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Orthopedic Surgery Procedures

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The purpose behind most orthopedic surgical procedures is to increase and enhance mobility of a joint as well as to repair damaged bone, muscular, or neural tissues caused by sports injuries, arthritis, fractures, and muscle and bone diseases. Common orthopedic services and procedures include partial or total hip replacement surgery, as well as hip resurfacing surgery, partial or total knee replacement procedures and those that focus on hands, elbow, or shoulder joints.

Surgical orthopedics and treatments help treat chronic diseases such as various forms of arthritis in the hands, knees and back. For example, rheumatoid arthritis severely inhibits mobility in the fingers and hands. Orthopedic care is designed to relieve pain and increase mobility require a team effort from specialists in orthopedics surgery as well as specialists who focus on the musculature damage such arthritis causes.

Knee problems, such as torn cartilage or tendonitis in the knee joint, caused by sports injuries are often treated with a combination of arthroscopy, or a minimally invasive procedure, or knee surgery.

Orthopedics surgery and treatments may help or repair damage to hip joints caused by traumatic injuries, fractures or osteoarthritis conditions. Such treatments may require surgical procedures to replace broken joints with partial or total artificial joints, as well as the use of pins or braces to hold bone sections together.

Sports injuries such as tennis elbow or baseball elbow may require treatment to repair damage to the tendons that attach muscle to bone at these critical joints in the arm.

Orthopedic services and treatments to reduce deformity and increase mobility of the spine and neck caused by scoliosis, fibromyalgia, bursitis or arthritis are common as well. Orthopedic surgery involves many different techniques and methods for the treatment of hundreds of bone or joint injuries and conditions that limit range of motion or cause pain in men, women and children.

Hip orthopedics, including joint replacement surgeries, has become increasingly common and allow for the total or partial replacement of joints. The use of alternative materials such as plastics, metals, and ceramic implants provides increased mobility in a great percentage of surgery candidates.

Benefits of Orthopedic Surgeries

In most cases, recovery from most types of orthopedics surgery is relatively rapid. Depending on the specific type of surgery, recovery time varies from two weeks to four months. Physical and Occupational therapy usually follows any type of orthopedic surgical procedure, which will help restore muscle strength, coordination, and mobility. Some physical therapy is also performed through the use of hydrotherapy and massage.

After orthopedics surgery that addresses a variety of issues, such as partial or total joint replacement, arthroscopy to remove bone or cartilage tissues as well as procedures to relieve pain and loss of movement through osteoarthritis or rheumatoid arthritis, patients can expect a reduction of pain, increased mobility and improved quality of life. Success rates with joint replacement and Arthroplasty are higher than 90%, and longevity of prosthetic implants provide long-term relief.

Our Procedures

Instability Repair Procedures

The shoulder joint is a complex structure that allows wide range of arm motion and power when it is functioning properly.

Due to its unique structure the stresses often placed on it may injure the muscles and tendons of the shoulder joint. One of the most common injuries is recurrent shoulder dislocation and injury to the rotator cuff tendons.

If trauma has caused dislocation and injury to the major supporting structures of the shoulder joint, it may become chronically “loose” or unstable. The instability is caused mostly by a detachment of the ligaments that run between the glenoid (shoulder socket) and upper arm (humerus). This detachment most commonly occurs at the labrum-bone interface. In an unstable shoulder joint, the humerus develops a tendency to slip out of its socket, either partially (subluxation) or completely (dislocation). Dislocation, recurrent subluxation and persistent looseness can damage the head of the humerus, and other parts of the joint.

Your surgeon may recommend surgery to repair the labrum, ligaments and tendon if:

• Instability is likely to worsen and cause further damage to the joint.

• Instability is causing persistent pain and inflammation.

Acute traumatic dislocation has occurred in a patient younger than 25 years of age The procedure to repair the labrum (Bankart repair) and tendons may be done either with an open procedure or with the help of an arthroscope (key hole surgery) depending on the degree of damage in the joint.

Rotator Cuff Procedures

One of the most common injuries of the shoulder occurs to the rotator cuff tendons. The rotator cuff tendons are important keeping the shoulder joint stable and allowing flexibility of the arm and shoulder. It is composed of four tendons that connect the shoulder blade (scapula) to the upper arm bone (humerus). Rotator cuff tears are more common in patients older than 40 years of age and they can cause shoulder weakness and pain. They can also occur in younger patients following sudden major trauma.

Tears most commonly occur at the “insertion”, where the tendon joins the muscle to the bone. A tear is unlikely to heal by itself and they vary from a partial tear to a more complex full thickness tear.

After failed conservative treatment options that consists of physiotherapy, rest and cortisone injections, surgery may be indicated.

The surgical technique used depends on the size and depth of the tear and its location. Your surgeon will undertake rotator cuff surgery using one of the following methods:

• Open surgery

• Arthroscopy (key hole surgery) with small incisions.

