Many industries have been hurt by the COVID-19 pandemic. One you may not have considered is orthopedic surgery. The pandemic shut down many elective surgeries, which include many orthopedic procedures, for long periods of time.
Until the pandemic, though, these surgeries have been a growth industry. Since 2000, the common cold has been replaced as the No. 1 reason people go to a doctor by musculoskeletal issues, says Dr. Nicholas A. DiNubile, an orthopedic surgeon with Premier Orthopedics & Sports Medicine in Havertown, Pennsylvania, and a spokesperson for the American Academy of Orthopedic Surgeons. In 2017, there were about 22.3 million orthopedic surgery procedures performed worldwide, according to the research firm Research and Markets. That number is forecast to grow to about 28.3 million by 2022, making this one of the most rapidly growing surgical procedure categories.
Baby boomers continue to age but still want to stay active, and they will suffer 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 balky knees, hips, backs and other body parts fixed.
Here are some of the most common orthopedic surgeries.
Joint Replacement Surgery
Hip and knee replacements are most common. These joints wear out from osteoarthritis (“wear and tear” arthritis), inflammatory arthritis such as rheumatoid arthritis, trauma or torn muscles, as in the rotator cuff of the shoulder. New techniques allow many procedures to be done minimally invasively, allowing shorter hospital stays — often, in fact, same-day surgery — and quicker recoveries. “Patients feel so good, a month out they are asking to play sports again. Slowing them down becomes the issue,” says DiNubile, a knee specialist and the author of the best-selling “FrameWork” series of orthopedic health books.
Shoulder replacement and rotator cuff repairs are also increasing, thanks again to better surgical tools and newer, minimally invasive techniques. “These (procedures) have gotten so much better in recent years and are now more common. People recover and get back to sports,” DiNubile says.
Minimally invasive arthroscopic procedures are also common and are becoming more so because “what you can do has changed significantly,” DiNubile says. 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 make for quicker and easier recovery, less blood loss and shorter hospital stays.
For instance, in knee arthroscopy, DiNubile’s specialty, he can now preserve and repair tears in the meniscus, the cushions that rest between knee bones, rather than remove 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 what he calls “Philly potholes” in the tissue. Repairs to the labrum in the hip also can return people to action without the need for more major replacement surgery.
Even repairs to the anterior cruciate ligament, or ACL, one of the most common joint surgery procedures, are now almost always done arthroscopically. “It used to be a nightmare. We had to open the knee from stem to stern, and recovery just from surgery and rehab was over year,” he says. “Now we like to say it’s harder for the surgeon, but easier for the patient. They walk out feeling pretty good and are on crutches for only a few days.”
Carpal Tunnel Surgery
Carpal tunnel surgery addresses symptoms of compression in the median nerve of the hand, which can include numbness or tingling in the thumb, index and long finger, as well as pain and prickly discomfort, typically worse at night.
“Although popular culture in the United States would have that typing is a risk factor for developing carpal tunnel syndrome, most studies investigating the cause of carpal tunnel syndrome fail to show a link to typing as a cause,” says Dr. Julie Adams, professor of orthopedic surgery at the University of Tennessee College of Medicine–Chattanooga, and a spokesperson for the American Academy of Orthopedic Surgeons. “In fact, one well-done and longitudinal Swedish study suggests that carpal tunnel syndrome is actually less common in desk workers than in laborers. Probably development of carpal tunnel syndrome is multifactorial, meaning it involves many factors including genetics, environment, use, hormonal factors and presence of other diagnoses or problems such as arthritis,” says Adams, a hand and upper extremity specialist.
The carpal tunnel in the wrist, through which the median nerve travels, is the most common compressive disease, followed by cubital tunnel, which is compression of the ulnar nerve — the “funny bone” — inside the elbow.
The surgery for carpal tunnel syndrome or cubital tunnel syndrome is same-day surgery, and may be done under a variety of anesthesia choices, including local anesthesia all the way up to being put to sleep, Adams says. “Generally speaking, patients start using their hands and limb for daily activities right away, avoiding activities that can tear open the wound or promote infection. After the wound has healed, patients return to normal activities.”
Trigger Finger Release
This procedure addresses symptoms associated with thickening of the tendons or the ring through which the tendons move in the finger. Patients who have this condition will experience pain in the palm where the fingers meet the hand, and catching, clicking or locking of the fingers as they make a fist or try to straighten the fingers, Adams says.
Surgery is often done under local anesthesia or local anesthesia with some sedation, and it’s an outpatient surgery. The patient generally has a soft dressing and starts using the hand right away.
This is second only to arthroscopic knee and shoulder surgery in frequency, but DiNubile is “surprised it is still way up on the list. So much is preventable, and with the right rehab, you can avoid surgery.” Back pain is very challenging, and surgery often does not cure it, he says. “I would love to see less back surgery and more prevention,” such as losing weight, stopping smoking, exercising core muscles more and learning how to bend and stretch when picking things up.
Advances in back surgery have allowed surgeons to move to minimally invasive procedures for disk repair and replacement and spinal fusion. The tools and technologies have gotten much better: “I like to say that the ‘parts department’ has gotten very good in orthopedics in all areas,” DiNubile jokes.
[Read: Tips for Chronic Pain Relief.]
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 upon every prescribing physician in the U.S. to help with the opioid epidemic. “Since then, many different measures and organizations, including the AAOS, and state medical boards have educated patients and physicians about appropriate opioid prescribing practices and developed new laws or guidelines which help us as physicians and surgeons and our patients as we balance providing pain relief but do so in a safe and responsible manner,” Adams says.
These new guidelines include placing anesthetic agents directly into the hip, knee and other surgical sites, and using combination anti-inflammatory and other pain medication “cocktails” to limit narcotics. “This creates a much better experience for patients,” DiNubile says.
There has also been a bigger focus on rehabilitation post-surgery to reduce pain and improve recovery. “We know it’s such an important part of the process,” DiNubile says.
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