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Orthopaedic Clinic

At the Emirates Hospital in Jumeirah, we have four full time Western trained orthopedists each concentrating on a different area: Dr. Issam Mardini for the spine (back and neck), Dr. Amer Mansour for joints such as knee and shoulder problems, Dr. Kaisser Yameen for hands and feet, and Dr. Marwan Khazen for trauma. Dr Amer also covers our branch in Dubai Marina. We also have sub-specialists visiting from abroad such as Dr Khaled Neeman for total knee replacement and ACL problems.

Orthopaedics is the medical specialty devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of your body's musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles and nerves and allows you to move, work and be active. 

Once devoted to the care of children with spine and limb deformities, orthopaedics now cares for patients of all ages, from newborns with clubfeet to young athletes requiring arthroscopic surgery to older people with arthritis. And anybody can break a bone.


Your orthopaedist

Your orthopaedist manages special problems of the many regions of the musculoskeletal system.

Your orthopaedist is skilled in the

1) Diagnosis of your injury or disorder . 
2) Treatment with medication, exercise, surgery or other treatment plans . 
3) Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function. 
4) Prevention with information and treatment plans to prevent injury or slow the progression of diseases. 

While most orthopaedists practice general orthopaedics, some may specialize in treating the foot, hand, shoulder, spine, hip, knee, and others in pediatrics, trauma or sports medicine. Some orthopaedists may specialize in several areas. 

Your orthopaedic surgeon is a medical doctor with extensive training in the proper diagnosis and treatment of injuries and diseases of the musculoskeletal system. Your orthopaedist completed up to 14 years of formal education.

1) Four years of study in a college or university 
2) Four years of study in medical school 
3) Five years of study in orthopaedic residency at a major medical center 
4) One optional year of specialized education

Each year your orthopaedist spends many hours studying and attending continuing medical education courses to maintain current orthopaedic knowledge and skills.

Treatment

Orthopaedic patients have benefitted from technological advances such as joint replacement and the arthroscope that allows the orthopaedist to look inside a joint. But your visit will start with a personal interview and physical examination. This may be followed by diagnostic tests such as blood tests, X-rays, or other tests. 

Your treatment may involve medical counseling, medications, casts, splints, and therapies such as exercise, or surgery. For most orthopaedic diseases and injuries there is more than one form of treatment. Your orthopaedist will discuss the treatment options with you and help you select the best treatment plan to enable you to live an active and functional life. 

This brochure has been prepared by the American Academy of Orthopaedic Surgeons and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and its text should not be construed as excluding other acceptable viewpoints.


From Athletes to Seniors

Emirates Hospital’s Orthopaedic Center offers thoughtful, attentive care to patients suffering from arthritis, spinal problems, joint pain, and sports injuries. 

We bring our patients the latest advances in orthopaedics, focusing on advanced diagnostics and maximum repair, with minimum penetration of bone and tissue. 

We offer an array of treatment options to reduce pain and improve mobility – including medications and physical rehabilitation, as well as surgery and complete joint replacement. 

With the latest arthroscopic (minimally invasive) surgical techniques, we can repair joints, spinal discs and brittle bones, without large incisions (cuts), so that recovery is faster and less painful. Surgeons insert a miniature camera and instruments through a small cut in the patient's back, using local anesthetics. Patients often return home the same day.

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Workplace Health & Safety

We care for ill or injured workers, helping companies protect their employees' health and well-being. We work closely with physical therapists, to help workers return to the job safely and quickly. 

Our orthopaedic physicians are skilled at diagnosing work-related injuries, including cumulative trauma caused by repetitive reaching at the keyboard (carpal tunnel syndrome). 

Solving Back Problems
For spinal pain and injury that interferes with daily activities, Emirate's Orthopaedic Center offers sophisticated diagnosis and treatment. 

Before surgery is considered, physicians generally recommend conservative therapies, including bed rest, pain medications, and sometimes physical rehabilitation. 

When conservative treatment does not bring relief, our physicians use state-of-the-art surgery to treat painful disc problems and vertebral compression fractures. Using advanced Micro Endoscopic Diskectomy (M.E.D.) techniques and other minimally-invasive surgery, we can often repair the injured disk without major surgery.


