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Orthopedic surgery or orthopedics (alternatively spelt orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
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Orthopedic Services

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Orthopedic Procedures:

Orthopedic surgeries include various procedures:

Replacement Surgeries

Knee Replacement:

The primary reason for knee replacement surgery is osteoarthritis, a degenerative joint disease that leads to the breakdown of cartilage and bone in the knee. Patients are recommended for this surgery if they continue to experience significant pain despite trying other medical treatments, or if extensive damage is evident. Many individuals struggle with activities such as climbing stairs, sitting and rising from a chair, and even walking. Some may endure knee pain even during periods of rest.

The advantages of knee replacement surgery encompass improved mobility, relief from pain, and an enhanced quality of life.

Procedure:

Knee replacement surgery is typically conducted under general anesthesia. The surgeon makes an incision in the knee to expose the joint surfaces, removing damaged areas and attaching the prosthesis with surgical cement. Components of the artificial knee implant cap the ends of the thigh bone and shin bone, and a plastic spacer is inserted to form a functional knee joint. This artificial knee joint is securely cemented in place, with surrounding ligaments and muscles providing support for functions like bending, rolling, and gliding as the knee moves.

Recovery time:

After surgery, detailed instructions from the surgeon guide the care of the knee. Caution is advised to prevent damage to the new knee joint, especially from falls. Gradual resumption of physical activity is recommended.

Recovery typically takes 3-6 weeks, allowing most patients to engage in low-impact activities. High-impact activities should be avoided until cleared by the surgeon. Due to limited bending and range of motion after surgery, acquiring assistive items, such as a long-handled shoe horn, sponge and shower hose, dressing stick, sock aid, and reaching stick, can facilitate a smoother recovery. Any drainage at the surgical site, increased swelling, redness, pain, or tenderness in the knee should be promptly reported to the doctor.

Hip replacement:

Hip replacement, a surgical intervention to alleviate hip pain, involves replacing parts of the hip joint with artificial implants. The hip joint comprises a ball (at the top of the femur or thigh bone) and a socket (in the pelvis or hip bone). The surgery may entail the replacement of one or both components, aiming to facilitate the resumption of daily activities and exercise with reduced pain.

Benefits of the surgery include enhanced mobility, pain relief, and an improved quality of life.

Procedure:

Hip replacements are typically performed in a hospital or surgery center, often considered outpatient procedures. Although a short overnight stay may be necessary for observation. The surgeon removes the ball part of the joint, creates an opening in the top of the femur, inserts the stem of the ball prosthesis, attaches the ceramic replacement head, removes damaged cartilage, and affixes the new cup. Leg movement is assessed to ensure proper functionality.

Recovery time:

Post-surgery, detailed instructions from the surgeon guide care. Caution is urged to prevent falls and damage to the new joint. Gradual resumption of physical activity is recommended.

Recovery commences immediately, with encouragement to move around soon after surgery. Patients without additional health conditions may go home once they demonstrate the ability to walk, climb stairs, and enter/exit a car. The surgeon or therapists advise on walking readiness, pain management, and rehabilitation needs. Completing physical therapy is crucial for effective recovery and surgery success.

Assistive items for ordinary activities can aid in a smooth recovery due to limited bending and range of motion post-surgery. Any drainage, increased swelling, redness, pain, or tenderness should be reported promptly to the doctor.

Ankle replacement:

Ankle replacement surgery involves replacing a damaged ankle joint with an artificial implant, often necessitated by arthritis affecting the joint or other foot joints. Over time, arthritis can wear away the smooth cartilage on bone surfaces, leading to pain, inflammation, and swelling. The procedure aims to enable individuals to resume daily activities and exercise with reduced pain, providing benefits such as improved mobility, pain relief, and an enhanced quality of life.

Procedure:

Typically conducted under general anesthesia, the surgeon makes an incision in the ankle to access the affected joint. Damaged parts of the tibia and talus bones are removed, and artificial metal joints are attached to the remaining bone surfaces. A piece of plastic is inserted between these joints to facilitate smooth gliding.

