HealthONE - May 14, 2021
by Leslie Mitchell

Over the past 20 years, the introduction of new techniques, technologies and protocols have considerably advanced the field of orthopedics.

Patients undergoing orthopedic surgery today can expect improved outcomes and a safer surgical experience than in the recent past.

Dr. John Woodward is chair of orthopedic surgery at Swedish Medical Center. A practicing orthopedic surgeon since 2001, Dr. Woodward specializes in joint replacement, sports medicine, and trauma. Here, Dr. Woodward details some of the changes that have improved orthopedics since he began practicing over twenty years ago.

More focus on pre-operative care

Today there is more of a focus on medical optimization prior to surgery. This means the surgeon and a team of multidisciplinary specialists work closely with the patient before surgery to ensure they are at their optimum health. Addressing and treating any underlying health issues before surgery often leads to better results. As part of the pre-op medical optimization, specialists can order ultrasounds, x-rays and blood tests. Once the tests are done, the patient might be advised to lose weight, quit smoking or get their diabetes under control – all factors that can improve the patient's surgical experience.

New technologies and procedures have created more options for patients to modify their own treatment.

Advanced imaging

Imaging technology has improved significantly. Older X-rays have been replaced with digital x-rays, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. These technologies help the surgeon gain a clearer, more accurate view of the affected area, which in turn helps them provide more precise diagnoses and more effective treatment.

Faster recovery times

Recovery time and surgery duration have dropped considerably in recent years. A patient undergoing joint replacement 20 years ago would face up to 5-7 days in the hospital, experience nausea and vomiting, and a long wait before they could return to daily activities. Today, patients are up and walking within hours of surgery, experience less symptoms, and can return home the same day.

Improved pain control

Pain control has advanced in the past 15-20 years due to the fact we now use shorter acting spinal anesthesia and there is less narcotic use. Rather than using general anesthesia, shorter-acting spinal anesthesia lessens the risk of blood clots, fatigue, nausea, and vomiting. The shorter acting anesthesia allows the body to get up and moving shortly after surgery and helps reduce the risk of post-operative falls and injuries. There is also less narcotic use. Due to high rates of opioid addiction, surgeons are now limiting the use of narcotic pain medications. Doctors opt instead for a multimodal approach to pain control- utilizing nerve blocks, nonsteroidal anti-inflammatory drugs and other pain-relieving agents. Patients often experience less side-effects and can return home in a safer manner.

Improved technologies

Twenty years ago, most knee replacements were fixated to the bone with high quality cement. Bone cement results in an interface between the metal component and the bone cement, and the patient's bone and the bone cement. Both these interfaces can have problems. Today, we have the option to use press fit technology which avoids the need for cement and allows the bone to grow onto the components. Cementless designs utilize 3D printing technology that when used correctly, may improve implant longevity. Additionally, this technology shortens surgical time, avoids complications such as loosening of the joint, and has the potential to last much longer than cement.

Implant technology has also changed significantly. Today, the use of advanced metal alloys (ex. titanium, ti-nidium, oxinimum) and improved polyethylene (plastic) bearing surfaces have greatly improved hip and knee replacement surgeries. In addition, these implants are now nickel-free – which is a rare allergy in some joint replacement patients. These modern implants are much more durable and long lasting than previous implants.

Minimally invasive techniques

Minimally invasive techniques and technologies have become more popular. Surgeons have evolved from performing lengthy, invasive surgeries to more arthroscopic procedures that are minimally invasive, have shorter recovery times and fewer complications. Minimally invasive surgeries can result in smaller incisions, more precise soft tissue dissection, faster recovery, and less pain. New technologies in implant design, fracture management and arthroscopic advancements have allowed surgeons to use minimally invasive techniques in a wider array of procedures.

Patients are more empowered

Patients today have the ability to be more engaged in their care. New technologies and procedures have created more options for patients to modify their own treatment. For example, advanced imaging can be used to determine which patients would benefit from arthroscopy or arthroplasty. In a combined doctor/patient decision-making process, the patient can decide which procedure they would prefer to undergo. As the field of orthopedic surgery continues to grow and innovate, patients can look forward to continued advancements and health benefits while enjoying a safer, more active quality of life.

To find out more about your orthopedic options or to schedule an appointment, contact the orthopedics team at Swedish Medical Center 303-789-2663.

John Woodward, MD is a board-certified orthopedic surgeon with special interests in trauma, sports injuries and joint replacement. He completed his undergraduate degree at the University of California at Los Angeles in 1992. After receiving a Bachelor of Science Degree in Kinesiology with departmental honors, magna cum laude status, and Phi Beta Kappa induction, Dr. Woodward traveled to Boston for medical school. He graduated from Tufts University School of Medicine with a Doctor of Medicine degree in 1996. While in Boston, he was involved in research and publications involving arthroscopy and sports medicine. Dr. Woodward completed both his surgical internship and Orthopaedic Surgery residency at the Maricopa Medical Center in Phoenix, Arizona, in 2001. He currently serves as the Section Chief at the Department of Orthopaedic Surgery at Swedish Medical Center. Dr. Woodward has published and presented cartilage research at numerous national meetings including the American Academy of Orthopaedic Surgeons. In 2002 Dr. Woodward was inducted into Who's Who in Medicine and Healthcare. He also teaches fracture management to fellow orthopaedic surgeons and lectures throughout the United States. His non-professional interests include mountain biking, basketball, golf and Southwestern art. Dr. Woodward is board certified by the American Board of Orthopaedic Surgery, a Fellow of the American Academy of Orthopaedic Surgeons. He is a member of the American Medical Association, the Colorado Medical Society, and Colorado Orthopaedic Society. Dr. Woodward works at the Swedish, Highlands Ranch and Southwest offices.