Orthopedics & Sports Medicine 2019
Modern Orthopedics by Leslie Cardé THE PRACTICE OF ORTHOPEDICS dates back to primitive man. Fossil evidence suggests that early man treated fractures with hand-carved wooden splints. Splinted femurs and forearms have been found in archaeological excavations dating to 300 B.C. Crutches have been depicted on Egyptian cave carvings, and the ancient Greeks treated fractures and dislocations with traction and casting. The modern medical practice of orthopedics has come a long way since fossil evidence showed early man attempting to treat bone fractures with handcarved wooden splints. But prehistoric man didn’t have one important problem that the modern man and woman face— osteoarthritis. This occurs when the joint cartilage and the underlying bone degenerate, causing boneon-bone friction when the pad of cartilage between bones disappears. This ordinarily occurs from middle age onward. Our prehistoric ancestors didn’t live long enough to have such problems. Active 50-somethings have already started the process of degeneration, especially if they partake in high-impact sports like running, or if they are overweight. For every pound of excess weight, about 4 pounds of extra pressure is exerted upon 96
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the knees—a key weight-bearing joint. So, a person who is 10 pounds overweight has 40 pounds of extra pressure on his knees. Excess weight puts a burden on both the knees and the hips, according to the Arthritis Foundation. Orthopedic surgeons know that when the cartilaginous pads disappear between the bony hinges of our joints, the remedy is often surgical reconstruction. But knee replacements and artificial hips, as they’re known, have seen big strides in terms of more sophisticated anesthesia and less-invasive surgical techniques. For many patients, having a local spinal, where a small needle with local anesthetic is injected in the lower lumbar spine, eliminates the need for general anesthesia. It is similar to an epidural, which some females have during childbirth. However, the difference is only a small amount of anesthesia is needed. The major benefits include less risk of nausea and vomiting following the operation, less postoperative pain, and in fact a greater capacity to walk sooner. Some patients have concern that they don’t want to be aware during the surgery, so most people also have an intravenous sedation which makes them unaware of anything happening during