ORTHOPEDICS


Hip Replacement

Overview

The hip joint is among our most mobile joints of our body. The components that form the hip joint may be damaged over time, or a trauma may result in loss of stability in the hip joint.

Total hip replacement or total hip arthroplasty is indicated for pain and joint instability that do not respond to medication treatments and physiotherapy and rehabilitation and are severe enough to affects daily life activities.

The most common causes of pain and instability are osteoarthritis, rheumatoid arthritis and traumatic injuries. Moreover, blood supply to the hip joint may reduce due to traumatic and inflammatory events, resulting in necrosis in the ball-like head of the femur (aseptic necrosis).

Why is this procedure done?

Total hip replacement is performed to cure joint disorders that hinder daily life activities (climbing stairs, walking, and getting out of the bed) and do not respond to medication treatment and physiotherapy.

There is no absolute age or weight limitation for total hip replacement. The operation decision is based on the severity of pain and the degree of disability rather than patient's age. Therefore, personalized assessment of each patient or selection of good candidates is extremely important.

 

Risks

As the case for all surgeries, total hip replacement involves some risks.

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

These risks may be related to surgery and anesthesia, but there are also some risks that may be faced after the surgery.

Those risks are as follows:

  • Infection
  • Clot formation and migration of the clot to other body parts
  • Laxity of hip prosthesis over time
  • Revision surgery
  • Failure to obtain desired range of motion

When these complications occur, albeit rare, recovery time may prolong, complete recovery might fail or revision surgery might be required. You should inform your orthopedic surgeon about your concerns before the surgery.

Your surgeon will explain in detail whether those risks apply to you or if so, the rate of occurrence.

 

Preparation

The first phase of preoperative preparation is same in our all Hospitals. Decision of total hip replacement is made by your orthopedic surgeon based on a series of tests and examinations. Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not. All other treatment options, including but not limited to medications, injections, physiotherapy and other surgical procedures, are taken into consideration.

  • Review of health history
  • A detailed physical examination
  • Necessary laboratory tests and radiology studies
  • Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

A preoperative discussion with your orthopedic surgeon about total hip replacement is very important. All details of the procedure, potential risks and healing period are explained.  

You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.

Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.

Surgery and early postoperative period

After you are hospitalized, preparations are completed and your anesthesiologist will assess you to determine the best anesthesia technique. Orthopedist will first cut the damaged cartilage and bone and prepare them for joint replacement. Artificial (prosthesis) hip joint, which is made of metal alloy or other suitable materials, is then placed so as to take over the function of the hip joint. Artificial joints are attached to existing bones and surrounding tissues using screws, plates and other fixation materials. The range of motion of the hip joint is checked once more before the surgery is completed.

Our physiotherapist will help you to learn how to use your new hip joint, but moving your legs after the surgery will not only facilitate wound healing, but it will also contribute to the success of the surgery.

You will be given pain killer(s) after the surgery in order to manage the postoperative pain.

Treatments will be started and measures will be taken to eliminate risks arising out of clot formation.

You may also need to use antibiotics to prevent a possible infection.

It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.

You should see your surgeon for follow-up visits that are scheduled before you are discharged.

If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

 

Results

You will need inpatient care for several days after the surgery. At this time interval, both your overall health will be stabilized and your joint will be adapted to post-discharge period by physiotherapy procedures.

Always remind that postoperative pain is a natural component of the recovery. Your doctor and nurse will take necessary measures to manage your pain.

Being able to use your new hip joint requires both patience and strict compliance to the instructions.

Physical therapy, which is a part of post-operative care, will be initiated before you are discharged. However, in order to speed up the healing process, you will need to keep doing the exercises at home.

You may need to use a wheelchair for a few days before full recovery. In addition, in order not to strain your hip joint, you have to comply to some basic rules at your home (standing up carefully from sitting position, not crossing your legs, avoiding abnormal rotational motions in your operated leg, removing objects that can lead to stumbling, use of seat extensions).

If you strictly follow all instructions, you will probably start doing all routine daily life activities, with no restriction, within several weeks. However, sufficient strengthening and elasticity of muscles might require several months or sometimes up to one year

 

 

Knee Ligament Surgery - ACL Reconstruction

 

Knee Ligament Surgery – ACL Reconstruction

Overview

The knee is one of the most complex parts of your body and this joint is of vital importance for your mobility.

