Ankle Replacement
Ankle replacement involves replacing the damaged parts
of the three bones that make up the ankle joint with
artificial joint parts (prosthetic components) made
of high-quality metal and plastic.
The
parts are typically held in place by bone cement.
The artificial joints come in different sizes to fit
the patient. The patient may receive general anesthesia
(unconscious, no pain) or a spinal anesthetic (awake,
but no feeling below the waist). Patients receiving
spinal anesthesia also receive medicine to help them
relax during the operation. The surgeon makes an incision
in the front of the ankle to expose the ankle joint.
After gently pushing the tendons to the side, the
surgeon disconnects the shin bone (tibia) and the
smaller lower leg bone (fibula) from the main bone
of the ankle (talus). The damaged surfaces of the
bones are removed, and the artificial joint is attached.
Screws are also commonly used to help support the
artificial ankle. After putting the tendons back into
place, the surgeon closes the wound with stitches.
A brace may be used to keep the ankle from moving.
Ankle replacement surgery may be performed if the
ankle joint has been severely damaged. Causes of damage
include: Osteoarthritis, Rheumatoid arthritis, Fracture,
or Arthritis due to previous ankle surgery. The patient
will be in the hospital up to four days. Physical
therapy to improve ankle motion may be prescribed
a few days after the procedure. To avoid swelling,
the foot may be raised higher than the heart while
sleeping or resting. Recovery can take two to three
months. The patient should stay off their foot for
several weeks, and use a walker or crutches. High-impact
activities, such as step aerobics, should be avoided
while recovering from ankle replacement surgery. A
successful ankle replacement will eliminate pain and
allow the ankle to move up and down. In general, total
ankle replacements last from 10 to 15 years, depending
on the patient’s activity level and overall
health.
Arthroscopy
Arthroscopy is a method of viewing a joint, and, if
needed, to perform surgery on a joint. An arthroscope
consists of a tiny tube, a lens, and a light source.
The device is inserted into a small incision and allows
a surgeon to look for joint damage or disease. The
device also allows the surgeon to perform reconstructive
procedures on the joint, if needed. This procedure
is typically performed on the knee, shoulder, elbow,
or wrist. The type of anesthesia depends on the particular
joint and other factors. A regional anesthetic numbs
the affected area, but the patient may remain awake,
depending on whether other medications are used. For
more extensive surgery, general anesthesia may be
used. In this case the patient is unconscious. The
area is cleaned with antiseptic soap. A pressure band
may be applied to restrict blood flow (tourniquet).
An incision is made into the joint, and sterile fluid
is introduced into the joint space to provide a better
view. The arthroscope is then inserted, and the inside
of the joint is viewed by displaying the image on
a monitor. One or two small additional incisions may
be needed, in order to use other instruments. These
instruments can be used to remove bits of cartilage
or bone, take a tissue biopsy, or perform other minor
surgery. In addition, ligament reconstruction can
be performed using the arthroscope in many cases.
The joint may need to be manipulated to provide a
better view, so there may be some tugging on the leg
(or arm, if done on the shoulder). After the test,
the joint will probably be stiff and sore for a few
days. Slight activity such as walking can be resumed
immediately, however excessive use of the joint may
cause swelling and pain and may increase the chance
of injury. Depending on your diagnosis, there may
be other exercises or restrictions.
This test is performed when there is: Suspected ligament
tear; Damaged meniscus cartilage; Evidence of bone
fragments from a fracture; Joint pain from an injury;
Unexplainable joint pain; Lesions or other problems
detected by x-rays; Joint disease; or A need for joint
surgery. Arthroscopy can help monitor the progression
of a disease or determine whether a treatment is working.
The diagnostic accuracy of an arthroscopy is about
98%, although x-rays and sometimes MRI scans are taken
first because they are a noninvasive. Ice is commonly
recommended after arthroscopy to help relieve swelling
and pain. Normal activity should not be resumed for
several days or longer. Special preparations may need
to be made concerning work and other responsibilities.
