Esquivel v. Illinois Workers’ Compensation Commission

by Chris Rocks on June 17, 2010

Editor’s comment: We feel the Appellate Court majority correctly affirmed the Circuit Court ruling that claimant’s failure to comply with the requirements of section 19(f)(1) of the Workers’ Compensation Act (Act) resulted in a lack of subject matter jurisdiction to consider the appeal. Our only complaint is how long it takes for an unquestionably defective appeal to end.

In Esquivel v. Illinois Workers’ Compensation Commission, Claimant appealed the judgment of the Circuit Court dismissing with prejudice his petition for administrative review. Claimant’s Application for Adjustment of Claim with the IWCC was filed December 2, 2002. A hearing according to section 19(b) of the Act was held on August 18, 2006 where the Arbitrator ordered the employer to pay medical expenses and 104 weeks of TTD benefits for certain periods up to August 29, 2005. The Arbitrator denied Claimant’s request for benefits from the date of August 30, 2005 through the date of hearing.

Claimant sought to appeal this decision and filed a timely petition for review with the Commission. On March 11, 2008, the Commission issued a decision affirming the decision of the Arbitrator and fixed the probable cost of the record at $35. Claimant received the Commission’s decision on March 24, 2008. On April 9, 2008, Claimant filed in the Circuit Court a petition for administrative review, a request to the Circuit Court clerk to issue summons to the Commission and the parties of record, and a certificate of mailing of the summons to the Commission. Oooops–there is nothing in the record indicating Claimant or his counsel tendered a receipt as proof of payment of the probable cost of the record or an attorney affidavit stating the same had been paid to the Commission.

The clerk of the Circuit Court issued the summons and they were delivered on April 14, 2008. On August 22, 2008, Respondent’s counsel filed a motion to dismiss on the basis the Circuit Court lacked subject matter jurisdiction because Claimant did not strictly comply with the requirements of section 19(f)(1) of the Act. Specifically, Respondent asserted Claimant failed to file a notice of payment of the probable cost of the record or an affidavit of his attorney stating that payment had been made.

Claimant countered by attempting to file an affidavit instanter on October 28, 2008. The affidavit stated a check made payable to the Commission in the sum of $35 was mailed on April 8, 2008 and a copy of the check was attached.

Upon review, the Circuit Court dismissed Claimant’s petition with prejudice. It stated filing of a receipt or an affidavit showing payment to the Commission of the probable cost of the record is a condition precedent to the vesting of subject matter jurisdiction in the Circuit Court and because Claimant failed to satisfy this precondition jurisdiction did not exist.

Claimant appealed the ruling. The Appellate Court began its analysis by stating the Circuit Court exercises special statutory jurisdiction in workers’ compensation proceedings and such jurisdiction is present only if the appellant complies with the statutorily mandated procedures set forth.

Section 19(f)(1) of the Act states in relevant part:

A proceeding for review shall be commenced within 20 days of the receipt of notice of the decision of the Commission. The summons shall be issued by the clerk of such court upon written request returnable on a designated return day, not less than 10 or more than 60 days from the date of issuance thereof, and the written request shall contain the last known address of other parties in interest and their attorneys of record who are to be served by summons.

In its decision on review the Commission shall determine in each particular case the amount of the probable cost of the record to be filed as a part of the summons in that case and no request for a summons may be filed and no summons shall issue unless the party seeking to review the decision of the Commission shall exhibit to the clerk of the Circuit Court proof of payment by filing a receipt showing payment or an affidavit of the attorney setting forth that payment has been made of the sums so determined to the Secretary or Assistant Secretary of the Commission, except as otherwise provided by Section 20 of this Act.

820 ILCS 305/19(f)(1) (West 2006). (Emphasis added).

The Appellate Court majority reasoned that, in order to perfect jurisdiction on appeal, an appellant must file the written request within 20 days and also exhibit to the clerk of the circuit court, within the same time frame, either a receipt showing payment of the cost of the record or an affidavit of an attorney setting forth that such payment has been made to the Commission. In the present case, there is no indication that within the statutory 20 day period Claimant exhibited such documentation showing proof of payment. It wasn’t until over six months later that Claimant sought to file an affidavit of his attorney. Thus, the statutory requirements had not been met and the Court affirmed the judgment of the circuit court which dismissed with prejudice Claimant’s appeal from the Commission.

