rthopedics—covering the musculo-skeletal system, including bones, joints, ligaments, tendons, muscles and nerves—is one of those medical fields most people don’t know much about until they need to. Whether it’s because of nagging aches and pains or sudden injury, a fair portion of patients land in the orthopedics office looking for both surgical and nonsurgical solutions. Luckily for them, those solutions are increasingly plentiful.
“Orthopedics is a field that’s experiencing tremendous, astronomic advancements,” says Dr. Richard Glad of Dean Health. “The management of everything from trauma to reconstruction has become much more effective, and efforts toward recovery are much quicker.”
Dr. David Bartlett, who has been practicing orthopedics at the independently owned Bone and Joint Surgery Associates since 1978, agrees that this is a very exciting time in orthopedics.
“A tremendous percentage of patients who present to their family doctor have a musculoskeletal problem,” says Bartlett, who specializes in arthroscopic surgery and knee replacement. “Sore ankle, sore knee, sore shoulder. It’s a lot more than just broken bones.”
Bartlett, who describes a recent “run of technological advancements,” has performed partial and total knee replacements since the early 1980s, but now he’s skilled in Makoplasty, a robot-assisted partial knee replacement. This minimally invasive procedure has far less downtime—days as opposed to months—and is, in Bartlett’s words, “the most amazing development I’ve seen in my professional career.”
“It’s the same partial knee replacement I’ve always done and felt so good about,” he says, “now with the added precision of a robot and a computer in the operating room.”
Bartlett says Makoplasty is best suited to younger, more athletic patients, which is why he values the portfolio of surgical and nonsurgical solutions available at small, two-doctor Bone and Joint Surgery Associates, and the independence to determine what each patient needs. His colleague, Dr. Holly Duck, specializes in sports medicine and uses ultrasound to administer cortisone shots, and the two of them also prescribe physical therapy, medication and education as needed.
“We get to take care of each patient the way we feel fits best for that patient,” says Bartlett.
“The best thing you can do is take care of yourself ahead of time,” says Meriter Medical Group‘s Dr. Jim Bowers, an orthopedic surgeon who specializes in knee and hip surgery and treats a number of arthritic patients. “It’s preventive medicine.”
Bowers says inactivity is a key issue in prevention, but it’s not about the scale. “Two people can have the same weight but one of them will likely never have problems with joints if they’re exercising low impact twenty to thirty minutes, three to five times a week,” says Bowers.
For many it’s the pain that keep them from exercising—but Bowers says his patients are often surprised when he prescribes exercise for moderate and even some advanced arthritis. For chronic issues such as locking or catching in an otherwise healthy knee, however, exercise may worsen the problem.
“That’s why you need an evaluation,” says Bowers. “You need to know, am I making things worse by pushing through this pain, or is that exactly what I need to be doing?”
In addition to traditional, “tried and true” cortisone shots, Bowers also works with joint fluid therapy, in which Hyaluronate, the viscous, slippery fluid found in normal cartilage, is injected. It coats the arthritic areas and provides pain relief, and it is quickly gaining popularity as a nonsurgical, nonpharmacological therapy for osteoarthritis.
For surgical options, Bowers says the most exciting development in his practice is anterior approach hip replacement,
a highly specialized, muscle-sparing procedure involving a special table upon which the patient lies on the back instead of the side.
“That has really made a difference in my patients’ lives,” says Bowers. “Their recovery is quicker, they have fewer restrictions and I believe it’s more accurate.”
Although technological advancements allow for innovative solutions, greater outcomes and less downtime, Dean Health’s Glad offers a word of caution.
“Just because it’s new doesn’t necessarily make it better,” says Glad. “We’ve become a culture of wanting instant corrections, and a lot of times a little patience would go a long way. There are many orthopedic problems that will get better with conservative management.”
Glad, a surgeon who successfully managed his own shoulder problem with physical therapy, anti-inflammatory medications and a cortisone injection, notes that many people don’t realize that nonsurgical options may provide the solution they need. The only way to find out what’s best for you is to go in for an evaluation with a trusted expert.
“You want to be sure you are treated with something that has a significant track record, by someone experienced who can tell you what the best procedure is for your specific problem,” says Glad.