Physical therapy may also be recommended.
Clubfoot Repair
Clubfoot repair is surgical correction of a birth
deformity of the foot and ankle. The type and extent
of surgery depends on the how severe the deformity
is. The defect involves tight tendons and ligaments
in the foot and ankle. The surgery involves lengthening
some tendons and releasing tight ligaments to place
the bones and joints in normal positions. Sometimes,
pins are temporarily placed in the foot
and
a cast is applied after surgery to maintain its position
while it heals.
The newborn's clubfoot is initially treated with casts.
If the casts do not provide enough correction of the
clubfoot, surgery is considered. Surgery is also considered
if the clubfoot is recurrent (happens after being
treated previously), or if it is associated with neuromuscular
disorders or syndromes. If surgery is necessary, the
foot usually becomes quite functional. Physical therapy
may help keep the foot in good position and help improve
function and flexibility. Bracing after surgery is
frequently necessary. In most cases, the child's foot
and calf may remain smaller than normal throughout
life. The surgically corrected foot is generally very
functional, although typically somewhat stiffer than
a normal foot or one treated without surgery.
Elbow replacement
Elbow replacement involves surgically replacing bones
that make up the elbow joint with artificial elbow
joint parts (prosthetic components). The artificial
joint consists of two stems made of high-quality metal.
They are joined together with a metal and plastic
hinge that allows the artificial elbow joint to bend.
The artificial joints come in different sizes to fit
the patient. The patient may receive general anesthesia
or regional anesthesia. The orthopedic surgeon makes
an incision,
usually
in the back of the upper and lower arm, to expose
the elbow joint. The surgeon removes the lower end
of the bone in the upper arm (humerus) and the upper
end of the large bone in the lower arm (ulna), along
with any damaged tissue. The orthopedic surgeon drills
out a portion of the center of the humerus and ulna
and inserts one stem of the prosthesis into each bone.
Usually, bone cement is used to hold the stems in
place. The surgeon then attaches the two stems together
with the hinge system. The orthopedic surgeon closes
the wound with stictches, applies a bandage, and might
place the arm in a splint for stability. Elbow replacement
surgery can be performed when the patient’s
joint has been severely damaged.
Hip Joint Replacement
This surgery is performed to replace all or part of
the hip joint with an artificial device (a prosthesis).
The hip is essentially a ball and socket joint, linking
the "ball" at the head of the thigh bone
(femur) with the cup-shaped "socket" in
the pelvic bone. A total hip prosthesis is surgically
implanted to replace the damaged bone within the hip
joint. The total hip prosthesis consists of three
parts:
A cup that replaces hip socket; A metal or ceramic
ball that will replace the fractured head of the femur;
and A metal stem that is attached to the shaft of
the bone to add stability to the prosthesis. If the
surgery is a "hemi-arthroplasty," the only
bone replaced with a prosthetic device is the head
of the femur. The surgery will be performed using
general or spinal anesthesia. The orthopedic surgeon
makes an incision, often over the buttocks, to expose
the hip joint. The head of the femur is cut out and
removed. Then, the hip socket is cleaned out and a
tool called a reamer removes all of the remaining
cartilage and arthritic bone. The new socket is implanted,
after which the metal stem is inserted into the femur.
The artificial components are fixed in place, sometimes
with a special cement. The muscles and tendons are
then replaced against the bones and the incision is
closed. A small drainage tube is placed during surgery
to help drain excess fluids from the joint area. Many
surgeons also place a knee immobilizer or special
pillow between the legs in the operating room to prevent
the hip from dislocating. If the procedure is elective
(planned in advance rather than in response to an
injury), the patient can donate blood several weeks
prior to surgery to replace any blood lost during
the procedure.
