Procedures
Knee Replacement
The knee is a hinge joint where the thigh bone (femur) and the bone of the lower leg (tibia) meet. Arthritis (particularly osteoarthritis) and certain knee injuries and diseases can damage the cartilage that normally cushions the joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments -- such as anti-inflammatory medications and cortisone injections -- fail to relieve pain or improve movement.
During a total knee replacement, the entire joint is replaced with an artificial prosthesis. The end of the femur is replaced with a metal shell. Then the end of the tibia is fitted with a plastic cup and a metal stem that fits into the shell on the femur. This reduces friction in the joint, easing pain and allowing a greater range of movement. The main ligament of the knee (the posterior cruciate ligament) may be left in place, removed or replaced with an artificial post. The kneecap may also be replaced with, or supported by, a piece of plastic. The surgery itself lasts between one-and-a-half and three hours.
After the procedure, the patient rests in a recovery room and then in a hospital room. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort. Physical therapy starts right away to speed healing and to ensure that the patient enjoys full use of the joint. Therapy progresses from use of walkers and crutches to walking on stairs and slopes, with home exercises to supplement formal sessions. In addition, continuous passive motion (CPM) machines can reduce recovery time and the risk of muscle contracture without straining the joint.
Knee replacements today last about 20 years in 85-90% of well-selected patients.
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Hip Replacement
Most damaged hips are the result of osteoarthritis or "wear-and-tear" arthritis, a degenerative type of arthritis that causes the cartilage to wear away over time so the bone ends rub together. Other common causes of hip degeneration include rheumatoid arthritis, trauma, osteonecrosis (bone decay), prior surgeries, and tumors.
Joint replacement surgery removes the damaged, painful parts of the hip and replaces them with a prosthesis made of metal and plastic. The artificial joint can relieve pain and improve mobility when your natural hip can no longer do its job. An artificial ball and metal stem replaces the worn head of the thigh bone and a metal cup and artificial liner replaces the worn socket of the pelvis. The prosthesis allows the hip joint to move smoothly, so patients can enjoy a greater range of pain-free movement.
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Shoulder Replacement
Although not as common as knee or hip replacements, shoulder replacement surgery is a successful treatment option for people suffering from osteoarthritis and other joint disorders. This procedure was first used in the 1950s to treat shoulder fractures, but can now be used for arthritis, rotator cuff tears or osteonecrosis.
Like the hip joint, the shoulder is a ball and socket joint that provides a full range of motion allowing you to raise, twist and bend your arm. Replacement surgery includes the placement of an artificial metal ball and plastic socket.
Shoulder replacement surgery is performed under general anesthesia through an incision in the front of the shoulder. The procedure usually lasts about two hours and requires a short hospital stay. Full recovery can take two to three months.
The replacement helps restore movement and reduce pain. Although successful and safe, joint replacement is usually reserved for patients who have not found relief from more conservative treatment. It is important to consider the risks of surgery before undergoing this procedure. Complications of total shoulder replacement include infection, dislocation and nerve damage. Talk to your doctor today to find out if you can benefit from total shoulder replacement.
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Joint Replacement
Through overuse and aging, our joints often become weak and painful, limiting movement and affecting daily lives. Healthy joint ends are covered with a cushioning layer of cartilage that protects the bones from rubbing against each other and causing pain. The effects of time and excessive wear-and-tear causes this cartilage to slowly wear away and leave our joints weak and unprotected.
Joints refer to the area where two or more bones meet. While there are different kinds of joints all over our bodies, the ones most commonly used and more easily damaged are synovial joints. Synovial joints include those in the neck, shoulders, elbows, wrists, hands, hips, knees, ankles and feet.
Joint disorders are common because of the frequent pressure applied to the area throughout our lives. They are most common in athletes and older people. But joint disorders such as arthritis and fractures do not necessarily result in lifelong pain. Joint reconstructive surgery offers relief for many people through safe and minimally invasive procedures by experienced professionals.
Joint reconstruction ranges from minor repairs to the damaged joint to total joint replacement. These treatment options can offer temporary pain relief or permanent solutions to joint disorders. The type of treatment best for you depends on the type of severity of your joint disorder. Together, you and your doctor can develop the most effective treatment option for your needs.
Some of the different types of joint reconstructive surgery include:
- Joint Replacement Surgery - Joint replacement is a complicated procedure that is for severe joint pain that does not respond to more conservative methods. Replacement surgery is usually performed on the hip, shoulder or knee. Prosthetic joints are designed to move just like regular joints and are made of durable metal and plastic to fit together smoothly. The length of relief depends on the individual, but replacement joints tend to last for over 10 years.
- Arthroscopy - Arthroscopy is a minimally invasive procedure that allows your doctor to make minor adjustments to joints through tiny incisions and the use of a camera. This procedure can help to release pressure from a tight ligament to increase the range of motion for a stiff joint, remove bone spurs and trim soft tissues like cartilage.
- Osteotomy - Osteotomy or "bone cutting" removes a section of bone near a damaged joint. This shifts the weight away from the damaged cartilage to an area with healthier cartilage, temporarily relieving the pain. This procedure is typically performed on the knee or hip for younger patients who do not want to have joint replacement surgery yet.
- Resurfacing Surgery - Resurfacing is most commonly performed on the hip and is also for younger patients who may not benefit from total hip replacement. It is less complicated than hip replacement and usually retains a more normal feeling after surgery. Results can last up to 8 years, but long-term studies are not yet available.
