Orthopaedic Surgery

Regular physical activity helps us look and feel good. It also keeps us healthy. Our bones, joints and muscles are key to helping us stay physically active. Collectively our bones, joints and muscles form the musculoskeletal system. The various components of the musculoskeletal system work together seamlessly to provide us with function and mobility.

Sometimes, conditions such as sports injuries, degenerative diseases, spinal disorders, and infections can affect the musculoskeletal system. These conditions can cause pain, swelling, deformity and loss of function. Such conditions require careful assessment and evaluation, so as to reach an accurate diagnosis.

The good news is that there are effective treatment options that can relieve pain and restore physical activity. Indeed, the potential for excellent recovery is greater when musculoskeletal conditions are treated early rather than late.

The treatment of musculoskeletal conditions is non-surgical in most cases. Occasionally surgical treatment is needed. Surgery involving the musculoskeletal system is termed orthopaedic surgery. Orthopaedic surgery most commonly involves joint surgeries, such as the knee replacement, hip replacement, shoulder and ankle surgeries.

At Orthopaedic and Hand Surgery Partners, our goal is to provide holistic, comprehensive, evidence-based care for all of our patients so that they can overcome their musculoskeletal conditions and resume healthy physical activity.

The Knee Joint

The knee joint is formed by the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other.

Damage to the cartilage and bone within the knee joint is called osteoarthritis. This can result from degeneration (wear and tear) or trauma (fractures and ligament injuries), resulting in knee pain, stiffness, joint deformity and limping.

This can sometimes be severe enough to affect daily mobility and one’s quality of life. The diagnosis of knee osteoarthritis is made after a thorough clinical assessment of the knee joint. X-rays and MRI scans are done to confirm the diagnosis.

ACL Reconstruction

ACL is an acronym for the ‘anterior cruciate ligament’. It is an important ligament that is found in the center of the knee, and it helps to maintain knee stability by preventing forward and twisting movements of the tibia (or shin bone) relative to the femur (or thigh bone). Injuries to the ACL are common. They usually occur due to twisting, non-contact injuries during sporting activities such as soccer, basketball or netball.

This surgery is usually performed under general anesthesia, using minimally invasive arthroscopic (keyhole) techniques. The surgery essentially involves replacing the torn ACL with a new ACL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new ACL graft is secured within these tunnels. An overnight stay in hospital is usually required after ACL reconstruction.

The rehabilitation process consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The success rate of ACL reconstruction surgery has been reported to be about 90%.

Meniscus Surgery

The meniscus is a rubbery, C-shaped disc that cushions your knee. It also helps to protect the cartilage in the knee. Each knee has two menisci – one at the outer edge of the knee and one at the inner edge.

Patients with small meniscus tears may be treated non-surgically with a course of rehabilitation. However, patients with large or displaced meniscal tears, who develop persistent pain, swelling and loss of joint function, are candidates for surgical treatment. Surgical treatment options include meniscus repair, partial meniscectomy and meniscus transplant.

This surgery is usually performed under general anesthesia and takes about 1-2 hours. An overnight stay in hospital is usually required after the surgery and 4-6 weeks of crutch-assisted ambulation may be advised.

The rehabilitation process consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The success rate of meniscus surgery has been reported to be about 80-90%.

Cartilage Repair

Cartilage is the smooth elastic tissue that covers the ends of the bones at these joints. The cartilage allows for the joint surfaces to glide smoothly and painlessly against each other. Injuries to the cartilage can occur with acute traumatic injuries or with chronic repetitive injuries. Cartilage injuries can result in pain, swelling and stiffness of the joint.

Patients with small cartilage injuries may be treated non-surgically with a course of rehabilitation. However, patients with cartilage injuries, who develop persistent pain, swelling and loss of joint function, are candidates for surgical treatment. Surgical treatment involves cartilage repair. Cartilage has a low potential for intrinsic repair because of its poor blood supply. Therefore specialized repair techniques are employed to repair this tissue. An overnight stay in hospital is usually required after cartilage repair.

The rehabilitation process consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The success rate of cartilage repair surgery has been reported to be about 70-90%.

Patella Instability Surgery

Patellar (or kneecap) dislocations are common injuries and affect mainly adolescents and young adults. In this condition, the patella moves out of its usual location in the front of the knee to the lateral or outer side of the knee. This can occur because of direct trauma or a twisting injury of the knee.

