Orthopaedic

Arthroplasty is the surgical reconstruction or total replacement of degenerated joints, such as the knee and hip joints. It is used to alleviate pain and help restore range of motion in conditions such as arthritis.

Arthroscopy is a minimally invasive surgical procedure in which an examination and/or repair of the interior of a damaged joint is performed using an arthroscope. It is a type of endoscope that is inserted into the joint through a small incision.

The primary difference is that ligaments connect bone to bone and tendons attach muscle to bone. Ligaments are fibrous connective tissues made of collagen that attach two bones together to form a joint. A ligament’s function is to stabilize and hold structures together, thereby restricting movement. The strongest ligament is the iliofemoral, which extends from the uppermost and largest bone of the pelvis (ilium) to the thigh bone (femur) in front of the hip joint.

Tendons are fibrous, dense, ropelike tissues made of collagen that connect muscle to bone or to a body structure such as the eyeball. Unlike ligaments, tendons initiate and enable movement. The Achilles is the thickest tendon in the body, connecting the calf muscles to the heel bone.

The rotator cuff is a group of tendons that connect the four muscles of the upper shoulder to the bones. When a rotator cuff tendon becomes inflamed or partially tears, it can cause pain and limit shoulder movement. Acute cuff tears can occur from falling on an arm, car accidents, high-impact sports including skiing, snowboarding, and football, or any other activities that can overstress the shoulder. Overuse cuff tears are commonly associated with sports such as baseball/softball, cricket, tennis, rowing, and weightlifting, as well as occupations such as painting and carpentry.

The symptoms of hip arthritis can superficially resemble back pain or sciatica. Hip joint pain is typically experienced in the buttock, groin, or the front of the thigh downward to the knee. A thorough physical examination by your physician and simple x-ray of the hip can usually pinpoint the source of pain. Since lower back pain affects an estimated one in 10 people worldwide, it is quite possible to suffer from both degenerative back and hip pain.

Although exercise does not delay the need for knee replacement surgery, it plays an important role in the management of arthritis. Part of the arthritic process involves the formation of bone spurs and subsequent loss of motion, so exercise is key to maintaining range of motion. Knee replacement has been shown to reliably alleviate pain from arthritis in a majority of patients, but it is important to keep in mind that your post-operative range of motion will not be better than range of motion prior to developing arthritis.

Several conditions can cause chronic joint pain and disability, which can be alleviated by undergoing joint replacement surgery. Arthritis, fractures, or other conditions can damage the articular cartilage lining the ends of the bones, resulting in pain and stiffness. When nonsurgical treatments such as medications, physical therapy, and changes to everyday activities do not relieve pain and disability, your doctor may recommend total joint replacement.

According to the American Association of Hip and Knee Surgeons, in general, total joint replacements last 15 to 20 years. A more accurate way to assess longevity is to look at the annual failure rates. The most current data suggests that both hip and knee replacements have an annual failure rate between 0.5 to 1.0%. Statistically, if you have total joint replacement surgery today, you have a 90 to 95% chance of the joint lasting 10 years, and an 80 to 85% chance that it will last 20 years.

If the surgery was on your left knee and you have an automatic transmission, you can resume driving when you are comfortable, generally three weeks after surgery. If your surgery was on your right knee, your driving could be restricted for one month to six weeks. Please be aware that you should NEVER drive while taking narcotics. If you do not have the confidence to resume driving, postpone this activity until you do. It might be helpful to test your driving ability on a quiet street prior to driving in traffic.

As with any operation, there can be complications, but the two main concerns are infection and blood clots. The latter can lead to deep vein thrombosis, and a potentially life-threatening condition called pulmonary embolism. To avoid this, you will be prescribed antibiotics and blood thinners. Specific precautions are followed in the operating room to reduce risk of infection and blood clots, such as special stockings to help blood circulate through your legs. According to several studies, the risk period for clots in the deep veins can endure for up to 12 weeks after hip replacement surgery and up to six weeks after knee replacement surgery. Many surgeons recommend taking anticoagulants for a minimum of six weeks after surgery. Historically, overall complication rates are between 10 to 15%.

Osteoarthritis is a disease associated with the wear and tear of aging, caused by the breakdown of cartilage in joints, and as such, it affects older people more often. The disease can affect any joint in the body, but the weight-bearing joints of the hips, knees, and spine are more commonly impacted. Osteoarthritis is a far more prevalent disease than rheumatoid arthritis, with 9.6% of men and 18.0% of women age 60 and older suffering from symptomatic osteoarthritis worldwide. Rheumatoid arthritis, classified as an autoimmune disorder, affects 0.3% to 1% of people in developed countries. Rheumatoid arthritis is caused by the immune system mistakenly attacking the body's tissues. It generally affects younger adults than osteoarthritis, although children and older adults can also develop the disease. In addition to causing joint problems and potential deformities, it can sometimes affect other organs of the body, including the skin, eyes, lungs, and blood vessels.

Like many medical specialties, minimally invasive surgical approaches are being utilised with increasing frequency in orthopaedic surgery. For example, in traditional knee replacement surgery, the surgeon makes a long vertical incision in the centre of the knee to view and access the joint. Minimally invasive total knee replacement uses a shorter incision and a different, less-invasive technique to expose the joint. The goal of all types of minimally invasive surgery is the same – to reduce postoperative pain, speed recovery, and in the case of inpatient surgeries, reduce the length of hospitalisation.

Generally, a broken collarbone is left to heal naturally using a simple triangular sling to support and stabilise the arm and hold the bones together in a normal position. After a confirmed diagnosis is made via x-ray, a patient will be given over-the-counter painkillers, which usually suffice in alleviating pain. If the injury is severe – for example, the bone has broken through the skin, or the bones are not lining up and overlapping, surgery may be warranted.

The soft tissue lining of the ankle joint is called the synovium. When this lining becomes inflamed due to acute trauma, rheumatoid arthritis, overuse, or osteoarthritis, it is known as synovitis. The condition can cause pain, swelling, and loss of motion. If nonsurgical treatment options fail to provide relief, ankle arthroscopy can be used to surgically remove areas of the inflamed synovium.

Arthrofibrosis is an inflammatory condition in which excessive scar tissue can form in or around major joints including the knee, shoulder, ankle, wrist, and hip. It can result from surgical complications or initial injury to the joint. Infections and / or bleeding into the area are believed to be major contributing factors that lead to this condition. Arthrofibrosis is a major complication of anterior cruciate ligament (ACL) surgery of the knee. Some people have a genetic predisposition, however, most orthopaedic surgeons agree that a number of steps can help prevent it. These include moving the joint as quickly as possible after surgery to help prevent scar tissue from forming, and timing surgical removal of the scar tissue only after the area has healed properly from the original surgical procedure.

Osteotomy is a surgical procedure that involves removing a wedge of bone located near a damaged joint. The ultimate goal of the procedure is to cause a shift of weight from the area where there is cartilage damage to an area where there is more normal or healthy cartilage. For instance, when a person has osteoarthritis of the knee, there is typically more damage to the inner portion of the knee. The surgeon removes bone from the outside of the lower leg bone near the knee, resulting in the patient shifting his or her body weight towards the outer side and away from the inner damaged cartilage. Once the wedge of bone is removed, the surgeon attaches the remaining bones together using pins or staples to secure them. An immobilization cast or internal plates are sometimes used for stability.