Revenge of Surgery: Orthopedic Style
I've started my summer job. Before I get into what I'll be doing, since that's not entirely clear at this point, and not the most exciting part of this post, I'll talk about my experiences scrubbing in on knee replacements.
Queasy folks beware - much descriptive gore ahead.
Knee replacements, and all joint replacements, really, are a very interesting kind of procedure in that they can be easily explained to a layperson without the layperson knowing what happens or how on Earth it's done. Take knee replacements. Ask Joe Everyman what a knee replacement surgery is and he'll probably tell you it's when the doc puts in a metal knee. Sounds so simple.
But here's something Mr. Everydude didn't consider: how does this new metal knee FIT in there? You can't just stick a big hunk of metal in between someone's femur and tibia and expect their legs to remain the same length. But he understands that, so he could think for a moment and say, a bit disgusted, that the doc has to cut out some bone in order to do this procedure (if he doesn't just assume that a "metal joint" is one where there's a metal cap placed over the existing bone, which many people would). Now he's getting much closer. But still not really there.
What actually needs to happen is that the bones are sawed down to rather boxy shapes at the end, cleaned with a power washer, and pre-fabricated prosthetic bone-ends are cemented into place at the end of the bone, leaving the new "bionic" bone the same length as the original one, just with metal at the end. Even this is a huge oversimplification, but it's the main idea. There are different sizes of prostheses, for petite people or the truly "big-boned" alike.
I watched some knee replacements recently. The procedure is not exactly delicate in the way many people usually think surgery would be. How could it be with power tools involved? Still, there is a certain amount of finesse needed to coax a limb into the correct position, apply the guide, and use the saw to get the exact shape and specs needed for the prosthesis to fit on. Kinda jarring at times, but also delicate at others. Let's just say it makes sense that these patients experience lots of pain post-op.
With all that sawing and shoving and drilling going on, you'd figure these things would be very bloody affairs. But they're usually not. The surgeons apply a tourniquet whenever possible to minimize blood flow to the region and allow them a cleaner work environment. Trouble arises when the patient is so large that even with a tight tourniquet, the sheer volume of compressible fat in there allows the pressure to be dissipated before it compresses the innermost vessels, so a fair amount of blood still circulates through. Once that happens, the surgery becomes a lot more messy. After one particular case, with a really obese patient, I looked like I had just committed a heinous crime. I think the nurses expected me to pass out or something... but aside from having seen loads of surgeries already, I always try to keep in mind that no matter how bad it looks, what we're doing is for the patient's good and I think that keeps me focused.
Queasy folks beware - much descriptive gore ahead.
Knee replacements, and all joint replacements, really, are a very interesting kind of procedure in that they can be easily explained to a layperson without the layperson knowing what happens or how on Earth it's done. Take knee replacements. Ask Joe Everyman what a knee replacement surgery is and he'll probably tell you it's when the doc puts in a metal knee. Sounds so simple.
But here's something Mr. Everydude didn't consider: how does this new metal knee FIT in there? You can't just stick a big hunk of metal in between someone's femur and tibia and expect their legs to remain the same length. But he understands that, so he could think for a moment and say, a bit disgusted, that the doc has to cut out some bone in order to do this procedure (if he doesn't just assume that a "metal joint" is one where there's a metal cap placed over the existing bone, which many people would). Now he's getting much closer. But still not really there.
What actually needs to happen is that the bones are sawed down to rather boxy shapes at the end, cleaned with a power washer, and pre-fabricated prosthetic bone-ends are cemented into place at the end of the bone, leaving the new "bionic" bone the same length as the original one, just with metal at the end. Even this is a huge oversimplification, but it's the main idea. There are different sizes of prostheses, for petite people or the truly "big-boned" alike.
I watched some knee replacements recently. The procedure is not exactly delicate in the way many people usually think surgery would be. How could it be with power tools involved? Still, there is a certain amount of finesse needed to coax a limb into the correct position, apply the guide, and use the saw to get the exact shape and specs needed for the prosthesis to fit on. Kinda jarring at times, but also delicate at others. Let's just say it makes sense that these patients experience lots of pain post-op.
With all that sawing and shoving and drilling going on, you'd figure these things would be very bloody affairs. But they're usually not. The surgeons apply a tourniquet whenever possible to minimize blood flow to the region and allow them a cleaner work environment. Trouble arises when the patient is so large that even with a tight tourniquet, the sheer volume of compressible fat in there allows the pressure to be dissipated before it compresses the innermost vessels, so a fair amount of blood still circulates through. Once that happens, the surgery becomes a lot more messy. After one particular case, with a really obese patient, I looked like I had just committed a heinous crime. I think the nurses expected me to pass out or something... but aside from having seen loads of surgeries already, I always try to keep in mind that no matter how bad it looks, what we're doing is for the patient's good and I think that keeps me focused.
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