What is arthritis?
As many as 70 million people in the United States have some form of arthritis or joint inflammation. We do have a lot of people who suffer from arthritis in the UAE since humidity and air-conditioning increase joint pain. It is a major cause of lost work time and serious disability for many people. Although arthritis is mainly a disease of adults, children may also have it. 

What is a joint?
A joint is where the ends of two or more bones meet. For example, a bone of the lower leg, called the shin or tibia and the thighbone, called the femur, meet to form the knee joint. The hip is a ball and socket joint. It is formed by the upper end of the thighbone-the ball-fitting into the socket-part of the pelvis called the acetabulum. 

The bone ends of a joint are covered with a smooth material called cartilage. The cartilage cushions the bone and allows the joint to move easily without pain. The joint is enclosed by a fibrous envelope called the synovium which produces a fluid that helps to reduce friction and wear in a joint. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move. 

What is inflammation?
Inflammation is one of the body's normal reactions to injury or disease. In an injured or diseased joint, this results in swelling, pain, and stiffness. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability. 

Types of arthritis
There are more than 100 different types of arthritis. 

What is osteoarthritis?
The most common type of arthritis is osteoarthritis. It is seen in many people as they age, although it may begin when they are younger as a result of injury or overuse. It is often more painful in weightbearing joints such as the knee, hip, and spine than in the wrist, elbow, and shoulder joints. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries. 

In osteoarthritis, the cartilage covering the bone ends gradually wears away. In many cases, bone growths called "spurs" can develop in osteoarthritic joints. The joint inflammation causes pain and swelling. Continued use of the joint produces pain. Some relief may be possible through rest or modified activity. 

What is rheumatoid arthritis?
Rheumatoid arthritis is a long-lasting disease that can affect many parts of the body, including the joints. In rheumatoid arthritis, the joint lining swells, invading surrounding tissues, and producing chemical substances that attack and destroy the joint surface. This commonly occurs in joints in the hands and feet. Larger joints such as hips, knees, and elbows also may be involved. Swelling, pain, and stiffness are usually present even when the joint is not used. Rheumatoid arthritis can affect people of all ages, even children. However, more than 70 percent of people with this disease are over 30 years old. Many joints of the body may be involved at the same time. 

How is athritis diagnosed?
Making a diagnosis of arthritis often includes evaluating symptoms, a physical examination, and X-rays, which are important to show the extent of damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. 

How is arthritis treated?
The goals of treatment are to provide pain relief, increase motion, and improve strength. There are several kinds of treatment: 

Medications - Many over-the-counter medications, including aspirin, ibuprofen, and naproxen (common anti-inflammatory drugs) may be used to effectively control pain and inflammation in arthritis. Acetaminophen (Tylenol) may be used to effectively control pain. Prescription medications also are available if over-the-counter medications are not effective. The physician chooses a medication by taking into account the type of arthritis, its severity, and the patient's general physical health. Patients with ulcers, asthma, kidney, or liver disease may not be able to safely take anti-inflammatory medications. Injections of liquid cortisone directly into the joint may temporarily help to relieve pain and swelling. It is important to know, however, that repeated frequent injections into the same joint can damage the joint and have undesirable side effects. 

Joint protection - Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learning methods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy (such as heat treatments) may be used to decrease stiffness and to strengthen the weakened muscles around the joint. 

Surgery - In general, an orthopaedist will perform surgery for arthritis when other methods of nonsurgical treatment have failed to give relief. The physician and patient will choose the type of surgery by taking into account the type of arthritis, its severity, and the patient's physical condition. Surgical procedures include:

  • removal of the diseased or damaged joint lining;
  • realignment of the joints;
  • total joint replacement; and fusion of the bone ends of a joint to prevent joint motion and relieve joint pain.

 

Is there a cure for arthritis?
At present, most types of arthritis cannot be cured. Researchers continue to make progress in finding the underlying causes for the major types of arthritis. In the meantime, orthopaedists, working with other physicians and scientists, have developed many effective treatments for arthritis. 

In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function. 

In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function. A total joint replacement, for example, can usually enable a person with severe arthritis in the hip or the knee to walk without pain or stiffness. 

Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons. 

What is arthroscopy?
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose and treat problems inside a joint. 

The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint." In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint. By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery. 