Hip joint replacement is primarily done in people
age 60 and older. The operation is usually not recommended
for younger people because of the strain they can
put on the artificial hip, causing it to fail prematurely.
The reasons for replacing the hip joint include: Severe
pain from arthritis in the hip that limits an individuals'
ability to do the things they want to do; Fractures
in the elderly of the neck of the femur (usually requires
a hemi-arthroplasty); or Hip joint tumors. The results
of hip prosthesis surgery are usually excellent. The
operation relieves pain and stiffness, and most patients
(over 80%) need no help walking. With time -- sometimes
as long as 20 years -- the artificial joint will loosen
and revision surgery will become necessary. Younger
people may wear out the lining of their new cup and
need it replaced before the prosthesis loosens. The
patient will remain in the hospital for 3 to 5 days
after surgery. However, some people may need to stay
temporarily at a rehabilitation unit or long-tern
care center until mobility has improved and they are
safely able to live independently. These centers will
provide intensive physical therapy to assist you in
regaining muscle strength and flexibility in the joint.
The use of crutches or a walker may be necessary for
as long as 3 months, although most people who did
not use them before are able to walk without them
in several weeks.
Knee Joint Replacement
Knee joint replacement is surgery to replace a painful
damaged or diseased knee joint with an artificial
joint (prosthesis). The operation is performed under
general anesthesia. The orthopedic surgeon makes a
cut over the affected knee. The patella (knee cap)
is moved out of the way, and the ends of the femur
(thigh bone) and tibia (shin bone) are cut to fit
the prosthesis. Similarly, the undersurface of the
knee cap is cut to allow for placement of an artificial
component. The two parts of the prosthesis are implanted
onto the ends of the thigh bone (femur), the shin
bone (tibia), and the undersurface of the knee cap
(patella) using a special bone cement. Usually, metal
is
used on the end of the femur, and plastic is used
on the tibia and patella, for the new knee surface.
However, newer surfaces including metal on metal,
ceramic on ceramic, or ceramic on plastic are now
being used. In many cases, a mini-incision can now
be used to avoid cutting the tendon on the front of
the knee. This allows for faster, less painful recovery
than standard total knee replacement. A small drainage
tube is placed during surgery to help drain excess
fluids from the joint area. The leg may be placed
in a continuous passive motion (CPM) device after
surgery. This is a mechanical device that flexes (bends)
and extends (straightens) the knee to keep the knee
from getting stiff. Gradually, the rate and amount
of bending will be increased. The leg should always
be in this device when in bed. The CPM device helps
speed recovery, and decreases pain, bleeding, and
infection.
Knee joint replacement may be recommended for: knee
pain that has failed to respond to conservative therapy;
knee pain that limits or prevents activities of importance
to the patient; arthritis of the knee; decreased knee
function caused by arthritis; inability to sleep through
the night because of knee pain; or some tumors involving
the knee. People who have a prosthetic device (such
as an artificial joint) need to take special precautions
against infection. They should carry a medical identification
card indicating that they have a prosthetic device.
Also, always inform health care provider of your prosthetic
knee joint. The results of a total knee replacement
are often excellent. The operation relieves pain in
over 90% of patients, and most need no assistance
walking after recovery. Most prostheses last 10 to
15 years, some as long as 20 years, before loosening
and requiring revision surgery. The hospital stay
generally lasts 3-5 days, but the total recovery period
varies from 2-3 months to a year. Walking and range-of-motion
exercises will be started immediately after surgery.
Some patients require a short stay in a rehabilitation
hospital to become safely independent in their activities
of daily living. It may be necessary to use crutches
or a walker for a few weeks or even months after surgery.The
physical therapy started in the hospital will continue
after going home until strength and motion return.
Contact sports should generally be avoided, but low
impact activities, such as swimming and golf, are
usually possible after full recovery from surgery.