• Arthroscopy plus four to five centimeter incisions.

The tendon is anchored to the bone in one of two ways:

• Small holes are drilled in the prepared area of bone. Strong stitches are placed in the end of the torn tendon and then looped through the holes to anchor the tendon to the bone.

• Small, strong anchors, with sutures attached, are fixed into the bone. These suture anchors are made of metal, plastic or a synthetic material. The stitches are then passed through the torn end of the tendon and tied down to the anchors.

Following your surgery you will need to refrain from doing any activities with your shoulder so that the tendons can heal to bone. You will also follow a rehabilitation protocol to improve your shoulder movement and muscle strength.

Ligaments Procedures

The Anterior Cruciate Ligament (ACL) is an important ligament for normal knee function and stability. The ACL may stretch beyond its normal range if the knee twists abnormally or sustained a hyperextension injury as in a collision. This may lead to a complete tear or separation of the ACL ligament. A complete tear of the ACL can cause recurrent knee instability preventing return to rigorous activity. In particular the ACL and PCL(Posterior Cruciate ligament) control the movement of the tibia forwards or backwards during walking and running.

The aim of surgery is to provide the most stable joint possible. Without reconstructive surgery the knee joint may degenerate further, with damage the cartilage of the femur and tibia leading to early adult posttraumatic arthritis or cause associated injuries to the menisci in the knee joint that will further compromise knee joint stability.

Surgical reconstruction is performed by replacing the ligament with a tendon graft harvested from the patella tendon or hamstrings muscles at the back of the leg. In some cases a ligament graft from a human donor may be used.

Dr Smith is using the latest surgical techniques to enhance recovery to full activity within 6 months after such a serious knee injury. He uses arthroscopy assisted and limited incision surgery to reduces post-operative morbidity.

Following you surgery you will follow an intense rehabilitation protocol to strengthen your thigh muscles and to regain the movement in your knee joint.

Osteotomy Procedures

Knee osteotomies (breaking and realignment of the knee joint) are salvage procedures to slow down the progression of knee arthritis in the younger patient. The aim is to delay a knee replacement surgery tha got functional limitations in a younger patient.

Although an osteotomy won’t stop you from developing knee osteoarthritis in the future, it may slow down the progression of the disease until you are ready to have a total knee replacement. Different surgical techniques including open and closing wedge tibial or distal femoral osteotomies can be performed with certain advantages and disadvantages for each individual technique, but all procedures share the same goal in slowing down your osteoarthritic disease. The alignment may also be further controlled with the aid of navigated computer surgery.

Replacement Procedures

Surgery of the knee may replace part or the entire joint. This surgery has a high success rate in relieving pain and restoring mobility. About 95 out of every 100 procedures can be confidently predicted to be successful. The procedure has become common due to: Major improvements in surgical techniques, Increasing number of older patients, Better artificial prosthesis.

The gold standard is still to perform a total knee replacement rather than only replacing part of the knee (unicompartemental knee replacement) However in a selected few patients this may give them functional good results better than a total knee replacement.

Surgeons know from clinical studies and experience that at 10 to 15 years after implantation 95 out of 100 knee joint prosthesis are still functioning well. Some prosthesis may have lasted more than 20 years. Not everyone will get the same results from this surgery and patients need to have realistic expectations about what the surgery can achieve. As you getting older it may be necessary to replace part or all of the knee components; when there is evidence of loosening or wear of the prosthesis (revision knee replacement surgery).

The objective of a knee replacement is mostly for pain relief; the procedure does not result in a normal knee. Computer navigated surgery may be used to aid in achieving a better overall alignment of the artificial knee in the body and also to give a better ligament balanced knee. Placing tracking devices on the limb that the computer then uses to generate data about the patient’s knee does this.

Arthroscopy Procedures

Knee arthroscopy is a common procedure that orthopaedic surgeons use to examine and treat the inside of the knee joint. An arthroscope is a thin fiber-optic telescope that is passed into a joint through a small stab incision. This procedure may be done under a general or local anaesthetic.

A camera is attached to the arthroscope and a view of the joint can be seen on a video monitor enabling the surgeon to examine the inside of your joint. Depending on the diagnosis, the surgeon may be able to treat a number of conditions during the same procedure. Various kind of procedures can be performed with the aid of an arthroscope, for example anterior and posterior cruciate ligament reconstruction, patella realignment procedures, meniscus repair or meniscectomies, meniscus transplants and cartilage regeneration procedures. Most arthroscopies can be done as a day procedure, thereby reducing the problems that can occur with prolonged bed rest, such as blood clots and chest infections.

Hip Replacement Procedures

Replacement of the hip joint has become a common operation over the past 45 years. The hip joint is the ball and socket joint that connects the thigh bone (femur) to the pelvic bone (acetabulum). When the joint is diseased or damaged the protective cartilage cushion can wear away, allowing the bone of the head of the femur to rub directly against the acetabulum leading to pain, stiffness, limping and muscle weakness.

