Broad Perspective Article that Shares your Knowledge and Wisdom of Orthopedics
By Dr. James C. Wittig, Chairman of the Department of Orthopedics, Morristown Medical Center, and Medical Director, Orthopedic Oncology, Atlantic Health System
It’s been an incredible time of innovation for the orthopedic field over the past few decades, and the way we are treating patients before, during, and after their time in the operating room is changing.
Over the past two decades in particular, we saw the emergence of sophisticated robotic and navigation devices that helped us more easily and accurately perform joint replacements and orthopedic oncology (limb-sparing) surgeries, high-quality prosthetics, customized implants, better biological bone and soft tissue grafts,and 3D printing for joints and customized pieces.
Many recovery times have been shortened significantly because of the emergence of minimally-invasive surgeries, where instruments are inserted through small incisions rather than a more invasive surgery, and that has also led to better outcomes. Finally, the way we control pain has changed. We now use nerve blocks, non-opioid pain control, and better anti-inflammatories that control pain and allow the patient to begin to move again with less side effects than previous medications.
"Telehealth capabilities that virtually link patients to physicians and the care team can help clinical teams easily communicate with the patient from home"
These advancements are often highly publicized and talked about in the media, literature, and in patient brochures, which help them make more informed decisions about where they will receive their care and how they will be treated after their surgeries.
But I believe one of the most important advancements in orthopedic medicine right now is actually the work we’re doing before the patient has surgery. We’re working across multidisciplinary teams to optimize each patient’s health before they are wheeled into the operating room.
Whether that’s weight loss, smoking cessation, or getting a chronic disease like diabetes under control, ensuring the patient is as healthy as they can be before their surgery has led to more positive patient outcomes and a faster return to a better quality of life.
We have also changed the way we treat patients after their surgery. In the past, orthopedists and physicians in general were often incredibly cautious not to let patients with major surgeries ambulate until they had weeks of rehabilitation. This involved days in the hospital, followed by time in a rehabilitation or skilled nursing facility. Now, because of advancements in minimally invasive techniques, pain control, the comfort of physicians performing these surgeries, and more literature supporting early ambulation, patients are encouraged to walk within hours of their surgery, and most are able to go home the next day—greatly reducing recovery times.
We are also exploring better ways to use telemedicine and video technology. Especially for mobility-limited patients, pre-and post-follow-up visits can be difficult to attend or missed entirely if their injury or condition prohibits them from walking or being in a car. Telehealth capabilities that virtually link patients to physicians and the care team can help clinical teams easily communicate with the patient from home. This is especially helpful during the immediate postoperative period for the first several weeks after surgery. The technology can be used to provide education to patients—through videos, notifications, pamphlets, Q&As, etc. When the patient is continuously coached and more informed, they can have more meaningful, educated conversations with their care team, and improved outcomes.
In the coming months, I think the field can expect to see an increase in patient optimization before surgery, more streamlined care delivery models that focus on the patient’s journey from pre-op to post-op recovery, continued early ambulation, advancements in imaging and prosthesis, discharge to home versus rehab or skilled nursing facilities when appropriate, and virtual/telehealth visits.
The field has far from reached its limit in terms of innovation. Future modifications in joint replacement, materials, mechanical designs, minimally invasive instruments and discoveries in biologics and growing new bone and cartilage will prove beneficial, but often take years to develop. While these are some of the most necessary innovations, we need to focus on improving other patient specific factors to continue to optimize outcomes.