Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.


Upper Limb

  • Trigger Finger

    Trigger Finger and Trigger Thumb are common hand conditions. This condition occurs when the tendons in the thumb and fingers do not glide smoothly because a nodule formation that causes the tendons to catch or get stuck when the fingers or thumb is bent. It then becomes difficult to straighten the fingers and thumb back out. It can also cause pain, discomfort, and swelling.

    Causes
    The cause of Trigger Finger and Trigger Thumb is not always clear. The condition is more common among women than men. In some cases, repetitive gripping, such as holding tools, can cause the tendons to become irritated and form a nodule.

    Symptoms
    The symptoms of Trigger Finger and Trigger Thumb usually begin with pain and discomfort at the base of the finger or thumb. The area may be swollen and you may feel a small lump. Your finger will feel like they catch or get stuck when you try to move them.

    Treatment
    For people with mild symptoms, your doctor may suggest over-the-counter pain medication to reduce discomfort and swelling. In some cases, physicians choose to inject an anti-inflammatory cortisone medication into the site.

    Surgery
    Surgery is only recommended when other treatments have failed. There are a couple of surgical options, and your doctor will help you decide which is best for you. For the thumb, your surgeon will numb the area and make a small opening on the base of your thumb and make an incision in the tendon sheath. This will create a larger tunnel for the tendons to fit through and enable them to glide easily.
    For the other fingers, the tendon sheath can be safely opened with the tip of a needle. This will also create a larger tunnel for your tendons to move through with ease.

    Recovery
    You will be able to move your fingers or thumb immediately following surgery however you may experience slight discomfort or swelling at the area for a short period.

  • Carpal Tunnel Syndrome

    Carpal Tunnel Syndrome is a condition occurs when the Median Nerve in the wrist is compressed.
    Carpal Tunnel Syndrome is more common in women and people between the ages of 30 and 60 years old. Individuals with Carpal Tunnel Syndrome may feel numbness, pain, and a "tingly" sensation in their fingers, wrists, and arms.




    Anatomy
    The Median Nerve passes from the arm, through the wrist, and into our fingers. At the center of the wrist joint, the Median nerve goes through a passageway called the Carpal Tunnel.

    The Median Nerve supplies the sense of feeling to our thumb, index finger, middle finger, and half of the ring finger.

    Causes
    Carpal Tunnel Syndrome develops when the tissues and tendons in the Carpal Tunnel swell and make the area within the tunnel smaller. Usually, the exact cause of carpal tunnel syndrome is unknown.

    Symptoms
    The primary symptoms of Carpal Tunnel Syndrome are pain, numbness, and tingling. The numbness and tingling is typically present in the thumb, index, middle, and half of the ring finger. Your symptoms may be more pronounced at night, when you perform certain activities, or in cold temperatures.

    Diagnosis
    Simple tests will be performed to determine if there is pressure on the Median Nerve.

    Treatment
    The symptoms of Carpal Tunnel Syndrome can often be relieved without surgery. In Mild cases, your doctor may recommend that you wear a splint at night to support your wrist in a neutral position. Splints may also be worn during activities that aggravate your symptoms to position the wrist properly and provide wrist support.

    In moderate cases, sometimes doctors choose to inject corticosteroid medication, an anti-inflammatory medication, to provide symptom relief. Only in severe cases, where the symptoms of tingling are constant or when there is weakness in the hand will surgery be needed.

    Surgery
    Surgery is usually done under local anaesthesia, a small incision is made over the carpal tunnel and the tough bands of ligament is divided over the carpal tunnel. This will open up the space of the carpal tunnel and remove the reassure on the nerve.

    Recovery
    Your skin will take 2 weeks to heal, and the inner tissues scan take unto 6 weeks. During this time you will be taught some exercises to be done in order to keep your wrist mobile.

  • Tennis Elbow

    Tennis elbow is a type of tendinitis -- inflammation of the tendons -- that causes pain in the elbow and arm. It develops when a small portion of one to the tendons that connects the muscles of the forearm to the humerus fails and gradually plus away from the bone.

