A hip replacement is a procedure performed to replace the existing destroyed hip joint, usually destroyed by some type of arthritis or trauma. It is one of the most successful operations of modern times. The primary aim is to relieve pain and improve function. It is usually performed in middle aged to older patients. The existing bone surfaces are removed surgically and replaced with metal and/or plastic, but recent advances have seen the emergence of new materials, such as ceramics, which have better wear properties. Remember that this is a mechanical device and may wear out over time, with a certain percentage of people requiring a revision hip replacement at some stage in their lifetimes. As with any major surgical procedure there are potential complications, including infection, dislocation and fracture around the hip. These complications are rare, usually around one percent or less frequent. Most people are very happy with their hip replacements; surgeons often refer to this as the "forgotten hip", meaning that most people function so normally thereafter, that they forget they have ever had the operation. This is a major surgical undertaking, and should be planned and discussed in detail with your Orthopaedic surgeon.
Knee replacements, together with hip replacements, are probably the most successful operations of our times. It aims to relieve pain and improve function by replacing the existing destroyed bone surfaces of the knee with metal and polyethylene. These materials provide a smooth surface for joint articulation and thereby relieve pain. Potential complications include infection, fracture and implant loosening over time. Infection is the most feared complication as it is very difficult to eradicate in the presence of a prosthestic joint. However all precautions are taken to prevent this, and it only occurs less than one percent of the time. Careful pre-operative planning is essential with clinical examination, appropriate X-rays, optimisation of medical conditions such as diabetes and hypertension , eradication of any infections etc. It is important not to shave the area before surgery as this may increase the risk of infection. As with any mechanical device, it may wear out over time and may need to be revised. Bear in mind that any revision joint replacement is more complicated and more risky than the initial one. However revisions are usually only required 15 to 20 years later, depending on how active the patient is. Please discuss this surgery in detail with your Orthopaedic surgeon to see if it is appropriate for you.
We live in an unsafe environment; interpersonal violence and motor vehicle collisions are very common, often resulting in broken bones. More and more fracture are being treated surgically, as functional results are usually better, rehabilitation is quicker, and fewer long term complications occur in surgically fixed fractures. Fractures involving joints are more likely to be fixed surgically as perfect reduction is necessary to prevent joint stiffness and arthritis. Often screws, plates and metal rods are used to fix fractures. Patients often have concerns regarding these implants; however they are quite safe and do not usually cause any problems in themselves. Sometimes they need to be removed after the fractures have healed. Children's fractures are usually less complicated to treat and heal quicker, with fewer requiring surgery. Plaster casts are often used to treat children's fractures. Of course each fracture is different and must be assessed by a specialist to determine the appropriate treatment.
Flat feet are common and quite often do not need any surgical intervention. Patients often complain of the inside sole of the shoe wearing out faster than the outer sole. Sometimes more serious problems may occur, resulting in pain. Pain may be due to arthritis in the joints of the foot or impingement if the deformity is severe. In adults a common cause is weakening of a tendon on the inside of the foot, called the tibialis posterior tendon. This tendon can be reconstructed in some cases. Mostly however some form of osteotomy is required, ie the bones of the foot needs to be cut and re-orientated, and sometimes even fused to achieve correction of the deformity. In children sometimes a more minor procedure can be performed.
This is less common than flat feet and more severe and more progressive. It usually occurs as part of a neurological condition. Since it is progressive, surgery is usually recommended. Osteotomy ( bone cuts) of the heel bone is almost always required, together with some releases of soft tissue structures . Sometimes a tendon can be transferred to allow better functioning of the foot. The results of this surgery are usually good. However one should always be cautious of any foot surgery if one is diabetic, and it is important to optimize diabetic control first, before considering surgery.
Toe deformities are common, and many people live with them. Sometimes they cause pain or calluses when shoes are worn. Wearing "wide toe" shoes can often relieve some symptoms. Surgery is quite reliable in correcting toe deformities. It will usually require excision of a part of the bone in the affected toe, and the insertion of a thin smooth wire into the bone (called a Kirschner wire or "K" - wire) . This wire is left sticking out of the toe for several weeks, and is subsequently removed painlessly in the doctors rooms. Naturally infection is a potential complication of this procedure, but if it occurs , it can usually be managed quite simply with antibiotics and wire removal. Sometimes more complicated procedures are required to correct severe toe deformities which can be discussed in consultation with your Orthopaedic Surgeon.
