Orthopedic Surgery

Orthopedic surgery includes procedures within the musculoskeletal system. The musculoskeletal system provides form, support and stability to your body and includes your bones, muscles, ligaments, joints, etc. Some of the most common orthopedic surgeries happen in the knees, hips, spine, shoulders, feet and ankles. While these surgeries are conducted on thousands of patients every day, each person’s experience and recovery is unique. If you’re preparing to have surgery, ask your doctor about options for managing pain before, during and after surgery.

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See below for more details on each of these procedures.

Knee Replacement

The knee is the largest joint in the body, and having healthy knees is required to perform most everyday activities like walking or climbing stairs. Over the past 20 years, 14 million Americans have been diagnosed with knee osteoarthritis (OA), one of the most common joint disorders in the United States. If your knee is severely damaged by arthritis or injury, your doctor might suggest a knee replacement (also called total knee arthroplasty or TKA). A knee replacement involves removing the damaged parts of the bones at the knee joint (the tibia, sometimes called the shin bone; the femur, or thigh bone; and the patella, or kneecap) and replacing them with artificial parts.

More than 90 percent of people who have total knee replacement surgery experience a dramatic reduction in knee pain and significant improvement in the ability to perform regular daily activities.

If you’re experiencing pain, your doctor may recommend treatment options to help alleviate this discomfort prior to surgery, such as ice, over-the-counter medications (e.g., acetaminophen, ibuprofen, etc.) or non-drug interventions (e.g., acupuncture, meditation, massage therapy, or cryoanalgesia).

Patients who have a total knee replacement may stay in the hospital for up to 3 days; however, many surgeons have significantly reduced the number of in-patient stays. In fact, many knee replacements are now being conducted at Ambulatory Surgical Centers (ASC) on an outpatient basis, meaning patients can go home the same day as their surgery. While most people can return home following their procedure, patients who require extra attention or do not have a caretaker at home may be transferred to a rehabilitation center.

Opioids may be prescribed to manage pain following knee replacement surgery; however, pain can also be managed with long-acting, non-opioid medications. The best way to reduce opioid exposure is for your clinician to use a multimodal pain management approach, meaning that multiple types of pain medication are used in the lowest effective doses to provide effective pain control with minimal side effects and minimal reliance on opioids. A recent study found that patients who received a non-opioid option for total knee replacement took 78 percent fewer opioids than those who received other medications. Over-the-counter (OTC) pain medication, as well as rest, ice, compression and elevation (RICE) may also be recommended after surgery. In many cases, outpatient physical therapy will be prescribed. Most patients can resume normal daily activities, including driving, 3-6 weeks after surgery.

Hip Replacement

If your hip has been damaged by arthritis, a fracture, or other conditions, something as simple as walking may be painful. You might consider hip replacement surgery (also called total hip arthroplasty)if medications and lifestyle changes don’t minimize your pain. Hip replacement surgery can relieve pain, increase motion and help you get back to enjoying normal daily activities. In a total hip replacement, the damaged bone and cartilage is removed and replaced with artificial parts.

More common in women than men, more than 300,000 hip replacements are performed every year. Most people undergo hip replacement between the ages of 50 and 80. It’s always helpful to develop a plan when having surgery, including pain management options.

People can spend 1-3 days in the hospital after hip replacement surgery; however, more and more hip replacements are occurring in Ambulatory Surgical Centers (ASCs) as outpatient procedures, meaning patients go home the same day as their surgery. It takes about 3-6 months to resume full function and daily activities. Making slight modifications to your home, such as fastening safety bars or handrails to your shower or bath, and raising your toilet seat, may make recovering easier. You should be able to get back to normal activities of daily living within 3-6 weeks after surgery.

Hear one patient’s story of her hip replacement here.

Spine Surgery

There are several conditions that may lead to spine surgery, including broken vertebrae, spinal weakness, or herniated disks. The most common procedure to relieve back pain is a spinal fusion (a surgical technique used to join two vertebrae). Other common spine surgeries include discectomy (removal of an injured disk) and laminectomy (removal of tissue between disks in the spine), which is commonly used to treat pain in the lower back.

Even though spinal fusions can reduce pain, they can result in more long-term back pain since immobilizing a section of your spine places additional stress and strain on the areas around the fused portion. Be sure to talk to your doctor about how your pain will be managed following surgery.

A hospital stay of 2-3 days is usually required following spinal surgeries; however, it can take several months for the affected vertebrae to heal. Your doctor may recommend that you wear a brace to keep your spine appropriately aligned, and physical therapy will help you learn how to move, sit, stand, and walk to keep your spine properly aligned.

Foot and Ankle Surgery

The most common foot and ankle surgeries are bunionectomies and ankle fusions. Certain sports have an increased risk of these injuries, such as dance, gymnastics, soccer or basketball, because of the added strain on this particular part of the body.

A bunion is a painful bony bump that develops on the inside of the foot by the big toe. Bunions worsen over time and may require surgery if symptoms are not relieved. Anyone can get a bunion, but they are more common in women. More than 150,000 bunion procedures are performed in the U.S. each year. In most cases, bunion surgery includes correcting the alignment of the bone and repairing the soft tissues around the big toe.

Ankle fusions are common in older adults, as many people lose muscle mass and bone strength as they age. Approximately 25,000 ankle fusion procedures are performed each year in the U.S. Ankle fractures are the most common reason people require ankle fusion surgery. Talk to your doctor before surgery about the pain management options available. There are long-acting non-opioid options that can help limit, or completely eliminate, the need for opioids following foot and ankle procedures.

Although many foot and ankle procedures are done on a same-day basis with no hospital stay, a long recovery period is common. During the immediate post-operative period, it’s important to keep your foot or ankle elevated to minimize swelling. Bones – such as those in the foot and ankle – can take 7 weeks to heal to about 80 percent of their normal strength. It often takes up to 6 months for full recovery, with follow-up visits to your doctor sometimes necessary for up to a year.

Rotator Cuff Surgery

The rotator cuff is a group of muscles and tendons that work together to stabilize the shoulder and allow it to move in various directions. Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the upper arm bone (humerus). Ongoing pain is the main indication for surgery. If you have been experiencing shoulder pain for at least 6 months, you may want to consider surgery.

Approximately 4.5 million patient visits occur each year in the U.S. related to shoulder pain and nearly 250,000 surgeries are performed each year.

Procedures can be done by either arthroscopy – a minimally invasive procedure – or open surgery. Many types of medicines are available to help manage pain from shoulder surgery, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen, and long-acting local anesthetics. Regional anesthesia, such as nerve blocks, may also be used. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Recovery can take 4-6 months, depending on the size of the tear and other factors. Recovery from surgery often requires physical therapy and rehabilitation.

Hear one patient’s story of her rotator cuff surgery here.