Recovery time:

Post-surgery care instructions from the surgeon are crucial to avoid damaging the new joint. Initial significant pain can be managed with pain medications, gradually diminishing over a few days. A splint may be worn for a couple of weeks, and crutches might be needed for several weeks. Instructions on foot movement, rest, and leg elevation during the initial weeks are provided.

Full weight-bearing on the foot may take a few months, and the surgeon, physical therapist, or occupational therapist guides walking readiness and pain management. Rehabilitation needs are discussed, emphasizing the importance of motivation and cooperation in completing physical therapy for an effective recovery and overall surgical success.

Limited bending and range of motion post-surgery make assistive items for everyday activities beneficial. Any post-surgery symptoms like drainage, increased swelling, redness, pain, or tenderness should be promptly reported to the doctor.

Shoulder replacement:

Total shoulder replacement is a intricate procedure involving the substitution of the shoulder joint with artificial components. This replacement is performed to alleviate pain stemming from arthritis or severe fractures in the shoulder. The ultimate objective of this surgery is to enable individuals to resume daily activities and exercise with reduced pain, offering benefits such as enhanced mobility, pain relief, and an improved quality of life.

Procedure:

The shoulder, a ball-and-socket joint, consists of the upper arm bone’s ball and a socket in the shoulder blade. Ligaments and rotator cuff tendons hold the ball in place. During shoulder replacement, the ball is substituted with a metal ball attached to a stem, which is inserted into the humerus shaft. Cement may be used to secure the stem. The socket may be replaced with a plastic piece, typically cemented into a groove based on the severity of arthritis and the integrity of rotator cuff tendons.

Recovery time:

Detailed post-surgery care instructions from the surgeon are crucial to prevent damage to the new joint. While the arm is braced, it can be removed for therapy sessions. Antibiotics are administered intravenously for a day to prevent infection. Physical therapy commences the day after surgery, beginning with finger, wrist, and elbow movements. Some shoulder motion is initiated shortly after surgery, and a home exercise program is outlined by the physical therapist.

The recovery period for shoulder replacement typically spans three to six months for healing, with up to a year needed to regain full strength and range of motion. Any post-surgery symptoms such as drainage, increased swelling, redness, pain, or tenderness should be promptly reported to the doctor.

Bunion Surgery:

Many individuals with bunions can alleviate pain through simple treatments such as wearing wider shoes or using shoe pads to reduce pressure on the big toe. However, if these measures prove ineffective, bunion surgery may be recommended by a doctor. The common objectives of most bunion surgeries include realigning the joint at the base of the big toe, alleviating pain, and correcting deformities in the bones of the toe and foot.

Procedure:

Various surgical techniques exist to correct bunions, involving the realignment of bones, ligaments, tendons, and nerves to bring the big toe back to its proper position. Due to the diverse shapes and sizes of bunions, surgeries vary. Typically, bunion surgery involves correcting bone alignment and repairing the soft tissues surrounding the big toe. The doctor will discuss the most suitable surgery type, such as osteotomy with tendon and ligament repair, arthrodesis, exostectomy, or resection arthroplasty.

In osteotomy, small bone cuts are made to realign the joint, followed by fixing the new break with pins, screws, or plates, along with repairing tendons and ligaments. This results in straighter bones and a balanced joint. Arthrodesis involves removing arthritic joint surfaces and using screws, wires, or plates to hold them together until healing occurs. This is often employed for severe bunions or arthritis. Exostectomy removes the bump from the toe joint, while resection arthroplasty involves removing the damaged joint portion, creating a flexible “scar” joint. The latter is typically used for elderly patients or those with previous unsuccessful bunion surgeries or severe arthritis.

Recovery time:

Post-surgery care instructions provided by the surgeon are crucial. Despite many bunion procedures being same-day with no hospital stay, a more extended recovery period is common, often taking up to 6 months for full recovery. Sutures are usually removed around 2 weeks after surgery, and continued foot support from dressings or a brace may be necessary for 6 to 12 weeks. Most patients experience reduced foot pain and improved big toe alignment after bunion surgery, and the recovery length depends on the specific procedures performed and adherence to postoperative instructions. Returning to tight-fitting shoes, a common cause of bunion deformity, should be avoided based on the doctor’s recommendations.