The knee ligaments connect your femur to your lower leg bones (tibia and fibula). Knee ligaments function by limiting the extreme rotational motions of the joint between these bones, namely the knee joint. Therefore, knee ligaments are most frequently injured during sports and sudden motions.

In the past, knee ligament injury could terminate sports life of most professional athletes. Recently, it is often possible to resume the sports life even if multiple ligaments are injured.

Anterior cruciate ligament is the most frequently injured ligament of the knee joint. The deformed or torn ligament as a result of the strain is either repaired or replaced by a tendon graft that is obtained from another part of the body.

Why is this procedure done?

The knee joint has significantly wide range of motion and the range of these motions is limited by the ligaments in and around the knee. These ligaments are extremely strong tissues and keep the bones that form the knee joint connected to each other.

Among the aforementioned ligaments, the most frequently injured one is the anterior cruciate ligament. This ligament limits the rotational motion of the knee joint and it is injured due to many reasons, including but not limited to sudden halt, sudden change of direction while running fast, jumping from a high place in wrong position and direct impact to the knee. This injury not only leads to pain, but it also causes instability of the knee joint.

If you are not a professional athlete and your condition is mild, the condition can be treated by combining medication treatment with physiotherapy. However, if more than one ligament is injured, the person is a professional athlete and the knee joint is instable, treatment option is to repair or replace the ligament. If the condition is left untreated, knee joint will lose the stability as a result of tear or deformity and subsequently, additional load will be born on the meniscus and other joint structures, resulting in other problems in them.

 

Risks

As the case for all surgeries, there are some risks involved in knee replacement surgery (ACL reconstruction).

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

These are as follows:

  • Infection – the risk of infection is usually below 1%.
  • Blood clots
  • Knee Pain
  • Weakness of muscles.
  • Stiffness of the knee joint
  • Revision surgery
  • Failure to obtain desired range of motion

When these complications occur, albeit rare, recovery time may prolong, complete recovery might fail or revision surgery might be required. You should inform your orthopedic surgeon about your concerns before the surgery.

Your surgeon will explain in detail whether those risks apply to you or if so, the rate of occurrence.

 

Preparation

The first phase of preoperative preparation is same in all Our Hospitals. Decision of knee ligament repair or replacement (ACL reconstruction) is made by your orthopedic surgeon based on a series of tests and examinations. Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not. All other treatment options, including but not limited to medications, injections, physiotherapy and other surgical procedures, are taken into consideration.

  • Review of health history
  • A detailed physical examination: your doctor will first review your symptoms and health history. In the assessment, your doctor will examine the instable knee in all aspect and compare it with the intact knee.
  • Necessary laboratory tests and radiology studies
  • Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

A preoperative discussion with your orthopedic surgeon about knee ligament repair or replacement (ACL reconstruction) is very important. All details of the procedure, potential risks and healing period are explained.  

You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.

Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.

Surgery and early postoperative period

Reconstruction of anterior cruciate ligament is a surgery that is performed under general anesthesia. Arthroscopic surgery is preferred in all suitable patients as this technique ensures less harm to the patient, reduction of postoperative pain, and shorter hospital stay and quicker recovery. In this method, a very thin tube equipped with a small camera in one end, called arthroscope, is inserted into the knee through very small incisions.  Tears and deformities of the ligament are repaired with surgical instruments inserted through other incisions, or ligament is removed entirely and replaced by a graft that is obtained from other parts of the body. If a graft is used, the graft is securely attached to the surrounding bones with screws and similar fixation devices. Next, surgical instruments and camera are removed and small incisions are sutured.

Patients are usually discharged in the same day after the surgery.

You will be informed about the exercises you need to do, and the actions you need to avoid after discharge. You will also be informed in detail about home care (ice pack, bandage, rest, and elevation of legs) after the discharge.

You will be given pain killer(s) after the surgery in order to manage the postoperative pain. You may also need to use antibiotics to prevent a possible infection.

It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.

