DRTHOCape Cod Orthopaedics& Sports Medicine, P.C.SPORTS"Opioid-Free" Total Joint ReplacementMEDICINETotal Joint Replacement (TJR) is the standard of care fordisabling arthritis of the knee and hip. It was introducedin the 1960's and has a proven long term success rate. Min-imally invasive techniques (MIS) have been developed toperform TJR through smaller incisions without disruptingmuscle or tendon. These MIS techniques in conjunctionwith progressive Anesthesia protocols allow rapid recov-ery. TJR can now be performed as an outpatient procedurewithout the need for a hospital stay. In addition, currentAnesthesia techniques in conjunction with multi-modalpain management can eliminate the need for opioid (nar-cotic) medication after surgery.including the risk of addiction, the phenomenon of "opi-oid-induced hyperalgesia" (OIH) where patients receivingopioids after surgery can actually become more sensitive topain, is compelling. Our "Opioid Free" post surgery proto-cols encourage rapid recovery after TJR and have assistedthe majority of patients to be discharged home rather thanto skilled nursing facilities (SNF's) or nursing homes.ACCEPTINGNEW PATIENTS!130 North StreetDr. Remia has utilized an "Opioid-Free" approach for TJRfor the last several years; if you would like to learn moreabout the possibility of "Opioid-Free" total joint replace-ment with your upcoming Orthopedic procedure, pleaseHyannis, MA 02601(508) 775-8282(508) 775-8280 faxcontact Dr. Remia.Current Anesthesia techniques including spinal, nerveblocks and local injections during surgery, have allowed pa-tients to recovery comfortably and mobilize rapidly. The useof "Multi-Modal" pain management including IntravenousTylenol and Motrin, nerve pain medications (Lyrica andGabapentin) and Cox-2 inhibitors (Celebrex) can eliminatethe need for narcotic medications altogether after surgery.Aside from the obvious reasons to avoid opioid narcoticsLen Remia, M.D., is board certified by the American Boardof Orthopaedic Surgery. He earned his medical degree atBoston University School of Medicine. He completed hisOrthopaedic Residency and Trauma Fellowship at HarvardMedical School. Dr. Remia is fellowship trained in SportsMedicine, which he completed at Kerlan-Jobe OrthopedicClinic in Los Angeles, California. He is accepting new pa-tients at Cape Cod Orthopaedics and Sports Medicine, P.C.18 Route 6A, Bldg. 2Sandwich, MA 02563(508) 775-8282(508) 775-8280 faxLen Remia, M.D.MIS TOTAL JoINT REPLACEMENTAND SPORTS MEDICINEwww.capecodortho.comCall 508-568-3775NWCN13853757CAPEOPAEDICSP.C. DRTHO Cape Cod Orthopaedics & Sports Medicine, P.C. SPORTS "Opioid-Free" Total Joint Replacement MEDICINE Total Joint Replacement (TJR) is the standard of care for disabling arthritis of the knee and hip. It was introduced in the 1960's and has a proven long term success rate. Min- imally invasive techniques (MIS) have been developed to perform TJR through smaller incisions without disrupting muscle or tendon. These MIS techniques in conjunction with progressive Anesthesia protocols allow rapid recov- ery. TJR can now be performed as an outpatient procedure without the need for a hospital stay. In addition, current Anesthesia techniques in conjunction with multi-modal pain management can eliminate the need for opioid (nar- cotic) medication after surgery. including the risk of addiction, the phenomenon of "opi- oid-induced hyperalgesia" (OIH) where patients receiving opioids after surgery can actually become more sensitive to pain, is compelling. Our "Opioid Free" post surgery proto- cols encourage rapid recovery after TJR and have assisted the majority of patients to be discharged home rather than to skilled nursing facilities (SNF's) or nursing homes. ACCEPTING NEW PATIENTS! 130 North Street Dr. Remia has utilized an "Opioid-Free" approach for TJR for the last several years; if you would like to learn more about the possibility of "Opioid-Free" total joint replace- ment with your upcoming Orthopedic procedure, please Hyannis, MA 02601 (508) 775-8282 (508) 775-8280 fax contact Dr. Remia. Current Anesthesia techniques including spinal, nerve blocks and local injections during surgery, have allowed pa- tients to recovery comfortably and mobilize rapidly. The use of "Multi-Modal" pain management including Intravenous Tylenol and Motrin, nerve pain medications (Lyrica and Gabapentin) and Cox-2 inhibitors (Celebrex) can eliminate the need for narcotic medications altogether after surgery. Aside from the obvious reasons to avoid opioid narcotics Len Remia, M.D., is board certified by the American Board of Orthopaedic Surgery. He earned his medical degree at Boston University School of Medicine. He completed his Orthopaedic Residency and Trauma Fellowship at Harvard Medical School. Dr. Remia is fellowship trained in Sports Medicine, which he completed at Kerlan-Jobe Orthopedic Clinic in Los Angeles, California. He is accepting new pa- tients at Cape Cod Orthopaedics and Sports Medicine, P.C. 18 Route 6A, Bldg. 2 Sandwich, MA 02563 (508) 775-8282 (508) 775-8280 fax Len Remia, M.D. MIS TOTAL JoINT REPLACEMENT AND SPORTS MEDICINE www.capecodortho.com Call 508-568-3775 NWCN13853757 CAPE OPAEDICS P.C.