Limited bending and range of motion post-surgery make assistive items for everyday activities beneficial. Any post-surgery symptoms like drainage, increased swelling, redness, pain, or tenderness should be promptly reported to the doctor.

Disk Herniation Surgery:

Disks, the circular cushions situated between spinal bones, serve as shock absorbers, enabling bending and movement without bone friction. When a disk ruptures, protruding between bones, it may exert pressure on nearby nerves, causing pain, numbness, and weakness in the back, legs, and arms. While rest, pain relievers, and physical therapy often alleviate a herniated disk, persistent symptoms may warrant surgery, offering quicker pain improvement compared to other treatments.

Herniated Disk Surgery Overview:

The surgical approach aims to relieve nerve pressure caused by the herniated disk. Various surgeries achieve this, providing relief from symptoms like pain, weakness, and numbness within weeks after the procedure.

  • Diskectomy: In this surgery, the surgeon removes the damaged disk, alleviating nerve pressure.
  • Lumbar Laminotomy: Occasionally, a small bone piece, the lamina, is removed from the vertebra to access the herniated disk, relieving nerve pressure, leg pain, and sciatica.
  • Spinal Fusion: Following diskectomy or laminotomy, fusion of adjacent vertebrae stabilizes the spine, preventing further pain.
  • Artificial Disk Surgery: Limited to specific lower back disks, this surgery involves replacing the damaged disk with a plastic or metal one, enhancing spine stability and mobility.

Recovery time:

Post-surgery care instructions provided by the surgeon are essential. Typically, returning to a desk job may occur in 2 to 4 weeks, while individuals handling heavy lifting or machinery might need 6 to 8 weeks. Although surgery offers relief for most, there’s a small chance symptoms may persist or recur. Approximately 5% of cases experience recurrent herniation despite surgery.

The recovery period for shoulder replacement typically spans three to six months for healing, with up to a year needed to regain full strength and range of motion. Any post-surgery symptoms such as drainage, increased swelling, redness, pain, or tenderness should be promptly reported to the doctor.

Knee Osteotomy Surgery:

Each joint, including the knees, is equipped with cartilage—a cushioning tissue at the bone junction. For some individuals, the wearing away of this cartilage in a joint can lead to osteoarthritis, resulting in uncomfortable friction between the tibia and femur. This pressure often manifests as knee pain and stiffness.

A knee osteotomy is a surgical intervention employed by surgeons to address pain and instability caused by damage or arthritis in a specific part of the knee joint. Osteotomy becomes a viable option when only a distinct area of the knee is affected, and knee replacement may not be necessary.

The majority of individuals undergoing knee osteotomy find relief from pain and an improvement in knee function, contributing to an enhanced quality of life. Following the procedure, most people can resume their normal physical activities without significant restrictions.

Procedure Overview:

During knee osteotomy surgery, the surgeon repositions the bones in the shin or thigh to realign the knee, redistributing body weight from the damaged region to a healthier area. The two primary types of osteotomy are opening wedge and closing wedge. In a closing wedge osteotomy, a bone wedge is cut from the leg, and the sides are brought together to close the space. Alternatively, an opening wedge osteotomy involves opening a section of the bone, sometimes utilizing a graft to maintain the space between the osteotomy gap ends.

Recovery time:

Post-surgery care instructions from the surgeon are crucial. While most patients regain the ability to walk unaided within eight to 12 weeks, a complete recovery may take six months to a year. Typically, individuals who have undergone knee osteotomy can resume their usual activities three to six months after the surgery.

Arthroscopic Knee Debriment Surgery

Knee arthroscopy is a surgical technique that enables physicians to examine the knee joint without the need for a substantial incision through the skin and surrounding soft tissues. This procedure is employed for both diagnosis and treatment of various knee issues.

Knee conditions that may necessitate arthroscopy include an inflamed synovial membrane, chondromalacia, an unstable knee, ligament injuries or tears, and meniscus tears.

Procedure Overview:

Arthroscopic debridement of the knee is typically performed on an outpatient basis. The surgeon utilizes a small camera, known as an arthroscope, which is inserted into the knee joint. The camera transmits images to a video monitor, guiding the surgeon in using miniature surgical instruments. The thin nature of the arthroscope and instruments allows for small incisions, reducing postoperative pain and joint stiffness, and often accelerating the recovery process.