In our view, this Court made the correct decision when it recognized that the failure to satisfy each and every statutory requirement will result in a lack of subject matter jurisdiction. However, it should be noted this was a 3-2 decision with two justices outlining their belief the material provisions of section 19(f)(1) were satisfied by Claimant.

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civil litigation services for the defense of 
self-insured employers and insurance carriers.

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Dealing With Unpaid Medical Bills Under the Illinois Workers’ Compensation System

by Chris Rocks on June 15, 2010

Editor’s comment: There is a clear path for submission of medical bills in this state and we want medical providers and other observers to start to think about following it. The Illinois Workers’ Compensation Act contemplates medical bills for care incurred which the patient claims are reasonable, necessary and related to the work injury be submitted to the insurance carrier/TPA who is assigned the adjustment of the claim, whether it is accepted or disputed.

We suggest the parties on both sides of this problem, both the medical provider and the insurance carrier/TPA have HIPAA-compliant releases that should outline the proper federal medical privacy standards. If you need a HIPAA-compliant release, send a reply and we will forward it. We do not recommend anyone rely on the supposed “workers’ compensation exception” to HIPAA—it is too unreliable.

How do you find out the injury/disability claim and related medical treatment is being made under workers’ compensation? Ask the patient.

Once the patient advises you of that fact, the next inquiry is the name and address of the employer. If you have the name and address of the employer, you may be able to do several things toward getting bills submitted for processing. First, ask the employee to look at the state-required notice posted in their workplace in relation to workers’ compensation—ask them to look at the bottom and get the name/address of the workers’ compensation carrier. Second, you can call and/or send the bills to the risk manager at the patient’s employer and ask them to submit them. Third, you can call and ask the name/address of the employer’s workers’ compensation carrier or TPA. Fourth, you can check the Illinois Workers’ Compensation Commission’s website for the name and address of the carrier—if you need help navigating that site to obtain the needed information, send a reply and we will point you in the right cyberdirection.

Next, be sure you submit the medical bills to the employer or insurance carrier in the proper form with proper documentation. In order to reconcile bills to the Illinois medical fee schedule they are needed in HCFA1500 form. In order to expedite the process we always ask for any medical bills from any provider to be in this form to save lots and lots of work later. We have a paralegal that has a medical bill payer background and can price and process Illinois WC medical bills but still needs the billing on this form.

What is supposed to happen following proper submission? Well, Rule 7110.70 of the Illinois Rules Governing Practice indicates they are supposed to pay the bills or tell you why they aren’t.

The Rule states (in part):

When an employer denies liability for payment of the cost of all or a part of an employee’s medical care, or initially accepts liability but subsequently declines further responsibility for providing or paying for all or a part of such care (for any reason including but not limited to the necessity or propriety of the care, or continuing care, or the unreasonableness of the cost of care), the employer shall promptly notify the employee with a written explanation of the basis for the denial of liability or further responsibility.

e) Failure by either party to comply with the provisions of subsection (a), (b), (c) or (d) of this Section, without good and just cause, shall be considered by the Commission or an Arbitrator when adjudicating a petition for additional compensation pursuant to Section 19(l) of the Act, or a petition for assessment of attorneys’ fees and costs pursuant to Section 16 of the Act.

Again, if they accept the bill and pay it, you are good to go. What do you do if they fight it, ignore you or deny it?

Well, you need to remain diligent. If the matter is disputed by the employer, the applicable rule states:

When there is a dispute over the compensability of or amount of payment for a procedure, treatment, or service, and a case is pending or proceeding before an Arbitrator or the Commission, the provider may mail the employee reminders that the employee will be responsible for payment of any procedure, treatment or service rendered by the provider. The reminders must state that they are not bills, to the extent practicable include itemized information, and state that the employee need not pay until such time as the provider is permitted to resume collection efforts under this Section. The reminders shall not be provided to any credit rating agency. The reminders may request that the employee furnish the provider with information about the proceeding under this Act, such as the file number, names of parties, and status of the case. If an employee fails to respond to such request for information or fails to furnish the information requested within 90 days of the date of the reminder, the provider is entitled to resume any and all efforts to collect payment from the employee for the services rendered to the employee and the employee shall be responsible for payment of any outstanding bills for a procedure, treatment, or service rendered by a provider.

