Orthopedic Surgery

•	Diagnosis of an injury or disorder
•	Treatment with medication, exercise, surgery or other programs
•	Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function
•	Prevention with information and treatment plans to prevent injury, help improve your lifestyle or slow the progression of diseases.

While most orthopedic surgeons practice general orthopedics, some may specialize in treating the foot, hand, shoulder, spine, hip, knee, and others in pediatrics, trauma or sports medicine. Some orthopedic surgeons may specialize in several areas. 

An orthopedic surgeon is a medical doctor with extensive training in the proper diagnosis and treatment of injuries and diseases of the musculoskeletal system. An orthopedic surgeon completes up to 14 years of formal education. 

Orthopedic surgeons must also demonstrate mastery of orthopedic knowledge by passing both oral and written examinations given by the American Board of Orthopedic Surgery. 
Each year your orthopedic surgeon spends extensive time studying and attending continuing medical education (CME) courses to maintain current orthopedic knowledge and skills. 

Orthopedic Treatments

Orthopedic patients have benefited from technological advances such as joint replacement and arthroscopy, which allows the orthopedic surgeon to look inside a joint. But most visits to an orthopedic surgeon will start with a personal interview and physical examination. These steps may be followed by diagnostic tests such as blood tests, X-rays, or other tests. 

Orthopedic treatment may involve medical counseling, medications, casts, splints, and therapies such as exercise, or surgery. For most orthopedic diseases and injuries there is more than one form of treatment. An orthopedic surgeon will discuss the treatment options with you and help you select the best treatment plan to enable you to live an active and functional life. 

Total Joint Replacement (TJR)

What is a joint? 

A joint is formed by the ends of two or more bones which are connected by thick tissues. For example, the knee joint is formed by the lower leg bone, called the tibia or shin bone, and the thighbone, called the femur. The hip joint is formed by a ball and socket, with the upper end of the femur being the ball, and a part of the pelvis, called the acetabulum, being the socket. 

The bone ends of a joint are covered with a smooth, cushiony layer called cartilage. Normal cartilage allows almost frictionless and pain-free movement. However, when the cartilage is damaged or diseased by arthritis, joints become stiff and painful. Every joint is enclosed by a fibrous tissue envelope or capsule that has a smooth tissue lining called the synovium. The synovium produces fluid (synovial fluid) that lubricates the joint and reduces friction and wear in a joint. 

What is a total joint replacement? 

A severely arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis. 

Why is a total joint replacement necessary? 

The goal of TJR is to relieve pain in the joint caused by cartilage damage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, possibly some laboratory and diagnostic tests will show the extent of damage to the joint. Total joint replacement is considered only if other treatment options do not relieve joint pain and disability. 

How is a total joint replacement performed? 

A TJR patient is given an anesthetic and the orthopedic surgeon will replace the damaged parts of the joint. For example, in an arthritic knee the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee movement and function. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal ball attached to a metal stem fitted into the femur, and a plastic socket is implanted into the pelvis, replacing the damaged socket. Although hip and knee replacements are the most common, joint replacement can be performed on other joints, including the ankle, foot, shoulder, elbow and fingers.

What is done before a total joint replacement? 

Prior to TJR surgery, an orthopedic surgeon may make recommendations, such as suggesting that a patient: 

In addition, it is well documented that orthopedic surgery patients can have a poor nutritional profile prior to surgery. Nutritional imbalances can negatively impact the immune system, delay wound healing, increase susceptibility to infection and cause longer hospital stays.

Today, many orthopedic surgeons recommend nutritional supplements in the months/weeks before surgery in order to build the nutritional status of patients prior to hospital admittance (see Pre-/Post-Surgical Nutritional Support below). 

What is involved in the TJR recovery process? 

An orthopedic surgeon will usually encourage you to use your "new" joint shortly after the surgical procedure. Following a TJR, patients will often stand and begin walking the day after surgery. Initially, this is accomplished with the help of a walker, crutches or a cane. 

Most patients have some temporary pain in the replaced joint because the surrounding muscles are weak from inactivity and the tissues are healing from surgery, but it will end in a few weeks or months. 

Exercise is an important part of the recovery process. An orthopedic surgeon or the orthopedic surgeon’s staff will recommend a post-surgical exercise program. Exercise programs vary for different joint replacements and for differing needs of each patient. 

Maintaining good nutrition is also a critical component of the post-op period. Patients should be encouraged to eat a healthy diet that includes the recommended daily amounts of essential vitamins and minerals. Specific supplements may also be considered as part of total post-surgical patient care in order to help provide nutritional insurance for bone repair and soft tissue healing. 

After your surgery, it is usually permitted to play golf, walk and dance. However, more strenuous sports, such as tennis or running, may be discouraged. 

The motion of your joint will generally improve after surgery. The extent of improvement will depend on how stiff your joint was before surgery. 

Is total joint replacement permanent? 

Older patients can expect their total joint replacement to last ten years or longer. It usually provides years of pain-free living that would not have been possible if not for the TJR procedure. Younger joint replacement patients may require an additional joint replacement in their lifetime. 

Prosthesis materials and surgical procedure techniques are improving constantly through the innovative efforts of orthopedic surgeons working with orthopedic industry engineers and other scientists in academia and private settings. The future is bright for those who choose to have a total joint replacement to achieve an improved quality of life through greater independence and healthier pain-free activity. 

Pre-/Post-Surgical Nutritional Support

Some recommended nutrient supplementations before and after surgery include:

Vitamin A stimulates the immune response. Post-operative supplements of vitamin A for seven (7) days increase collagen synthesis and the bursting strength of the scar and increase lymphocyte activation.

Moderate degrees of zinc deficiency are not uncommon, even in developed countries and may be associated with poor wound healing. Zinc is involved in the early remodeling of collagen….supplementation may accelerate wound healing in patients following surgery. 

Iron deficiency interferes with wound healing due to tissue hypoxia…Iron deficiency also interferes with the ability of leukocytes to kill bacteria, increasing the risk of wound infection.

Copper plays an important role in the maintenance and repair of bone and is a co-factor in a number of enzymes involved in wound healing, including those which catalyze the cross-linkage of collagen. Plasma levels of copper and the copper-transport protein, ceruloplasmin, fall rapidly after injury….Copper supplementation may increase the rate of fracture healing.

Vitamin C deficiency seriously impairs the speed and strength of wound healing and results in markedly reduced collagen synthesis, decreased resistance to infection, and the formation of abnormally fragile capillaries….Vitamin C is a vital co-factor in the formation of hydroxyproline residues in procollagen, and deficiency results in decreased collagen formation.

Vitamin D is an essential nutrient in the repair of bone fractures and overall bone health. Blood levels of vitamin D and its active metabolites fall in patients with healing fractures and bones.

Vitamin E acts as an antioxidant, inhibiting and preventing lipid peroxidation. Enhancement of the immune response and an anti-inflammatory action are other means by which vitamin E might support wound healing. Vitamin E supplementation should be stopped just prior to surgery and resumed following discharge from the hospital.

Vitamin K deficiency may result in bleeding into wounds and hematoma formation, which directly impair healing and predispose patients to wound infection.