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee-at cartilage and ligaments, and under the kneecap. The surgeon can determine the amount or type of injury, and then repair or correct the problem, if it is necessary. 

Why is arthroscopy necessary?
Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI, or CT also scan may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through "open" surgery or from X-ray studies. 

Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are: 

Inflammation
Synovitis - inflamed lining (synovium) in knee, shoulder, elbow, wrist, or ankle. 
Injury - acute and chronic 
Shoulder - rotator cuff tendon tears, impingement syndrome, and recurrent dislocations 
Knee - meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability 
Wrist - carpal tunnel syndrome 

Loose bodies of bone and/or cartilage - knee, shoulder, elbow, ankle, or wrist 

Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are made by engineers in electronic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future. 

How is arthroscopy performed?
Arthroscopic surgery, although much easier in terms of recovery than "open" surgery, still requires the use of anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal or a local anesthetic, depending on the joint or suspected problem. 

A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments. 

When indicated, corrective surgery is performed with specially-designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically. 

For instance, most meniscal tears in the knee can be treated successfully with arthroscopic surgery. 

Some problems associated with arthritis also can be treated. Several disorders are treated with a combination of arthroscopic and standard surgery.

  • Rotator cuff procedure
  • Repair or resection of torn cartilage (meniscus) from knee or shoulder
  • Reconstruction of anterior cruciate ligament in knee
  • Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
  • Release of carpal tunnel
  • Repair of torn ligaments
  • Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist.

After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications. 

Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program. 

The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The extensive "open" surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon. 

 

What are the possible complications?

Although uncommon, complications do occur occasionally during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than one percent of all arthroscopic procedures. 

What are the advantages?
Although arthroscopic surgery has received a lot of public attention because it is used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than "open" surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery. 

Recovery after arthroscopy
The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and adhesive strips can be applied to cover the small healing incisions. 

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. 

It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes and others who are in good physical condition may in some cases return to athletic activities within a few weeks. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality. 

Fractures
What bones are made of 

"Thank goodness it's only a fracture. I thought it might be broken." People often think that a fracture is less severe than a broken bone, but fractures are broken bones. 

To understand why bones break, it helps to know what bones do and what they are made of. The bones of the body form the human frame, or skeleton, which supports and protects the softer parts of the body. Bones are living tissue. They grow rapidly during one's early years, and renew themselves when they are broken. 

Bones have a center called the marrow, which is softer than the outer part of the bone. Bone marrow has cells that develop into red blood cells that carry oxygen to all parts of the body and into white blood cells that help fight disease. Bones also contain the minerals calcium and phosphorus. These minerals are combined in a crystal-like or latticework structure. Because of their unique structure, bones can bear large amounts of weight. 

How fractures occur
Bones are rigid, but they do bend, or "give" somewhat when an outside force is applied to them. When this force stops, bone returns to its original shape. For example, if you fall forward and land on your outstretched hand, there's an impact on the bones and connective tissue of your wrist as you hit the ground. The bones of the hand, wrist and arm can usually absorb this shock by giving slightly and then returning to their original shape and position. If the force is too great, however, bones will break, just as a plastic ruler breaks after being bent too far. 

Types of fractures
The severity of a fracture usually depends on the force that caused the fracture. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than breaking all the way through. If the force is extreme, such as in an automobile collision or a gunshot, the bone may shatter. If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an "open" fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur. 

Treating your fracture
Because fractures hurt and make it difficult if not impossible to use the part of the body that is injured, most people call a doctor or seek emergency care quickly. In some cases, however, a person can walk on a fractured bone in the leg or foot, or use a fractured arm. Just because you can use your hand or foot does not mean that you do not have a fracture. If you think a bone may be broken, you should seek medical help immediately. A medical examination and x-rays are usually necessary to tell for sure and to ensure proper treatment. 

It is very important to control the movement of a broken bone. Moving a broken or dislocated bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone. That's why people giving first aid or emergency treatment may splint or brace your injury before medical treatment is given. Also, if there is an open wound it should be covered by a clean cloth or bandage on the way to further medical treatment. 

At the emergency room, clinic or doctor's office, the physician usually applies a splint to prevent further damage, to lessen the pain and to help stop any bleeding. The patient is usually asked to recline and elevate the injured part. Elevation helps to reduce bleeding and swelling. 

