Comprehensive Overview of Pediatric Orthopedic Surgery: Treatments and Therapies
This article outlines the various treatment options available for pediatric orthopedic patients at Mayo Clinic, highlighting medical therapies, supplements, over-the-counter and prescription medicines, physical therapy, and surgical interventions. It emphasizes the role of glucosamine and chondroitin for arthritis symptoms, compares the effectiveness of NSAIDs, discusses the cautious use of opiates, and reviews the effectiveness and safety of injection therapies. Surgical options like fusion and arthroscopy are detailed, showcasing their applications and advantages.
Comprehensive Overview of Pediatric Orthopedic Surgery: Treatments and Therapies
E N D
Presentation Transcript
Part III Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota
Medical Therapy • Supplements • Over-the-counter medicines • Prescription medicines • Injection therapy
Supplements • Little scientific evidence for/against products • Not subject to FDA regulations • Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms • No evidence for other compounds
OTC Medicines • Tylenol • NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve) • Equally effective in all major studies • Quite safe when taken with supervision • Stomach ulcers • Kidney trouble
Prescription Medicines • Prescription NSAIDs • Celebrex, Mobic, etc • No better than ibuprofen or naprosyn in comparable doses • Benefits for select patients • Primary benefit is convenience • Cardiovascular risks unknown
Prescription Medicines - Opiates • Synthetic derivatives of morphine • Effective • But… tolerance building and habit forming • Frequent depression and side effects • Used very selectively and carefully under specialty supervision
Physical Therapy • Important aspect of joint care in SS • Particularly important before and after any surgery
Injection Therapy • Injection of cortisone or hyaluronic acid derivatives • Effective in ~2/3rds patients • Effect often fades • Safe for up to 3-4 times/year
Surgical Treatment • Fusion • Arthroscopy • Realignment / reshaping • Joint replacement
Fusion • Traditional treatment for arthritis in the young • “No motion, no pain” • Not for patients with multiple joint involvement • Spine, ankle, wrist possible exceptions
Arthroscopy • Low morbidity outpatient procedure • Doesn’t “burn” bridges • Effective against well defined targets • Focally torn cartilage • Not effective for generalized joint pain or arthritis
Realignment Procedures - Knee • Surgically change alignment to “offload” worn area • Delay need for joint replacement
Realignment Procedures - Hip Impinging bump on the edge of a malformed femoral head (ball)
