

write a surgeon review




Dr. Wesley Lackey

write a surgeon review




Dr. Richard Jackson




Dr. Joshua Carter



Video: Watch an Anterior Hip Replacement

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Anterior Approach to Hip Replacement

We provide the direct anterior approach (DAA) to the hip replacement here at MCJR. The DAA involves going around the muscles of the hip instead of splitting through them. Because of this, your hip is less likely to be dislocated and the recovery is less painful. Therefore, the DAA typically allows for a faster and smoother recovery than a traditional hip replacement. Dr. Joshua Carter and Dr. Wesley Lackey specialize in this approach. You can learn more about the anterior approach here.

Watch the Surgery:

Rotator Cuff Tears and Repairs

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What is the rotator cuff?

The rotator cuff is comprised of four muscles – the subscapularis, the supraspinatus, the teres minor, and the infraspinatus – that combine to form a “cuff” over the upper end of the arm, or the humerus. These muscles are what lift and rotate the arm and stabilize the ball of the shoulder within the joint.


How will I know I tore my rotator cuff?

The pain of a rotator cuff tear is usually in front of your shoulder that continues down the side of your arm. Because of this pain, it may be difficult to raise your arm overhead, comb your hair, or reach behind your back. Your arm may feel weaker and you may be awakened by pain, especially if you sleep on the affected side.

The two main causes of rotator cuff tears are injury and degeneration. Most tears are caused by the natural wearing down of your tendons. However, if you are an athlete who uses your arms in repetitive motions, such as a baseball pitcher, tennis player, or swimmer, you are more likely to have a rotator cuff injury. Some occupations may make you more at risk as well, including construction jobs, painting, and manual labor.

Rotator cuff tears are more common in the dominant arm.

When should I see a doctor?

Rotator cuff tears can worsen or extend over time, especially if you continue to move your arm in the same motions that tore your cuff in the first place without being treated.

If you have chronic pain in your arm, it is best to get it checked out by an orthopedic surgeon. Your doctor may order further diagnostic study, including x-rays and MRIs, to determine the best treatment options. Early diagnosis and treatment of a tear may prevent a permanent loss of motion and loss of strength.

Small rotator cuff tears may be treated non-surgically with anti-inflammatory medications, steroid injections, and physical therapy. These treatment options can relieve pain and restore strength in the other areas of your arm so you don’t strain your rotator cuff. However, larger rotator cuff tears cannot heal on their own and will very likely require surgery. If you are very active or have to lift your arms overhead often because of your job or your sport, surgery may be the best option.

There are several different surgical options, depending on the severity of your cuff tear. You will have to consult with a surgeon to determine which surgery would be most effective for you. You may simply need an arthroscopic surgery. The surgeon creates a small incision and repairs the tear through a camera. This option is relatively pain-free. However, if your tear is more extensive, you may need a traditional rotator cuff repair surgery, or open tendon repair. In this surgery, your surgeon reattaches the damaged tendon to the bone. This option requires a larger incision and the recovery time will be longer than that of an arthroscopic surgery.


One of the most important aspects of treating a rotator cuff tear is the rehabilitation after your surgery. Physical therapy will greatly increase your strength and improve your shoulder’s function after surgery. If you avoid physical therapy, your shoulder will lose motion and strength and could make you more susceptible to future injury.

If you wish to watch animated videos of these surgeries, check out this page on Mayo Clinic.

Dr. Richard Jackson specializes in shoulder surgeries and treatments. If you are suffering from shoulder pain, call our office to schedule a consultation! 317-455-1064.

Early Symptoms of Knee Arthritis

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If you’ve been having pain in your knees, but aren’t sure if it’s connected to arthritis, check for these warning signs:

  • Increase in pain

    • You may have a gradual increase in pain, especially in the morning or after a period of inactivity. Some people experience pain when they move from a standing to a sitting position, when they kneel, or even when they are simply sitting down. Climbing stairs becomes especially difficult if you have osteoarthritis. More severe osteoarthritis will likely wake you in your sleep.
  • Swelling and Warmth

    • You may experience swelling or warmth when you first wake up or if you’ve been sitting for a long time. Swelling in the knee occurs when bone spurs (osteophytes) form as the cartilage in your knee breaks down, or when too much fluid builds up in the knee. If your osteoarthritis is mild, the swelling can often be aided by anti-inflammatories.
  • Stiffness and Locking

    • Osteoarthritis will weaken the muscles in your knee, which can cause your knee to give way or lock up. The joint may lock up so you can’t easily bend it or straighten it on command.
  • Creaking or popping sounds upon bending

    • Your knees may feel like they’re grinding as you move, and you may hear cracking or popping sounds. These sounds usually occur in arthritic knees because smooth cartilage has worn down and your bones rub together. The wearing down of cartilage can develop bone spurs.