X-rays can help the physician determine whether there is a fracture, and if so, what type of fracture it is. If there is a fracture, the doctor will "reduce" it, by restoring the parts of the broken bone to their original positions. "Reduction" is the technical term for this process. 

All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Broken bone ends heal by "knitting" back together with new bone being formed around the edge of the broken parts. The specific method of treatment depends on

  • the severity of the break.
  • whether it is "open" or "closed."
  • the specific bone involved-a broken bone in the spine (vertebra) is treated differently from a broken leg bone or a broken rib.

 

Types of treatment
The following treatments are used for various types of fractures.

  • Cast immobilization-A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal. 

  • Functional cast or brace-The cast or brace allows limited or "controlled" movement of nearby joints. This treatment is desirable for some but not all fractures. 

  • Traction-Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment. 

  • Open reduction and internal fixation-In this type of treatment, an orthopaedist must perform surgery on the bone. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments very exactly. Because of the risks of surgery, however, and possible complications, such as infection, they are used only when the orthopaedic surgeon considers such treatment to be the most likely to restore the broken bone to normal function. 

  • External fixation-In this type of treatment, pins or screws are placed into the broken bone above and below the fracture site. Then the orthopaedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After an appropriate period of time, the external fixation device is removed.

 

Each of these treatment methods can lead to a completely healed, well-aligned bone that functions well. Remember that the method of treatment depends on the type and location of the fracture, the seriousness of the injury, the condition and needs of the patient, and the judgment of the orthopaedist and the patient. 

Successful treatment of a fracture also depends greatly on the patient's cooperation. A cast or fixation device may be inconvenient and cumbersome, but without one a broken bone can't heal properly. The result may be a painful or poorly functioning bone or joint. Exercises during the healing process and after the bone heals are essential to help restore normal muscle strength, joint motion and flexibility. Help your broken bone heal properly-follow your orthopaedist's advice. 

Preventing broken bones
Even though healthy bones are very strong, any bone will break if the force applied against it is great enough. Bones that are weakened by disease or misuse may break more easily than healthy bones. To develop and maintain healthy bones, a person needs adequate amounts of calcium and proper exercise. 

Because of the way bones are made, calcium is very important in the growth, development, and maintenance of strong bones. Adequate amounts of calcium are necessary as a child grows and for the adult as well. Women, in particular, must have enough calcium in their diet. The female hormone estrogen regulates the use of calcium in women's bodies. Following menopause, when women produce far less estrogen, calcium regulation is more difficult. So it is very important that women make their bones as strong as possible before menopause, through weight-beating exercise and adequate calcium in their diets. In some women after menopause, bones fracture very easily because they have been weakened by calcium depletion. 

Because of the way bones are made, they also get stronger with regular but not excessive exercise. If a person is active, bones will become stronger and more dense. The bones of an inactive person are often not as strong and may fracture more easily than those of an active person. For this reason, older people should try to remain physically active. 

Proper diet and exercise, along with an understanding of what bones are made of and how they break, may help in preventing some fractures. If you do break a bone, seek medical treatment and remember-follow your orthopaedist's advice. 

The Knee
About 10.8 million visits are made to physicians’ offices because of a knee problem. It is the most often treated anatomical site by orthopaedic surgeons. 

There are many components to the knee making it vulnerable for various types of injuries. Many injuries are successfully treated conservatively, while others require surgery to correct. Here are some facts about the knee from the American Academy of Orthopaedic Surgeons. 

How does the knee work?
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 bracing the joint against abnormal types of motion. Other parts of your knee, like cartilage, serve to cushion your knee or help it absorb shock during motion. 

What are the most prevalent 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) often are injured in sports. The posterior cruciate ligament (PCL) also is frequently injured. 

Changing or twisting direction rapidly, slowing down when running, and landing from a jump are often the causes of tears in the ACL. Athletes participating in skiing and basketball and athletes wearing cleated shoes, such as football players, are susceptible to ACL injuries. 

Injuries to the MCL usually are caused by contact on the outside of the knee. These types of blows to the knee often are encountered in contact sports such as football. 

The PCL can be injured during a sports activity when the athlete receives a blow to the front of the knee or makes a simple misstep on the playing field. Athletes engaging in contact sports such as football or soccer are susceptible to a PCL injury. 

