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Linda feels great after pickleball fall led to trauma surgery

Linda Canfield never thought that her first attempt at playing pickleball would end with a 90-mile ambulance ride to UW Health University Hospital in Madison, Wisconsin, followed by an orthopedic trauma surgery the next day.

In August 2022, the St. Paul, Minnesota resident, two college friends, and their husbands ventured to Galena, Illinois for a summer weekend getaway. On that hot Saturday afternoon, Linda, then 64, decided to give pickleball a try. With paddles in hand, Linda, one friend, and her husband began hitting the ball around the court.

“We were almost finished, and I remember running laterally across the court,” Linda recalled. “My legs got awkwardly wrapped around each other, and in an instant, I fell to the ground. I heard a pop and knew right away that I had broken something, and it was probably my hip.”

Unable to move, Linda lay on the court while friends called 911.

“I remember the siren blowing as I was lying there in pain, sweating and swearing to myself,” Linda said. “The court surface was scorching hot. The EMTs were asking lots of questions so they could decide what to do before moving me.”

Eventually, the crew safely moved Linda into the ambulance before taking her to the local hospital. X-rays would show that the break was not a simple one. Linda would need to go to a larger hospital with greater orthopedic expertise. The next closest larger hospital was 15 miles away in Dubuque, Iowa, but it was full.

Husband advocated for UW Health

Linda’s husband, Jim Thornton, who earned his master’s degree at UW–Madison, strongly urged the EMT crew to transport Linda to UW Health in Madison..”

“I just felt in my heart that with all of the good surgeons there and Madison being a leading trauma center, UW would be the best place,” Jim recalled.

As Linda’s ambulance departed for Madison, Jim followed behind in his car; they arrived at University Hospital early that evening. Surgery to repair Linda’s bone break took place the following day.

“I remember the orthopedic surgical team preparing me. They all made me feel I was in very capable hands,” Linda said. “They even asked me what kind of music I liked, so after I told them, they put some Carrie Underwood on.”

A native of Rochester, Minnesota, Linda recalled talking to her mother on the phone from her hospital bed in Madison.

“My 90-year-old mother still lives in Rochester and suggested that I come to the Mayo Clinic,” Linda said. “Of course, I was in no position at this point to come to Rochester. I told my mom that my UW Health surgeon was named Dr. Paul Whiting and she Googled him.

“After she discovered that Dr. Whiting went to Harvard Medical School, she was satisfied that I was in good hands,” Linda said. “Dr. Whiting got a big laugh out of that story.

Fracture was just below the hip 

While casually described as a broken hip, Linda actually broke the uppermost portion of her left femur, the bone that runs straight from the knee to the hip. Surgeons call her break a subtrochanteric femur fracture.

“Linda was fortunate that the hip joint itself was not broken, so she was able to keep her native hip,” said Dr. Whiting.

“We repaired Linda’s fracture by making an incision and inserting a 15-inch titanium rod inside the hollow part of the femur,” said Dr. Whiting. “We secured the rod, which is about one-half inch thick, with screws above and below the fracture. This provides rotational stability and durability while the fracture heals. Because the rod is placed inside the bone, patients generally don’t experience any hardware irritation.”

Although the natural healing process is not complete until three to six months after surgery, patients with Linda’s type of repair can bear full weight on the leg right away because this type of surgical construct provides such excellent stability. After five nights in the hospital, Linda was discharged to go home.

Grateful for so many caring experts

Linda and Jim appreciated everyone involved in her care, including Dr. Whiting, the orthopedic nurses, physical therapists, and other staff.

“I was so impressed with everyone, from Dr. Whiting, who was so personable, to the fellow who cleaned my room to the person who brought my food tray,” Linda said. “A lot of folks complain about this or that when they’re in the hospital, but I think it’s important to thank all of these kind people who do such a great job.”

Knowing that Linda would prefer to receive follow-up care close to home, Dr. Whiting referred her to a St. Paul-based orthopedic trauma surgeon who had done his residency at UW Health.

“By six months after surgery, I was feeling like my old self,” Linda said. “Last year, we traveled to Hawaii, Texas, Olympic National Park in Washington State, and Europe, where I walked up hills and on uneven sidewalks. Some of my companions even had a hard time keeping up with me.”

For Dr. Whiting and his team, people like Linda are exactly why they do what they do.

“With our extensive experience, training, and the latest technology, our goal at UW Health is to help our patients get back to doing the things they enjoy, whether it’s playing pickleball, tennis, running, or walking,” said Dr. Whiting. “When we can achieve that, we’ve hit a home run.



