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Total knee replacement surgery is regarded as a modern surgical procedure by which damaged cartilage and bone from the surface of your knee joint is removed and replaced with an artificial surface of metal and plastic. Total knee replacement surgery on a damaged knee joint by placing an artificial metal will ease pain and allow your knee to be more

Most patients who undergo knee replacement surgery show consistent good results. If cared and maintained properly the artificial knee will last for at least 15 to 20 years. A significant number of people who have undergone knee replacement surgery experience a considerable decrease in the knee pain and show impressive positive results in their ability to perform common activities of daily living.

Surgical procedure
There are four basic steps involved in knee replacement procedure:

  • Prepare the bone: The damaged cartilage surfaces are removed along with small amount of bone.
  • Position the metal implants: The removed cartilage and bone is replaced with artificial metal that recreates the surface of the joint.
  • Resurface the patella: The basement of the kneecap is cut and resurfaced with a plastic button
  • Spacer is inserted: A plastic spacer is inserted between the metal components to make a smooth gliding surface.

Recovery at home

The success of knee replacement surgery largely depends on how strictly you follow orthopedic surgeon’s instructions at home during the first few weeks after surgery. The patient should take extreme care to avoid soaking the wound in water until it has completely healed and dried. Patient should continue to bandage the wound to prevent irritation from clothing or support stockings.

Regular exercise is an important part of home care, particularly during the first few weeks after the knee surgery. Patient should be able to carry on his routine activities of daily living within 3 to 6 weeks following surgery.


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TotalHipReplacement is the procedure in which a physician surgically removes a diseased hip joint and replaces it with an artificial joint called as prosthesis. The artificial joint is made up of a ball component of either metal or ceramic and a socket, which has a liner made of plastic or metal. The artificial implants used in total hip replacement are biocompatible meaning they are designed to be accepted by your body.

Total hip replacement surgery is performed on patients with hip joint damage from osteoarthritis or an injury. The other possible causes of joint deterioration are inflammatory arthritis, hip disorders of infancy and trauma.

Total hip replacement is only recommended when all other conservative treatments fail to yield any result and the patient continues to suffer from significant pain, stiffness or problems with hip function.

Surgical procedure

Total hip replacement is performed only after the patient is given anesthesia. The surgeon makes small incisions over the front side of the hip through tissue layers. The damaged bone and cartilage are then removed from the hip and replaced with appropriate prosthesis. The nature and type of prosthesis depends on the needs of the particular patient and the doctor performing the surgery. This man-made joint is specially designed to function in the same natural, gliding motion as that of an active hip joint.

Recovery Process

Physical therapy has a significant role in the recovery process after total hip replacement. Most of the patients are able to stand and even walk the help of a therapist, within 24 hours. The rehabilitation program normally includes some exercises related to the muscles surrounding the hip joint, as wells as training in activities of daily life (stair climbing, walking, bending). The main objective of this rehabilitation process is to regain strength and motion. Almost 90 percent of the people can resume their normal activities within three to six months. In general, hip replacements last 10 to 15 years or longer and most people are very much satisfied with the result.


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The shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.

Depending on the nature of the problem, non surgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.

How the Normal Shoulder Works

The shoulder is a ball-and-socket joint. It is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle).

The ball at the top end of the arm bone fits into the small socket (glenoid) of the shoulder blade to form the shoulder joint (glenohumeral joint).

The socket of the glenoid is surrounded by a soft-tissue rim (labrum).

A smooth, durable surface (articular cartilage) on the head of the arm bone, and a thin inner lining (synovium) of the joint allows the smooth motion of the shoulder joint.

The upper part of the shoulder blade (acromion) projects over the shoulder joint. One end of the collarbone is joined with the shoulder blade by the acromioclavicular (AC) joint. The other end of the collarbone is joined with the breastbone (sternum) by the sternoclavicular joint.

The joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The capsule allows a wide range of motion, yet provides stability.

The rotator cuff is a group of muscles and tendons that attach your upper arm to your shoulder blade. The rotator cuff covers the shoulder joint and joint capsule.

The muscles attached to the rotator cuff enable you to lift your arm, reach overhead, and take part in activities such as throwing or swimming.

A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures.

Shoulder Problems and Treatments

Bursitis or Tendinitis

Bursitis or tendinitis can occur with overuse from repetitive activities, such as swimming, painting, or weight lifting. These activities cause rubbing or squeezing (impingement) of the rotator cuff under the acromion and in the acromioclavicular joint. Initially, these problems are treated by modifying the activity which causes the symptoms of pain and with a rehabilitation program for the shoulder.

Impingement and Partial Rotator Cuff Tears

Partial thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.

The conservative nonsurgical treatment is modification of activity, light exercise, and, occasionally, a cortisone injection. Nonsurgical treatment is successful in a majority of cases. If it is not successful, surgery often is needed to remove the spurs on the underside of the acromion and to repair the rotator cuff.

Full-Thickness Rotator Cuff Tears

Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity is successful in a majority of cases.

If pain continues, surgery may be needed to repair full- thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff, and repair of some tears.

Both techniques require extensive rehabilitation to restore the function of the shoulder.


Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments.

The two basic forms of shoulder instability are subluxations and dislocations. A subluxation is a partial or incomplete dislocation. If the shoulder is partially out of the shoulder socket, it eventually may dislocate. Even a minor injury may push the arm bone out of its socket. A dislocation is when the head of the arm bone slips out of the shoulder socket. Some patients have chronic instability. Shoulder dislocations may occur repeatedly.

Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital. Arthroscopic surgical repair is often done on an outpatient basis. Following either procedure, extensive rehabilitation, often including physical therapy, is necessary for healing.