Sounds simple, doesn’t it? In layman’s terms, keep sending notices consistent with the law.

What does a medical bill provider do if you find out the claim has settled and you haven’t been paid? Well, our rule is pretty simple. If the insurance carrier/TPA knew about either the medical bill or treatment, it needed to have been addressed at the time of settlement as accepted or disputed. You should have the documentation listed above to be able to demonstrate to the insurance carrier/TPA and counsels for both sides of your efforts to make them aware and keep them aware of your interest in the claim. If the only notice of the bill was to the patient/employee, you may have a problem.

If the insurance carrier/TPA can demonstrate a complete lack of knowledge of a medical bill or course of medical care prior to settlement of the claim, we find it difficult to believe they would be held responsible for it and our typical recommendation is to deny the claim.

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Eugene F. Keefe, Michael J. Danielewicz, John P. 
Campbell, Joseph R. Needham and Shawn R. Biery with 
the goal of providing high-quality and cost-effective 
civil litigation services for the defense of 
self-insured employers and insurance carriers.

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Event: 12th Annual Chicago Trauma Symposium

by Chris Rocks on June 11, 2010

Title: 12th Annual Chicago Trauma Symposium
Location: Palmer House Hilton | Chicago, IL
More Information: Click here
Date & Time: August 5th – August 8th 2010

Description: The Chicago Trauma Symposium is designed to provide participants with a basis for recognition and modern management of complex trauma and musculoskeletal injuries. The intensive 3-1/2 days of lectures, hands-on workshops and discussion includes ample face-to-face time with colleagues.

Why you should attend the Chicago Trauma Symposium this year:

Some of the “Who’s Who in Orthopaedic Trauma” on faculty will share their expertise in the following areas:

  • Spine
  • Workers’ Compensation
  • Pediatrics
  • Polytrauma & Pelvic Ring
  • Hip & Femur
  • Tibia
  • Upper Extremity & Hand
  • Foot & Ankle
  • Interactive Debates

**30.5 AMA PRA Category 1 Credits & 30.5 CCMC Credits Available

Course Features:

  • Keynote Addresses highlighting:
    • “Orthopaedic Life in Iraq & Afganistan” by Colonel Colin Miller, MD, United States Arm
    • “AAOS Update 2010″ by John Callaghan, MD, AAOS President
    • “Healthcare in the UK” by Denis Calthorpe, FRCSI
  • Specialized Hands-on Workshops offering solutions and techniques for:
    • Spinal Injuries
    • Pediatric Long Bone Fractures
    • Upper Extremity
    • Lower Extremity
  • Learn about new products and services from Exhibitors who are eager to serve your fracture management needs
  • Centrally located in the heart of Chicago’s Loop, the upscale Palmer House Hilton is easily accessible by air, rail or car.  Top restaurants and world-class attractions are within walking distance of the venue.

Questions? Contact:
Tracy Sferra, Course Coordinator
Phone: 1-847-324-3965
Fax: 1-847-929-1183
Email: tracy@drjimenez.com

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Keating v. 68th and Paxton, L.L.C. – Important Ruling For Commercial Property Owners

by Chris Rocks on June 9, 2010

Editor’s comment: In Keating v. 68th and Paxton, L.L.C., claimant was working on a commercial property when he fell and was impaled on a fence. Ouch. Plaintiff filed an amended complaint which alleged the owners and property managers who hired him to work on the property were statutory employers under sections 1 and 3 of the Workers’ Compensation Act and were obligated to provide Plaintiff with the benefits of workers’ compensation insurance. He further alleged Defendants knowingly failed to provide him with such insurance. As a result, he alleged Section 4(d) of the Act permitted him to sue Defendants in circuit court, where proof of his injuries constituted a rebuttable presumption of liability against Defendants.

