Joint Replacement Surgery

Minimally Invasive Joint Replacement

Total Hip Replacement THR and Total Knee Replacement TKR are very successful surgical treatment for arthritis of the hip and knee respectively.

Over the last several years hip and knee replacement surgery has evolved to a Minimally Invasive technique.

Advantages of Minimally Invasive Joint Replacement are

·         Less tissue trauma – muscles and tendons are avoided or separated, not cut

·         Faster and less painful rehabilitation

·         Smaller incisions and less scarring – two incisions of 1½ to 2 inches each, rather than one 10- to 12-inch incision

·         Shorter hospital stay – 1-2 days (vs. 3-5 days); some patients go home in less than 24 hours

·         Reduced blood loss and less need for pre-surgery blood donation

·         Faster return to work and daily activities

Minimally Invasive Knee Replacement Incisions

Joint Replacement Surgery

Computer Assisted Joint Replacement

Computer Assisted Surgery (CAS) technology allows the surgeon to simultaneously visualize two- or three-dimensional views of the patient's anatomy on a monitor, and provides real-time, intra-operative views of surgical instruments and the relative digital positioning of implantable devices.

Total Hip Replacement (THR)

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components.

Total Knee Replacement (TKR)

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts.

Uniknee Replacement

Unicompartmental knee replacement is a minimally invasive surgery in which only the damaged compartment of the knee is replaced with an implant. It is also called a partial knee replacement.

Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all of your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.

Revision Hip Replacement

Revision hip replacement is a complex surgical procedure in which all or part of a previously implanted hip-joint is replaced with a new artificial hip-joint.

Sports Medicine

Sports injuries occur when playing indoor or outdoor sports or while exercising. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures and dislocations.

The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).

·         Rest:Avoid activities that may cause injury.

·         Ice: Ice packs can be applied to the injured area, which will help reduce swelling and pain. Ice should be applied over a towel on the affected area for 15-20 minutes, four times a day, for several days. Never place ice directly over the skin.

·         Compression: Compression of the injured area also helps reduce swelling. Elastic wraps, air casts and splints can accomplish this.

·         Elevation: Elevate the injured part above your heart level to reduce swelling and pain.

Some of the measures that are followed to prevent sports-related injuries include:

·         Follow an exercise program to strengthen the muscles.

·         Gradually increase your exercise level and avoid overdoing the exercise.

·         Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards and pads, comfortable clothes, and athletic shoes before playing any sports activity, which will help reduce the chances of injury.

·         Make sure that you follow warm-up and cool-down exercises before and after the sports activity. Exercises will help stretch muscles, increase flexibility and reduce soft tissue injuries.

·         Avoid exercising immediately after eating a large meal.

·         Maintain a healthy diet, which will nourish the muscles.

·         Avoid playing when you are injured or tired. Take a break for some time after playing.

·         Learn all the rules of the game you are participating in.

·         Ensure that you are physically fit to play the sport.

Some of the common sports injuries include:

Shoulder injuries

Severe pain in your shoulders while playing your favorite sport, such as tennis, basketball and gymnastics, may be caused by a torn ligament or dislocation of the shoulder bone. These may result from overuse of your shoulder while playing sports. Simple pain or acute injuries may be treated with conservative treatment, while chronic injuries may require surgical treatment.

Hip injuries

Fractures of the femur bone, labral tear and hip dislocation are some of the common sports injuries affecting the hip. The hip joint bears more weight and is more susceptible for injuries while playing sports. Hip injuries require immediate medical intervention to avoid further complications. Rehabilitation programs and physical therapy is often recommended following medical intervention, where you need to perform certain exercises to strengthen your muscles and improve movements.

Knee injuries

The anterior cruciate ligament (ACL) is major stabilizing ligament in the knee, which may tear with over use while playing sports. The ACL has poor ability to heal and may cause instability. Other common sports injuries in the knee include cartilage damage and meniscal tear. Knee injuries during sports may require surgical intervention, which can be performed using open surgical or a minimally invasive technique. Your surgeon will recommend physical therapy to strengthen your muscles, and improve elasticity and movement of the bones and joints.

Fractures/Trauma

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.

The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Types of fractures include:

·         Simple fractures in which the fractured pieces of bone are well aligned and stable.

·         Unstable fractures are those in which fragments of the broken bone are misaligned and displaced.

·         Open (compound) fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.

·         Greenstick fractures: This is a unique fracture in children that involves bending of one side of the bone without any break in the bone.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

·         Casting
closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

·         Traction
Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

Surgical Therapy

·         Open Reduction and Internal Fixation (ORIF)
This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.

·         External fixation
External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

·         Open fractures with soft-tissue involvement

·         Burns and soft tissue injuries

·         Pelvic fractures

·         Comminuted and unstable fractures

·         Fractures having bony deficits

·         Limb-lengthening procedures

·         Fractures with infection or non-union

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.