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Susan comes full-circle for her knee replacement at UW Health

Since she was a little girl, Susan Cowles had good reason to suspect that her knees may one day need medical attention. She was grateful for seven pain-free decades, but by her early 70s, a knee replacement became imminent.

Now 74, Susan was born with an extremely rare skeletal abnormality known as Schmid Metaphyseal Chondrodysplasia. It is typically characterized by short stature and a waddling gait.

As a child, Susan and her parents frequently traveled to Madison so she could receive care from UW specialists. While she built a life and career in medical social work in Milwaukee, Susan returned to Madison for care once again as an adult more than six decades later.

Susan as a young girl

Aside from her 4’5” stature and short, bowed legs, little else has gotten in Susan’s way. Once she reached her early 70s, however, Susan began experiencing serious knee arthritis.

“Genu Varum or ‘bowed legs’ is a common deformity with patients who have Schmid Metaphyseal Chondrodysplasia,” says Dr. Brian Nickel, Susan’s UW Health orthopedic surgeon. “Because Susan’s legs were not straight, extra pressure continued to mount, especially on the inside of her right knee,” he adds. “Her resiliency allowed her knees to last until her early 70s before the pain got bad enough on her right side to make her a candidate for a total knee replacement.”

Dr. Nickel, whose training included a fellowship at the #1 ranked Hospital for Special Surgery in New York City, has performed thousands of knee and hip replacements throughout his six years at UW Health. Susan’s case, he says, required far more preparation and planning than a more conventional patient would need.

Dr. Nickel’s most challenging knee surgery

“Every step of Susan’s surgery was different because of her short stature,” Dr. Nickel says. “This was the most challenging surgery I have done on a first-time knee replacement patient. At UW Health, one of the advantages for patients like Susan is that our team has frequent experience with complex cases. Not only do we provide the highest ranked care in the state for orthopedic surgery, but we also know how to deal with the so-called curve balls. This makes it all the more fulfilling to help patients like Susan get back to living a better life.”

Now with her surgery several months behind her, Susan is back to walking a mile every day supplemented with plenty of yoga stretching. She is incredibly pleased with her outcome.

Making Susan’s story even more compelling is the amount of time since she first traveled to Madison for care. Some 65 years ago, Susan’s parents were having a hard time getting answers about their daughter’s short stature.

“I was misdiagnosed twice as a child, leaving my parents stumped and discouraged,” Susan says. “Finally when I was about 9, our family doctor arranged for me to see a pediatric specialist at UW-Madison named David W. Smith.”

Dr. David Smith joined the UW faculty not long after the creation of the Department of Pediatrics in 1957. Although he would leave Madison within a decade, Dr. Smith would come to be known as a pioneer in the field of dysmorphology — the study of birth defects including growth abnormalities such as Susan’s.

Falling in love with Madison from an early age

“I just loved coming to Madison with my parents,” Susan says. “We would always make a day of it and spend time exploring the university campus. I remember thinking how much I wanted to go to college there, but coming from a strong Catholic family, my parents preferred that I go to a Catholic university in Milwaukee. I never lost my love for Madison, however.”

While being seen by Dr. Smith and a young doctor-in-training named Arlan Rosenbloom, Susan joined a trailblazing medical study that would lead to the establishment of Schmid Metaphyseal Chondrodysplasia as a unique form of inherited dwarfism. Because the field of genetics was in its infancy in the 1960s, Dr. Smith’s study, published in the Journal of Pediatrics in 1965, would later emerge as a seminal piece of clinical research.

“Dr. Smith and I drove across Wisconsin meeting with about two dozen children like Susan and their families,” recalls, Dr. Rosenbloom, the 89-year-old nationally distinguished expert in growth abnormalities. “We learned that the cells at the end of the shorter bones in these kids were disorganized, which disrupted the normal growth process.”

Fast forward to 2022, when the pain in Susan’s right knee was making life difficult.

“An orthopedic surgeon in Milwaukee asked me to have DNA testing to confirm that I truly had the Schmid form of metaphyseal dysplasia,” Susan says. “I started by calling a local genetics department but nobody called me back for two weeks. So I Googled the Genetics Department at UW. A genetics counselor named Peggy Modaff answered her phone directly and listened to my story.”

UW genetics counselor connected Susan with Dr. Nickel

Not only did Peggy send Susan the DNA test kit right away — the test confirmed Susan’s original Schmid diagnosis — but later Peggy provided Susan with recommendations for UW Health orthopedic surgeons.

“Peggy sent me the names of two UW orthopedic surgeons and one of those was Dr. Brian Nickel,” Susan says. “That’s how I first connected with him, so thanks to Peggy and her fast response, I was on my way.”