Defendants then filed a motion to strike those newly added paragraphs pursuant to section 2-615 of the Code of Civil Procedure (Code) (735 ILCS 5/2-615 (West 2006)). Defendants argued the allegations were legally insufficient to invoke section 4(d) of the Workers’ Compensation Act because Plaintiff failed to allege the Workers’ Compensation Commission made the requisite findings that Defendants were statutory employers and they knowingly failed to provide him with the benefits of workers’ comp insurance.

Following a hearing, the circuit court granted both of Defendants’ motions. On the motion to strike, the court found the Illinois Workers’ Compensation Commission had exclusive jurisdiction to determine whether Defendants were statutory employers under the Act and whether they knowingly failed to provide Plaintiff with required insurance.

The Appellate Court, First District ruled the demolition worker’s claims against the owner and managers of the apartment complex on which he was working knowingly failed to provide workers’ compensation insurance in violation of the Workers’ Compensation Act were required to be first presented to the Illinois Workers’ Compensation Commission for hearing before any civil action against Defendants could be filed in circuit court.

The Appellate Court noted allowing an injured worker to bypass the Workers’ Compensation Commission would defy the stated purpose of the Illinois Workers’ Compensation Act. The Court also noted the Illinois legislature demonstrated a clear intent to vest the Commission with primary jurisdiction superior to that of the circuit court with respect to determining the existence of an employee-employer relationship.

As academicians, we agree with this legal outcome. We also caution the owners of all commercial properties that you need to insure anyone working on the property has to have workers’ compensation coverage for their workers and the workers for any contractor or sub-contractor on the job.

This is a ruling of first impression. Please do not hesitate to send your thoughts and comments.

GkeefePost Provided by Gene Keefe of Keefe, Campbell & Associates, LLC. The firm was started by 
Eugene F. Keefe, Michael J. Danielewicz, John P. 
Campbell, Joseph R. Needham and Shawn R. Biery with 
the goal of providing high-quality and cost-effective 
civil litigation services for the defense of 
self-insured employers and insurance carriers.

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Update on Cramer v. IWCC & Viacom Outdoor

by Chris Rocks on June 1, 2010

bowlingAs you may recall, Illinois Workers’ Compensation Commission Panel B upheld denial of benefits determined by the Arbitrator based upon an injury which occurred at an employer sponsored charity bowling event. See previous post here.

Paul Coghlan, from Paul A. Coghlan & Associates, P.C., was kind enough to inform us that the commission has been reversed (on May 27th, 2010) by the Circuit Court of Cook County. To read the full decision, go here.

Paul represented the petitioner in this case and can be reached at 630.887.2922 or by email at pcoghlan (at) pcpclaw (dot) com.

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Jobs: Account Executive for Workers Compensation Medical Bill Review in Naperville, IL

by Chris Rocks on May 19, 2010

Morgan Consulting Resources is an executive search firm focusing on the Healthcare Industry for 15 years. We have extensive experience in bringing together leadership talent with organizations that cover all aspects of Healthcare Services – Providers, Payers and Supporting Service organizations. We have been retained by a workers compensation medical bill review corporation to conduct a search for an Account Executive. This position will be located in Naperville, IL.

This nationwide company was formed in 1995 and have been growing rapidly. By focusing on medical bill review, they are able to leverage their experience and expertise to provide the best possible service and savings for their clients. They utilize the Ingenix PowerTrak system and their clients include insurers, large self-insured employers, TPAs and municipalities.

The Account Executive reports to the President. The department consists of one other Account Executive, an Account Manager and administrative support. Our client is looking for a dynamic individual, focused on business growth and retention. The candidate we seek will be a high energy, enthusiastic sales person with the skills of a competitive self-starter. A track record in achieving significant sales growth and excellent relationship building skills are a must. We are looking for someone with at least 3 years of workers’ compensation sales experience in any one of various sectors including: bill review, care management, PPO, etc.

The company offers a strong salary, commission and benefit package as well as a supportive culture that has led to long term employees in this entrepreneurial environment.

If interested, please contact Rosie Saenz at rosie@morganconsulting.com.

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New Commissioner | Same Old Secrecy

by Chris Rocks on May 18, 2010

Editor’s comment: We were told current Illinois Governor Pat Quinn was a reformer. He has started a number of reform initiatives and actually called for a change to the Illinois constitution mandating what people in other parts of the country call “ethics”—most Illinois politicians don’t understand or use that term much.