    Despite its name, you can still get tennis elbow even if you've never been near a tennis court. Instead, any repetitive gripping activities, especially if they use the thumb and first two fingers, may contribute to tennis elbow. Tennis elbow is the most common reason that people see their doctors for elbow pain. It can pop up in people of any age, but it's most common at about age 40.

    The Causes of Tennis Elbow
    Tennis elbow usually develops over time. Repetitive motions -- like gripping a racket during a swing -- can strain the muscles and put too much stress on the tendons. That constant tugging can eventually cause microscopic tears in the tissue.

    Symptoms of Tennis Elbow
    The symptoms of tennis elbow include pain and tenderness in the bony knob on the outside of your elbow. This knob is where the injured tendons connect to the bone. The pain may also radiate into the upper or lower arm. Although the damage is in the elbow, you're likely to hurt when doing things with your hands.

    Tennis elbow may cause the most pain when you:

    • Lift something
    • Make a fist or grip an object, such as a tennis racket
    • Open a door or shake hands
    • Raise your hand or straighten your wrist

    Treatment For Tennis Elbow
    • Early stage treatment
      During this stage, usually activity modification or topical analgesic medications used in combination with a special band that is applied to the affected muscle produces excellent results in a few weeks.

    • Late stage treatment with injectables
      Injecting the area with an anti-inflammatory agent like cortisone sorts out the problem. Sometimes for refractory cases, surgical debridement and repair of the tendon maybe necessary.

Sports Injuries

  • Ankle

    Ankle injuries are often thought of as sports injuries. But you don't have to be an athlete or even a "weekend warrior" to turn your ankle and hurt it. Something as simple as walking on an uneven surface can cause a painful, debilitating sprain.


    What Kinds of Ankle Injuries Are There?

    Sprains, Strains, and Fractures
    Ankle injuries are defined by the kind of tissue -- bone, ligament, or tendon -- that's damaged. The ankle is where three bones meet -- the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion.

    A fracture describes a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.

    Muscle and tendon strains are more common in the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of a tendon is called tendinitis. Microscopic tendon tears that accumulate over time, because of being repeatedly over stretched, and don't heal properly lead to a condition called tendinosis.

    Treatment available
    Treatment of these injuries depend on the type and severity. It can range from simple braces to anti-inflammatory injections or even arthroscopic surgery of the ankle joint.

  • Knee

    Knee Anatomy and Function
    The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thighbone (femur), which rotates on the upper end of the shinbone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. The knee also contains large ligaments, which help control motion by connecting bones and by bracing the joint against abnormal types of motion. Another important structure, the meniscus, is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and helps it absorb shock during motion.


    Common Knee Injuries
    Many athletes experience injuries to their knee ligaments. Of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are often injured in sports. The posterior cruciate ligament (PCL) may also be injured.


    ACL injury
    Changing direction rapidly, slowing down when running, and landing from a jump may cause tears in the ACL. Athletes who participate in skiing and basketball, and athletes who wear cleats, such as football players, are susceptible to ACL injuries. ACL injuries can be arthroscopically reconstructed and the patients will be able to return to sports in in 9 months to 1 year.


    MCL injury
    Injuries to the MCL are usually caused by a direct blow to the outside of the knee. These types of injuries often occur in contact sports, such as football or soccer. MCL tears are usually treated conservatively and they heal well.


    Torn cartilage / Meniscal Tear
    When people talk about torn knee cartilage, they are usually referring to a torn meniscus. The mensicus is a tough, rubbery cartilage that is attached to the knee's ligaments. The meniscus acts like a shock absorber. Torn meniscus that are left untreated will lead to erosion and damage to the articular cartilage. Treatment for meniscal injuries is arthroscopic surgery.

  • Shoulder

    Shoulder injuries are very common, especially among people who play sports that require overhead arm motions. The most common injury is inflammation of the bursa (bursitis) in the shoulder. This causes pain on movement and eventually can lead to frozen shoulder.

