Total joint arthroplasty for persons with osteoarthritis.

Osteoarthritis is a process largely associated with aging, and Americans today are living longer than ever before, with the most recent data from the Centers for Disease Control and Prevention showing an average life expectancy of 78.2 years. With an increasingly older society, there will be an increased need for medical and surgical treatment of osteoarthritis. At the same time, a decline in the number of surgeons performing total joint arthroplasty is anticipated, by as much as 30% in some studies. Due to this anticipated shortage, nonoperative physicians will play a more prominent role in patient care and should become better educated in maximizing nonoperative care, recognizing appropriate surgical indications, and educating their patients on surgical outcomes. Total joint arthroplasty offers pain relief and potential functional improvement. Unfortunately, the outcomes for joint replacement differ significantly by the joint being replaced. The best examples of positive outcome for both pain relief and functional improvement are total hip arthroplasty and total knee arthroplasty. Shoulder arthroplasty has demonstrated encouraging outcomes but the outcome data is not yet as robust as the data for hip and knee arthroplasty. Elbow arthroplasty provides good pain relief but functional outcomes are not nearly as good, and significant potential complications exist. Lastly, ankle arthroplasty has not demonstrated outcomes that are as positive as the other major joints, and the criterion standard treatment continues to be ankle fusion. In this article, surgical options for arthroplasty will be reviewed for each of the major joints, including the joint-specific indications and outcomes for each procedure.

Surgical treatment and outcomes of lumbar radiculopathy.

Lumbar disk herniation is a significant cause of lumbar radiculopathy and results in billions of dollars in health care expenditure. Herniated lumbar disks cause mechanical and chemical irritation of the nerve roots leading to complaints of sciatica. Surgeons have several surgical options when approaching herniated disks, including various microsurgical procedures. The 3 most prominent studies to date on surgical and nonsurgical management of herniated disks agree on the efficacy of surgery over medical management in the short term but have some discrepancies when looking at long-term results. Cauda equina syndrome is a variation of lumbar disk herniation in which patients experience a combination of saddle anesthesia, abnormal lower extremity reflexes, and neurogenic bowel or bladder symptoms.

Surgical treatment and outcomes of cervical radiculopathy.

Cervical radiculopathy, when resistant to conservative treatment, can require surgical treatment. There are numerous surgical treatment options available, such as posterior cervical foraminotomy, anterior cervical foraminotomy, anterior cervical diskectomy and fusion, and cervical disk arthroplasty. This article describes the surgical techniques, reviews their respective indications, and examines their outcomes.

Perioperative management of the patient with cardiac disease.

The overall incidence of perioperative death is relatively low. However, patients with coronary artery disease are at higher than average risk of perioperative cardiac complications. Thus, preoperative testing for cardiac disease should be done in certain patients in an effort to reduce postoperative mortality and morbidity. Patients who require emergent orthopaedic surgery are at greater risk of perioperative cardiac events than are those who undergo elective procedures. Certain modalities, such as beta blockers, statins, and alpha-2 agonists, may be started or continued in the postoperative period to further enhance cardiac function. We review the current recommendations for preoperative cardiac testing in orthopaedic patients and for perioperative management of orthopaedic patients with known cardiac disease.