What happened at the Workers’ Compensation Commission last week was the same sort of secret, clandestine and under-the-cover shenanigans we have grown so used to from past administrations. We knew Paul Rink; he was a former Commissioner who appeared to have been gently nudged out several months ago. We have been awaiting his successor and now he has been appointed. You may all note the vacancy was not filled with a publicized national or even state-wide search for the best possible candidate—we don’t do things that way in this poorly-run state. Everything is closely guarded, like it is a nuclear secret and if the news gets out about what they do filling a state job, the sky might fall.

Last week, Governor Pat Quinn appointed Daniel R. Donohoo as a Commissioner. You may note the Commissioners sit as administrative appeal officers—there are nine of them. While they haven’t completely figured it out just yet, Commissioner Donohoo may fill the “public” member seat on Panel B and be the swing vote between the labor Commissioner, Barbara Sherman and the employer representative, Kevin Lamborn. Please note they may scramble the three panels but they will be certain to insure two members vote for labor and the management member gets to file lots of dissents.

The Commission has advised new Commissioner Donohoo holds a B.S. degree in Business Administration from Southern Illinois University and a J.D. degree from Thomas M. Cooley Law School. He served as the Madison County Recorder of Deeds for 21 years and operated his own accounting firm for 17 years.

We want everyone to note we don’t know and have never met Commissioner Donohoo. He may turn out to be the best administrative appeal officer in Illinois history. To our knowledge, he isn’t going to fill the bill on what some folks feel would represent “diversity.” From our research, we assure our readers he:

  • Doesn’t have any formal workers’ comp training
  • Doesn’t have a workers’ compensation litigation background
  • Isn’t an associate or partner at a workers’ comp petitioner or defense firm
  • Has never, ever handled a litigated workers’ compensation claim that we can find on the web or elsewhere.

Our research indicates new Commissioner Donohoo graduated from Thomas M. Cooley Law School in Michigan exactly two years ago today on May 17, 2008. We are fairly confident they don’t have a class or even a seminar on Illinois workers’ compensation law and practice in Lansing, MI. The Illinois Attorney Registration and Disciplinary Commission’s website indicates he was licensed to practice law in Illinois November 6, 2008. That is about eighteen months ago, so while he may be a veteran deed-recorder and accountant, he is a complete newbie as a work comp lawyer.

We ask all of our readers, why would they hire someone with absolutely no WC experience to a top-level state job? Whose brother’s-cousin’s-uncle do you have to know to get the nod on that sort of work?

Well from the outside, looking in, we assume Mr. Donohoo is part of the Madison County Insiders—he was the Madison County Recorder of Deeds for more than two decades. He is probably already eligible for a state/county pension when he reaches the right age. If you aren’t aware of it, Madison County is a small, mostly rural county in southern Illinois across the Mighty Mississippi River from St. Louis. Madison County has been repeatedly designated as a “judicial hellhole” for their approach to litigation that comes to this tiny county from all over the United States. Every month for years on end, little Madison County, IL with a population of about 140,000 has a monthly asbestos trial call of about 400 pages—if all those claims were to be tried in a given year, most adults in that county would be on indefinite jury duty. If you ever get to visit the county seat of Edwardsville, you may see what has to be the biggest rural county courthouse in the history of our planet—the place was fully funded with about $90 millions dollars derived from the interest on an appellate bond in the amount of about $600 million dollars on a tobacco verdict later tossed out by the Illinois Supreme Court.

How did Madison County get so prominent in Illinois WC circles? Well, if you go back down memory lane about nine years to 2001-2, our current former-Governor-about-to-be-tried-on-June-3 was locked in a very close three-way primary election battle with Paul Vallas and our current junior U.S. Senator Roland Burris. Rumors are the former Governor made a deal with the Madison County Plaintiffs’ bar that gave him the political edge to win the primary and then the general election. As part of that bargain, we understand the former Governor turned over substantial control of the then-named Illinois Industrial Commission to the Madison County Insiders who quietly changed the name, funding and make-up of the place into a shiny new not-very-diverse Plaintiff-Petitioner-dominated place that has been anathema to Illinois business ever since.

