ORTHOPAEDICS

Some types of pain result from a disease or accident. Other pain may linger or come back after treatment. Sometimes, pain results from treatments (such as pain after surgery). Some pain has no known cause. The types of pain include:

• Acute: This type of pain is sharp and often results from an injury. Acute pain gets better when providers treat the injury or disease that’s causing the pain. This type of pain can result from a bone fracture, muscle spasms, a burn or other kind of accident. Some illnesses and disorders, such as appendicitis and shingles, cause acute pain.
• Chronic: Providers call pain that lasts more than six months chronic pain. This type of pain can result from an untreated injury or disease. It can also result from conditions like arthritis, fibromyalgia or nerve damage (neuropathy). Low back pain is another type of chronic pain.
• Nociceptive: Nerve cell endings (nociceptors) send pain signals to your brain when you have an injury. Nociceptive pain happens when you break a bone, bump your head or pull a muscle. The pain can be sudden and short-lived or long-lasting. It can affect your internal organs (visceral pain) or your musculoskeletal system (somatic pain).
• Neuropathic: Problems with the nervous system cause neuropathic pain (nerve pain). It happens when nerves fire pain signals to the brain by mistake, even when they aren’t damaged. Diabetes, multiple sclerosis (MS) and HIV commonly cause this type of pain.

Some of the following symptoms may be related to conditions that hip replacements address. They include:

• Pain in the anterior hip or groin.
• Pain in the buttock and trochanteric region.
• Pain with activity and at rest.
• Pain that gets worse when you put weight on the leg.
• Stiffness/tightness of the hip.
• Loss of motion.
• Difficulty sleeping.
• Difficulty walking.
• Difficulty putting on shoes and socks.

Total ankle replacement surgery usually treats ankle arthritis. Arthritis develops from changes to the cartilage (tough tissue) covering the bones of a joint. The cartilage becomes thinner and rougher. Ankle arthritis can happen with age, from general wear and tear. It may also come from repeated ankle injuries, ankle fractures or certain health conditions.

Common symptoms of ankle arthritis include:

• Difficulty walking.
• Joint pain.
• Joint swelling.

Most people find relief from ankle pain and other symptoms with basic treatments, often used together. Healthcare providers consider these treatments “conservative therapies.” They may include medications, physical therapy or orthotics (special shoe inserts or devices, like braces, to relieve pain). Sometimes, though, severe ankle arthritis requires more targeted treatment. When that happens, a healthcare provider may suggest total ankle replacement.

Wrist replacement is performed in a hospital or outpatient surgical center. The procedure usually takes less than two hours.

The surgical team will:

1. Give you anesthesia through an IV in your arm to put you to sleep. Most patients will also get an upper extremity block to provide longer-lasting post-operative pain relief.
2. Make an incision (cut) on the top of your wrist.
3. Remove your joint and cut away damaged cartilage and bone.
4. Insert the prosthesis.
5. Attach it to the bones on each side of your joint with pins, screws or bone cement.
6. Make sure the artificial joint is in place and secure.
7. Test that your joint moves appropriately.
8. Ensure that surrounding tissues such as tendons and nerves are back in place.
9. Close the incision, usually with stitches.
10. Wrap your wrist in sterile bandages and a splint.

Wrist replacement surgery may be combined with other procedures to correct associated problems in tendons, nerves and thumb or finger joints.

The goal of artificial disk replacement is to reduce pain and improve mobility in patients with cervical disk disease. This procedure is an option for certain people with cervical radiculopathy and/or myelopathy that have minimal degeneration of the disk.

Spinal disks are located between the bones or vertebrae of the spine and act as cushions or shock absorbers for the vertebrae. The discs also contribute to the flexibility and motion of the spinal column. The discs consist of two parts:

• The inner portion: soft material
• The outer portion: a stronger, fibrous material

During the aging process, disks can weaken and develop tears or cracks in the outer portion, resulting in degenerative disc disease. Additionally, the inner portion may bulge out and press against the outer portion, resulting in pain. The purpose of artificial disk replacement is to replace the worn out disk while also preserving the spine’s motion.