    Some shoulder conditions require surgery. Conditions like torn cartilage, torn muscle or ligaments will usually need to undergo Arthroscopic surgery to repair the lesions.

    Most often though, the problem is simple and just due to the bursitis,therefore a simple injection with anti-inflammatories will cure the condition.

Hip & Knee Arthritis

  • Arthroscopic Debridement Knee & Hyaluronic Injections (Gel Injections)

    Knee arthroscopic surgery is a key hole procedure performed through small incisions in the skin to repair injuries to tissues such as ligaments, cartilage, or bone within the knee joint area. The surgery is conducted with the aid of an arthroscope, which is a very small instrument guided by a light source attached to a television monitor. Other instruments are inserted through two incisions around the knee. Arthroscopic surgeries range from minor procedures such as flushing or smoothing out bone surfaces or tissue fragments (lavage and debridement) associated with osteoarthritis, to the realignment of a dislocated knee and ligament grafting surgeries. The range of surgeries represents very different procedures, risks, and aftercare requirements.

    Diagnostic Arthroscopy Introduction
    Arthroscopic surgery allows diagnosis and treatment of joint problems through small incisions in the skin. A camera attached to a scope is used to see inside your joint.

    Incision
    Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.

    Visualization
    The scope is inserted into the knee. Saline solution flows through a tube (cannula) and into the knee to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.

    Diagnosis
    Using the video monitor as a guide, the surgeon can make a diagnosis. A variety of surgical instruments like this probe can be inserted through other incisions to treat specific problems.

    End Of Procedure
    The surgical instruments are removed and the procedure is completed.


    What is Hyaluronic Acid?
    Hyaluronic Acid viscosupplementation injects a preparation of hyaluronic acid into the knee or hip joint. Hyaluronic acid is a naturally occurring substance around in the synovial (joint) fluid.
    It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis ("wear-and-tear" arthritis) have a lower-than-normal concentration of hyaluronic acid in their joints.

    Viscosupplementation may be a therapeutic option for individuals with osteoarthritis of the knee. Viscosupplementation has been shown to relieve pain in many patients who cannot get relief from nonmedicinal measures or analgesic drugs.



    Conditions treated with Hyaluronic Acid
    • Osteoarthritis of Hip
    • Osteoarthritis of the Knee

    What are the risks of HA Viscosupplementation?
    The simple procedure involves injecting the HA into the joint affected. The risks involved are similar to any injection, including bleeding, infection, and possible adverse reactions.

    What happens during a HA Viscosupplementation?
    The physician will administer local anesthesia to the area being injected. This will prevent excess pain and discomfort during the procedure itself. The HA injection will be ready to be administered in a prefilled syringe. The surgeon will first aspirate the affected joint to remove any fluid that may be present. After removing the fluid, the HA is injected into the joint. You will be able to get up and walk immediately after the procedure.

    What activity can I do after I receive HA Viscosupplementation?
    During the first week after HA Viscosupplementation, heavy and strenuous exercise involving the affected joint should be avoided. However, you can continue your regular daily activities as normal.

    How many treatments do you need?
    Most patients only require one HA Viscosupplementation once a year depending on the severity of osteoarthritis. If your condition is more advanced, you may require to have the injections repeated again between 6 months to 9 months after the first treatment.

    How does HA Viscosupplementation work?
    As a natural component in your joints, Hyaluronic Acid provides joints a smooth surface to allow movement. Over time, the concentration of Hyaluronic acid in your joints decreases, the joints can not move freely causing pain and discomfort. With HA Viscosupplementation, it seeks to restore the concentration of HA to that of a normal healthy joint. This leads to reduce pain, and increased functionality of the joint.

    How long does it take for HA Viscosupplementation to "work"?
    Most patients notice some element of improvement almost immediately after HA Viscosupplementation. As time goes on the pain and soreness related to the injury decreases, increasing the ability to do functional daily living activities.

  • Total Knee Replacement (TKR)

    Total knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.