Peggy’s immediate willingness to listen to Susan’s phone call and then act swiftly left Susan extremely impressed.

“So many people say they’ll get back to you and never do,” Susan says. “Peggy was absolutely fabulous.”

Loving life and feeling free from debilitating knee pain, Susan is amazed at her good fortune, especially with two UW Health encounters spanning more than six decades.

“Everything good to me happens at UW,” she says.

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Andy North is hitting the links of life after hip replacement

Madison native and two-time U.S. Open golf champion Andy North had plenty of options when he finally decided that he couldn’t put off hip replacement surgery any longer.

“I’ve had about 15 surgeries over the past 50 years, mostly sports-related, for my neck, my back, my knees and elbow,” North says.

Over the past few years, however, there was still a part of North’s body that was crying out for help — his left hip.

“By early 2022, I knew I needed to get it taken care of,” says North, 72. “It had been getting worse for the past 5 years and I couldn’t swing a golf club the way I wanted to,” North says. “I couldn’t exercise normally. There were some days it bothered me tremendously, but I was stubborn and just put up with it longer than I should have.”

Although North travelled to places such as Vail, Colorado and Reno, Nevada for some of his surgeries, it didn’t take him long to discover that the best place to have a hip replacement done was in his own backyard — at UW Health. He sat down with Dr. Brian Nickel, a leading joint replacement orthopedic surgeon, in May 2022.

“After I met with Dr. Nickel,” North says, “I felt very comfortable moving ahead. His reputation and track record are very solid and he does hip and knee replacements all the time. You don’t want a guy who does one or two of these a month.”

North also appreciated the convenience of having everything done at UW Health East Madison Hospital, just 30 minutes from his Madison home.

“I didn’t want to get on a plane to get this done, and clearly there was no reason to with the reputation of UW Health’s orthopedic program.”

Nickel, who performs between 700 and 800 joint replacement surgeries a year, checked all the boxes for North, as did the entire Orthopedics team, which is ranked as the best in Wisconsin and “high performing” nationally by U.S. News & World Report.

After talking with Nickel, North knew it was time to move forward. With a busy schedule due to his ESPN golf broadcasting travels, North scheduled the operation for mid-July when his calendar lightened up.

Home the same day

“Andy did great,” Nickel said. “He came in early in the morning and things went very well. He was up and walking about two hours after we finished up the surgery and by early afternoon, Andy was already home.”

Having been through so many operations, North knew what to expect in terms of recovery.

“It’s important to start doing the rehab work before surgery,” North says. “That really helps get the body ready for rehabbing once you get home. I used a walker for about a week. I was eager to get on with my life so I started by walking the halls of my building as much as five times a day. I’m also not a big pain med guy so I was able to manage with Tylenol.”

After a month or so, he was walking throughout his neighborhood and feeling more like himself. On the same day of his 4-week checkup, he hit about 30 golf balls to test his swing. About 10 days later, he met a friend for a little “chip and putt” session, or so he thought.

“I tried a couple long shots and ended up playing 27 holes that day, walking 20,000 steps along the way,” North says. “I was totally worn out and was sore everywhere…well, everywhere except my hip, which felt great.”

As more time passed, North continued to feel better than he had in years. He was doing anything he wanted three months after surgery.

For those who may be putting off hip replacement because they think their active days are over, Nickel has plenty of encouragement.

“You don’t have to be a pro golfer like Andy to have similar results,” Nickel says. “Whether you’re a golfer, pickleball player, gardener or whatever your favorite activity, the majority of people can resume the active life they used to enjoy just two or three months after surgery.”

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Partial knee replacement gets Dr. Kunstman up and running again

Dave Kunstman is a busy guy. A Family Medicine doctor who also serves as the interim Chief Medical Officer for UW Health, Dave cherishes physical activity as a way to stay healthy while clearing his mind.

“A 15- or 20-minute run makes my day,” Kunstman says. “It allows me to shut everything else out for a brief time, which is really helpful. It is a mindfulness practice for me.”

In early 2021, Dave, then 53, began experiencing pain in his left knee during his ritual runs. Before he knew it, he had to stop running and get it checked out. An imaging procedure revealed bone-on-bone osteoarthritis in the medial portion, or inside half, of the knee. Physical therapy didn’t help. He even tried acupuncture, which didn’t do much either.

Eventually, the UW Health Sports Medicine team referred Dave to Dr. Brian Nickel, a UW Health orthopedic surgeon who recommended a partial knee replacement.

“The beauty of a partial knee replacement is that we only replace the damaged portion of the knee, rather than the entire knee,” Nickel says. “If only one of the three sections of the knee is damaged, a patient might be a candidate for a partial, however many people do not qualify because too much of their knee has deteriorated. As a young patient with all knee ligaments intact and damage confined to one area, Dave was a good candidate for a partial replacement.”

