Orthopaedic & Spine Surgery

Prior to any surgery, patients will have to undergo extensive testing to determine appropriate corrective procedures. Tests may include x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), diagnostic arthroplasty, and blood tests. The orthopaedist will determine the history of the disorder and any treatments that patient had previously undergone. Surgery candidates undergo standard blood and urine tests before surgery and, for major procedures, need to undergo an electrocardiogram or other diagnostic tests prior to the operation.

Orthopaedic surgeons perform various types of surgeries. The common procedures include:

• Arthroscopy – a procedure using special cameras and equipment to visualize diagnose and treat problem inside a joint.
• Fusion – a “welding” process by which bones are fused together with bone grafts and internal devices (such as metal rods) to heal into a single solid bone.
• Internal Fixation – a method to hold the broken pieces of bone in proper position with metal plates and pins or screws while the bone is healing.
• Joint Replacement (partial, total and revision) – when an arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis.
• Osteotomy – the correction of bone deformity by cutting and repositioning the bone.
• Soft tissue repair – the mending of soft tissue, such as torn tendons or ligaments.
• Spine – to correct problems with the small bones of the spine (vertebrae). It is a “welding process and the basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
• Arthroplasty – to restore the function a stiffened joint and relieve pain.

Arthroscopy or also known as arthroscopic surgery is a minimally invasive treatment of joints (‘arthro’ meaning joints and ‘scope’ meaning looking into.) This surgery is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. And thanks to the smaller incisions, both pain and scarring can be minimized. However, recovery rates and durations still vary according to the severity the condition as well as the patient’s overall health.

Arthroscopy is more advantageous compared to an open surgery because surgeons don’t have to cut through uninjured tissue to get to the damaged or injured tissue. The smaller surgical instruments allow the surgeons to view the joint area via a video monitor in order to diagnose and repair torn joint tissue such as ligaments or cartilage.

The common joints that can be treated through arthroscopy are the knee, shoulder, elbow, wrist, ankle, and hip joint.

As many types of sports place extreme stress on the knee, it is one of the most common parts of the body that can easily sustain an injury. A meniscus tear is a common injury that affects the knee joint. Even without playing sports, a twisted ankle can cause similar patterns of injuries; the kind that can happen to an athlete and can therefore be treated in the same manner.

In such cases, the surgeons will have to repair the torn tissue or reconstruct torn ligaments. Some ligaments, when torn, are not repairable, so they need to be reconstructed. Reconstruction surgery uses replacement tissue or also known as a graft to replace the ligament. The most common grafts are autografts, which utilize part of the patient’s body, such as the tendon of the kneecap or one of the hamstring tendons, to replace damaged tissues. Once the graft is in place, the replaced tendon is then gradually converted to become a new ligament.

Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. These injuries involve the rupture of at least two of the main ligaments of the knee, and are associated with meniscus ruptures and cartilage injuries.

Multiple ligament injury of the knee is a complex problem in orthopaedic surgery, something that is not commonly dealt with in Malaysia. Multiple ligament knee injuries are usually the result of knee dislocations following a high energy motor vehicle accidents or high velocity sport injuries. The surgical reconstruction takes a dedicated and highly experienced team to execute and is a very technically demanding procedure.

The rehabilitation program differs according to the type of injuries. The rehab physician and the therapist need to be aware of the patients’ injuries and they will propose a certain rehab program based on the injuries. The orthopaedic surgeon will guide the rehabilitation process because we diagnose the problem; and the rehab physician and the therapist who will run the day-to-day program.