Orthopedics and innovation: How technology helps patients recover

2014-04-16T16:51:00Z Orthopedics and innovation: How technology helps patients recoverJennifer Pallay nwitimes.com
April 16, 2014 4:51 pm  • 

James Murphy, a third generation orthopedic surgeon, has seen firsthand how improvements in technology impact patient care.

Murphy, an orthopedic surgeon out of East Chicago’s St. Catherine Hospital, part of the Community Healthcare System, says his father and grandfather both practiced on the southeast side of Chicago. Between his father’s era and his, there has been a lot of innovation, he says.

In the 1950s and ‘60s, orthopedic surgery meant plastering fractures and putting patients in traction with long hospital stays. The technologies available today have changed all that for the better, he says, so that even patients with complex injuries can be treated as outpatients or have minimal hospital stays.

When his grandfather completed his residency, the program was one of the first orthopedic residencies in the world. He was part of the American Academy of Orthopedic Surgeons started in 1933 at Northwestern University in Chicago. Prior to that, doctors were either general surgeons who did every type of surgery or family physicians.

“We need to appreciate where we came from so was we go forward, we know that we’re part of something bigger than just our clinic or our hospitals. It’s a fellowship of orthopedic surgeons that goes back over a century," Murphy says. "The physicians who came before us really kind of blazed the trail for what we are able to do. A lot of times we forget about that."

The most major advancement is the treatment of arthritis, he says. Growing up in the 1970s, he remembers parties where one room was filled with the older family members who would sit and have food and drinks brought to them. There was also a bucket near every home's front door where seniors would leave their canes.

“That doesn’t exist now,” Murphy says. Nowadays, senior family members are walking around, talking about their golf games and latest travels. Joint replacement has been the greatest advancement as people age. When their knees and hips become arthritic, they can have them replaced to stay active.

Murphy also does ankle replacements, a surgery not many doctors are trained to do. It is an area that is a little underserved, he says. The pain causes sufferers to limit activity in the workplace and recreationally and eventually affects their ability to walk at all.

“It really is a life altering thing where now we can get people active and engaged.”

Arthroscopic surgery has also done a lot to change the way doctors treat patients. They are able to make smaller incisions and use a camera the size of a pencil to see the joint in question. Through a second incision they use instruments to correct whatever problems exist.

"Recovery is such night and day difference," he says, leaving doctors to abandon many of the older protocols.

He compares the shifts in technology to personal computers. "The one you bought five years would never get to market now, the same has happened in arthroscopic surgery."

Some parts of practicing medicine are constant, Murphy says, no matter the generation.

“The main denominator is to have the compassion and care to take the time for patients. They all come to you with a problem and they are looking to you to not only treat the problem but to educate them on the problem so that together you can navigate it and get through it. I’m sure it was rewarding then and it’s very rewarding now."

Gregory McComis, orthopedic surgeon at North Pointe Orthopaedics in Munster, says the anterior total hip replacement is a huge advancement in orthopedic medicine.

“A traditional total hip, which was done for the past 50 years, was done through incision in your buttocks or backside of your hip,” he says. It was more painful and required more rehab. Patients were also at risk for dislocating their hips after surgery.

The anterior hip procedure uses a smaller incision in the groin to remove the ball of the hip joint and replace it with one made of metal and plastic. Doctors do not cut through as many muscles, making it minimally invasive. Patients can get up and walk on day of surgery and go to normal activites in four to six weeks. The muscle sparing means patients will never have an issue with muscle weakness or chance for hip dislocation.

"This can’t be duplicated in any other way," he says.

The procedure was popularized in the United States by a California surgeon around 2005.

McComis started doing the procedure in January 2010 and has done almost 700 of them. Patients come from throughout the Midwest to see him. About 30 percent of patients are in their mid to late 50s.

"A lot of surgeons are not doing this procedure because it is technically more challenging but I think the benefits far outweigh the risks for the patients."

William Biehl, orthopedic surgeon out of St. Anthony Health in Michigan City, uses technology while doing knee replacements. His technique involves having patients get an MRI scan of their knee. A model is then constructed of the knee for which Biehl can “make special jigs that are specific to the patient’s knee.” When he puts those jigs on the knee during surgery, it helps him make better cuts.

Other surgeons utilize computer navigated surgery when making cuts.

Biehl also says availability of vitamins is an important change for orthopedics. Over the last five years, over-the-counter vitamin D3 tablets have become available and they are fairly inexpensive. Although Midwesterners may think they get enough vitamin D, they must have direct sunlight over 80 percent of their body to activate it, something unlikely to happen during the winter months.

“Once it becomes warmer in spring and summer, more people get active and then I see a lot of kids with stress fractures or growth plate injuries. I think a lot of this is due to our vitamin d metabolism around here.” Biehl recommends taking the suggested amounts of calcium with vitamin d3, which for most adults will be 1200 mg calcium with 800 iu of vitamin d3.

Glinda Tufts, of Crown Point, had both knees replaced six weeks apart in 2009 at Rush University Medical Center in Chicago. She had tried steroid injections for the osteoarthritis in her knees but it continued to get worse.

She was most worried about pain and discomfort following surgery but says it went much better than she thought. Anyone considering the surgery should go the minimally invasive route, she says, and avoid methods that open the whole knee.

She was home within 48 hours after the first knee replacement and within 24 hours after the second. The first week post-surgery, she had in-home care but by the second week, she was driving to physical therapy.

Before you can leave the hospital, you have to be complete certain tasks, she says.

“Within 24 hours of having a knee replaced you can climb a flight of stairs. It’s pretty amazing what they can do now.”

Dwight Tyndall, a spine surgeon based in Munster, says that outpatient spine surgery offers many advantages for patients.

“When I first came in practice, the way I was trained, if a patient was having any type of spine procedure, they would be in the hospital three to five days,” he says. “Now we’ve gotten to the point, at least in my practice, where they are going home the same or next day.” With smaller incisions, new techniques and tools, patients can recover faster and can get back to their life sooner, he says. Blood transfusions and large amounts of pain medications are also no longer needed.

“As one of the leaders to move us in that direction, it has been very exciting to see those developments,” he says. Patients don’t want to be in the hospital for multiple days and these advancements mean they no longer have to.

Work related injuries and age related changes are among the top reasons for spine surgery, he says, with patients ranging from their 20s to 70s. Even his young patients often have preconceived or fairly negative ideas about spine surgery and Tyndall educates them about how much has changed.

“We’re still getting the same thing done, with the same objective. The techniques have changed so they have to throw all their preconceptions out the window as far as how long the surgery is going to take, how quickly they get home, how quickly they will recover,” he says.

“The beautiful thing about that is I’ve been able to move my surgeries from hospital based procedures to a surgery center based procedure.” Moving the procedures to outpatient buildings is more cost effective and efficient. Outpatient surgery centers have been used in plastic surgery and sports medicine for some time but the use of them for spine surgery is a fairly recent development.

“It’s the wave of the future since we’re so preoccupied with costs and outcomes. I definitely think it’s the way we’re going to go,” Tyndall says. “I think it will be beneficial for the entire health care system and especially for our patients.”

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