Faster recovery

Not only do patients recover faster from partial (versus total) knee replacements, Nickel says, but satisfaction is often greater because existing healthy tissue and bone are preserved. This usually results in greater range of motion and knee function. The only downside, he says, is that partial knee replacements fail at a slightly higher rate than total knee replacements — about 3 percent per year versus 1 percent per year.

Like several of his primary care colleagues, Dave wasn’t all that familiar with partial knee replacements.

“A partial knee replacement is actually more technically challenging than a total knee,” says Nickel, who performs about 400 knee replacements a year, about 10 percent of which are partial replacements.

Confident in Nickel’s experience and track record of excellent outcomes, Dave decided to move forward. A surgery date was set for late June 2022.

“I arrived at 6 a.m. and was on my way home by noon,” Dave says. “I was up and around with crutches that same day. After 3 days, I was walking without crutches. Within 3 weeks, I started biking, hiking, and swimming. There was some temporary surgical pain that everyone has, but the pain from the knee arthritis was entirely gone.”

Two months following surgery, Dave began preparing to resume his beloved running routine, guided by a back-to-running program from UW Health Sports Medicine therapists.

Long wait for total knee replacement averted

“The difference is pretty remarkable,” he says. “I know I may need to have a total knee replacement down the road, but it might not be for at least another 12 to 15 years. Having the partial knee replacement right away saved me from spending at least another 10 years missing out on running while waiting for my knee to get bad enough to need the full replacement.”

By telling his story, Dave also hopes more primary care doctors will appreciate what a valuable option partial knee replacements can be for their own patients.

“When I came back to work and people asked me about it, quite a few were not aware that partial knee replacements were a thing,” Dave says. “Hopefully, my experience will result in many other patients exploring this as an option for themselves. I have nothing but great things to say about my experience.”


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Joseph Mitchell, MD, joins the UW Department of Orthopedics and Rehabilitation

Joseph Mitchell, MD, joined the Department of Orthopedics and Rehabilitation at the University of Wisconsin School of Medicine and Public Health on May 1, 2022. Originally from Milwaukee, Wisconsin, Dr. Mitchell earned his BS in Biology from the University of Wisconsin-Parkside. He then completed medical school and residency at the University of Wisconsin School of Medicine and Public Health. Following his residency, Dr. Mitchell went on to fellowship for one year at the University of California-San Diego, where he broadened and further honed his joint replacement skills.

After completing his fellowship, Dr. Mitchell practiced with Aurora Orthopedics in Sheboygan, WI. However, not long after he had begun to practice outside of academics, Dr. Mitchell discovered that he missed the curiosity and engagement of the medical students, residents, and fellows he had worked with throughout residency and fellowship.

Thus, when he learned of an opening for a joint replacement specialist in our department, he was thrilled at this opportunity to return to what he feels is his “medical home.”

An orthopedic surgeon specializing in adult reconstruction of the hip and knee, Dr. Mitchell is highly skilled in both primary and revision hip and knee replacement surgery. He has specific expertise using the anterior approach for hip replacement – a technique known to have a steep learning curve. Dr. Mitchell has performed over 800 joint replacements, using the anterior approach in many of these cases. In fact, because of his extensive training and experience – and because this approach expedites patient recovery by as much as three months, according to some studies – Dr. Mitchell uses this technique almost exclusively when performing a hip replacement.

Also certified to do robotic knee and hip replacement, Dr. Mitchell is trained in patient-specific instrumentation, or patient-specific implants, using their own anatomy to create the ultimate implants that are used.

Reflective of his goals and passions, Dr. Mitchell’s research interests include comparing the advantages of anterior approach hip replacement vs. the traditional posterior approach. He is also investigating the use of robotic navigation vs. traditional instruments (manual instrumentation) to determine if computer navigation makes a difference in patient outcomes. In addition, he plans to both study and work toward increasing diversity within the orthopedic field.

The factor that initially drew Dr. Mitchell to the orthopedics specialty – and why he is so passionate about both practicing and teaching in the field today – is that “more than any other specialty, orthopedics enables a physician to quickly improve a person’s quality of life with a short procedure.”

“What really drives me is knowing that, although the surgical procedure itself is the same every time, for that individual, you are putting them back to a place they were 10, 15, maybe 20 years ago, in terms of their mobility and their quality of life. You give them back their ability to get out and just enjoy the things they enjoy doing. Seeing those patients at follow up and having them do very well, that is what motivates me to keep doing what I’m doing.”


June 13, 2022