Other than ligament injuries, are there any other types of injuries? 

Torn knee cartilage is experienced by many people. When people talk about torn knee cartilage, they usually are referring to a torn meniscus. The mensicus is a tough, rubbery cartilage that is attached to the knee's ligaments. It acts like a shock absorber. 

In athletic activities, mensicus tears usually occur when twisting, cutting, pivoting, decelerating, or being tackled. Direct contact is often involved. 

How are knee injuries treated?
There are a variety of methods used by orthopaedic surgeons to treat knee injuries in athletes. The most important advice is to seek treatment as soon as possible. A common method used by orthopaedic surgeons to treat mild knee injuries is R.I.C.E.-rest, ice, compression, and elevation. Rest the knee by staying off it or walking only with crutches. Apply ice to control swelling. Use a compressive elastic bandage applied snugly but loosely enough so that it does not cause pain. Finally, keep the knee elevated. 

What is the lower back?
Your lower back is a complex structure of vertebrae, disks, spinal cord, and nerves. There are:

  • five bones called lumbar vertebrae - stacked one upon the other, connecting the upper spine to the pelvis
  • six shock absorbers called disks - acting both as cushion and stabilizer to protect the lumbar vertebrae
  • spinal cord and nerves - the "electric cables" which travel through a central canal in the lumbar vertebrae, connecting your brain to the muscles of your legs
  • small joints - allowing functional movement and providing stability
  • muscles and ligaments - providing strength and power and at the same time support and stability

 

Why is low back pain common?
Low back pain is one of the most frequent problems treated by orthopaedic surgeons. Four out of five adults will experience significant low back pain sometime during their life. After the common cold, problems caused by the lower back are the most frequent cause of lost work days in adults under the age of 45. 

The lower or lumbar spine is a complex structure that connects your upper body (including your chest and arms) to your lower body (including your pelvis and legs). This important part of your spine provides you with both mobility and strength. The mobility allows movements such as turning, twisting or bending; and the strength allows you to stand, walk and lift. Proper functioning of your lower back is needed for almost all activities of daily living. Pain in the lower back can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living. 

How is low back pain diagnosed?
Most cases of low back pain are not serious and respond to simple treatments. Your orthopaedist can accurately diagnose and effectively treat most types of low back pain in the office. You will be asked about the nature of your symptoms and whether you sustained an injury. You also will have an examination of your spine and legs. For many episodes of low back pain no expensive tests are needed for initial assessment and treatment. 

If your pain is severe and not responding to treatment or if you have significant leg pain, some imaging tests may be required. Plain X-rays will show arthritis and bone diseases, but will not show soft tissues such as the lumbar disks or nerves. For conditions or injuries that involve these soft tissues, CT scan (computerized tomography) or MRI (magnetic resonance imaging) may be needed. Occasionally, a bone scan will be needed to assess bone activity and electrical tests, EMG (electromyography) may be needed to determine if the spine condition has caused nerve or muscle damage. 

What are the common causes?
Low back pain can be caused by a number of factors from injuries to the effects of aging. 

Low Back Sprain and Strain - The muscles of the low back provide power and strength for activities such as standing, walking and lifting. A strain of the muscle can occur when the muscle is poorly conditioned or overworked. The ligaments of the low back act to interconnect the five vertebral bones and provide support or stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse. 

These injuries, or sprain and strain, are the most common causes of low back pain. Frequently, a combination of other factors may increase the likelihood of injury or disease:

  • poor conditioning
  • improper use
  • obesity
  • smoking

The natural effects of normal aging on the body, in general, and low back, in particular, are osteoporosis or decreased amount of bone; decrease in strength and elasticity of muscles; and decrease in elasticity and strength of ligaments. Although you cannot totally halt the progress of these effects, they can be slowed by regular exercise, knowing the proper way to lift and move objects, proper nutrition, and avoidance of smoking. 

Age - "Wear and tear" and inherited factors will cause degenerative changes in the disks, called degenerative disk disease, and arthritic changes in the small joints. These changes occur to some degree in everyone. When severe, they can cause low back stiffness and pain. Arthritic bone spurs and inflamed joints can cause nerve irritation and leg pain. Almost everyone develops "wear and tear" changes in their low back as they age, although for most people it causes little pain or loss of function. 