If you are beginning to experience these symptoms, but aren’t ready for surgical intervention, you can try to combat these symptoms with anti-inflammatories, heat on stiff joints, ice packs on swollen joints, and physical therapy. If you would like your knees to get checked out by a doctor, please call our office to schedule a consultation at 317-455-1064.



Aging Athletes: Exercise With or Without Joint Replacement

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Baby boomers were the first American generation to make daily exercise a priority. Today, many aging athletes are defying the myth that you have to stop playing your favorite sport as you age. However, as much as they hate to admit, their aging bodies are not as elastic as they once were, and previous athletic injuries may catch up with them as they age. Decline in athletic performance accelerates after the age of 60, and recovery times from injuries increase.

Musculoskeletal conditions and injuries are very common in aging athletes, including muscle strains, tendinopathy (rotator cuff tears, Achilles tendon tears, etc), meniscal tears with osteoarthritis in the knees, or worse – fractures.

As you age, it is very important that you listen to your body and treat your aches and pains with care.


What are some tips for preventing injury?

-Stretch, warm up, and cool down. The importance of stretching increases as you age. Stretching and proper warm-up and cool-down exercises will prevent injury and will keep your body nimble.

Avoid abruptly changing your exercise activity level or regimen.

-Allow for adequate recovery time for your body. Don’t do too much at once because your body takes longer to adjust to change.

-Cross-train: Alternate your exercise routines so that you strengthen different muscles. This will help you avoid overuse injuries.

-Invest in some good, supportive shoes.

R.I.C.E: Rest, Ice, Compression, Elevation. This regimen is important for people of all ages who struggle with athletic aches and pains.

What about athletes who need joint replacement?

Aging athletes can have joint replacement and still be active. In fact, they should definitely remain active! Although some people may be able to return to hard-impact sports like tennis, jogging, and rock-climbing, surgeons recommend that post-replacement athletes should consider lower impact exercise. This includes swimming, cycling, yoga, or the elliptical. Generally, the American Academy of Orthopedic Surgery (AAOS) does not recommend running after a total knee replacement. However, some partial knee replacement patients have been able to return to running. Modern total joints are proving to hold up to hard-impact sports fairly well, but every case is different. If you have a total joint replacement and are eager to get back to the activity level you crave, please speak with your surgeon about possibilities.


Managing Diabetes and Osteoarthritis

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Managing Diabetes and Osteoarthritis

Although diabetes and osteoarthritis are independent conditions, they have been known to aggravate one another. It can be more difficult to manage your osteoarthritis pain when you have diabetes because your internal systems don’t operate as efficiently. However, controlling your osteoarthritis will in turn help stabilize your diabetes, and vice versa.

Fragile and fluctuating blood sugar levels cause both type 1 and type 2 diabetes because your body doesn’t use insulin properly.

People with type 2 diabetes are more likely to develop osteoarthritis, but it is usually because of excess weight – not directly because of fluctuating blood sugar levels. However, once you have osteoarthritis, your diabetes can make the pain worse. Osteoarthritis inflames your joints, and fluctuating blood sugar levels can make the pain and swelling in your joints worse.


An anti-inflammatory, low glycemic diet is one of the best ways to control your diabetes and arthritis. Some of the best foods to eat are oatmeal, whole grains, nuts, most fruits, skim milk, and vegetables.  Many low-glycemic foods also help fight inflammation in your joints.

Keep away from high-glycemic foods including high-carb foods, fried food, pretzels, and sugar-sweetened drinks. Try to stay away from highly processed and packaged foods, as many of these foods contain a large amount of sugar.

If you believe you are a candidate for joint replacement surgery and you have diabetes, make sure you do the following before surgery:

  1. Eat low glycemic food
  2. Monitor your blood sugar levels carefully
  3. Take the medications prescribed to you
  4. Check with your doctor about potential risks
  5. Be sure to continue physical activity, even if your arthritis makes that more difficult. Physical activity helps lower your blood pressure, your risk for heart disease, and reduce the pain and stiffness of arthritis.

It is very important to keep your muscles strong if you have both arthritis and diabetes; weakened muscles can lead to weakened bone health. Diabetics may be more likely to have complications with osteoarthritis and joint replacements, and recovery time usually takes longer, but it is definitely manageable!

If you are interested in having a joint replacement, please call our office for more information. We are here to help and want your journey to recovery to be as painless as possible!

Office #: 317.455.1064