Relieving patients’ pain

One of the biggest joys of practicing orthopedic surgery in a small town environment is seeing people repeatedly over the years, forming friendships and sharing laughter together. Although most patients bring a special element to our day at the office, there are several that stand out.

Freda, a woman who received my first knee replacement, is one such patient. Although she passed away years ago, she made my staff and I smile every time she came for an appointment. She still does today when we remember her and exchange stories. She was known for sending dirty greeting cards, which always seemed to arrive on a day when we needed a smile. She would bring hard candy and knickknacks to sell to us all during most visits. On one busy day, she asked me if I would give her away at her upcoming wedding. I thought this was clearly a joke. To my shock she was serious, and I got excellent practice for later in life giving my daughters away at their weddings. I learned the importance of not stepping on the train or, worse, on the veil. It turns out that this makes the bride’s head snap back. This does not make for good video.

Another patient, despite my efforts to deter him, did multiple flips off the diving board at the Elks pool. He brought me a video to show how well he could do it again and again. This was after having had both hips replaced.

I met Bob, a farmer, when one of his cows knocked him down and injured him. We became the best of friends. He taught me to shoot and became my Randolph County father figure for many years. Some of my best hunting memories are riding around looking for a track on an icy mountain road in the middle of the night on a snowy December Randolph County bear hunt. Many other patients bring me stories of the various activities they have been able to do after we have fixed them.

Another topic is a more serious one. As most of us know, the State of West Virginia and our local community are suffering from the plague of narcotics abuse and related crime. Fortunately, things are starting to change for the better. The state legislature passed laws, which although they may make things seem inconvenient, will help to cut back the number of narcotics that are in the system.

As an orthopedic surgeon, I see patients in terrible pain. This includes those suffering from fractures or patients who are recovering from surgery. The new laws require physicians to prescribe medications in the acute setting one week supply at a time. Although most of us understand this, we must remember that pain medicine is potentially addictive. It is also at risk of being diverted to street use. The unfortunate reality is often visitors will find pill bottles and sneak some for their later abuse and/or sale on the street.

Remember that there are alternatives to narcotic pain medication as well. This includes using simple over-the-counter medications such as Tylenol, a good analgesic. Nonsteroidal anti-inflammatories such as ibuprofen and naproxen help both pain and inflammation. Good old ice packs work wonders, as I have learned through my own use over the years, as do sports creams and physical therapy.

Finally, it is important to remember to dispose of any leftover pain medication in the proper fashion. Many drugstores now have a drug collection center, which is a safe way to get rid of extra medications without risking the environment or community abuse.

Finally, as this is a potpourri article, I wanted to mention modern bearings in orthopedic surgery. The bearing, or new moving parts, applies to arthroplasty or joint replacement surgery. There are many options which include cobalt chrome, steel, and ceramic to provide a very hard bearing that in most applications will last forever. More difficult is the edge that will be rubbed or worn against. This would be the acetabulum or socket in the hip, the tibia in the knee, or the glenoid or socket in the shoulder.

All options have potential risks. Metal on metal hips were extremely popular several years ago but have fallen out of favor for now due to concerns with problems with the metal debris and what it could do to the body. Ceramic is an extremely durable option but, again, concerns exist about the bearing squeaking or even breaking. Although the material has been engineered to become tougher, breakage still occurs and leaves shards that are extremely difficult to remove completely. This resembles broken glass fragments which seem to appear in someone’s back yard over the years no matter how often and carefully people try to remove them.

Finally, highly cross-linked polyethylene is the most common wear bearing used in modern orthopedics. It is an extremely durable plastic material which is manipulated for toughness, wear resistance, and strength.

The majority of my joint replacements today utilize metal or ceramic components with highly cross-linked polyethylene as the wear bearing. As new alloys and materials are fashioned, it is probable that new and exciting choices will become available.

Obviously the goal is a joint replacement that would never come loose or never wear out, as we are performing this surgery in younger and more active patients routinely.