Osteoporosis and Fractures - All bones lose bone strength over time and the lumbar vertebrae, particularly in postmenopausal women, can be fractured or compressed from a fall or even from the stress of lifting or everyday activities. 

Protruding Disk - The disk is composed of a soft center or nucleus, which, in children and young adults, is jelly-like. The nucleus is surrounded by a tougher outer portion called the anulus. With normal aging, the nucleus begins to resemble the anulus. During middle-age, fissures or cracks may occur in the disk. These may be the source of back pain. If the crack extends out of the disk, material from the disk may push out or rupture. This often is referred to as a herniated or slipped disk. If the protruded disk presses a nerve, it may cause pain in the leg. 

What is the best treatment?

Most low back pain can be safely and effectively treated following an examination by your orthopaedic surgeon and a prescribed period of activity modification and some medication to relieve the pain and diminish the inflammation. Although a brief period of rest may be helpful, most studies show that light activity speeds healing and recovery. It may not be necessary for you to discontinue all activities, including work. Instead, you may adjust your activity under your orthopaedist's guidance. 

Once the initial pain has eased, a rehabilitation program may be suggested to increase your muscle strength in your low back and abdominal muscles as well as some stretching exercises to increase your flexibility. Weight loss if you are overweight, and quitting smoking if you are a smoker, also will decrease the chances of a recurrence of your low back pain. The best long-term treatment is an active prevention program of maintaining your physical condition and observing proper lifting and postural activities to prevent further injuries. 

When is surgery needed?
Most low back pain, whether acute or chronic, almost always can be treated without surgery. The most common reason for surgery on the lower back is to remove the pressure from a "slipped disk" when it causes nerve and leg pain and has not responded to other treatments. Some arthritic conditions of the spine, when severe, also can cause pressure and nerve irritation, and often can be improved with surgical treatment. 

Prevention
The normal effects of aging that result in decreased bone mass, and decreased strength and elasticity of muscles and ligaments, can't be avoided. However, the effects can be slowed by:

  • exercising regularly to keep the muscles that support your back strong and flexible
  • using the correct lifting and moving techniques; get help if an object is too heavy or an awkward size
  • maintaining your proper body weight; being overweight puts a strain on your back muscles
  • avoid smoking
  • maintaining a proper posture when standing and sitting; don't slouch

 

Total Joint Replacement
What is a joint? 

A joint is formed by the ends of two or more bones which are connected by thick tissues. For example, your knee joint is formed by the lower leg bone, called the tibia or shin bone, and your thighbone, called the femur. Your hip is a ball and socket joint, formed by the upper end of the femur, the ball, and a part of the pelvis called the acetabulum, the socket. 

The bone ends of a joint are covered with a smooth layer called cartilage. Normal cartilage allows nearly frictionless and pain-free movement. However, when the cartilage is damaged or diseased by arthritis, joints become stiff and painful. Every joint is enclosed by a fibrous tissue envelope or a capsule with a smooth tissue lining called the synovium. The synovium produces fluid that reduces friction and wear in a joint. 

What is total joint replacement?
An arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis. 

Why is total joint replacement necessary?
The goal is to relieve the pain in the joint caused by the damage done to the cartilage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, possibly some laboratory tests and x-rays will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve your pain and disability. 

How is a total joint replacement performed?
You will be given an anesthetic and the surgeon will replace the damaged parts of the joint. For example, in an arthritic knee the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee movement and function. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal ball attached to a metal stem fitted into the femur, and a plastic socket is implanted into the pelvis, replacing the damaged socket. Although hip and knee replacements are the most common, joint replacement can be performed on other joints, including the ankle, foot, shoulder, elbow and fingers. 

The materials used in a total joint replacement are designed to enable the joint to move just like your normal joint. The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Several metals are used, including stainless steel, alloys of cobalt and chrome, and titanium. The plastic material is durable and wear resistant (polyethylene). A plastic bone cement may be used to anchor the prosthesis into the bone. Joint replacements also can be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly. 

What is the recovery process?
In general, your orthopaedist will encourage you to use your "new" joint shortly after your operation. After total hip or knee replacement you will often stand and begin walking the day after surgery. Initially, you will walk with a walker, crutches or a cane. 