Heel pain is common, and while there are many causes, the commonest cause is related to the plantar fascia, a tight band of tissue on the underside of the foot which inserts on the heel. The main treatment for this is stretching of this plantar fascia tissue and also stretching of the Achilles tendon. It is advisable to exhaust conservative treatment measures for this before considering surgery. Surgery is unreliable and has many complications. See a physiotherapist and be regular in doing the stretching exercises and one does not even have to see an Orthopaedic surgeon for this. Injecting the heel can sometimes alleviate symptoms, but it is a painful injection. Using a "golf ball" or squash ball to roll under the heel is also a useful exercise to do regularly.
Patients develop meniscal tears as a result of injury or as a result of degeneration. This manifests itself as pain and locking in the knee and it is necessary to either repair the meniscus or remove the torn tissue if it cannot be repaired. This procedure is done arthroscopically via a few small incisions and is often done as a day case. Patients are fully ambulant after the procedure.
Due to injury usually from sporting activities, there are a number of ligaments that can be damaged around the knee the most common being the Anterior Cruciate Ligament (ACL). Some of the ligament injuries can be managed conservatively but the ACL and the ligaments on the outer aspect of knee will usually require reconstruction.
ACL reconstruction is done arthroscopically via a few small incisions and patients have a choice as whether to reconstruct their ACL with tendon graft which we harvest from another area around the knee or reconstruct with tendon harvested from a cadaver which we obtain from a tissue bank. Patients require bracing after the procedure and intensive rehabilitation.
Acromioplasty is done for patients with impingement and rotator cuff problems of the shoulder. The main problem with impingement is difficulty with overhead activities. Left untreated it can lead to tears in the rotator cuff tendons in the shoulder. The procedure is done arthroscopically via a few small incisions and space is created for the rotator cuff tendons by shaving some bone off the acromion.
When tears develop in the rotator cuff due to impingement and degeneration or due to acute injury, it is important to have these tendons repaired so as regain adequate movements to the shoulder and to prevent premature arthritis of the shoulder which can be a debilitating condition. The procedure is done arthroscopically via a few small incisions and the rotator cuff is then sutured back onto the bone via advanced instruments and implants that we have at our disposal these days.
When patients have shoulder dislocations, there is an element of instability that persists especially in young adults. As a result of the dislocation, tissue is torn off the socket of the shoulder joint and this may not heal back with conservative treatment. Thus it becomes important to repair this tissue back onto the socket to stabilize the shoulder. The procedure is done arthroscopically via a few small incisions and the tissue is the repaired back to its original position via advanced instruments and implants that we have at our disposal these days.
Carpal tunnel syndrome occurs when there is pressure on the median nerve in your wrist resulting in pain and numbness to fingers. Release involves creating more space for the median nerve by dividing the ligament (transverse carpal ligamanent) that overlies this nerve. It is a minor procedure, done as a day case and would usually heal without complications in 1 week.
This condition occurs when the sheath and pulley of the tendons moving the thumb, become contracted and results in severe pain when moving the thumb and wrist. Release involves dividing this sheath. Symptoms improve almost immediately. This is done as a day case and would usually heal without complications in 1 week.
Arthroscopy is a procedure where a thin camera is inserted into a joint, in this case the ankle joint. It is a minimally invasive procedure, usually performed via two tiny incisions over the front of the ankle joint. The inside of the ankle is then seen magnified on a monitor in real time. It can be used to treat a variety of conditions that may cause ankle pain, such as cartilage defects (osteochondral lesions), ankle ligament injuries, ankle impingement, ankle arthritis and removal of loose bodies in the joint. In ankle impingement pain caused by bone or soft tissue in the joint can be debrided off easily. Cartilage defects can be removed and drilled with a specially designed device to stimulate new cartilage growth. Although this new cartilage is not the same as normal joint cartilage, it does usually provide some relief. This procedure is performed under general anaesthetic and is usually a day procedure. Most patients can walk out of hospital on the same day with minimal pain.
Hallux valgus is the condition where the big toe deviates outwards, usually causing a painful bunion. The pain is the usual cause for presenting for treatment. Each case is carefully examined and classified together with X rays to plan the best operation. There are over a hundred operations described for this condition. Quite often simple changes in footwear (lose the high heels!) can be sufficient to effect pain relief. If surgery is decided upon, it will usually involve one or two osteotomies (cutting the bone to shift it to a better position and holding it with a screw or plate); together with a soft tissue release. Sometimes if there is arthritis in the joint, then a fusion may be the best and most reliable option. A fusion is a procedure where the joint is "stuck together" to lose all movement and therefore reliably achieve pain relief. It is a reliable procedure for pain relief if pain is severe and pre-existing arthritis is present.