Orthopedic Surgery

Orthop(a)edics 101

April 6th, 2011 By Emory Orthopaedics & Spine Center

Orthopedics 101Is it “orthopaedic” or “orthopedic”? What does “musculoskeletal” really mean? What’s the difference between a ligament and a tendon? Today we’re going to answer some of the more pressing questions people have about this fascinating area of medicine.

First off, let’s discuss the use of orthopaedic v. orthopedic. Orthopaedic is derived from the Greek orthos, for correct or straight, and paideion, for child. Today, orthop(a)edics refers to the correction of spinal and bony deformities in both children and adults. In the U.S., we like to keep things simple, so “orthopedics” has become the standard spelling. In Great Britain and its other former (non-U.S.) colonies, orthopaedics is preferred. The academic world, like the Brits, enjoys fancying things up, so in most universities and other academic settings, orthpaedics stands. Microsoft Word prefers it without the “a.” Take your pick.

Simply put, orthopaedic (or orthopedic) surgery is the branch of surgery concerned with conditions of the musculoskeletal system. What’s the musculoskeletal system? Clearly, it’s a system that involves the muscles and the skeleton. Also called the “locomotor system,” the musculoskeletal system includes the parts of your body that help you move. And help you stay in one place. The bones provide stability, while the muscles help the bones stay in place and move. Joints allow motion, and cartilage keeps the bone ends from rubbing against one another. It’s all about how bones are connected to other bones and joints and muscles by connective tissues called tendons and ligaments.

What’s the difference between a tendon and a ligament, you ask? A tendon (or sinew) is a tough band of tissue that connects the muscle to the bone. A ligament connects bones to other bones. But wait—let’s not forget the fascia. The fascia is a layer of fibrous tissue that surrounds muscles and groups of muscles, as well as blood vessels and nerves, and binds all of these together. The layers of fascia include a superficial fascia (connected to the dermis, or skin), a deep fascia (surrounding the bones and muscles), and a subserous, or visceral, fascia (supporting the organs).

The surgeons and physiatrists at the Emory Orthpaedics & Spine Center are intimately familiar with every aspect of the musculoskeletal system and can diagnose and treat myriad ailments, both surgically and nonsurgically. So if you’re hurting, whether from a broken bone or a stretched or torn ligament or tendon, come see us. With or without the “a,” we know our orthop(a)edics.

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New Biomaterials Mean Fewer Hip and Knee Replacement Reoperations

January 13th, 2011 By James R. Roberson, MD

James Roberson, MDIn Emory Orthopaedics, we perform hundreds of hip and knee replacement operations every year. Most of these operations are highly successful, but occasionally, a reoperation is necessary. In these cases, it’s usually because the materials originally used in the knee or hip have worn down over time.

At Emory, we’ve been testing new and improved biomaterials for use in hip and knee replacements for more than a decade, and we’ve found that a new generation of biomaterials is making a significant difference in the longevity of these replacements. This means fewer patients will need reoperations down the road.

The failure rate in a knee replacement operation is directly related to how fast the knee wears, which is affected by how well the knee was put in, the patient’s activity level, the patient’s weight, and the wear resistant properties of the materials used. Think of the tires on a car. The stronger the tire material, the longer it lasts. What if, instead of getting 30,000 miles on a set of tires, you could get 100,000 miles? In essence, that order of magnitude difference is similar to the improved wear resistance of new biomaterials used in hip and knee replacement.

I’ve been using alternative bearing surface materials in hip replacements for about 12 years, starting with metal on metal, then ceramic on ceramic, and now highly cross-linked polyethylene. All three materials have dramatically improved wear resistance and have worked very well for several thousand patients, with no measurable wear on any patient visible through x-rays. But while metal on metal and ceramic on ceramic are useful in hip replacements, they aren’t an option in knee replacements. Until recently, this was also true of cross-linked polyethylene. However, the more recent second generation techniques for cross-linking now make this a viable option for knee replacement also.

Polyethylene, simply put, is a plastic formed from long molecular chains made of carbon and hydrogen atoms linked together. Prior to cross-linking manufacturing techniques, these molecular chains consisted of carbon atoms linked to other carbon atoms in single long chains with the remainder of the molecular bonding sites filled with hydrogen atoms. On a molecular level, cross-linking simply means that the single chains now are cross bonded together to, in essence, create a woven structure. This results in a material that looks identical but is actually a more wear-resistant form of plastic.

