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)