Fractured Collarbone and Acromioclavicular Joint Separation

A fractured collarbone and acromioclavicular separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated non surgically with slings or splints. Severe displaced fractures or acromioclavicular joint separation may require surgical repair.

Fractured Head of the Humerus (Arm Bone), or Proximal Humerus Fracture

A fractured head of the humerus is a common result of falls on an outstretched arm, particularly by older people with osteoporosis. If fragmented or displaced, it may require open surgical repair and possibly replacement with an artificial joint (prosthesis).

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tearing of the capsule or the rotator cuff. Osteoarthritis occurs when the articular surface of the joint wears thin. Rheumatoid arthritis is associated with chronic inflammation of the synovium lining which can produce chemicals that eventually destroy the inner lining of the joint, including the articular surface.

Shoulder replacement

Shoulder replacement is recommended for patients with painful shoulders and limited motion. The treatment options are either replacement of the head of the bone or replacement of the entire socket .

Orthopaedic Evaluation

The orthopaedic evaluation of your shoulder consists of three components:

A medical history to gather information about current complaints; duration of symptoms, pain and limitations; injuries; and past treatment with medications or surgery.
A physical examination to assess swelling, tenderness, range of motion, strength or weakness, instability, and/or deformity of the shoulder.
Diagnostic tests, such as X-rays taken with the shoulder in various positions. Magnetic resonance imaging (MRI) may be helpful in assessing soft tissues in the shoulder. Computed tomography (CT) scan may be used to evaluate the bony parts of the shoulder.
We will review the results of your evaluation with you and discuss the best treatment. If surgery is the best option , you will be explained the benefits vs potential risks and complications .

Preparing for Surgery

No food or drink after midnight before surgery.
Discuss with us what to do about medications taken in the morning.
Pre-anaesthetic check up prior to the surgery .
Types of Surgical Procedures

You may be given the option to have an arthroscopic procedure or an open surgical procedure.


Arthroscopy allows us to insert a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images inside the joint are relayed to a TV monitor, allowing us to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is with the arthroscope. Arthroscopy often can be done on an outpatient basis.

Open Surgery

Open surgery may be necessary and, in some cases, may be associated with better results than arthroscopy. Open surgery often can be done through small incisions of just a few inches.

Recovery and rehabilitation is related to the type of surgery performed inside the shoulder, rather than whether there was an arthroscopic or open surgical procedure.

Possible Complications After Surgery

There are always some risks with any surgery, even arthroscopic procedures. These include possible infection, and damage to surrounding nerves and blood vessels. However, modern surgical techniques and close monitoring have significantly minimized the occurrence of these problems.

After surgery, some pain, tenderness, and stiffness are normal. You should be alert for certain signs and symptoms that may suggest the development of complications.

Fever after the second day following surgery

  • Increasing pain or swelling
  • Redness, warmth, or tenderness which may suggest a wound infection
  • Unusual bleeding (some surgical wound drainage is normal and, in fact, desirable
  • Numbness or tingling of the arm or hand
  • Prevention of Future Problems & Summary

As you can see, the shoulder is extremely complex, with a design that provides maximum mobility and range of motion. Besides big lifting jobs, the shoulder joint is also responsible for getting the hand in the right position for any function. When you realize all the different ways and positions we use our hands every day, it is easy to understand how hard daily life can be when the shoulder isn’t working well.

It is important that you continue a shoulder exercise program with daily stretching and strengthening. In general, patients who faithfully comply with the therapies and exercises prescribed by the physical therapist will have the best medical outcome after surgery.


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Arthroscopy is done to diagnose and treat a number of joint problems, most commonly those affecting the:

  • Shoulder
  • Joint
  • Elbow
  • Ankle
  • Wrist
  • Hip

During this procedure, an instrument called an arthroscope is inserted into your joint through a small cut in the skin. The arthroscope is provided with a light source and a video camera attached to it. Images captured by the camera can watch on a video monitor. These magnified pictures provide a clear picture and the physicArthroscopic-Surgeryian can analyse the problem inside the joint. The surgeon makes a few more incisions to allow entry of thin surgical instruments to insert a graft and repair damaged part. The procedure usually is performed in the outpatient setting and normally takes about two hours.


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Spine surgery is a major undertaking, and rehabilitation is an important part of helping patients gets the most possible benefit from their surgery. Back surgery can help relieve some causes of back pain, but it’s rarely necessary. Most back pain resolves on its own within two months. Low back pain is one of the most common ailments seen by family doctors. Back problems typically respond to nonsurgical treatments — such as anti-inflammatory medications, heat, gentle massage and physical therapy.

Back surgery might be an option if conservative treatments haven’t worked and your pain is persistent and disabling. Back surgery often more predictably relieves associated pain or numbness that goes down one or both arms or legs. These symptoms often are caused by compression of nerves in your spine. Nerves may become compressed for a variety of reasons, including:

Disk problems: Bulging or ruptured (herniated) disks — the rubbery cushions separating the bones of your spine — can sometimes press too tightly against a spinal nerve and affect its function.

Overgrowth of bone: Osteoarthritis can result in bone spurs on your spine. This excess bone can narrow the amount of space available for nerves to pass through openings in your spine.


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Minimally invasive surgery is becoming more and more common today. These procedures are performed through tiny incisions instead of one large opening. Because the incisions are small, patients tend to have quicker recovery times and less discomfort than with conventional surgery — all with the same benefits.

During a minimally invasive procedure, surgeons make several small incisions in the skin — just a few millimeters, in some cases. A long, thin tube with a miniature camera attached at the end (called an endoscope) is passed through one of the incisions. Images from the endoscope are projected onto monitors in the operating room so surgeons can get a clear (and magnified) view of the surgical area. Special instruments are passed through the other openings. These instruments allow the surgeon to perform the surgery by exploring, removing, or repairing whatever’s wrong inside the body.


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