Over the past three to five years, we’ve performed approximately 1,000 knee replacement surgeries using cross-linked polyethylene. While all three materials—metal, ceramic, and polyethylene—appear to perform fairly evenly in hip replacement surgery, cross-linked polyethylene is less expensive than ceramic on ceramic. Although the individual patient does not experience a cost difference, this is a benefit to the industry as a whole. Our goal is to develop improved materials that will result in better outcomes and be cost-effective.

If you’re having knee or hip surgery, you can trust your doctor to choose the most effective material for you. Regardless of whether it’s metal on metal, ceramic on ceramic, or cross-linked polyethylene, with all of these new biomaterials, we are cautiously optimistic that wear may no longer be a problem.

Have you had or are you going to have hip or knee replacement surgery? Have you had experience with any of the new biomaterials? We’d like to hear from you. Please take a moment to give us feedback in the comments section below.

About James R. Roberson, MD:

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

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Getting In Shape For Surgery

July 27th, 2010 By Dr. Bradbury

In this post, I’ll discuss the importance of “getting in shape” for surgery. When conservative nonsurgical measures fail, and we’re considering joint replacement surgery for the treatment of end stage arthritis of the hip or knee, it’s important to take measures to increase your chance of success and reduce the risk of complications. Ideally, these steps should take place well before the actual procedure, and can be compared to “training for a marathon”. Generally, we look at three things in particular: Are you close to your ideal body weight? Are you aerobically conditioned? Are you a nonsmoker? If the answer to each of these questions is yes, you’re probably an excellent candidate for surgery. If not, we suggest that you take the following steps prior to scheduling surgery:

Lose weight

Being at or close to your ideal weight enhances your chances of surgical success. (You can calculate your BMI here.) If your BMI is 30–39, you have a higher risk of complication from surgery. If your BMI is 40 or above, you may not be a candidate for surgery right now, but we have resources at Emory to support you in your weight-loss efforts. Emory Family Medicine offers weight-loss counseling services, and the Emory Bariatric Center provides both surgical and nonsurgical weight-loss options. Weight loss is among the most important steps toward improving overall health and quality of life. In most cases, weight loss will improve the pain and loss of function associated with arthritis of the hip and knee. This improvement can be significant enough to obviate the need for surgery.  If surgery is necessary, appropriate weight loss prior to surgery will dramatically reduce the risk of complications including infection and dangerous blood clots. In addition, it will speed the recovery process and help prevent future orthopedic problems.

Get active

Patients who exercise regularly tend to recover from surgery more quickly than patients who don’t. If you’re preparing for orthopedic surgery such as knee or hip replacement, weight training and cardiovascular exercise can smooth the recovery process. When your muscles and soft tissues are strong and well conditioned, they help stabilize the knee and protect the joints, helping you get moving again more quickly.

Further, if you‘ve been diagnosed with hip or knee arthritis, don’t discontinue exercise and aerobic conditioning. Exercise has been scientifically proven to improve the pain and loss of function associated with arthritis of the knee. If you aren’t currently active, you can start now by slowly introducing exercise into your schedule—even just three times a week is helpful. Choose an exercise that does not cause pain. In general, lower impact exercises such as swimming, cycling, and the elliptical machine will allow elevation of heart rate while minimizing pain associated with hip or knee arthritis. There’s no evidence that increasing activity level will cause worsening of knee arthritis.

If you need help creating an exercise plan, the physical therapists at the Emory Orthopedics & Spine Center can work with you. Having professional support and/or a partner to exercise with can make it easier to begin and stick with an exercise program.

Stop smoking

Smoking cigarettes increases the risk of complication after orthopedic surgery. If you’re a smoker, cessation from smoking for at least one month before and one month after surgery can significantly reduce the risk of complications after surgery. Smoking can inhibit bone’s ability to heal itself, slow surgical wound healing, and increase the risk of infection following surgery. Smokers also have an increased chance of having lung problems, such as pneumonia, after surgery. One study demonstrated that smoking cessation prior to and after surgery could reduce the risk of complication by more than 50%.

If you need help quitting, Emory Family Medicine offers smoking cessation counseling services.

Are you getting in shape for orthopedic surgery? We welcome your questions and feedback in the comments section below.

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

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