ORTHOPEDIC SURGERY ASSOCIATES, P.A.
Services Offered
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Sports Medicine
ACL Repair
Bone-Patella-Bone graft
Hamstring tendon graft -
Arthroscopic Surgery
Knee Arthroscopy
Shoulder Arthroscopy
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Hand Surgery
Carpal Tunnel Release -
Fracture Care
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Foot & Ankle Surgery
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Pediatric Orthopedics
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Industrial/Work Related Injuries
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X-Ray Facility
Total Knee Replacement
Also known as total knee arthroplasty, this is a surgery that is performed for severe degeneration of the knee joint. More than 300,000 people undergo the procedure each year. A knee replacement can help to eliminate most of the pain from arthritis. It is indicated if conservative treatment methods have failed and the pain from the arthritis is limiting your lifestyle and activities. Knees wear out for a variety of reasons. These include inflammation from arthritis, injury or simple wear and tear. A knee replacement is the resurfacing of the worn out surfaces of the knee. A surgeon replaces lost cartilage with metal and plastic (see picture). This is typically done through an incision down the center of the knee. The incision averages 6 inches to 10 inches long. The goal of knee replacement is to provide a pain-free knee that allows relatively normal activities and lasts for as long as possible. Using the current techniques, 90 percent to 95 percent of knee replacements should last 15 years or longer.
Although not as common as total knee replacement, the partial or unicompartmental knee replacement is a viable alternative in limited situations. The designs of the unicompartmental types of knee replacements have improved over the years, and thus have made smaller, less invasive incisions.
The "uni," as it is commonly called, is used to replace a single compartment of the arthritic knee. The knee joint has three compartments: the medial (inner) compartment, the lateral (outer) compartment and the patellofemoral (kneecap) compartment. If the damage is limited to either the medial or lateral compartment, that compartment may be replaced with the uni.
If two or more compartments are damaged, the uni may not be the best option. The uni is also less desireable for a young, active person because it may not withstand the extremes of stress that high levels of activity create. It is best suited for the older, slim person with a relatively sedentary lifestyle. Only between six and eight out of 100 patients with arthritic knees are good candidates for a unicompartmental knee replacement.
Because the uni can be inserted through a relatively small incision (about 4" or 6" long), which does not interrupt the main muscle controling the knee, rehabilitation is faster, hospitalization is shorter and return to normal activities is more rapid than after a total knee replacement.
However, this is still a serious operation, which has all the same risks as total knee replacement.
Total Hip Replacement
Total hip replacement is a common procedure. It involves removing the head of the thighbone (femur). The ball-and-socket mechanism of the hip is replaced with artificial implants.
Hip replacement surgery involves making a 4-inch to 10-inch incision on the side of the hip. The muscles are split or detached from the hip. The hip is dislocated. The ball of the femur is removed. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. The cup implant is pressed into the bone of the socket. It may be secured with screws. A bearing surface is inserted into the socket.
Next, the femur is prepared by removing some bone from the inside of the thighbone. A metal stem is placed into the thighbone to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cementless implants have a rough, porous surface. It allows bone to adhere to the implant to hold it in place. A ball is then placed on the top of the stem. The ball-and-socket joint is recreated.
As the population ages over the next decade, this procedure is expected to become even more common. Patients who undergo hip replacement are typically 60 to 75 years old. More than 90 percent of hip replacements last for 10 years or more. The new implants are engineered to last longer. Pain and mobility improve after hip replacement. This allows patients to maintain their independence and quality of life.
Carpal Tunnel Release
Carpal tunnel syndrome is a common source of hand numbness and pain. Carpal tunnel syndrome becomes more common as we grow older and seems to affect people with certain medical conditions such as diabetes, thyroid conditions and rheumatoid arthritis more frequently. It is caused by increased pressure on a nerve entering the hand through the confined space of the carpal tunnel. The median nerve travels from the forearm into your hand through a tunnel in your wrist. The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called the transverse carpal lligament. Electrical testing of the nerve function is often performed to help confirm the diagnosis and clarify the best treatment option in your case. Conservative methods such as NSAIDs, night splinting, or modifying aggrevating factors are sometimes attempted, but surgical decompression will cure most cases.
The carpal tunnel is released when the strong roof of the carpal tunnel is cut during carpal tunnel surgery to increase the size of the tunnel and decrease pressure on the nerve. This is done through an incision in the palm or wrist. Risks of the surgery include bleeding, infection and nerve injury. Some pain, swelling and stiffness are expected, but severe problems are rare.
After surgery, elevating the hand and moving the fingers helps minimize swelling and stiffness. Minor soreness in the palm is common for several months after surgery. Most patients have improvement following surgery, but recovery may be gradual. When carpal tunnel syndrome has been present longer and the nerve is more severely affected, recovery is slower and less complete.
Knee Arthroscopy
If you have persistent pain, catching, or swelling in your knee, a procedure known as arthroscopy may help relieve these problems.
Arthroscopy allows an orthopaedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, utilizing a pencil-sized instrument called an arthroscope. The scope contains optic fibers that transmit an image of your knee through a small camera to a television monitor. The TV image allows the surgeon to thoroughly examine the interior of your knee and determine the source of your problem. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.
The procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems. Today, arthroscopy is one of the most common orthopaedic procedures in the United States.
Shoulder Arthroscopy
Shoulder arthroscopy like knee arthroscopy uses small cameras that are inserted through several small incisions to help diagnose and treat several shoulder conditions. The "scope" allows the surgeon to perform a surgery through a much smaller incision which is less invasive. The surgeon may use arthroscopic surgery with rotator cuff tears, impingement syndrome, labral injuries, or recurrent dislocations. Arthroscopic surgery does not eliminate the possibility of open surgery, which may be necessary once the problem is identified.
Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it takes several weeks for the joint to maximally recover. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function.
For an interactive look at knee arthroscopy please click on the link below
For an interactive look at knee arthroscopy please click on the link below
ACL Injury
The anterior cruciate ligament (ACL) is one of the most common ligament injuries to the knee. It often occurs in the active person involved in athletic activities and is more common in women than in men. It's estimated that each year in the United States between 100,000 and 200,000 people tear their ACL (approximately 1 in 3,000).
The ACL is an important stabilizer in the knee and controls side-to-side rotation and front-to-back stability. Over time, knee instability may cause irreparable damage to the cartilage and other parts of the knee. The decision between operative and non-operative care will be discussed between you and the surgeon and may be dependent on age, lifestyle, activity modification, and injuries to other parts of your knee. An important thing to remember with ACL injuries is that there will always be arthritic changes with both treatment methods, but reconstruction may preserve the joints cartilage and slow the arthritic process.
ACL tears cannot be repaired using suture to sew it back together and must be reconstructed using a substitute graft that is made of tendon. Commonly used grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Another graft possibility is from a cadaver, but studies show a relatively high risk of infection. Talk with your surgeon about the graft options to find a graft that is best suited to your lifestyle.
There is no best way to treat an ACL injury and one must review all their options with their surgeon and be informed of potential risks, complications, and expected outcomes before a treatment plan is determined.