- Arthrodesis - Arthrodesis fuses together two bones in a damaged joint to prevent the joint from moving and causing pain. This is a more extreme treatment method that is used when medication and other conservative methods are no longer effective.
- Small Joint Surgery - If joints in the hands or feet cannot be used because of damage, they may be replaced to restore limited movement and activities.
Joint reconstructive surgery can provide great relief to patients who suffer from severe pain that affects their everyday lives. Surgery can restore movement and make life easier. Talk to your doctor to find out if surgery may be right for you.
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ACL Tear and Arthroscopic Reconstruction
Tear of the ACL (Anterior Cruciate Ligament) in the knee is among the most common knee injuries, especially among physically active people and athletes, and one which can be successfully treated via Arthroscopic ACL Knee Reconstruction surgery.
How does someone injure the ACL?
The ACL is a ligament that connects the tibia (leg) to the femur (thigh) and one which is frequently injured in contact sports such as football, soccer, basketball, and skiing - although there are many scenarios for injury to this ligament, such as accidents in the home, in the workplace, and automobile accidents. ACL injuries among athletes tend to be more common in women - such as a female soccer player who suddenly changes direction and feels a pop in her knee. In contact sports, such as football, the injury typically occurs when another player impacts the side of the knee. Often people will complain of hearing a loud "pop", which is the sound of the actual ligament tearing.
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Arthroscopic Surgery
Arthroscopy is a minimally invasive procedure that allows doctors to diagnose and sometimes treat joint injuries and disease through small incisions in the skin. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.
During an arthroscopic procedure, a thin fiberoptic light, magnifying lens and tiny television camera are inserted into the problem area, allowing the doctor to examine the joint in great detail.
For some patients it is then possible to treat the problem using this approach or with a combination of arthroscopic and “open” surgery. Sports injuries are often repairable with arthroscopy. Tendon tears in the knee are frequently repaired in this way. Other potentially treatable injuries include torn cartilage or ligaments, inflamed joint lining, carpal tunnel syndrome, rotator cuff tears, and loose bone or cartilage.
Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery:
- No cutting of muscles or tendons
- Less bleeding during surgery
- Less scarring
- Smaller incisions
- Faster recovery and return to regular activities
- Faster and more comfortable rehabilitation
Arthroscopy is not appropriate for every patient. Your doctor will discuss the options that are best for you.
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Rotator Cuff Repair
The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery may be used to treat this often serious condition.
Rotator cuff surgery may be performed laparoscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.
Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. Recovery time depends on the type of surgery, but can take several months. As with any surgery, there are certain risks involved with rotator cuff repair such as infection, pain or stiffness, nerve damage or the need for repeated surgery. These complications are rare and most people receive successful outcomes from this procedure.
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Fractures
A fracture is a break or crack in a bone that occur when the bone cannot withstand outside forces, often as a result of trauma or disease. Fracture, break and crack all refer to the same thing. Fractures can range from a small crack in the bone to complete separation. They are often caused by a fall, motor vehicle accident or sports injury. Normal activities can also cause fractures for people at a higher risk, including those with low bone density (osteoporosis), bone tumors, cancer or brittle bone disease (osteogenesis imperfecta).
Some of the different types of fractures include:
- Stress Fracture - A stress fracture occurs as a result of overuse. Because of repeated use, the bone becomes weak and cannot absorb the shock that is put on it. It is common in the lower leg or foot and especially among athletes.
- Compression Fracture - A compression fracture occurs as a result of old age. People with osteoporosis are at high risk for this type of fracture because their bones lose calcium. The weakened bones, usually in the spine, can crumple under the force of gravity.
- Incomplete (Greenstick) Fracture - A greenstick fracture occurs when the bone bends but does not completely break. This occurs most often in children, who have high levels of calcium in their bones.
- Comminuted Fracture - This occurs when the bone cracks into several fragments. It occurs as a result of high impact trauma or osteoporosis.
A bone fracture causes pain, swelling and sometimes bruising of the affected area. Applied weight or pressure causes even more severe pain. They are usually easy to diagnose, but treatment requires precision and care by experienced professionals.
At practice of Dr. Gary Rombough , we offer specialized knowledge and care for the treatment of fractures. Our doctors will treat your injury every step of the way until it is completely healed. Bone fractures can be diagnosed by physical examination and an X-ray or CT scan. Immobilizing the area is often helpful in relieving pain before proper treatment begins. Treatment for bone fractures depends on the location and type of fracture, as well as the patient's medical history. We take all of these factors into account when developing a treatment plan.
Mild fractures, including stress and greenstick fractures, usually only require the conservative treatment methods of ice, rest and anti-inflammatory medication. Moderate fractures may require splints or braces along with pain medication. The immobilization helps relieve pain and speed up recovery. More severe fractures may require surgical treatment, especially open fractures with wounds that need to be closed.
After the proper treatment is performed, the rehabilitation process begins. It is important to care for your fracture while it heals. Full healing can take several weeks to several months. Your doctor will advice you on how to care for your fracture and helpful measures you can take to ensure a speedy and healthy recovery.
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Rehabilitation
Recovery may take some time after foot injury or surgery. Depending on the severity of the injury, the type of surgery, your age and general health, and other factors, you may need to undergo rehabilitation to regain strength in your foot and ankle or relearn how to perform tasks such as flexing your foot or walking.
Rehabilitation often takes three forms: physical therapy to increase your foot/feet's strength, mobility and fitness; occupational therapy to help you perform day-to-day activities; and pain management to decrease discomfort while performing rehabilitation exercises and when at rest.
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