Most patients have some temporary pain in the replaced joint because the surrounding muscles are weak from inactivity and the tissues are healing, but it will end in a few weeks or months. 

Exercise is an important part of the recovery process. Your orthopaedic surgeon or the staff will discuss an exercise program for you after surgery. This varies for different joint replacements and for differing needs of each patient. 

After your surgery, you may be permitted to play golf, walk and dance. However, more strenuous sports, such as tennis or running, may be discouraged. 

The motion of your joint will generally improve after surgery. The extent of improvement will depend on how stiff your joint was before the surgery. 

What are the possible complications?
Tell your orthopaedic surgeon about any medical conditions that might affect the surgery. Joint replacement surgery is successful in more than 9 out of 10 people. When complications occur, most are successfully treatable. Possible complications include: 

Infection- Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. 

Any infection in your body can spread to your joint replacement. 

Blood Clots- Blood clots result from several factors, including your decreased mobility causing sluggish movement of the blood through your leg veins. Blood clots may be suspected if pain and swelling develop in your calf or thigh. If this occurs, your orthopaedic surgeon may consider tests to evaluate the veins of your leg. Several measures may be used to reduce the possibility of blood clots, including:

  • blood thinning medications (anticoagulants)
  • elastic stockings
  • exercises to increase blood flow in the leg muscles
  • plastic boots that inflate with air to compress the muscles in your legs

 

Despite the use of these preventive measures, blood clots may still occur. If you develop swelling, redness or pain in your leg following discharge from the hospital, you should contact your orthopaedic surgeon.

Loosening- Loosening of the prosthesis within the bone may occur after a total joint replacement. This may cause pain. If the loosening is significant, a revision of the joint replacement may be needed. New methods of fixing the prosthesis to bone should minimize this problem. 

Dislocation- Occasionally, after total hip replacement the ball can be dislodged from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs. Most commonly, dislocations are more frequent after complex revision surgery. 

Wear- Some wear can be found in all joint replacements. Excessive wear may contribute to loosening and may require revision surgery. 

Prosthetic breakage- Breakage of the metal or plastic joint replacement is rare, but can occur. A revision surgery is necessary if this occurs. 

Nerve injury- Nerves in the vicinity of the total joint replacement may be damaged during the total replacement surgery, although this type of injury is infrequent. This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity. Over time these nerve injuries often improve and may completely recover.

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Preparing for total joint replacement

Before surgery, your orthopaedic surgeon will make some recommendations, such as suggesting that you:

  • donate some of your own blood so that, if needed, you may receive it during or after surgery
  • stop taking some drugs before surgery
  • begin exercises to speed your recovery after surgery
  • evaluate your need for discharge planning, home therapy and rehabilitation after surgery

Is total joint replacement permanent?

Most older persons can expect their total joint replacement to last a decade or more. It will give years of pain-free living that would not have been possible otherwise. Younger joint replacement patients may need a second total joint replacement. Materials and surgical techniques are improving through the efforts of orthopaedists working with engineers and other scientists. The future is bright for those who choose to have a total joint replacement to achieve an improved quality of life through greater independence and healthier pain-free activity. 

Toe Joint Replacement

What is toe joint replacement? 

Arthritis in great toe joint and persistent pain in metatarsals are quite often long lasting illnesses which need long term medication and lead to decreased walking distance. 

These diseases - Hallux rigidus and metatarsalgia -can now be treated with small ceramic implants to replace the joint. The cause of the.] joint destruction is thereby not of any importance. A joint should be replaced by an implant when there is no surgical method available to conserve it. Indications are degenerative destruction of the joint, systemic diseases, trauma or other destruction of the joints and hallux rigidus. 

These ceramic implants are fixed without cement in press- fit technique and give immediate stability and thus allow early weight bearing After 6 weeks the bone has grown towards the implant and merges with its ceramic layer. There is no rejection and no abrasion of particles. 

So this small joint replacement is a good alternative to resection arthroplasty The implants have excellent biocompatibility. Severe cases of metatarsalgia can be treated and full weight bearing can be gained.

The surgery can be done by our Specialist Orthopedic Surgeon who has vast experience in joint replacements. After short stay surgery mobilization with a specially provided heel bearing shoe allows full weight bearing.

 



 

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