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Total knee replacement:

A total knee replacement (tkr) or total knee arthroplasty is a surgery that replaces an arthritic knee joint with artificial metal or plastic replacement parts called the ‘prostheses.

The procedure is usually recommended for the patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy.

The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).

Total hip replacement:

Hip replacement, also called hip arthroplasty, is a surgical procedure to address hip pain. The surgery replaces parts of the hip joint with artificial implants. The hip joint consists of a ball (at the top of the femur, also known as the thigh bone) and a socket (in the pelvis, also known as the hip bone).

Common causes of hip pain

  • Osteoarthritis (most common)
  • Rheumatoid arthritis
  • Osteonecrosis (avascular necrosis)
  • Injury such as hip fracture
  • Tumour in the hip joint

Sports medicine:

Knee arthroscopy

1: ACL reconstruction

The acl is one of the most commonly injured ligaments of the knee.  Approximately half of acl injuries occur along with damage to the meniscus, articular cartilage, or other ligaments.  Injured ligaments are considered sprains and are graded on a severity scale.

Grade 1 sprains:

the ligament is mildly damaged in a grade 1 sprain. It has been slightly stretched but is still able to help keep the knee joint stable.

Grade 2 sprains:

a grade 2 sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 sprains:

this type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been torn in half or pulled directly off the bone, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most acl injuries are complete or near complete tears.

2: PCL reconstruction

The posterior cruciate ligament, or pcl, is the strongest ligament of the knee. While the anterior cruciate ligament, or acl is injured more often than the pcl and is more commonly discussed, a torn pcl accounts for more than 20% of reported knee injuries. The acl sits in front of the pcl location in the knee. A torn pcl is commonly missed and left undiagnosed.

The posterior cruciate ligament’s most important function is to prevent posterior translation of the knee at higher knee flexion angles. Thus, patients commonly complaining of problems with deceleration, problems going down stairs and inclines or general twisting, turning or pivoting activities.

PCL injuries are classified according to the amount of injury to the functional ligament:

  • Grade 1 pcl sprain: partial pcl tear
  • Grade 2 pcl  tear: near complete pcl tear
  • Grade 3 pcl tear: a complete pcl tear – the ligament is non-functional

3: MPFL reconstruction

The medial patellofemoral ligament (MPFL) is most commonly injured during a high-impact sporting event that includes pivoting or a tackle. The injury occurs when the patella dislocates and tears the ligament on the inside of the knee and surgery may be required to correct it.

The medial patellofemoral ligament, also called the mpfl is similar to a strong rubber band, in that the ligament has elastic-like qualities. The mpfl helps to stabilize the kneecap as the knee moves, and it prevents the kneecap from dislocating to the outside of the knee. The medial patellofemoral ligament is located in the centre of the knee, running from the femur (thigh bone) to the middle of the patella (kneecap).

4: Meniscus repair

Several knee injuries can affect the meniscus and are common in sports activities. The meniscus are small “c” shaped structures in the knee between the femur and tibia that act like cartilage and “shock absorbers” for the joint. The function of the meniscus is to distribute load and protect the articular cartilage of the knee from early degeneration. Each knee has two menisci- the medial meniscus and the lateral meniscus. Both of these structures can experience a tear from repeated squatting, a sudden twist, a sports injury or a severe fall.

Shoulder arthroscopy

1: Rotator cuff repair

Arthroscopic rotator cuff repair is a minimally invasive keyhole procedure to repair rotator cuff tendon tears. It is often done as a part of other keyhole procedures in the shoulder, such as a subacromial decompression and acromioplasty, biceps tenodesis, and ac joint excision.

Small or partial tears can respond favourably to non-operative management, but you may experience a mild to moderate function deficit.  Moderate to large tears will likely require surgery. 

Surgery is often performed arthroscopically, and most patients achieve good results. Following surgery, many patients notice improved comfort, shoulder strength and function. It is important to note that this type of surgery often requires 12 months of post- operative rehabilitation.

2: Arthroscopic stabilization

Those who experience recurrent shoulder instability may need to undergo arthroscopic shoulder stabilisation. This procedure aims to stabilise the shoulder by preventing the shoulder joint from slipping out of place.

 instability most commonly occurs after a tear or stretch in the lining of the shoulder joint (the capsule), labrum or rotator cuff. Any tear, stretch or detachment can cause the ball of the shoulder joint (humeral head) to move in and out of the socket to varying degrees. Some individuals experience partial shoulder dislocations whilst others experience a complete dislocation.

Complex trauma:

Fractures happen when you have accidents like falling, getting in a car crash, or getting injured while playing sports.

 When you break a bone, sometimes you’ll need surgery to fix it. Other times, a splint, cast, brace, or sling might be enough for your bone to heal. The time it takes to fully recover depends on which bone is broken, where the break is, and how  severe  the injury is.

Fracture Treatment methods

Immobilization

When you have a fracture, how it’s treated depends on  many factors like type of bone, severity of fracture, it’s displacement etc If it’s not too serious and your bones didn’t  displace much, you might just need a splint or cast to keep everything in place while it heals. The splint is worn for about two to three weeks, while a cast might be needed for four to six weeks. During this time, you’ll probably have X-rays to check if the bones are healing properly.

Closed reduction

For  certain fractures, a procedure called closed reduction might be done. It’s a non-surgical method where the doctor physically aligns your broken bones from the outside by pushing and pulling your body part. They’ll use a local anaesthetic to numb the area, or you might receive sedatives to relax, or even be given general anaesthesia to be asleep during the procedure. Afterward, they’ll put a plaster over the fractured area.

Surgery

Certain fractures need surgery.

Internal Fixation

The surgeon will realign your bones and fix it, which means inserting  metal into the bone to hold it in place while it heals. There are different techniques for this:

Nails: A metal rod is placed inside the bone from top to bottom.

Plates and screws: Metal plates and screws are inserted into the bone to hold the pieces together.

Pins and wires: These are used for smaller bone pieces and can be used with  nails or plates.

External Fixation

If your fracture is open and you have a bad wound over the skin, or if your skin is crushed by the injury, your doctor might opt for an external fixation. During this procedure, they will place  pins into your bone on both sides of the fracture inside your body. These pins  will then be connected to a brace or bracket outside your body that holds everything in place. This external fixation is a temporary measure to stabilize the fracture and allow it to start healing. Later on, you might have an internal fixation surgery for a more permanent solution.

PRP/Ortho biologics:

Platelets are small, colourless, disk-shaped cell fragments lacking a nucleus that are found in blood.  They play an imperative role in clot formation and also have antimicrobial properties important in infection control.  However, the platelets in platelet rich plasma (PRP) are imperative in establishing an inflammatory and healing response in damaged tissue by releasing numerous growths factors and cytokines to stimulate the body’s own healing process.  These growth factors orchestrate the key biological processes required for healing. They have been shown to orchestrate to be an important element in healing processes, including angiogenesis, inflammation resolution and tissue regeneration.