Common types of orthopedic surgery

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Many industries have been affected by the COVID-19 pandemic. You may not have considered orthopedic surgery. The pandemic has ended many elective surgeries, which include many orthopedic procedures, for long periods of time.

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Until the pandemic, however, these surgeries were a growing industry. Since 2000, the common cold has been replaced as the number one reason people see a doctor for musculoskeletal problems, says Dr. Nicholas A. DiNubile, orthopedic surgeon with Premier Orthopedics & Sports Medicine in Havertown, Pa., And door- word of the American Academy of Orthopedic Surgeons. In 2017, around 22.3 million orthopedic surgeries were performed worldwide, according to research firm Research and Markets. That number is expected to reach around 28.3 million by 2022, making it one of the fastest growing categories of surgical procedures.

Baby boomers continue to age but still want to stay active, and they will experience more wear and tear on their bones, joints and muscles. As the COVID-19 pandemic recedes, they will once again fill operating rooms to have their knees, hips, backs and other body parts repaired.

Here are some of the most common orthopedic surgeries.

Joint replacement surgery

Hip and knee replacements are the most common. These joints wear out from osteoarthritis (“wear and tear” arthritis), inflammatory arthritis such as rheumatoid arthritis, trauma or tears in the muscles, such as in the rotator cuff of the shoulder. New techniques allow many procedures to be performed in a minimally invasive manner, allowing shorter hospital stays – often, in fact, same-day surgery – and faster recoveries. “The patients feel so good, a month later, they ask to do sport again. Slowing them down becomes the problem, ”says DiNubile, knee specialist and author of the bestselling“ FrameWork ”series of books on orthopedic health.

Shoulder replacement and rotator cuff repairs are also on the increase, again thanks to better surgical tools and newer, minimally invasive techniques. “These (procedures) have improved so much in recent years and are now more common. People are recovering and returning to sport, ”explains DiNubile.

Arthroscopy

Minimally invasive arthroscopic procedures are also common and are becoming more and more so because “what you can do has changed dramatically,” says DiNubile. In arthroscopy, the surgeon cuts small holes, instead of large incisions, and inserts flexible scopes armed with cameras and surgical tools to perform the surgery. Smaller incisions allow for faster and easier recovery, less blood loss and shorter hospital stays.

For example, in knee arthroscopy, DiNubile’s specialty, he can now preserve and repair tears in the meniscus, the cushions that rest between the knee bones, rather than removing them. Or, when cartilage – the slippery tissue that is attached to the ends of bones – is damaged, which can lead to arthritis, surgeons can place grafts to regenerate new cartilage to fill in what he calls “lesions”. Philly ‘potholes in the fabric. Hip labrum repairs can also get people back to action without the need for more extensive replacement surgery.

Even repairs to the anterior cruciate ligament, or ACL, one of the most common joint surgeries, are now almost always performed arthroscopically. “Before, it was a nightmare. We had to open the knee from stem to stern, and the recovery right after surgery and rehab lasted over a year, ”he says. “Now we like to say it’s harder for the surgeon, but easier for the patient. They go out feeling pretty well and only wear crutches for a few days. “

Carpal tunnel surgery

Carpal tunnel surgery treats symptoms of compression of the median nerve in the hand, which may include numbness or tingling in the thumb, index finger, and forefinger, as well as prickly pain and discomfort, usually worse night.

“Although popular culture in the United States considers typing to be a risk factor for developing carpal tunnel syndrome, most studies investigating the cause of carpal tunnel syndrome fail to show a connection to typing. as a cause, “says professor Dr. Julie Adams. of Orthopedic Surgery at the University of Tennessee College of Medicine at Chattanooga, and spokesperson for the American Academy of Orthopedic Surgeons. “In fact, a well-conducted, longitudinal Swedish study suggests that carpal tunnel syndrome is actually less common among office workers than among blue-collar workers. The development of carpal tunnel syndrome is likely multifactorial, which means that it involves many factors, including genetics, environment, use, hormonal factors, and the presence of other diagnoses or problems such as arthritis, ”says Adams, a hand and upper limb specialist.

The carpal tunnel of the wrist, through which the median nerve travels, is the most common compressive disease, followed by the cubital canal, which is the compression of the ulnar nerve – the “funny bone” – inside the elbow. .

Surgery for carpal tunnel syndrome or cubital tunnel syndrome is day surgery and can be done under a variety of anesthesia choices, including local anesthesia until you fall asleep, Adams says. “Typically, patients immediately start using their hands and limbs for daily activities, avoiding activities that can tear the wound or promote infection. Once the wound has healed, patients resume their normal activities.

Trigger finger release

This procedure treats the symptoms associated with thickening of the tendons or the ring through which tendons move in the finger. Patients with this condition will feel pain in the palm where the fingers meet the hand, and will catch, snap or lock the fingers when they clench the fist or try to straighten the fingers, Adams says.

The surgery is often done under local anesthesia or local anesthesia with some sedation, and it is an outpatient surgery. The patient usually has a soft dressing and begins to use the hand right away.

Back surgery

It’s just behind arthroscopic knee and shoulder surgery in terms of frequency, but DiNubile is “surprised it’s still at the top of the list.” So many things are preventable, and with the right rehabilitation, you can avoid surgery. Back pain is very difficult and surgery often won’t cure it, he says. “I would like to see less back surgery and more prevention,” like losing weight, quitting smoking, exercising more core muscles, and learning to bend and stretch to pick up objects.

Advances in back surgery have allowed surgeons to switch to minimally invasive procedures for disc repair and replacement and spinal fusion. Tools and technologies have improved a lot: “I like to say that the ‘spare parts department’ has become very good at orthopedics in all areas,” jokes DiNubile.

Better pain management

Pain management has improved in all areas of orthopedic surgery. With the Turn the Tide campaign in 2016, Surgeon General Vivek Murthy called on all prescribing physicians in the United States to help fight the opioid epidemic. “Since then, many different measures and organizations, including the AAOS and state medical boards, have educated patients and physicians on proper opioid prescribing practices and developed new laws or guidelines that help us as physicians and surgeons and our patients to balance pain relief. but do it in a safe and responsible manner, ”says Adams.

These new guidelines include the use of anesthetic agents directly in the hip, knee and other surgical sites, and the use of anti-inflammatory drugs and other painkiller “cocktails” to limit narcotics. “It creates a much better experience for the patients,” says DiNubile.

Emphasis was also placed on post-operative rehabilitation to reduce pain and improve recovery. “We know this is such an important part of the process,” says DiNubile.


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