We want to make it clear, the folks brought to the Commission by this group are both honest and outwardly professional and many of them were and are very knowledgeable and ostensibly qualified. We are amazed to see someone move into a second-tier job that completely lacks any true WC background and wonder why he wasn’t started out as staff attorney for a Commissioner to then become an arbitrator and continue to move up. With that in mind, we caution we have no idea, absolutely none, how new Commissioner Donohoo will rule when cases are brought before him. We assume he will learn very rapidly on the job. When he needs help, he can ask the covert, hidden, undisclosed players-not-to-be-named-ever who got him the job. And the observers from Illinois business will continue to sigh and wait for the fall election to see how things go.

And please, everyone remember, the State of Illinois under Pat Quinn still ain’t ready for reform. A vote for Bill Brady will be a vote for jobs to grow and stay in this state.

GkeefePost Provided by Gene Keefe of Keefe, Campbell & Associates, LLC. The firm was started by 
Eugene F. Keefe, Michael J. Danielewicz, John P. 
Campbell, Joseph R. Needham and Shawn R. Biery with 
the goal of providing high-quality and cost-effective 
civil litigation services for the defense of 
self-insured employers and insurance carriers.

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Commissioner Daniel Donohoo Appointed by Governo Patt Quinn

by Chris Rocks on May 14, 2010

Governor Pat Quinn has appointed Daniel Donohoo as commissioner.

Commissioner Donohoo holds a B.S. degree in Business Administration from Southern lllinois University, and a J.D. degree from Cooley Law School. He served as the Madison County Recorder of Deeds for 21 years, and operated his own accounting firm for 17 years.

After completing the legally-required training, Commissioner Donohoo will be assigned a panel and hearing sites.

Daniel resigned as the Madison County Recorder of Deeds on January 31st, 2010.

From an article earlier this year:

EDWARDSVILLE – Madison County Recorder of Deeds Dan Donohoo said Friday he is resigning as of Jan. 31, and added that he has a lot of people to thank for his 21 years in office.

“Today, I am not looking for votes, but instead, giving a vote of thanks,” he said in his resignation letter.

Donohoo served four years as a County Board member before he was elected recorder.

He thanked his staff, family, other officeholders and friends.

He said he has learned much during his time in office, such as the importance of committed employees.

Apparently, he also can be thankful that he has kept his sense of humor.

“I have also learned from my fellow officeholder, Madison County Auditor Rick Faccin, that the only thing you should ever lie awake at night worrying about is not county government or the Recorder’s Office, but whether or not the Cardinals will finish in first place.

For the rest of the story from The Telegraph about Daniel Donohoo’s resignation, please click here.

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Partial Knee Replacements: A growing trend in the United States

by Chris Rocks on May 13, 2010

By: Brett Levine, MD, MS

Total knee arthroplasty (TKA) is one of the most successful operations performed by orthopaedists with an incidence that is rising with each passing year.  In 1998, it was estimated that 259,000 TKAs were performed and that number increased to 441,000 in 2004.7 This represents an average yearly increase of 9.4%.  Despite well-documented long-term results with TKA, there has been a current trend in the United States towards an increasing demand for partial (uni- and bi- compartmental) knee replacements.  Riddle et al estimated an increase in unicompartmental knee arthroplasties (UKAs) from 6,570 to 44,990 during the eight year period between 1998 and 2005 an average yearly increase of 32.5%.7 Improved surgical techniques and implant designs are thought to be responsible for this surge in the popularity of UKA.

Unicompartmental Knee Arthroplasty (UKA)

UKA is a surgery that has fallen in and out of favor over the past 30 years of joint replacement history.  Refinements in patient selection, improved long-term outcome data, surgical technique and implant designs have fueled the renewed interest in this procedure (Figure 1).  In properly selected patients UKA is an attractive alternative to osteotomy or TKA for isolated medial or lateral arthritic changes.  Favorable initial and long-term results have been found with UKA compared to high tibial osteotomy.2 Similarly Berger et al found 98% 10-year survivorship with revision or loosening as endpoints in 62 modular, cemented UKAs.1 Stringent selection criteria is important for the long-term success of a UKA and in the ideal patient would include: noninflammatory osteoarthritis with a mechanical axis deviation of less 5 degrees of valgus or 10 degrees of varus from neutral; intact cructiate ligaments; a range of motion greater than 90 degrees; a flexion contracture no greater than 10 degrees; and body weight less than 90kg.