    What is a total knee replacement?
    A total knee replacement, also known as total knee arthroplasty, involves removing damaged portions of the knee, and capping the bony surfaces with man-made prosthetic implants, allowing for a near-normal range of motion. This is done when the cartilage in the knee is completely worn out and the two ends of the bones rub against each other causing pain. If left untreated it will eventually lead to the affected limb bowing inwards or outwards.

    Many patients have the misconception that a knee replacement surgery involves cutting of the bones and replacing it with a new joint. In actual fact, a TKR is when the diseased ends of the affected joint is shaved off a few millimeters and a titanium cap is placed over the ends. In between the two caps, there is a special plastic lining that acts as a shock absorber.



    Legs that are bowed before surgery will become straight and back to normal alignment after the surgery.


    Before
    After
    Severe bone loss
    After Reconstructing bone

    Implant Materials & Design
    A standard TKR has 3 components; a femoral (thigh bone) end, a tibial (shin bone) end and an UHMWPE insert (spacer) that acts as a shock absorber. Both the femoral and tibial implants are made of titanium.

    The femoral implants that I use comes with two type of joint surfaces, a standard Cobalt Chrome surface (stainless steel) and an Oxinium® (ceramic metal) surface. The Oxinium® surface offers the least wear rate and therefore will last longer than the standard Cobalt Chrome implant.

    If the knees are severely bowed and has bone loss then additional special titanium augments and stems will need to be used to make the knee straight again and regain its full function. This makes the surgery more complicated and therefore I recommend that you do not wait until it reaches this stage.

    Visionaire Patient Matched / Specific Instrumentation (Customised Implants)
    Involves taking a special xray and MRI that is sent to the designers in the USA. The designers will prepare a 3D model plan that is sent back to the surgeon for evaluation. Once agreed by the surgeon, the designers proceed to customise a cutting block that is sent back to the surgeon for use during the knee replacement surgery that will ensure the implant fits the joint perfectly.

  • Total Hip Replacement (THR)

    What is a total hip replacement?
    A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum. The ball is the head of the thighbone (femur).

    Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal (or ceramic) ball and stem inserted into the femur bone and an artificial plastic (or ceramic) cup socket. The metallic artificial ball and stem are referred to as the "prosthesis."

    Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients.

    Choice of Implants
    Generally the implants unsed in this center are of the uncemented variety. There are 2 types of bearing surfaces used; metal on metal and ceramic on ceramic surfaces. The choice bearing surface is decided after taking into account the patients demands and activities.

