Advances in Orthopedics Driven by Patient Care
Charles Cornell, Orthopedic Surgery, Hip and Knee Replacement, Osteoporosis, HSS Orthopedics at Stamford Health Collaborative
We believe that advances in orthopedic care are driven less by technology and more by improvements in patient care. These improvements take the form of better education for patients prior to surgery, new approaches to pain management, accelerated recovery steps, and surgical improvements including the use of robotics.
The quality of care that has earned #1 nationwide ranking for the past nine years is now available locally by HSS Orthopedics provided by Stamford Health.
Dr. Charles N. Cornell, chair of the Department of Orthopedic Surgery at Stamford Health, offers further detail about what HSS, including HSS Orthopedics at Stamford Health, is doing to improve the level of care at each stage of the patient experience.
1. Pre-op optimization program: It is important to get patients fully prepared for what they can expect from elective surgeries. A pre-operative optimization program ensures that our patients are in optimal clinical condition prior to surgery. It begins with optimizing the patient’s medical health and includes improved education around the surgical experience. Patients gain a clearer understanding of the hospitalization dimension and what to expect post-surgery.
2. Enhanced pain management: The overall goal with newer approaches to pain management is to minimize post-operative pain for patients. We used to rely more on opioid medications to alleviate pain after surgeries, but the opioid crisis and the side effects of these treatments have compelled us to explore other solutions. Our surgical teams work closely with the anesthetic teams to develop safe, effective orthopedic surgery pain management solutions.
3. Use of nerve blocks: Nerve blocks act to block sensory nerves to the knee during knee surgery, which can be painful. Administered at the outset of surgery, nerve blockers last for 24 hours and result in little or no pain for patients after surgery, without limiting motor control. We can now get patients up, walking and starting on physical therapy on the same day of surgery.
4. Nonsteroidal anti-inflammatories: Newer anti-inflammatory medications, given both pre-op and post-op, are less harmful to the stomach and effective for treating pain. We’ve also been using new forms of acetaminophen, administered intravenously so it is onboard and working for patients during surgery. Once patients can eat and drink after surgery, we administer it orally.
5. Post-op benefits: Nerve blocks and anti-inflammatories offer patients a number of benefits over opioids. There are fewer side effects such as nausea and bloating, so patients can walk the same day of their surgery. Accelerated recovery enables them to eat and drink more quickly, be alert and get a good night’s sleep. Hospitalization is reduced to just a day or two from four or five days previously.
6. Robotic support: HSS was early in the robotics game, using robotic arm-assisted technology to help surgeons navigate surgeries and ensure the precise accuracy of procedures. During hip replacement surgery, for instance, the robot enhances the surgeon’s ability to accurately implant the components of the hip prosthesis.