BL Figure 2aA typical UKA involves resurfacing of the medial or lateral compartments with preservation of the patellofemoral compartments (Figure 2).  Small-incision and minimally invasive options are available for UKA patients with several centers performing the surgery as an outpatient.  The recovery rate for UKA has been reported to be three times faster than that of TKA.3 Blending rapid rehabilitation and peri-operative pain management protocols has led to excellent early functional outcomes for UKA patients.  However, it is important to recognize that patellofemoral and lateral compartment disease progression is not uncommon during BL Figure 2Bthe second-decade after implantation.  Conversion from UKA to TKA can be performed with relative ease and good success when disease progression does occur.

Patellofemoral Joint Arthroplasty (PFJ)

Patellofemoral arthroplasty is another form of partial knee replacement in which the patella and the underlying trochlea groove are resurfaced (Figure 3).  In patients with osteoarthritis of the knee, up to 10% of men and 24% of women will have isolated patellofemoral compartment involvement.6 In such appropriately indicated patients, long-term success has been reported at 15 years follow-up.4 If patella maltracking is addressed prior to PFJ, then progression of tibiofemoral arthritis is most often the limiting factor and can lead to failure in approximately 25% of cases.5

The overall conservative nature of a PFJ (preservation of the anterior and posterior cruciate ligaments, medial and lateral menisci and tibiofemoral articulation) affords a rapid recovery in a properly indicated patient population.  Modern implant designs and sound surgical technique allow this procedure to be an excellent intermediate stage for those young patients with isolated patellofemoral arthritic changes prior to TKA.5 Contraindications for PFJ include inflammatory arthritis, patella maltracking, chondrocalcinosis, and tibiofemoral disorders

Bi-compartmental Knee Arthroplasty

BL Figure 4AUntil recently UKA, PFJ and TKA were the only monolithic option for treating degenerative joint disease of the knee.  A new bi-compartmental knee arthroplasty has been introduced to treat the relatively common findings of medial and patellofemoral compartment arthritic changes.  The Journey Deuce (Smith and Nephew, Memphis, TN) allows for resurfacing of the medial and patellofemoral compartments, leaving the lateral compartment and anterior cruciate ligament intact (Figure 4).  By limiting the amount of bone and ligament resection, it is believed this new device will afford a more rapid, complete return to function.  Previously two separate implants (a patellofemoral replacement and a UKA) were required to treat bi-compartmental degenerative joint disease, or more traditionally, a TKA was performed.  Rolston et al reported that 73 out of 100 consecutive BL Figure 4Bpatients being seen for arthritic knee pain were noted to have well-preserved lateral compartments in the setting of advanced medial and patellofemoral degenerative changes, thus supporting the need for a bi-compartmental device.8

By preserving the anterior and posterior cruciate ligaments, normal kinematics and proprioception about the knee is maintained, allowing a return to function akin to that of UKA.  Similarly, preservation of bone stock and landmarks should allow for a relatively simple revision to a TKA when necessary.  It is believed that just as there has been a rise in UKA utilization recently, a similar trend will occur as surgeons gain more experience with bi-compartmental knee arthroplasty.  In a recent report, Rolston et al reported excellent early (33 month follow-up) results using the Journey Deuce bi-compartmental arthroplasty in 95 patients.8 The authors found less blood loss than TKA, an average range of motion of 117 degrees, and a high level of early function and patient satisfaction.  Contraindications for this procedure include lateral compartment arthritic changes, rheumatoid (inflammatory) arthritis, severe deformities, ACL deficient knees, and fixed flexion contractures.