Spinal Surgery - Cervical
Cervical spinal surgery is used to correct the part
of the spine in the neck, including problems with
the bones (vertebrae), disks, and nerves. The spinal
column is composed of 33 bones (called vertebrae)
spanning from the base of the skull to the pelvis.
Each vertebra has a round, solid body and a bony arch.
The spinal cord runs through the hole between the
arch and the body of the vertebra and is thus protected
by bone on all sides. A pair of spinal nerves (one
on the right and one on the left) runs out between
every vertebra. Soft intervertebral disks separate
the bodies of the vertebrae, and the arches are connected
to one another through joints called facets.
The
part of the spine in the neck is called the cervical
spine and consists of 7 vertebrae and 8 pairs of spinal
nerves (called C1 to C8 for cervical nerves 1 through
8). The two most common problems people have with
the cervical spine are disk herniation and stenosis.
Normally a vertebral disk has a fibrous outer "rind"
and a soft interior, somewhat like a thick-skinned
orange. When a disk herniates, the soft inside material
squeezes out through a break in the rind and can pinch
the nerves as they exit the spinal column. This will
cause pain and sometimes weakness and numbness in
the neck and arm.
Spinal stenosis occurs when the facet joints develop
arthritis and start to grow excess bone around them
(a typical response of a joint to arthritis). The
extra bone narrows the space through which the spinal
nerve exits the spinal column. This can lead to weakness
and pain in the neck and arms.
The specific surgery depends on the exact nature of
the problem. The surgery is conducted while the patient
is under general anesthesia (unconscious and pain-free).
If there is a single herniated disk, then the disk
may simply be removed through an incision either through
the front or back of the neck. If there is more than
one disk that needs to be removed, then the spine
usually needs to be fused to keep it from becoming
unstable. For surgery from the front that means that
bone is placed in the space where the disk was removed
and plates are screwed into the vertebrae to keep
them from moving. Rods are sometimes used to connect
the vertebrae if the surgery is done from the back.
Spinal stenosis is a more difficult problem to treat
and generally requires more extensive surgery. The
spinal nerves and cord need to be decompressed and
this can again be done from either the front or the
back. Again, if there is enough bone taken away that
the cervical spine becomes unstable, it will be necessary
to fuse the remaining bone together with bone and
plates, rods, or metal cages. The bone may be taken
from the patient's body, usually from either the hip
or the lower leg.
Surgery is generally used when conservative therapy
fails, if the pain and weakness become progressively
worse, or if there is evidence that the spinal cord
itself is being compressed. With surgery on a single
herniated disk, more than 90% of patients experience
total or near-total relief from their symptoms. More
complex surgeries on multiple disks vary in outcome,
depending on the technique and the particular case.
Spinal stenosis is more difficult to treat and results
from this surgery are not as good as for disk excision.
From 50% to 90% of patients can expect good to excellent
results.
Spinal Surgery - Lumbar
Lumbar spinal surgery is used to correct problems
with the spinal bones (vertebrae), disks, or nerves
of the lower back (lumbar spine). The spine consists
of bones (vertebrae) separated by soft cushions (disks).
Pressure on the nerves that branch off the spinal
cord can produce pain, numbness, tingling, or weakness.
Patients with spinal pain in the neck or back are
usually treated conservatively before surgery is considered.
Bedrest, traction, anti-inflammatory medications (nonsteroid
and steroid), physical therapy, braces, and exercise
are often prescribed.
Lumbar spinal surgery is done while the
patient
is under general anesthesia (unconscious and pain-free).
An incision is made over the troubled area. The bone
that curves around and covers the spinal cord (lamina)
is removed (laminectomy) and the tissue that is causing
pressure on the nerve or spinal cord is removed. The
hole through which the nerve passes may be enlarged
to prevent further pressure on the nerve. Sometimes,
spinal fusion is necessary to stabilize the area.
The outcome depends on the source of the problem or
the extent of the injury but most patients do very
well after surgery.
(Information given here has been
abridged from authentic sources like NIH, USA)