Orthopaedics and Joint Replacement

Introduction

Bone and joint surgery is a sub-specialty of orthopedic surgery focusing on diagnosing and treating conditions related to the musculoskeletal system, especially the bones and joints. This surgical specialty deals with various conditions affecting the body’s bones, joints, ligaments, tendons, and muscles. The field has witnessed remarkable advancements in recent years, ranging from treating fractures and joint diseases to complex reconstructions.

Procedures in Bone and Joint Surgery

Bone and joint surgery procedures aim to reduce pain, restore normal mobility, and improve patients’ quality of life. They include:

• Fracture Repair: This procedure is recommended to realign cracked bones and secure and stabilize them with plates, screws, or rods to initiate optimal healing.
• Joint Replacement: This procedure involves removing damaged or arthritic joints, such as the hip, knee, elbow, ankle, or shoulder, and replacing them with artificial implants called prostheses made of metal, plastic, or ceramic.
• Arthroscopy: This minimally invasive procedure involves inserting a small camera (arthroscope) into an affected joint through a tiny incision. Arthroscopy helps diagnose and treat joint conditions like torn cartilage, ligament injuries, and joint inflammation.
• Spinal Surgery: Spine surgery is required to treat conditions like herniated discs, spinal stenosis, scoliosis, or spinal fractures.
• Ligament and Tendon Repair: This surgical procedure may be required to repair or reconstruct torn ligaments or tendons.
• Correction of Congenital Deformities: This surgery helps correct musculoskeletal deformities at birth, like clubfoot or hip dysplasia.
• Fusion Surgery: Fusion surgery is performed to permanently join two or more bones to stabilize an area affected by bone degeneration. 

Multidisciplinary Team for Bone and Joint Surgery

The multidisciplinary approach in bone and joint surgery includes seamless coordination among multiple healthcare professionals across various specialties to provide comprehensive patient care. This multidisciplinary team includes:

• Orthopedic Surgeons: These specialists are trained in the diagnosis and surgical treatment of musculoskeletal conditions. They perform procedures such as joint replacements, fracture repairs, ligament reconstructions, and spinal surgeries.
• Radiologists: Radiologists interpret imaging studies such as X-rays, CT scans, MRI scans, and ultrasound to guide treatment decisions.
• Anesthesiologists: Anesthesiologists administer anesthesia and manage pain during surgical procedures to ensure patient comfort and safety during and after the surgery.
• Therapists: Physical therapists provide personalized exercise modules to improve patients’ strength, flexibility, and mobility. Occupational therapists help patients perform daily activities after the surgery with the aid of adaptive equipment and ergonomic training.
• Nurses: Nurses help with pre-, intra-, and post-operative care, including pain management, wound care, and patient education.
• Orthopedic Oncologists: Orthopedic oncologists specialize in diagnosing and treating bone and soft tissue tumors and collaborate with other multidisciplinary team members for surgery, chemotherapy, and radiation therapy.
• Pain Management Specialists: Pain management specialists focus on managing acute and chronic pain through medication management, removal of nerve blocks, etc.

Steps Involved in the Surgical Procedure

• Before the Surgery:

1. The surgeon evaluates the patient’s medical history, performs a physical examination, and reviews imaging investigations for adequate diagnosis and treatment.
2. If surgery is recommended, the patient undergoes necessary investigations, such as blood tests and an electrocardiogram (ECG), to ensure they are medically fit for surgery. 
3. The surgeon provides detailed instructions on preoperative preparations, like fasting or stopping certain medicines, etc.

• During the Surgery:

1. Anesthesia is administered depending on the procedure and the patient’s medical condition.
2. Surgery is performed as per the established protocols.
3. In some cases, intraoperative imaging techniques such as fluoroscopy or intraoperative CT scans may be used to guide the surgeon during the procedure.

• After the Surgery:

1. After the surgery, the patient’s vitals are closely monitored, and appropriate pain management measures are used.
2. The surgeon recommends required therapies depending on the type of surgery and the patient’s condition.
3. Medications and techniques like ice packs, elevation, and relaxation procedures are given for alleviating pain.
4. Detailed instructions on wound care, activity limitations, medications, and follow-up appointments are given. 
5. Most people need to rest at home for a few weeks after the procedure, depending on the type of surgery, physical activity level before the surgery, age, and medical conditions.

Complications in Bone and Joint Surgery

Bone and joint surgery, similar to any surgical procedure, poses certain risks. Although modern surgical techniques have significantly reduced the incidence of complications, it is important to be aware of possible adverse outcomes, such as:

• Infection: Surgical site infections can occur following the surgery, leading to redness, swelling, warmth, and drainage from the incision site. 
• Delayed Healing: Poor wound healing or delayed union of fractured bones can occur, especially in people with diabetes or vascular conditions and in people who smoke. 
• Implant Malfunction: In some cases, implants might loosen, dislocate, or break.
• Nerve Damage: During the procedure, nerves in the surrounding areas can be damaged, sometimes causing pain, numbness, and weakness.
• Blood Clots: Deep vein thrombosis (DVT) and pulmonary embolism (PE) can occur after the surgery due to prolonged immobility, trauma to blood vessels, and medical conditions.
• Stiffness and Reduced Range of Motion: Some patients might experience stiffness and limited range of motion in the operated joint because of scar tissue formation and inadequate rehabilitation.
• Allergic Reactions: Some patients might experience allergic reactions due to implant materials used during the surgery, leading to rash, itching, swelling, or difficulty breathing.

The multidisciplinary approach, advanced diagnostics and surgical expertise, and comprehensive rehabilitation associated with bone and joint surgeries provide transformative solutions for people with musculoskeletal disorders. Fortis has been redefining the boundaries of bone and joint treatment, ushering in an era of precision medicine and personalized care.