Pennsylvania Workers’ Compensation Lawyer Blog

While ankle injuries are common in PA workers’ comp cases, we do not hear about total ankle replacements as much as we hear of total knee replacements or total hip replacements. Unfortunately, sometimes a work injury causes such damage to the ankle, or triggers the development of arthritis in the ankle, such that a total ankle replacement is necessary.

A recent article on the American Academy of Orthopaedic Surgeons’ website talked of improvements in total ankle replacements. At this point, in the United States, only four types of implants are available for total ankle replacements. Each of these devices consists of only two components. This means there will not be much mobility in the ankle. Of course, the alternative, of fusing the ankle in one position, offers no movement at all.

Outside the United States, total ankle replacements are being done with a device containing three components, allowing greater mobility. FDA approval is being recommended for such devices to be approved for use in the U.S. The article suggests approval for these devices could come as soon as later this year.

As if an injured worker needed another reason to think of surgery as only a last resort, a recent article in Annals of Surgery journal noted that there is a discrepancy in the count of surgical instruments (including sponges) in nearly 13% of surgical procedures. This, of course, does not mean an instrument, or a sponge, is left in a surgical patient in 13% of procedures (that percentage is closer to 0.02%, or one in 5,000). Still, this seems like a staggeringly high percentage to have a miscount.

An article in Amednews.com suggests some solutions to reducing this figure. One is putting bar codes on sponges, which would then be scanned in and out. The count would then be automatic. The article suggests this would add only about $9.00 per surgical case. Another option is placing tiny radio-frequency identification (RFID) tags in the sponges. A wand could then be used to locate missing sponges, either inside a patient, or around the operating room. This would cost an additional $25.00 to $45.00 per surgical procedure.

While certainly no injured worker wants to rush into surgery, sometimes a work injury requires surgical intervention, whether it is a back surgery, a total knee replacement, or any other procedure. The hope is that these new technologies can make surgery safer, and less risky, for every injured worker.

One of the most common work injuries we see in PA is to the back, whether it is a herniated or bulging lumbar disc, an aggravation of degenerative disc disease, or a soft tissue injury, such as a strain or sprain. These injuries run from a minor strain, which can be cured by rest and medication, to a herniated disc encroaching on a lumbar nerve root, which can require injections and surgery.

When an injured worker has suffered a herniated lumbar disc, and is having pain or numbness down one or both legs (“radicular symptoms” or “lumbar radiculopathy”), surgery may be discussed. One of the more common procedures to relieve the pressure of a herniated lumbar disc pressing on a nerve root is called a discectomy, where the disc material is simply removed.

A recent article published in the Journal of Bone & Joint Surgery examined some previous studies regarding the timing and effectiveness of lumbar discectomies. One of the more interesting findings was that pain relief occurs first after a lumbar discectomy, followed by recovery of motor function (strength), then improvement in sensation. In other words, it is not unusual for the injured worker to continue to have abnormal sensation after surgery. This is an important thing to keep in mind after surgery, so that the injured worker does not feel as if his or her recovery is not going well.