ASK THE EXPERT

Ask the Expert: New trends allow for faster recovery times

2014-04-16T17:11:00Z Ask the Expert: New trends allow for faster recovery timesCarrie Rodovich nwitimes.com
April 16, 2014 5:11 pm  • 

Orthopedic Specialists of Northwest Indiana (OSNI) has been operating in Northwest Indiana for more than 17 years. Dr. Joseph Hecht, OSNI’s senior partner, specializes in arthritis related conditions and treatments, with an emphasis on knee and hip reconstructions. He completed his residency at the University of Chicago Hospitals. Dr. Hecht can be reached by calling his Munster office at (219) 924-3300.

What does an orthopedic specialist do?

In the broadest terms, an orthopedic surgeon takes care of diseases of the musculoskeletal system. That encompasses everything from the spine, extremeties and joints, including hips, knees, hands and feet. A general orthopedist covers everything from traumatic injuries to arthritis. I, myself, focus on things including hip and knee replacement but take care of most any problem considered general orthopedics.

Is there a difference in injuries people sustain when they’re younger or older?

Older people tend to come in with problems such as joints wearing out, or thinning of the skeleton, osteoporosis, which can lead to fractures. Young people tend to have traumatic injuries, such as slipping and falling and twisting an ankle and breaking it. Sports injuries in young people vary based on the sport. Football injuries have a different set of problems than a marathon runner or someone who works out with weights.

How has treatment and technology changed over the last few decades?

Techniques in surgery have moved towards making smaller incisions. Ruptured, torn tendons and other injuries that would have been invasive surgeries in the 1980s or 1990s are can now be fixed much more easily. Even the materials we use have changed. Stainless steel is still popular, but we also use titanium plates, which are lighter and more flexible, depending on where the injury is. Thirty years ago, a wrist break would be put in a cast that would go above the elbow and it would be held into position for six weeks. Now, surgeries can restore alignment of the wrist, and therapy can begin much sooner. That’s true of shoulder and knee tendon and ligament tears and other significant trauma, as well.

How has hip and knee replacement changed over the last few decades?

Techniques have made quite a few advancements in the last decade. There are smaller incisions, newer ceramics, metals and plastics with the trend toward shorter hospitalizations. These practices are gaining more acceptance as time goes along. One hip replacement technique that is gaining acceptance is to perform the hip surgery from an anterior interval (commonly called the direct anterior approach). The advantage of that is you go between the muscle planes rather than cutting through muscles to access the hip joint. This technique can be more difficult and requires additional training and experience, but specialized traction tables have been developed to facilitate the procedure. This causes less limping and within a month, patients are doing much better, much more quickly. Knee replacements are also making improvements. There are techniques to make smaller incisions and have less blood loss. Custom cutting blocks that are made from pre-surgical measurement planning techniques have become readily available. There are many ways to do hip and knee replacement surgeries, and new techniques are gaining popularity when they lead to faster patient recoveries. Is there a best technique that will hold up over the long term? There is no unequivocal proof or what we call level one evidence yet, but consistently good outcomes are always dependent on the skill and experience of the surgeon.

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