Our Orthopedic Services
We offer customized, individual care and access to the latest technology available for the diagnosis and treatment of orthopedic conditions.
In the past, most orthopedic surgical procedures required large incisions, lengthy hospital stays and weeks of recovery. Today, the use of small viewing scopes and much smaller surgical instruments has transformed the way that many surgical procedures are performed, particularly joint replacement surgery. We're one step ahead of you. At TMH, you can now walk the same day after receiving hip and knee surgery!
Interested in discussing treatment options or scheduling an appointment? Patients can select from two practices within the Tallahassee Memorial Orthopedic Center:
Joint Replacement & Repair
We perform more than 1,000 joint replacement and repair surgeries a year:
- Total hip, knee and ankle replacements.
- Shoulder replacements and resurfacing.
- Elbow replacements.
Treating Sports Injuries
We also offer a variety of treatment options for individuals with sports injuries:
- Surgical repair of ruptured Achilles tendon.
- ACL repair.
- Meniscectomy for a meniscus tear.
- Open carpal tunnel surgery.
- Osteotomy for osteoarthritis.
- Plantar fasciitis surgery.
- Rotator cuff repair.
- Tennis elbow surgery.
Patients who are experiencing side effects from other joint-related and spinal conditions may benefit from some of our other orthopedic surgeries:
- Arthroplasty and arthroscopy for surgeries for rheumatoid arthritis
- Decompressive laminectomy
- Spinal fusion
- Scoliosis spinal fusion
- Hammer, claw or mallet toes surgery
What to Expect
Anesthesia for Hip and Knee Surgery
Before your joint replacement surgery, your doctor will discuss anesthesia with you. The selection of anesthesia is a major decision that could have a significant impact on your recovery. It deserves careful consideration and discussion with your surgeon and your anesthesiologist. Here are things to consider:
- Your past experiences and preferences.
- Have you ever had anesthesia before?
- Did you have a reaction to the anesthesia?
- How do other members of your family react anesthesia?
- Your current health and physical condition.
- Do you smoke?
- Are you overweight?
- Are you being treated for any condition other than your joint replacement?
- Your reactions to medications.
- Do you have any allergies?
- Have you ever experienced bad side effects from a drug?
- What medications, nutritional supplements, vitamins, or herbal remedies are you currently taking?
Types of Anesthesia
There are three broad categories of anesthesia: local, regional and general.
Local anesthesia numbs only the specific are being treated. The area is numbed with an injection, spray or ointment that only lasts for a short period of time. Patients remain conscious during this type of anesthesia. This technique is reserved for minor procedures. For major surgery, such as hip or knee replacement, local anesthesia may be used to complement the main type of anesthesia that is used.
General anesthesia is often used for major surgery, such as joint replacement. General anesthesia may be selected based upon patient, surgeon or anesthesiologist preference or if you are unable to receive regional or local anesthesia. Unlike regional and local anesthesia, general anesthesia affects your entire body. It acts on the brain and nervous system and renders you temporarily unconscious.
- Administration. With general anesthesia, the anesthesiologist administers medication through injection or inhalation. The anesthesiologist will also place a breathing tube down your throat and administer oxygen to assist your breathing.
- Risks. As with any anesthesia, there are risks, which may be increased if you already have heart disease, chronic lung conditions or other serious medical problems.
General anesthesia affects both your heart and breathing rates, and there is a small risk of a serious medical complication, such as heart attack or stroke. The tube inserted down your throat may give you a sore throat and hoarse voice for a few days.
Regional anesthesia involves blocking the nerves to a specific are of the body, without affecting your brain or breathing. Because you remain conscious, you will be given sedatives to relax you and put you in a light sleep. The three types of anesthesia used most frequently in joint replacement surgery are spinal blocks, epidural blocks and peripheral nerve blocks.
- Spinal Block. In a spinal block, anesthesia is injected into the fluid surrounding the spinal cord in the lower part of your back. This produces a rapid numbing effect that wears off after several hours.
- Epidural Block. An epidural block uses a catheter inserted in your lower back to deliver local anesthetics over a variable period of time. The epidural block and the spinal block are administered in a very similar location; however, the epidural catheter is placed in a slightly different area around the spine as compared to a spinal block.
- Peripheral Nerve Block. A peripheral nerve block places local anesthetic directly around the major nerves in your thigh, such as the femoral nerve or the sciatic nerve. These blocks numb only the leg that is injected and do not affect the other leg. One option for a peripheral block is to perform a one-time injection around the nerves in order to numb the leg just long enough for the surgery. Another option for this type of block is to keep a catheter in place, which can deliver continuous local anesthesia around the nerves for up to several days after surgery.
Advantages to regional anesthesia may include less blood loss, less nausea, less drowsiness, improved pain control after surgery and reduced risk of serious medical complications, such as heart attack or stroke that may occur with general anesthesia. Side effects from regional anesthesia may include headaches, trouble urinating, allergic reactions, and rarely nerve injury.
Many patients may be apprehensive about spinal anesthetics. In order to alleviate this it is important to know what to expect on the day of your operation. The following is a brief summary of how we approach and administer spinal anesthetics:
- Prior to going to the operating room for your procedure, an anesthesiologist will evaluate you to determine if you are a candidate for a spinal anesthetic.
- Once in the operating room, you will be positioned on the operating bed by your anesthesia provider, who will then assess your lower back and determine the best approach to administer the anesthetic. A small amount of sedative medication may also be administered at this time.
- Your back will then be cleaned and sterilized and a sterile drape placed over it.
- A small amount of local anesthetic will be used to numb your skin. In many cases this “bee sting” is the worst discomfort a patient feels during the procedure.
- The spinal needle is then advanced through the numb area and a small amount of local anesthetic will be injected to temporarily block the nerves that go to your legs and hips.
- You will then be repositioned on the bed and given sedative medication which will limit the possibility of you remembering any of the operation at all.
Benefits of Spinal Anesthesia
Recent studies have indicated multiple benefits associated with spinal anesthetics compared to general anesthetics in patients undergoing total knee and hip arthroplasties. These benefits include the following:
- Decreased risk of postoperative pulmonary complications due to the avoidance breathing tubes and need for mechanical ventilation
- Decreased risk of postoperative kidney complications
- Less blood loss and less blood transfusions
- Decreased risk of DVT/PE (blood clots)
- Improved pain scores in the recovery room
- Less confusion and delirium in the recovery room
- Less nausea in the recovery room
- Less overall use of narcotic pain medications
- Additional medications can be administered in the spinal block to help with postoperative pain
- May decrease overall length of hospital stay
Pain Relief After Surgery
The goals of postoperative pain management are to minimize discomfort and allow you to move with less pain in order to participate in physical therapy after surgery. Postoperative pain relief may be achieved using a combination of oral medications or intravenous medications.
A common method of pain control is called “patient-controlled anesthesia” or “PCA.” With PCA, you will be bale to control the flow of intravenous medication, within preset limits, as you feel the need for additional relief.
If an epidural or peripheral nerve block was used for your surgery, the epidural or peripheral catheter can be left in place and anesthesia can be continued in the postoperative period to help control pain. You may also have control over the amount of pain medication you receive in these catheters, within preset limits. You will be closely monitored to avoid complications, such as excessive sedation or falls.
The proper use of pain relievers before, during and after your surgery is an extremely important aspect of your treatment. Proper use of pain medication can encourage healing and make your joint replacement a more satisfying experience. Take your time to discuss the options with your doctor and be sure to ask questions about things you do not understand.
After making a full recover, make this year the healthiest yet with tips from the TMH FOR LIFE program.