Once the surgeon locates the affected area, a series of minor incisions are made around it. Using specialized instruments, the surgeon proceeds to repair or remove small pieces of tissue or bone. Depending on the complexity, the surgery can last anywhere from 30 minutes to several hours. Following the procedure, the incisions are closed with sutures or adhesive strips, and the knee is wrapped in a compression bandage.

Recovery time:

Comprehensive postoperative care instructions will be provided by the surgeon. Most patients achieve full recovery and return to their regular activities after arthroscopic debridement. Given the minimally invasive nature of the surgery, the majority of individuals experience a swift recovery, often going home on the same day and employing ice packs to reduce swelling and pain.

Hip Pinning Surgery:

Surgery is typically the preferred treatment for a fractured hip, with hip pinning aimed at realigning and stabilizing the broken bones. This procedure is suitable for individuals whose fractures allow proper alignment.

Procedure Overview:

In hip pinning, the surgeon makes one or two incisions over the broken hip bone. The bone fragments are repositioned correctly, and pins or screws are employed to secure them in place. Additionally, a metal plate may be used to reinforce the fractured area. The entire surgical process typically lasts 2 to 4 hours.

Recovery time:

The surgeon will furnish detailed postoperative care instructions. In the initial months, assistance from a walker or crutches may be necessary, followed by potential progression to a cane. Support with daily activities like bathing, dressing, and cooking may be required initially.

Light activities can be resumed within a few weeks, with extra assistance being beneficial during this period. Returning to a normal routine may take at least 3 months, while complete recovery might extend to 6 months to 1 year. Some individuals, especially older patients, may experience limitations in mobility compared to their pre-injury state.

It is important to promptly contact your doctor if you observe symptoms such as drainage at the surgical site, increased swelling, redness, pain, or tenderness after hip pinning surgery.

Laminectomy Surgery:

Laminectomy stands as one of the most frequently performed back surgeries, wherein a surgeon removes the posterior section of one or more spinal bones to address issues such as bone spurs and ligaments that exert pressure on nerves.

Procedure Overview:

During a laminectomy, an incision is made in the back’s skin over the affected region. The muscles and soft tissues surrounding the spine are then retracted to expose the spinal area. Subsequently, the surgeon eliminates bone, bone spurs, and ligaments that are causing nerve compression. Once the surgery concludes, the incision is sutured, the patient is repositioned, and anesthesia is discontinued.

Recovery time:

Comprehensive postoperative care instructions will be provided by the surgeon. Activities involving bending, stooping, or lifting should be restricted for several weeks after the laminectomy. Early initiation of light walking and physical therapy exercises, following the doctor’s approval, can expedite recovery.

Recovery duration varies based on the surgery’s extent and individual circumstances. In general:

  • After a minor laminectomy, individuals can typically resume light activities within a few days to weeks.
  • If spinal fusion is combined with laminectomy, the recovery period may extend from two to four months.
  • Full activities involving lifting and bending may be deferred for two to three months, as advised by the doctor.

Spinal Fusion Surgery:

Spinal fusion is a surgical procedure that permanently fuses two or more bones in the spine, eliminating movement between them. This procedure is undertaken in cases of spinal injury or fractures, a weakened or unstable spine due to infections or tumors, conditions where one vertebra slips forward on another, abnormal curvatures, or spinal arthritis.

Procedure Overview:

Under general anesthesia, inducing a deep sleep to ensure the absence of pain, a surgical incision is made on the back or neck to access the spine. The patient may be positioned face down, and muscles and tissues are separated to expose the spine. A graft, often made of bone, is used to permanently secure the bones together. Additionally, rods, screws, plates, or cages may be employed to prevent movement between the vertebrae until the bone grafts fully heal. The surgery typically lasts 3 to 4 hours.

Recovery time:

Detailed postoperative care instructions will be provided by the surgeon. Resuming simple activities, such as light housework, may take 4 to 6 weeks, while complete recovery of the back may require 6 months to a year. A back brace might be recommended during the healing process, and physiotherapy sessions may be advised by the doctor.