In patients who have recurrent patella dislocations and symptoms of patella instability, reconstructive surgery is needed to improve patella stability. The most common surgical procedure that is performed is called a medial patellofemoral ligament (MPFL) reconstruction. The surgery involves drilling two bone tunnels in the inner or medial side of the patella and another bone tunnel in the medial or inner side of the knee. A hamstring tendon graft is then passed through and secured within these tunnels to serve as a check-rein to prevent further lateral or outward dislocation of the patella.

An overnight stay in hospital is usually required after such reconstructive surgery and 1-2 weeks of crutch-assisted ambulation may be advised.

The rehabilitation process consists of progressive knee range of motion and muscle strengthening exercises, as well as functional recovery. The success rate of patella instability surgery has been reported to be about 80-90%.

Knee Replacement

Knee replacement surgery involves replacing the worn out surfaces of the knee joint with prosthetic devices. If only one compartment of the knee is involved, then partial knee replacement may be performed. If more than one compartment of the knee is affected by osteoarthritis, then total knee replacement is carried out.

Such surgery is usually performed under general anesthesia and may take about 2 hours to perform. A 3-4 days stay in hospital is usually required after the surgery.

The rehabilitation process consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. The success rate of knee replacement surgery has been reported to be 90%.

Knee Osteotomy

Knee osteotomy (or bone-reshaping surgery) is used to improve the overall alignment and shape of the knee. This is useful in patients who have osteoarthritis mainly affecting one compartment of the knee that is associated with deformity or bowing of the knee. Such surgery is usually performed under general anesthesia and may take about 2 hours to perform. A 1-2 days stay in hospital is usually required after the surgery and 4-6 weeks of crutch-assisted ambulation may be advised.

The rehabilitation process consists of progressive knee range of motion exercises, muscle strengthening exercises, and functional return.

PCL Reconstruction

PCL is an acronym for the ‘posterior cruciate ligament’. It is an important ligament that is found in the center of the knee, and it helps to maintain knee stability by preventing backward movements of the tibia (or shin bone) relative to the femur (or thigh bone).

Injuries to the PCL are less common than those to the ACL (or anterior cruciate ligament). They usually occur due to direct, contact injuries to the knee during road traffic accidents or sporting activities.

This surgery involves replacing the torn PCL with a new PCL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new PCL graft is secured within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft).

At the same time, concomitant injuries to the other ligaments, menisci or cartilage may be addressed. An overnight stay in hospital is usually required after PCL reconstruction and 4-6 weeks of crutch-assisted ambulation may be advised.

The rehabilitation process consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The success rate of PCL reconstruction surgery has been reported to be about 80-90%.

The Hip Joint

The hip joint is a ‘ball and socket’ joint. The ‘ball’ component is formed by the upper end or head of the femur, also known as the thigh bone. The ‘socket’ component is formed by the acetabulum within the pelvis bone.

The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other.

Damage to the cartilage and bone within the hip joint is called osteoarthritis. This can result from degeneration (wear and tear), trauma, avascular necrosis (depletion of the blood supply to the head of the femur), inflammatory disorders (such as rheumatoid arthritis) or childhood disorders (such as dysplasia, where the acetabular socket has an abnormal shallow shape).

Patients who develop osteoarthritis of the hip joint can present with pain, stiffness and limping. This can sometimes be severe enough to affect daily mobility and one’s quality of life.

The diagnosis of hip osteoarthritis is made after a thorough clinical assessment of the hip joint. X-rays and MRI scans are done to confirm the diagnosis. Occasionally additional blood tests may be done to find out the underlying cause of the osteoarthritis.

Hip Arthroscopy

This surgery is carried out using minimally invasive arthroscopic (keyhole) techniques, and is usually performed under general anesthesia. The technique is used to treat conditions in the hip joint such as labral tears, femoroacetabular impingement and loose bodies. An overnight stay in hospital is usually required after hip arthroscopy.

The rehabilitation process consists of progressive range of motion exercises, muscle strengthening exercises, and functional return. The success rate of hip arthroscopy surgery has been reported to be about 90%.

Hip Replacement

The surgery involves replacing the worn out ball and socket components of the hip joint with prosthetic devices. Such surgery is usually performed under general anesthesia and may take about 2-3 hours to perform. A 3-4 days stay in hospital is usually required after the surgery.

The rehabilitation process consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. Hip replacement surgery has been reported to have a 90% success rate.