  • Preparation

    Before Surgery
    1. I will consult and discuss with you your condition
    2. X-rays and examinations will be done
    3. An appointment with the physician for pre op investigations to be done, so that you are safe for surgery
    4. I will arrange the appropriate implants to be delivered for your surgery
    5. The entire procedure will be explained to you in details including the surgery, the recovery in the ward, the post op physiotherapy, the expected discharge date and home preparations
    6. You will also be informed as to when to stop your blood thinners and anti-inflammatories
    7. Feel free to ask any questions that you have about the surgery
    During Admission
    1. Fasting for 8 hours before the surgery – no liquids or solid food
    2. Admission will be on the morning of the surgery
    3. You will be given a single room, not to be shared with any other patient
    4. You will be asked to have a shower with a special medicated soap
    5. You are to continue all your usual medications for Diabetes and High Blood Pressure until admission
    The Surgery
    1. The anesthetists will discuss with you the type of anaesthesia
    2. Usually it is an Epidural with a local nerve block infiltration
    3. You will be sedated during the procedure
    4. The incision for a Hip Replacement will be from the upper thigh curved to the buttock
    5. The incision for a Knee Replacement is a straight line in front of the knee
    6. Sometimes there might some residual numbness at one side of the scar especially the knee but this becomes less as time goes by ( ref. Love DT, Johnson D, Love BRT, Lester DK; American journal of Orthopaedic Surgery 2000)
    7. The straight forward surgery should take no more than 2 hours, if it is a complicated case it will take longer
    8. There will be a tube inserted into your knee (not for the Hip Replacement) for about 12 hours to drain out excess fluid from the knee
    Post Surgery
    1. The day of surgery is your day of rest
    2. You will be given adequate painkillers and antibiotics post surgery
    3. You will be started on a blood thinner the next day after surgery (2 weeks for knee replacement and 5 weeks for hip replacement)
    4. The physiotherapist will be working closely with you post op and teach you exercises that you need to do in bed
    5. There are special mechanical devices that will be attached to your leg and feet to provide intermittent compression to prevent blood clots
    6. You will be standing and taking your first few baby steps the first day after surgery
    7. There will be a continuous passive motion machine exercising your knee while you rest in bed
    8. You will be standing and walking with the aid of a walking frame
    9. For hip replacement patient you will be given a high commode chair to use in the toilet
    10. Day by day with the help of the physiotherapist you will be walking more
    11. Your expected stay in the ward is 5 days and you are allowed to be discharged if the wounds is dry, able to walk by yourself and can bend the knee to 90°
    12. Your stitches (if used) will be removed on the 14th day after surgery
    13. Patients from overseas are advised not to fly for the first 14 days after surgery to avoid blood clots
    Post Op Recovery
    1. You will be roughly using the walking frame for about 2 weeks
    2. There after you may progress to a walking stick if you're confident
    3. You skin incision will heal in 2 weeks
    4. The insides take about 6 -8 weeks to heal and so you will still be experiencing some pain daily, although it will be getting less as days go by
    5. At 6 weeks post surgery you should be about 50% recovered, at 3 months you will be about 80-90% recovered
    6. You may return to sports activities from the 3rd or 4th month onwards
    7. You may start to drive a car about 6-8 weeks after surgery, providing you have adequate muscle power of the operated leg
    8. You will have regular follow-ups at 3 months, 6 months and yearly after that.

  • Frequently Asked Questions(FAQ)

    1. How long is the surgery?
      Typically the surgical procedure for a TKR or a THR takes about 1.5 to 3 hours depending on the severity of the condition.
    2. What type of anaesthesia will I be under?
      The preferred choice of anaesthesia we use either for TKR or THR is called Spinal Epidural Anaesthesia. You will also have a continuous femoral nerve block for 2-3 days for patients undergoing total knee replacements.
    3. How long will I be on a wheel chair?
      You will NOT use a wheel chair. You will start walking the next day of surgery using a walking frame for both a TKR or THR surgery. You will be provided with a walking frame and for those undergoing a THR you will be provided with a commode chair as well.
    4. When can I bend my knee?
      For a TKR surgery, you leg will be placed in a machine to bend it starting the next day of surgery.
    5. How long will I be in the ward?
      Typically you hospital stay will be 5 days. It could be shorter but depends on a few criteria. You must be able to walk by yourself with the walking frame, you must be able to get in and out of bed your self, you must be able to bend you knee to bout 70-80 degrees (for TKR surgery) and you wound must be dry.
    6. When can I drive?
      Typically once you have attained muscle power in the operated leg. This usually is between 6-8 weeks after surgery.
    7. When can I return to work?
      This depends on the type of job you have. If you have a desk job the generally within one month from surgery, if you have a field job, then probably by 2-3 months. This generally depends on the individual's threshold of pain.
    8. Will I set off the metal detectors at the Airport?
      You might, depends on the sensitivity of the metal detectors. Anyway, you will be given an Identity Card.
    9. Will my legs be straight? Can it become bent again?
      For TKR surgery, your legs will be back to its original alignment, meaning it will be straight. Once straightened it will not become bent attain unless you break you bones.
    10. How long will it take me to recover from the surgery?
      In general, it will take about 2-3 months. This depends on the individual as well. At 6 weeks you should be about 50% recovered, at 3 months you will be about 80-90% recovered.
    11. How much does the surgery cost?
      Each patient is different. Please book an appointment with out consultant to get further details of the surgery.