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Less Pain, More Gain
5 ways orthopedic surgery just keeps getting better
By Lisa Fields

In the past, if you were experiencing the kind of bone, muscle or joint pain that stops you in your tracks, you had a lot to think about – especially when it came to orthopedic surgery.

Although many of today’s procedures existed then, there was a lot more involved in the decision-making. You had to consider the limited life of replacement joints and if the risks of a hospital stay, lengthy recovery and post-surgery pain would be worth it.

Fortunately, we’ve seen incredible innovation in orthopedic surgery in the past 2 decades, says Arthur Bartolozzi, MD, an orthopedic surgeon in Cherry Hill. An estimated 80 percent of procedures are now done in outpatient settings. And orthopedic practices have sophisticated imaging capabilities and other equipment that would have seemed like the stuff of science fiction decades ago.

As a result, surgery is an option for more people. Plus, they recover quickly and with less pain, and have a greater range of motion after far more effective physical therapy.

“Talking about this makes me excited about orthopedics, because we’ve really gotten better at everything that we do,” says Bartolozzi, of 3B Orthopaedics. “Anesthesia is way better. Surgery is less invasive, and it’s more accurate. There’s a lot of better technology, better surgical instruments and surgeries require less time in the operating room. All of these things lead to more rapid recovery for the patient to get back to normal living.”

These 5 improvements stand out:

 

More body parts can be replaced

In the past, joint replacement surgery mainly focused on hips, knees and shoulders. Smaller joints were rarely done, because the technology wasn’t good enough, says Christopher Carey, MD, an orthopedic surgeon in Voorhees. Today, hips, knees and shoulders are still the most-replaced joints – after all, they’re the ones that wear out most frequently. But smaller joints are being replaced with greater frequency. Ankle replacements are common. Finger and toe joints, plus vertebrae, can even be replaced.

“Initially, replacing those smaller joints was a last-ditch effort, but now, it’s one of the things that’s being offered as a proven line of treatment for a lot of these problems,” says Carey, noting that finger and toe joint replacement is now a common fix for arthritis.

 

Less pain, more gain

If you’re going for an elective orthopedic procedure, chances are you’ll have minimally invasive surgery and be sent home later the same day. Years ago, that would have been like winning the surgery lottery.

“For reconstructions 20 years ago, patients might have stayed in the hospital a couple of days,” says Jeffrey Daniels, MD, an orthopedic surgeon in Voorhees. “Now they’re done as outpatient procedures a lot of times. Unfortunately, insurance has a role in this, as well – insurances aren’t paying for lengthy hospital stays anymore.”

And although patients today don’t start physical therapy any sooner after surgery than they did decades ago, therapists can offer more intense help sooner. The smaller incisions that patients receive today typically cause less muscle damage and less intense post-operative pain. Today’s patients may see greater improvements more quickly.

 

Your body can help you heal

Biologic treatments, which use your own body to help you heal, have become more widespread in recent years. These include growth factors, stem cells, platelets or scaffolds which cells can build upon and energize the body’s healing capacity to treat joint inflammation, muscle injury and more, Bartolozzi says.

“In orthopedics, cartilage is the holy grail,” he adds. “When you lose cartilage, your joint starts deteriorating. Right now, there are a lot of interesting techniques which involve harvesting a patient’s own cartilage cells to fix defects in various joints. That’s one of the most exciting areas.”

 

Rise of robots and GPS

Improved technology has allowed for smaller incisions and greater precision during minimally invasive surgery. Computer-aided surgery, robotic-assisted surgery and navigation systems used to be sci-fi pipe dreams, but today, they’re widely used.

“With hips and knees – that’s something that’s been coming into vogue in the last 5, 10 years,” Daniels says. “You can call it GPS. It’s a navigation system where they use computers to make the bony landmarks and make more precise cuts during the surgery.”

 

 

Replacements last longer

Joint-replacement materials have evolved too, and today’s models last longer than in the past. Surgeons once used cement to anchor joints, but cement wears away over time, leading to additional surgery. Today, newer materials, including plastic and ceramic, are making a big difference, Daniels says.

“Your bone grows into the prosthesis,” he says. “It allows fixation over a period of time. As the materials get better, joint replacement gets better.”

 

Beyond successful surgeries

Today, orthopedic surgeons think beyond successful surgery, working to get patients back to their normal activities quickly. One procedure in particular that has evolved with patient recovery in mind is rotator cuff surgery.

“We are able to do it arthroscopically, without a big incision, without taking down the Deltoid,” Carey says. “It’s a reinforced repair, rather than just tying it right down to the bone. We get patients moving a little bit sooner, and they definitely track along a little bit faster than they had in the old classic days of not doing anything for 6 to 8 weeks after surgery.”

“Getting patients back to their activity levels sooner has definitely been the thrust of everything in orthopedics,” Carey adds.

March 2020
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