Hip Replacement Revision

In patients who develop a malfunctioning hip replacement, revision surgery may be necessary to reduce pain and restore mobility. The surgery involves replacing one or more components of the hip replacement, which have failed. At the same time, areas of bone loss may need to be restored with bone graft from the patient himself (autograft) or from a donor (allograft), or replaced with metal blocks.

Revision hip replacement is usually performed under general anesthesia and may take about 2-3 hours to perform. A 3-4 days stay in hospital is usually required after the surgery.

The rehabilitation process consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy, and the success rate has been reported to be approximately 80%.

Lateral epicondylitis, otherwise known as tennis elbow, occurs when the origin of the muscles near the elbow become overworked. Usually, this happens through repetitive motions of the wrist and arm. The condition is painful and, unlike the name suggests, is not exclusive to athletes. Any job that features repetitive motions, such as plumbing or carpentry, may cause the condition. Tennis elbow patients often describe the pain as “radiating.” People with tennis elbow tend to have a hard time shaking hands, turning doorknobs, or grasping objects.

Tennis elbow may be treated conservatively, but sometimes surgical treatments are necessary for certain cases. Surgical procedures that your doctor may use to treat tennis elbow are as follows: Injections for tennis elbow, Ultrasonic Tenotomy.

Certain medical conditions may increase the risk of a fracture around the elbow. For example, osteoporosis increases the risk of fracture in many older adults. Not everyone with a fractured elbow needs surgery. If possible, your doctor will treat your elbow fracture with more conservative treatments, like pain medicine, splints, and slings.

However, in certain patients, surgery may be needed. Surgery typically involves exposing the fractured bone, reducing it into the correct position and fixing it with implants like plates and/or screws. This procedure is also known as Open reduction and internal fixation (ORIF).

If you fracture the bones around your elbow, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery, so they are back in their proper alignment. In a closed reduction, a doctor physically moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of physically reconnecting the bones. This might involve special screws, plates, wires, or nails that the surgeon places inside the bones to fix them in the correct place. This prevents the bones from healing abnormally. The entire operation usually takes place while you are asleep under general anesthesia.

Elbow bursitis is a painful condition that involves inflammation of the bursae. Bursae are small, fluid-filled sacs that cushion the bones, tendons, and muscles near the body’s joints. When these sacs become inflamed, doctors call the condition bursitis. Not all cases of elbow bursitis require surgery. In fact, most of the time, these inflamed sacs will get better on their own.

There are more severe instances in which a doctor must surgically drain the inflamed sac. In the most severe cases, it may even be necessary to remove the affected bursa altogether. This, however, is exceptionally rare.

If conservative treatments have not alleviated the patient’s symptoms, your doctor will perform surgery.

RA is one of the most common types of elbow arthritis, but it is fundamentally different than most types of arthritis. Conventionally, arthritis affects the joints over time through age-related wear and tear, but RA is a little different. Medical experts classify RA as an autoimmune disorder because the condition confuses the immune system into attacking the body’s own tissues. Unlike wear and tear arthritis, RA is known to affect the joint linings, which causes painful swelling. Additionally, this may result in joint abnormalities and bone erosion.

If nonsurgical treatments (such as physical therapy/ physiotherapy) fail to alleviate your symptoms or slow RA progression, then your doctor may consider surgery. Surgery often helps RA patients, making their symptoms much more bearable. Additionally, RA surgery may even restore the patient’s ability to use their joints normally.

Rheumatoid Arthritis surgeries include: Synovectomy, Tendon Repair, Joint Fusion, Total Joint Replacement

OD occurs when the bone beneath the cartilage of a joint dies because of a lack of blood supply. When this happens, the bone and cartilage may break away, leading to pain and decreased motion and strength.

Most commonly, OD occurs in children and teenagers. The condition usually affects the knee, but it can also occur in the ankles and elbows, as well as in other areas. Symptoms of OD usually appear after a joint injury or several months of high-impact activities. There are different levels of OD and they all depend on the size of the injury. Additionally, medical experts must consider the nature of the fragment. This includes whether the fragment detaches partially, wholly, or remains in place.

For young children, OD may heal all by itself as the bones are still growing and maturing. Other cases, however, will require surgery. OD usually necessitates surgery when there is a loose fragment in the joint. Additionally, the doctor may consider surgery if your OD is still present, and your bones have stopped growing. In other cases, your doctor may consider surgery if conservative treatments have not worked for you over a period of 6-12 months.