Date: February 8, 2020

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DRTHO Cape Cod Orthopaedics & Sports Medicine, P.C. SPORTS "Opioid-Free" Total Joint Replacement MEDICINE Total Joint Replacement (TJR) is the standard of care for disabling arthritis of the knee and hip. It was introduced in the 1960's and has a proven long term success rate. Min- imally invasive techniques (MIS) have been developed to perform TJR through smaller incisions without disrupting muscle or tendon. These MIS techniques in conjunction with progressive Anesthesia protocols allow rapid recov- ery. TJR can now be performed as an outpatient procedure without the need for a hospital stay. In addition, current Anesthesia techniques in conjunction with multi-modal pain management can eliminate the need for opioid (nar- cotic) medication after surgery. including the risk of addiction, the phenomenon of "opi- oid-induced hyperalgesia" (OIH) where patients receiving opioids after surgery can actually become more sensitive to pain, is compelling. Our "Opioid Free" post surgery proto- cols encourage rapid recovery after TJR and have assisted the majority of patients to be discharged home rather than to skilled nursing facilities (SNF's) or nursing homes. ACCEPTING NEW PATIENTS! 130 North Street Dr. Remia has utilized an "Opioid-Free" approach for TJR for the last several years; if you would like to learn more about the possibility of "Opioid-Free" total joint replace- ment with your upcoming Orthopedic procedure, please Hyannis, MA 02601 (508) 775-8282 (508) 775-8280 fax contact Dr. Remia. Current Anesthesia techniques including spinal, nerve blocks and local injections during surgery, have allowed pa- tients to recovery comfortably and mobilize rapidly. The use of "Multi-Modal" pain management including Intravenous Tylenol and Motrin, nerve pain medications (Lyrica and Gabapentin) and Cox-2 inhibitors (Celebrex) can eliminate the need for narcotic medications altogether after surgery. Aside from the obvious reasons to avoid opioid narcotics Len Remia, M.D., is board certified by the American Board of Orthopaedic Surgery. He earned his medical degree at Boston University School of Medicine. He completed his Orthopaedic Residency and Trauma Fellowship at Harvard Medical School. Dr. Remia is fellowship trained in Sports Medicine, which he completed at Kerlan-Jobe Orthopedic Clinic in Los Angeles, California. He is accepting new pa- tients at Cape Cod Orthopaedics and Sports Medicine, P.C. 18 Route 6A, Bldg. 2 Sandwich, MA 02563 (508) 775-8282 (508) 775-8280 fax Len Remia, M.D. MIS TOTAL JoINT REPLACEMENT AND SPORTS MEDICINE www.capecodortho.com Call 508-568-3775 NWCN13853757 CAPE OPAEDICS P.C. DRTHO Cape Cod Orthopaedics & Sports Medicine, P.C. SPORTS "Opioid-Free" Total Joint Replacement MEDICINE Total Joint Replacement (TJR) is the standard of care for disabling arthritis of the knee and hip. It was introduced in the 1960's and has a proven long term success rate. Min- imally invasive techniques (MIS) have been developed to perform TJR through smaller incisions without disrupting muscle or tendon. These MIS techniques in conjunction with progressive Anesthesia protocols allow rapid recov- ery. TJR can now be performed as an outpatient procedure without the need for a hospital stay. In addition, current Anesthesia techniques in conjunction with multi-modal pain management can eliminate the need for opioid (nar- cotic) medication after surgery. including the risk of addiction, the phenomenon of "opi- oid-induced hyperalgesia" (OIH) where patients receiving opioids after surgery can actually become more sensitive to pain, is compelling. Our "Opioid Free" post surgery proto- cols encourage rapid recovery after TJR and have assisted the majority of patients to be discharged home rather than to skilled nursing facilities (SNF's) or nursing homes. ACCEPTING NEW PATIENTS! 130 North Street Dr. Remia has utilized an "Opioid-Free" approach for TJR for the last several years; if you would like to learn more about the possibility of "Opioid-Free" total joint replace- ment with your upcoming Orthopedic procedure, please Hyannis, MA 02601 (508) 775-8282 (508) 775-8280 fax contact Dr. Remia. Current Anesthesia techniques including spinal, nerve blocks and local injections during surgery, have allowed pa- tients to recovery comfortably and mobilize rapidly. The use of "Multi-Modal" pain management including Intravenous Tylenol and Motrin, nerve pain medications (Lyrica and Gabapentin) and Cox-2 inhibitors (Celebrex) can eliminate the need for narcotic medications altogether after surgery. Aside from the obvious reasons to avoid opioid narcotics Len Remia, M.D., is board certified by the American Board of Orthopaedic Surgery. He earned his medical degree at Boston University School of Medicine. He completed his Orthopaedic Residency and Trauma Fellowship at Harvard Medical School. Dr. Remia is fellowship trained in Sports Medicine, which he completed at Kerlan-Jobe Orthopedic Clinic in Los Angeles, California. He is accepting new pa- tients at Cape Cod Orthopaedics and Sports Medicine, P.C. 18 Route 6A, Bldg. 2 Sandwich, MA 02563 (508) 775-8282 (508) 775-8280 fax Len Remia, M.D. MIS TOTAL JoINT REPLACEMENT AND SPORTS MEDICINE www.capecodortho.com Call 508-568-3775 NWCN13853757 CAPE OPAEDICS P.C.

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