Knee Replacement Surgery

Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive arthritis, trauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in the United States is severe osteoarthritis of the knees.

Regardless of the cause of the damage to the joint, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decisions regarding whether or when to undergo knee replacement surgery are not easy. Patients should understand the risks as well as the benefits before making these decisions.

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Hip Replacement Surgery

Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.

Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.

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Foot and Ankle surgery

Hand Wrist Surgery

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when pressure is put on the median nerve as it passes through your wrist under the carpal tunnel ligament. This results in pins and needles and numbness in your fingers. Surgery is sometimes needed to ease pressure on the nerve. This is done by splitting the carpal tunnel ligament under local anaesthetic. You probably won’t need to stay overnight in hospital.

Dupuytren’s Contracture

This condition caused by tissue forming in the palm of your hand and your fingers. It’s often painless may only cause only skin nodules, but it can also form bands that make your fingers curl down into your palm. You may need surgery to remove the tissue and release your fingers, although it’s not always possible to make this completely better. The operation is generally performed as a day case, so you won’t need to stay in hospital.

Trigger Finger Release

If you have trigger finger, the affected finger can often bend normally but becomes stuck in a curled position. This is caused by the tendon which allows your finger to bend becoming thickened, so it becomes stuck in the tunnel where the tendon enters your finger. You may need to use your other hand to help ‘trigger’ your finger straight – which is where the condition gets its name from.

It may be referred to a hand therapist for a splint to be made for you to stop your finger triggering while you’re using it. A local injection helps in most cases. If this fails, you may need a minor day-case operation to open the tunnel and free the tendon. You should recover in one to two weeks.

Tendon Repair

There are two main groups of tendons that control your hand and wrist:

  • flexor tendons, which enable you to grip and to curl your fingers into a fist
  • extensor tendons, which open your fingers up.

Sometimes these tendons can tear or snap, which is called tendon rupture. Tendon rupture in your hand and wrist isn’t common, and when it occurs it’s usually as a result of rheumatoid arthritis or other types of inflammatory arthritis. You’ll need early treatment if surgery is to be successful and to protect the other
tendons in your hand from rupture.

In many cases undamaged flexor tendons from other fingers are used to repair the ruptured tendon. If the tendon has ruptured because it has rubbed against rough bone in your wrist, the bone will have to be smoothed or removed to prevent the repaired tendons from rupturing again.

Ganglion Removal

A thick fluid called synovial fluid helps joints and tendons move slowly. Sometimes this fluid leaks out of the joint or tendon sheath. The fluid then becomes very thick and sticky, and it may form pockets of fluid (cysts) known as ganglions. These ganglions:

  • feel firm or hard when pressed
  • are commonly found on the back of your wrist, but they can occur elsewhere
  • are commonly associated with osteoarthritis when seen on the tips of the backs of your fingers and in your wrist.

Ganglions sometimes disappear on their own, but if they become painful or reduce movement the fluid can sometimes be drainined using a needle. You may need minor surgery to remove them, although it’s likely that they’ll come back.

Knuckle (MCP Joint) Replacement

Rheumatoid arthritis of the knuckles (metacarpophalangeal or MCP joints) may cause damage and deformity, with the result that your fingers ‘drift’ sideways away from your thumb. This may be very painful and greatly reduce hand function. If it becomes difficult to use your hand, surgery can be carried out to replace your knuckles with small man-made (artificial) joints that act as flexible hinges. This operation reduces pain, improves the positioning of your fingers and so improves hand function.

Knuckle replacement surgery is now often performed as day surgery, although some hospitals may recommend that you stay overnight.

Trapeziectomy (Removal of the Trapezium)

The trapezium is a bone in your wrist at the base of your thumb. If you have arthritis in the joint here, it may cause pain and make simple tasks more difficult. The pain often comes and goes, and the condition will often become painless over time. But if your pain carries on, you may need an operation to remove the joint and your trapezium.

Sometimes surgeons may make sure you can’t move your thumb/wrist for a couple of weeks to allow for scar tissue to fill the gap removing the trapezium leaves, or occasionally they use a tendon to fill the space.

Wrist Fusion

Wrist fusion may be suggested if your wrist is badly damaged. This is where the bones in your wrist are fixed to the bones in your hand. This reduces pain and increases strength but usually stops you moving your wrist up and down. However, you’ll probably find it easier to turn your hand.

Wrist Joint Replacement

Wrist joint replacement isn’t yet a common operation. The aim is to keep some wrist movement and get rid of pain.

Shoulder Surgery

Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small cut (incision) in your skin.

The rotator cuff is a group of muscles and their tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in the shoulder joint and help the shoulder move in different directions. The tendons in the rotator cuff can tear when they are overused or injured.

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Arthroscopic Surgery

Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint.

The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.”

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Cervical Surgery

Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.

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Bunion Surgery

Bunion surgery generally involves an incision in the top or side of the big toe joint and the removal or realignment of soft tissue and bone. This is done to relieve pain and restore normal alignment to the joint. Small wires, screws, or plates may be used to hold the bones in place.

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Ilizarov Technique

The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques.

The apparatus is based on the principle which Ilizarov called “the theory of tensions”. Through controlled and mechanically applied tension stress, Ilizarov was able to show that the bone and soft tissue can be made to regenerate in a reliable and reproducible manner. The top rings of the Ilizarov (fixed to the healthy bone by the tensioned wire) allow force to be transferred through the external frame (the vertical metal rods), bypassing the fracture site. Force is then transferred back to the healthy bone through the bottom ring and the tensioned wires. This allows the Ilizarov apparatus to act as a sort of bridge, both immobilizing the fracture site and relieving it of stress, while allowing for the movement of the entire limb and partial weight-bearing. Middle rings (and tensioned wires) act to hold the bone fragments in place and to give greater structural support to the apparatus and limb. However, the critical load bearing rings are the top and bottom rings which transfer the force from the healthy bone down to the healthy bone, bypassing the fracture site.

Bone Lengthening/Reshaping

In addition to being used to support a fractured limb, the Ilizarov frame is also commonly used to correct deformity through distraction osteogenesis.

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Bone Fracture Treatment

The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal fixator or cast) where there is a high risk of infection or the fracture is of such severity that internal fixators are unworkable. Journalist Ed Vulliamy wrote a detailed description from the patient’s viewpoint of Ilizarov apparatus treatment of a bad fracture.