Conclusion

Partial knee replacements are an excellent means for managing isolated degenerative joint disease of the knee.  In appropriately indicated patients, a relatively fast and more complete recovery can anticipated than with TKA.  International registries have shown UKAs represent 10-15% of knee arthroplasties each year.  In the United States, this number has risen from 2.5% to 7.7% over eight years, 1998-2005.  In the era of less invasive surgery and rapid rehabilitation protocols, it is likely we will continue to see a rise in the number of uni- and bi- compartmental replacements being performed annually.

1.                  Berger RA, Meneghini RM, Jacobs JJ, Sheinkop MB, Della Valle CJ, Rosenberg AG, Galante JO. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005;87(5):999-1006.

2.                  Broughton NS, Newman JH, Baily RA. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5-10 years’ follow-up. J Bone Joint Surg Br. 1986;68(3):447-452.

3.                  Deshmukh RV, Scott RD. Unicompartmental Knee Arthroplasty: Long-term Results. Rosemont, IL: AAOS; 2006.

4.                  Kooijman HJ, Driessen AP, van Horn JR. Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br. 2003;85(6):836-840.

5.                  Lonner JH. Patellofemoral arthroplasty. J Am Acad Orthop Surg. 2007;15(8):495-506.

6.                  McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis. 1992;51(7):844-849.

7.                  Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty. 2008;23(3):408-412.

8.                  Rolston L, Bresch J, Engh G, Franz A, Kreuzer S, Nadaud M, Puri L, Wood D. Bicompartmental knee arthroplasty: a bone-sparing, ligament-sparing, and minimally invasive alternative for active patients. Orthopedics. 2007;30(8 Suppl):70-73.

Figures:

Figure 1.  High-flex uni-compartmental knee replacement.  Courtesy of Zimmer (Warsaw, IN) – Not Shown

Figure 2.  (A) Pre-operative AP radiograph with medial compartment arthritic changes.  (B) Post-operative radiograph after a medial unicompartmental arthroplasty.

Figure 3.  Patellofemoral arthroplasty component.   Courtesy of Zimmer (Warsaw, IN) – Not Shown

Figure 4.  (A) Picture of the Deuce™, bi-compartmental knee arthroplasty.  (B) AP radiograph showing an implanted bi-compartmental knee arthroplasty.  Courtesy of Smith and Nephew (Memphis, TN)

(Article courtesy of Midwest Orthopaedics at Rush)

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Q&A About Light Duty Work and TTD

by Chris Rocks on May 7, 2010

Editor’s comment: These questions were asked by a client and we provided our thoughts. We would love to hear yours about these tough issues.

The background to the questions:

  • Illinois Employer A doesn’t exactly have a light duty program.
  • The injured worker will eventually be able to return to full work at Illinois Employer A when recovered from an undisputed work injury.
  • During their recovery, the employer sends them to volunteer in a non-paid position at a not-for-profit organization.
  • TTD was paid while the employee was showing up and working at the not-for-profit organization.
  • Their goal was to avoid having the worker sitting at home watching Oprah.

Can the claimant refuse such work?

In the recent ruling in Interstate Scaffolding, the Illinois Supreme Court cited Hartlein v. Illinois Power and Hayden v. IWCC to rule an injured worker who is recovering from injury has to do the work a doctor says they can do.

We feel if they refuse such work, TTD is not due.

Is it vocational rehabilitation to put a worker into a light duty position at a charitable or not-for-profit company?

Without intending to be rude, the answer is nobody knows.

Vocational rehabilitation is not clearly defined in the statute or rules.

We have no problem calling it vocational rehabilitation to put someone into such a position because you are rehabbing them to return to their vocation!

But it truly doesn’t make much of a difference—you owe either temporary total disability or temporary partial disability in Illinois if a worker returns to an unpaid position or a low-paid light duty position while recovering from a work-related injury.

What if they get injured in the light duty position?

See the analysis in ABF Freight Systems v. The Workers’ Compensation Commission

We don’t agree with it but that appears to be the law in this state and we have to adjust.

GkeefePost Provided by Gene Keefe of Keefe, Campbell & Associates, LLC. The firm was started by 
Eugene F. Keefe, Michael J. Danielewicz, John P. 
Campbell, Joseph R. Needham and Shawn R. Biery with 
the goal of providing high-quality and cost-effective 
civil litigation services for the defense of 
self-insured employers and insurance carriers.

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