The world of Orthopedics is always advancing. There are new technologies and treatments being introduced regularly. In this article, I will attempt to bring you up to date on the standards of care and the emerging trends in some of the various areas of musculoskeletal medicine.
The first area I want to discuss is that of adult reconstruction. This area is popularly known as joint replacement and is becoming increasingly more common as our nation’s population ages.
The literature currently seems to be targeted more towards pain control, blood management, and accelerated rehab rather than the specific implant used.
With regard to pain control, the current standard of care is multimodal. Most surgeons will use, at a minimum, some sort of local injection at the time of surgery in addition to traditional intravenous or oral pain medications. Also used frequently are regional anesthetic blocks. In our practice we are utilizing a combination of a regional block, a local injection at the time of surgery, as well as both scheduled and as needed medications. This has resulted in a decreased need for intravenous narcotics and therefore less nausea and sedation allowing for a more rapid recovery.
The latest trend in blood management seems to be the use of Tranexamic Acid, which we use locally in the joint, to decrease postoperative bleeding. We have seen a dramatic reduction in the need for post-operative transfusions since implementing our protocol.
In the area of Hip Replacement there has been a lot of talk about negative results after Metal-on-Metal hips. This has been primarily played up by the media. In our practice we have not seen a higher rate of failure than can be expected with any hip replacement. However, due to the negative publicity most orthopedists, ourselves included, have moved away from these bearings in favor of more traditional Metal or Ceramic on Polyethylene bearings.
An exciting advance in Total Hip Replacement that we are now offering is the Anterior Approach Total Hip Replacement. This technique has some advantages in that it allows for a more rapid recovery and eliminates the need for traditional hip precautions in the post- operative period.
Moving on to the area of sports medicine, we continue to see advances in the use of arthroscopy. In the shoulder there are a large number of procedures, particularly for rotator cuff and labral pathology, where the standard of care is now considered to be an arthroscopic procedure. The same is true for the knee where we are now seeing techniques such as the all-inside ACL reconstruction.
Another large part of many orthopedic practices is fracture care. We have seen advances in the implants such as locked plating, which works better in osteoporotic bone, and the intramedullary nails now available making many fractures treatable with a less invasive approach.
Lastly, getting away from the surgical part of an orthopedic practice, we are also seeing more emphasis on the treatment of osteoporosis. This has to do both with the aging population and the simple fact that Orthopedic surgeons are most always involved with fracture care. The treatment for this disorder continues to evolve and at least in our practice we are trying to embrace this push that the orthopedist be more involved in osteoporosis treatment.
So if you or someone you know is dealing with a musculoskeletal injury or ailment, I urge you to contact the orthopedist of your choice and let us help you get back to the life and activities you enjoy.