Advances in Orthopedic Surgery

Abstract

Symbolized by a bent tree supported with a brace, the Greek words ortho (straight) and pais (child) were combined to form the word orthopaedics to describe the bracing and straightening of children's limbs and spines.1 Rooted in maintaining strong bones to support the body's structure, orthopedic surgery has expanded into many more areas in the past 10 years. In 2015, the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) issued a position statement, Innovation and New Technologies in Orthopaedic Surgery, which stated that orthopedic surgeons initiate innovations based on empiric knowledge and introduce new procedures and technologies after “extensive preclinical basic and applied research studies.”2(p1) Orthopedists are now multidisciplinarians, innovators, and pioneers in technologically complex areas such as minimally invasive surgery, navigational systems, and robotics. Advances in orthopedic surgery are evident today in many new areas, such as same-day surgeries, three-dimensional printing, and orthobiologics, to name just a few. Multidisciplinary collaborations are key, because no breakthroughs occur in a vacuum. Knowledge and expertise from other disciplines has aided in the development of successful orthopedic care plans that are more cost effective and patient centric. For example, coordination with anesthesia professionals has helped orthopedists build pain management algorithms that have allowed total hip arthroplasty and total knee arthroplasty patients to be discharged on the same day they have surgery. As a result of these total joint successes, health care providers continue to look at various payment models that provide quality care while reducing patients’ length of stay and readmission rates.3 Strong evidence supports that, in patients with no known contraindications, treatment with tranexamic acid decreases postoperative blood loss and reduces the necessity of postoperative transfusions following total knee arthroplasty.4 The move to quicker, more efficient orthopedic surgical procedures also is related to developments in technology, such as faster, lighter, more flexible drills and saw blades; biological products, such as platelet-rich plasma injections; and stem-cell therapies, in addition to newer implant and partial knee replacement choices. Improving on systems that can provide greater visualization, more exact calculations, and smaller incisions, orthopedic surgeons have been perfecting techniques using high-functioning computerized consoles. Literature on emerging robotics procedures in orthopedics has been trickling into more peer-reviewed journals, and newer robotics companies are developing smaller handheld devices. Orthobiologics is a vital part of the healing process for bones and tissue. The AAOS recently published an informative paper on the various therapies used in conjunction with surgery to improve patient outcomes. Autologous bone grafting, allografts and demineralized bone matrices, osteoconductive graft substitutes, patient-derived cellular therapies, bone marrow aspiration, platelet-rich plasma, and growth factors are all part of adjuvant therapies that are becoming commonplace.5 Gaining familiarity in these terms and treatments is advantageous to nurses working in orthopedics. Advances in orthopedics also are evident in the postoperative phase. Nursing care still includes the basics of RICE: rest, ice, compression, and elevation, but care is more specialized now. Cold therapy wraps, advanced braces, better abduction and adduction pillows, and continuous passive motion machines are available to assist with patient recovery in conjunction with layered pain management regimens and early ambulation. Nursing education on postoperative complications translates into greater patient comfort, shorter stays in the postanesthesia care unit, fewer cardiac and pulmonary complications, increased mobility, decreased risk of deep vein thrombosis, earli