Meniscus Repair Procedure:

Each knee contains two menisci, C-shaped rubbery cushions that function as shock absorbers in the knee joint. In cases of meniscus injury or tearing, often referred to as torn cartilage, surgery may be recommended by healthcare providers to either remove the damaged part or repair it. Meniscus surgery, a common procedure, aims to address torn meniscus, a piece of cartilage in the knee, and can contribute to returning to activities, improving mobility, enhancing knee stability, preventing or slowing arthritis development, and reducing or eliminating pain.

Procedure Overview:

The surgery involves making a few small incisions and typically lasts about an hour. Knee arthroscopy is the most common procedure for a torn meniscus. The surgeon creates small stab incisions in the knee, inserting an arthroscope—a thin tube with a light and video camera. The camera projects video images from inside the knee onto a monitor. Upon completing the meniscus repair, the surgeon closes the portals using stitches or surgical strips.

Recovery time:

Detailed postoperative care instructions will be provided by the surgeon. Full recovery from meniscus surgery can range from six weeks to three months. Specific recovery expectations for repair surgery may include being on crutches for four to six weeks, returning to a desk job in a week or two, taking four to six weeks off work for jobs requiring standing, and planning a three- to six-month recovery period for physically active jobs or a return to sports.

Achilles tendon Repair Procedure:

The Achilles tendon, a robust fibrous cord in the lower leg, connects the calf muscles to the heel and plays a crucial role in walking, running, and jumping. Ruptures or degeneration of the Achilles tendon can lead to pain, swelling, and limitations in foot movement.

Ruptured Achilles tendon: In cases of a tear, or rupture, an incision is made in the back of the calf during surgery. The surgeon stitches the torn tendon back together to restore its integrity. Alternatively, if degeneration is observed, known as tendinitis or tendinopathy, the surgeon may excise the damaged section of the tendon and repair the remainder using stitches. Severe damage may necessitate replacing part or the entire Achilles tendon, often using a tendon from another area of the foot. Minimally invasive procedures with small incisions and the use of a special scope may be employed for certain cases.

Recovery Process:

Postoperative care instructions will be provided by the surgeon. Achilles tendon surgery is typically performed as an outpatient procedure, allowing for same-day discharge. The recovery timeline varies based on factors such as age, overall health, the extent of the injury, and adherence to rehabilitation.

  • A cast or walking boot is required for 6 to 12 weeks to immobilize the foot and ankle.
  • Crutches are essential for daily tasks around the house, and weight-bearing on the leg is restricted until approved by the doctor.
  • Driving is permitted when foot and ankle movement and control are regained, crutches are no longer necessary, and prescription pain medication is discontinued (usually 4 to 6 weeks).
  • Return to work depends on job requirements; sitting jobs may allow a return in 1 to 2 weeks, while jobs involving standing may require 6 to 8 weeks. Highly physically active jobs may necessitate 3 to 6 months for a full return.

ACL and PCL Reconstruction Surgery:

The anterior and posterior cruciate ligaments, which are resilient bands of tissue in the central part of the knee connecting the tibia and femur, prevent uncontrolled sliding of the main bones. These ligaments can be torn due to sudden twisting movements or heavy blows to the knee. When physiotherapy proves ineffective, surgery becomes necessary.

Surgical Procedure:

The surgery involves several small incisions, utilizing arthroscopy—a thin tube with a light and video camera. Through arthroscopic tools, the ACL graft is obtained from the patient’s hamstring tendons, creating four “strands” that are sutured together. This graft is then pulled into the knee and secured to the bone, creating a scar that permanently anchors the graft in place.

Recovery Process:

The surgeon will provide detailed postoperative care instructions.

  • The recovery period is extensive despite the short procedure. Essential physiotherapy prevents knee stiffness, ensures appropriate graft stretching, and avoids re-rupture from premature or aggressive movements.
  • Immediate weight-bearing on the operated leg is permitted with a rigid knee brace and crutches. These are required for 1-2 weeks or until full range of movement is restored.
  • Subsequent focus involves building muscle strength and balance control. High-intensity training is generally not recommended until 9 to 12 months post-operation.
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