Treatment Principles
In managing a condition, the Orthopaedic Surgeon will advise what he feels to be the most appropriate treatment. These treatments may take one or more of several possible forms. The methods used are generally classified into those termed ‘operative’ methods and those termed ‘non-operative’ or ‘conservative’ methods.
Non-operative methods
Not every Orthopaedic condition requires an operation, and there are circumstances when a surgical procedure is not possible. In these instances the Surgeon has the following modalities of treatment available to him.
Pharmacological methods
Various drug preparations can be used to treat, or supplement treatment, of an Orthopaedic condition. The most commonly used drugs are those which serve to reduce pain. There are a wide variety of these preparations, which differ in their strengths of ability to reduce pain. The most commonly used such preparations are the ‘Non-steroidal anti-inflammatory’ agents.
Steroid agents may be injected locally to reduce the pain which arises from a tendonitis or bursitis. In doing so they alleviate the discomfort and allow for an improved motion of the trunk or limb.
Generalized musculo-skeletal conditions, such as Rheumatoid arthritis or the so-called ‘collagenoses’ which are allied to it, may be treated with steroid agents or other ‘disease modifying’ drugs in order to reduce the pain and inflammation which they cause in the joints of the body.
Tumours and malignancies occasionally affect the musculo-skeletal system. The treatment of these conditions is often surgical but these procedures are generally supplemented by ‘cytotoxic’ drugs.
Thrombosis of the deep veins of the leg is a complication which can occur in association with various forms of Orthopaedic treatment, particularly operative. There are many factors which are associated with its occurrence and some individuals are at greater risk of suffering it than others. Different pharmacological agents are often administered by mouth or by injection in an attempt to prevent it developing.
All drugs can have detrimental side effects. You should discuss any concerns in this respect regarding the drugs prescribed for you with your Surgeon or General Practitioner.
Physical methods
Physiotherapy – As stated, the aim of Orthopaedic management is to restore function to the affected part and regaining movement is of a affected limb or joint is of vital importance. The assistance of a Physiotherapist or Osteopathic practitioner is often of great help in this respect.
Supports and orthoses – such as splints, walking stick, crutches and the like play a valuable role in assisting movement of the limb and, in some cases, in replacing lost function.
Psychological methods
Pain often brings about a sense of anxiety in the affected individual and, if it continues for any length of time, is often accompanied by a feeling of depression. In this regard psychological support is generally of great benefit. This type of support can come from your family, your general practitioner or surgery nurse, or it may take the form of patient support groups involving groups of individuals similarly affected, or from counsellors and psychologists who are trained in this form of care.
Operative methods
In many instances, particularly where it is found that the non-operative methods are not of assistance, that surgery is indicated.
Although an Orthopaedic operation often brings about a revolutionary improvement in an affected individuals condition, taking away the pain and allowing the person to return to a relatively normal way of life, surgery is not without its hazards.
• Anaesthetic agents can affect the heart and blood vessels, leading to vascular collapse in susceptible individuals with subsequent damage to the heart or brain.
• Excessive bleeding can occur during the procedure, again leading to vascular collapse with potential for harm to the individual.
• Despite the area of surgery being cleaned and draped with care, operations expose the underlying tissues to infection by bacteria and other micro-organisms. This complication, particularly if it occurs after the insertion of an orthopaedic device, can be difficult to eradicate.
• Venous thrombosis can occur, with the risk of pulmonary embolism.
• Post operative chest infections and other complications can occur.
• Not all surgical procedures are curative.
One should therefore not, therefore, approach a surgical procedure in a blasé manner. The operation should be discussed with your surgeon and the expectations for the procedure should be realistic. The aim of the operation should be understood, and its potential benefits weighted against its possible disadvantages and/or complications.
