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Orthopaedics – جراحة العظام

Orthopedics (alternatively spelled orthopaedic surgery and orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

  • Hand surgery
  • Shoulder and elbow surgery
  • Total joint reconstruction (arthroplasty)
  • Pediatric orthopedics
  • Foot and ankle surgery
  • Spine surgery
  • Musculoskeletal oncology
  • Surgical sports medicine
  • Orthopedic trauma
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Common Procedures

  1. Knee arthroscopy and meniscectomy
  2. Shoulder arthroscopy and decompression
  3. Carpal tunnel release
  4. Knee arthroscopy and chondroplasty
  5. Removal of support implant
  6. Knee arthroscopy and anterior cruciate ligament reconstruction
  7. Knee replacement
  8. Repair of femoral neck fracture
  9. Repair of trochanteric fracture
  10. Debridement of skin/muscle/bone/fracture
  11. Knee arthroscopy repair of both menisci
  12. Hip replacement
  13. Shoulder arthroscopy/distal clavicle excision
  14. Repair of rotator cuff tendon
  15. Repair fracture of radius (bone)/ulna
  16. Laminectomy
  17. Repair of ankle fracture (bimalleolar type)
  18. Shoulder arthroscopy and debridement
  19. Lumbar spinal fusion
  20. Repair fracture of the distal part of radius
  21. Low back intervertebral disc surgery
  22. Incise finger tendon sheath
  23. Repair of ankle fracture (fibula)
  24. Repair of femoral shaft fracture
  25. Repair of trochanteric fracture



What is Spine Surgery?

Spine surgery is an invasive pain management procedure in which a specially trained doctor (the surgeon) uses instruments to make incisions to repair damaged spinal tissues. Or in other words Spine surgery whether back or neck surgery, can be sum up as an advanced treatment option for pain and disability caused by an identifiable lesion in the patient’s anatomy that has not adequately improved with non-surgical treatments. Although spinal arthritis tends to be chronic, the symptoms are rarely progressive and rarely require surgery on the painful spinal joints.

Types of Spine Surgery

There are different types of Spine surgeries, which include the following:

  • Discectomy: is a procedure to remove a portion of the disc that rests between each vertebrae. A herniated disc is the most common reason for spine surgery. In this type of spine surgery, the herniated disc is removed and relieves the pressure on the nerves.
  • Foraminotomy: is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just herniated disc. A foramenotomy removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column.
  • Spine Fusion: is a surgery that is done to eliminate motion between adjacent vertebrae. The spine fusion may be done because to treat a problem such as spondylolisthesis (unstable spine), or it may be done because of the extent of other surgery (such as a laminectomy).
  • Anterior Cervical Corpectomy Spine Surgery: When the cervical disease encompasses more than just the disc space, the spine surgeon may recommend removal of the vertebral body as well as the disc spaces at either end, to completely decompress the cervical canal. This procedure is often done for multi-level cervical stenosis with spinal cord compression caused by bone spur (osteophytes) growth.

Types of Spine Surgery Cont.

  • Cervical Spine Surgery: is performed for variety of cervical spine problems. Generally, surgery may be performed for degenerative disorders, trauma or instability. These conditions may produce pressure on the spinal cord or on the nerves coming from the spine. The goal this surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and prevent spinal abnormal motion.
  • Lumbar Laminectomy: is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves.
  • Endoscopic Spine Surgery: is an operation on the lumbar spine performed using a surgical endoscope and microsurgical techniques. This type of surgery is performed by orthopedic surgeons and neurosurgeons who are experts in diagnosing the causes of back and neck pain and recognizing when a patient is likely to get better with surgery
  • Spinal Disc Replacement: is a new surgery that is still quite uncommon. Spine disc replacement is done to treat specific types of back pain, while avoiding the problems associated with spine fusion surgery.

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What Is Knee Replacement?

Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation and is not a reason to perform knee replacement.

Other major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly.

Total knee replacement (TKR), also referred to as total knee arthroplasty (TKA), is a surgical procedure where worn, diseased, or damaged surfaces of a knee joint are removed and replaced with artificial surfaces. Materials used for resurfacing of the joint are not only strong and durable but also optimal for joint function as they produce as little friction as possible.

The "artificial joint or prosthesis" generally has two components, one made of metal which is usually cobalt -chrome or titanium. The other component is a plastic material called polyethylene. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports).

The general goal of total knee replacement is designed to provide painless and unlimited standing, sitting, walking, and other normal activities of daily living.

It's really nice to know that with proper care individuals who have had a total knee replacement can expect many years of faithful function. Studies show that patients can expect a greater than 95 percent chance of success for at least 15 years.

