Photo courtesy of Dr. Matthew Kraay
Orthopedic surgery is a procedure in which patients undergo various forms of joint replacement. Over the years, technology has advanced, so patients have a different pre- and post-operation experience than those of past patients.
Dr. Matthew Kraay, orthopedic surgeon for University Hospitals in Cleveland, answers questions regarding technological advancements for orthopedic surgery.
HealthScene Ohio: Regarding replacement procedures (hip/knee/shoulder), in what ways has technology advanced to allow for reduced recovery time?
Dr. Matthew Kraay: Design of joint replacement devices and specialized instrumentation to insert them have improved dramatically over the last several decades. This has resulted in longer lasting joint replacements, improved range of motion and more normal function after surgery. Surgical incisions have become shorter and less invasive, which has contributed to rapid recovery. In addition, we have focused on trying to better prepare our patients for joint replacement surgery. This involves optimizing their health and physical conditioning pre-op and educating them about what to expect after surgery.
Perhaps the most significant improvement promoting faster recovery after joint replacement surgery relates to better understanding of postoperative pain and how to better manage it. Prior to this, pain following joint replacement surgery limited patient recovery and made rehab difficult. This is no longer the case, and our patients typically walk the day of surgery and are home in one, or at most, two days after surgery. This was not possible without an effective method of pain management following surgery. We have also incorporated blood conservation techniques into our post-op programs which virtually eliminate the need for blood transfusions for most patients after surgery.
HSO: Orthopedics encompasses a variety of procedures that can be performed, not just hip, knee and shoulder replacements. What other types of procedures do orthopedic surgeons commonly perform?
MK: Orthopedic surgeons treat all types of bone and joint problems, both with and without surgery. Orthopedic surgeons treat sports injuries, broken bones or fractures, back, neck and spine problems, ankle and foot problems, problems of the shoulder, wrist elbow and hand, as well as pediatric bone and joint problems.
HSO: In what important ways has technology advanced in terms of patient care pre- and post-operation?
MK: Advanced imaging like MRIs have had a significant impact on being able to diagnose bone and joint problems non-invasively. Orthopedics has also pioneered the movement toward less invasive surgical techniques and movement of surgical procedures typically done as inpatients to the outpatient setting.
HSO: Computer-assisted surgical procedures are becoming increasingly common. What are some of the specific ways in which computers/robotics assist today’s orthopedic surgeons?
MK: Computer-assisted and robotic surgical procedures have been performed in many areas of medicine for 10-15 years. In orthopedics, computer-assisted surgery and robotics have been used mostly for joint replacement surgery. Although these technologies have improved over the years, they are not perfect and there is a definite learning curve associated with introduction of these new technologies into joint replacement surgery. Joint replacement surgery has long been recognized as one of the most reliable and predictable procedures in any area of medicine and at this time, it is not certain if the use of computers and robots in the operating room improves the results of these already successful surgeries.
In addition, these computer-assisted and robotic techniques add considerable cost to these procedures without clear-cut benefit, which is a major concern in our current era of dwindling healthcare resources, and as we try and control our nations’ healthcare costs.
Department of Orthopedic Surgery Chairman Dr. James Voos: University Hospitals currently utilizes robotic surgery in specific cases. As a hospital system, we are engaged in the continued development of robotic surgery techniques and are up-to-date with the most recent technology.
HSO: What medical advancements have become the ‘new norm’ since you have been performing surgery?
MK: Improved joint replacement implants and materials and improved instruments to perform these surgeries have made these surgeries even more long-lasting and durable. Patients recover more rapidly and get back to more active lifestyles sooner than ever before. Patients have little pain after surgery, and do not find joint replacement surgery unpleasant like they did in the past.
Yesterday’s exceptional patient who had minimal pain post-op, went home in a day or two, was done with therapy in a few weeks instead of months and quickly returned to an active lifestyle and whose joint replacement lasted their entire life is now the new norm.
HSO: In what ways has technology advanced for the custom cut total knee surgery to be available? In what ways does it differ from the original procedure?
MK: There is little if any role for custom implants or instruments in joint replacement surgery since essentially all manufacturers provide an extensive inventory of sizes and implant type to address virtually every patient’s needs.
HSO: With the increased occurrence of year-round sports seasons, have you seen an increase in the number of young patients who require orthopedic surgery?
MK: Since orthopedic problems can be degenerative, traumatic or related to athletic injuries, demand is pretty steady throughout the year.
HSO: Athletes aren’t the only patients who require orthopedic surgery. What other patients are prime candidates for orthopedic surgery?
MK: Patients with damaged or worn out joints, spinal problems or musculoskeletal injuries are prime candidates for orthopedic surgery.
HSO: What do the next ten years look like for orthopedic surgery?
MK: The use of joint preservation techniques and biologic solutions to address orthopedic problems will continue to grow in importance as we increase our understanding in these areas. In many areas of the U.S., patients are being offered expensive and unproven treatments like stem cell and platelet rich plasma (PRP) injections, as miracle cures for their arthritis and other musculoskeletal problems. Although use of stem cells and PRP to promote healing and tissue repair are currently unproven technologies, ongoing research in this area is expected to occur in the next decade and will help determine if these techniques actually benefit patients with arthritic or injured joints.
Photographer: Keith Berr
About the Expert
Matthew Kraay, MD, is an orthopedic surgeon for University Hospitals. His primary location is at University Hospitals Cleveland Medical Center. Kraay’s specialty is in orthopedic adult reconstructive surgery and general orthopedic surgery. Kraay has expertise in hip arthroscopy, hip replacement, knee arthroscopy, knee replacement, total joint replacement and adult reconstruction.
Bethany Schultz is a contributing writer. Feedback welcome at lfreudenberg@cityscenemediagroup.com.