Also called arthroplasty, joint replacement surgery is considered when other treatments have not relieved pain and disability. The aim is to relief pain and restores hip function. During surgery the surgeon removes the diseased hip joint and inserts an artificial joint or prosthesis. In consultation with you and based on your lifestyle and age, the surgeon will decided prior to operation which prosthesis is best for you. An alternative to a total hip replacement the option of having a hip resurfacing may be offered to you. With this technique, the surgeon uses a smaller prosthesis that requires less removal of bone. Hip resurfacing often works in the younger, active patient. It is not used in all patients due to certain constraints it may have on long-term outcome.

Under normal conditions, older people can expect their prosthesis to last about 10 years or more. Younger people may need to have a second procedure to replace the prosthesis when it wears out (Revision Hip Replacement Surgery).

Bunions Procedures

Bunions occur when the big toe deviates from its normal alignment. With the most common problem, called “hallux valgus”, the big toe deviates towards the other toes. This disrupts the joint, and arthritic changes sometimes develop in the joint. The prominent bone at the side of the big toe compresses the skin against the shoe, and a sac of fluid called bursa may form in the tissues. This swelling of soft tissue, bursa and underlying bone is called the bunion. It can be very painful.

As the big toes joint has moved, it crowds the second toe so that it is bent upwards, usually resembling a claw. The deformity of the second toe is called a hammer toe. This often causes a corn on top of the toe due to pressure from the shoe.

Hallux valgus tends to run in families and is more common in women. Shoes with a narrow pointed toe box and high heeled shoes contribute to the problem, according to some experts. After surgery, the foot has to heal for several weeks (at least) before the patient can walk easily and wear shoes comfortable.

Persistent pain is the key reason for surgery. Operating on painless bunions so the toe looks better can give disappointing results. This is called orthopaedic cosmetic surgery.

Claw and Hammer Toe Procedures

Claw toe is a condition where the two joints of the toe are deformed to be bent like a claw. In the early stages, the toe may be flexible, but after some time, the deformity becomes fixed. Hammer toe is similar, but only one joint is bent.

Claw toe tends to run I families. However some experts think it may be due to wearing shoes with a short narrow toe box.

Pressure on the top of the toes, due to shows, leads to painful corns. If the toe is still flexible, a splint may be helpful. Shoes with a wide, long toe box should be worn. The corns can be pared. In chronic cases where the deformity is fixed, further distortion of the structure of the foot leads to strain on the ball of the foot.

If conservative treatment fails, surgery may be an option. The surgeon may have to remove some tight tissue, cut some tendons, and fuse or trim the small bones in the toes.

Flat Foot Procedures

Flat foot is a flattening of the longitudinal arch of the foot. Usually it is associated with a turning of the heel. For most people with flat feet, their feet have developed that way. Most people will have minimal discomfort, but some do develop pain, stiffness and degenerative changes with age. Relief of symptoms can usually be achieved by wearing special arch supports.

In other people, flat foot develops later in life due to rupture of the tendon that maintains the height, structure and strength of the arch.

In some cases, surgery is the best treatment. To facilitate surgical reconstruction, the surgeon may use another tendon in the foot.

Another surgical technique is to “fuse” bones in the mid foot. Your surgeon can discuss bone fusion and which treatment is best for you.

Plantar Fasciitis Procedures

The plantar fascia is strong tissue that stretches from the heel bone (calcaneum) to the ball of the foot. It acts like the string of a bow to preserve the foot’s arch. Due to stresses caused by jumping, running on hard surfaces with thin soled shoes, or even prolonged standing, the fascia at its attachment to the heel bone can become inflamed and painful.

This is called a plantar fasciitis. The irritation and inflammation can lead to an outgrowth of bone from the heel bone into the fascia. This is called a heel spur. Some surgeons believe that the heel spur is not connected to the pain caused by plantar fasciitis.

In most patients treatment involves anti-inflammatory drugs, cortisone injections and the use of padding or special foot supports. If these treatments fail, surgery may be another option. The surgeon frees the plantar fascia and slides it along from the attachment to the heel. The spur is usually also removed.

Arthritis Procedures

Arthritis may affect the tarsal bones in the front, mid-foot and rear-foot causing instability and pain. Sometimes these joints need to be fused, a procedure called arthrodesis. While the treated part of the foot will remain stiff following an arthrodesis, it may relief most of the pain and make the foot and joint stable again.

Achilles Tendon Procedures

These conditions are more common in middle-aged men and athletes. Rupture may occur due to repetitive strain or by a simple stumble. Minor injuries to the Achilles Tendon do not require surgery, but in more serious cases of rupture surgery is the best option.

Modern techniques of Achilles tendon repair have better rates of healing and less risk of infection compared to older techniques.