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Eligibility for the surgery

If you have been told you have a severely damaged knee joint and would benefit from a total knee replacement, the questions you need to ask yourself are:

  • 1. Have all of the appropriate non-surgical treatments been tried.
  • 2. Is having painful knee significantly restricting my day to day activities and not allowing me to do the things I need to do and the things I enjoy doing?

If the answers to these questions are yes, you may be a candidate for a new knee.

Types of Knee Replacements

Broadly speaking, there are four basic categories of knee replacements depending on the degree of mechanical stability provided by the design of the artificial knee:

  • Non-constrained
  • Semi-constrained
  • Constrained or hinged
  • Unicondylar

The highly successful non-constrained implant is the most common type of artificial knee. It is termed non-constrained because the artificial components inserted into the knee are not linked to each other and have no stability built into the system. It relies on the person's own ligaments and muscles for stability. This is the key feature of this group of artificial implants helping to maintain the stability of the knee.

The semi-constrained implant is a device that provides increasing stability for the knee. This type of artificial knee has some stability built into it. It is used if the surgeon needs to remove all of the inner knee ligaments(some surgeons prefer to do this), or if the surgeon feels the new knee will be more stable with this type of implant.

Constraint or hinged variety implants are rarely used as a first choice of surgical options. In this case, the two components of the knee joint are linked together with a hinged mechanism. This type of knee replacement is used when the knee is highly unstable and the person's ligaments will not be able to support the other type of knee replacements. It is useful in the treatment of severely damaged knees particularly in very elderly people undergoing a revision replacement procedure. The disadvantage of this type of knee joint is that it is not expected to last as long as the other types.

A Unicondylar knee replacement replaces only half of the knee joint. It is performed if the damage is limited to one side of the joint only with the remaining part of the knee joint being relatively spared. It is now possible for the surgeon to replace only that area of the knee joint which is severely damaged. However, even with only half of the joint destroyed, many surgeons prefer doing a total knee replacement believing this is a better procedure than the half-knee (unicondylar) replacement. But equally, there are surgeons who believe it is more appropriate to perform a unicondylar knee in the right circumstance.

Exercising following Knee Replacement

Exercising the knee and leg muscles following surgery is extremely important to the success of the total knee replacement.

Exercises aim to quickly regain increasing motion in the knee following surgery, prevent muscle loss, which is inevitable after surgery, rebuild the muscle strength and prevent stiffness of the new knee joint.

It is important therefore, to carefully follow the rehabilitation instructions given by the physical therapists and doctors.

Quadriceps Setting

This is a good beginning exercise as it not only initiates the needed muscle contraction but also is helpful in increasing extension of the knee. It is optimal for both legs as both legs will be in a weakened state postoperatively. Try to do this exercise several times every hour. However, the amount of discomfort will determine how many each individual can perform.

While lying in bed with legs straight and together and arms at the side.

  • Tighten the quadriceps muscles while pushing the back of the knee downward into the bed.
  • Hold this muscle contraction for four to five seconds, relax for a short period of time and repeat 10-20 times for each leg.

Terminal Knee Extension

This exercise also helps promote muscle activity and increases knee extension. This exercise is to be repeated 10-20 times.

While lying in bed place a pillow or towel rolled up into a bolster under the operated knee to position the knee joint at approximately 40 degrees from full extension.

  • Tighten the quadriceps muscle and straighten the knee by lifting the heel off the bed.
  • Hold this muscle contraction for 5-10 seconds, then to slowly lower the heel to the bed.

Heel Slides (Knee Flexion)

This exercise will promote muscle activity of the hamstrings as well as help increase the amount of knee flexion. The physical therapist will record the amount of flexion and extension for a daily report on the patient's progress to be reviewed by the physician.

While lying in bed on the back, keep legs straight and together and arms at the side.

  • Slide the foot of the surgical limb toward the buttock to a point where a mild stretch is felt.
  • Hold this position to a count of ten then slowly returns to the starting position.

Straight Leg Raising

This is another excellent exercise to promote strength to the quadriceps and the flexor muscles important in ambulating. Once the individual can perform 20 repetitions without any difficulty, gradual resistance at the ankle (such as the use of ankle weights) can be utilized to further strengthen the muscles. The amount of weight used should be increased in no more than one pound increments.

  • Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. (This will help decrease or avoid unwanted strain on the low back region).
  • While keeping the involved leg straight, raise the straightened leg about six to ten inches off the bed.
  • Hold this position for 5-10 seconds, then lower the leg slowly to the bed and repeat 10-20 times.

Pillow Squeeze

This is a good exercise to help strengthen the hip adductors or groin muscles.

  • Place a pillow between the knees (or slightly above the knee joint line if pressure at this area is uncomfortable).
  • Next squeeze the pillow and hold for a count of ten.

Relax for a short period of time and repeat this exercise 10-20 times.

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