You should see your surgeon for follow-up visits that are scheduled before you are discharged.

If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

 

Results

Always remind that postoperative pain is a natural component of the recovery. Your doctor and nurse will take necessary measures to manage your pain.

After the knee ligament surgery (ACL reconstruction),you may need physical therapy to maintain the range of motion of the knee joint as well as to strengthen muscles and increase flexibility. You will also be instructed about home exercises.

Following these rehabilitation suggestions is crucial for your knee to regain its normal function. If you follow these recommendations, the functional difference between the two knees will disappear in a few weeks.

 

Spine Surgery

 

Spine Surgery

There are a total of 33 vertebrae in the spine in five major regions; neck (5),back (12),waist (5),sacrum (5) and coccyx (4). Intervertebral discs are located between two neighboring vertebras in order to enable our spine bear the load of your body and move our body forward, backward and both sides.

While the spine has physiological curvatures on the anterior-posterior plane, it extends straight from the neck to the coccyx on the vertical plane.

The reduction or increase of these physiological curvatures and spine’s rotation or curving to sideways brings are accompanied by many problems.

The goal of the spinal surgery is to relieve the pain caused by abnormal curvatures and to correct kyphosis and abnormal body posture to relieve the pain, treat joint problems caused by postural disturbance, and manage other neurological symptoms that may even involve fainting in advanced stage diseases.

Abnormalities that may occur in the spine can be congenital or may be acquired due to causes such as, deformation and improper body posture while working.

Scoliosis is most common abnormal curvature of the spine.  Scoliosis refers deformity of the spine.

Scoliosis implies a condition where the spine curves sideways at dorsal and lumbar level and it occurs more commonly in girls during rapid increase of body height.

On lateral view of normal human anatomy, some curvatures can be seen in the spine. For example, dorsal spine curves back, while cervical and lumbar spines curves front. However, the spine appears straight on the antero-posterior plane. Scoliosis refers a “S” or “C” configuration of the spine on this plane accompanied by abnormal rotation. Shoulder asymmetry, dorsal hump, abnormal body posture and lumbar curvature asymmetry can be seen in patients with scoliosis due to the abnormal curvature.

Forward bend test is used to diagnose the condition. If the test yields suspicious results, the person is asked to clench hands, bend forward and keep hands between knees. Meanwhile, the doctor stands behind the patient to check whether there is an asymmetry in the dorsal spine. If asymmetry is identified, scoliosis is considered. However, you will need to see a spine surgeon who is specialized in this condition.

Shoulder asymmetry, dorsal hump and asymmetry of lumbar curvature may be the symptoms of scoliosis.

Scoliosis has many underlying causes. For congenital cases, the problem might arise out of development or separation of vertebrae. Muscle disorders or nervous diseases, such as cerebral palsy, may play a role in neuromuscular cases. However, the condition is most commonly idiopathic or in other words, there is no clear underlying cause. This type is usually diagnosed in early adolescent girls. Genetic and environmental factors have been claimed.

Your spine surgeon may take measures to stop the progression.

There is no clear evidence that lifting heavy objects or hunching the back leads to scoliosis. However, pains originating from the spine can be prevented, if you work in good body posture while working with computer or studying lessons.

Do not worry; scoliosis is a treatable condition. You should necessarily see a spine surgeon as soon as possible.

There is no sports limitation. Swimming, volleyball, basketball and pilates are more commonly recommended as they exercise back muscles and help body balance and control.

Treatment is planned according to angle of curvature, age of the patient and developmental level of the body. For narrow angles and early stage cases, your doctor will offer options of corset and exercise along with regular follow-up. However, efficacy of these treatment methods has not scientifically been proven. Therefore, the curvature may progress. For advanced stage curvatures (angle >45°),surgical treatment is recommended. Screws are driven to vertebra and they are connected to each other using rods. Although spine surgeries are high-risk operations, the risk can be minimized if surgeries are carried out by specialized surgeons. Moreover, advanced technology provides surgeons with substantial means. Now, we use 3D printing technology in order to drive screws at accurate positions and to prevent damage to the nearby vital tissues (spinal cord, arteries, lungs etc.) in spinal surgeries.

Postoperative care varies for each type of scoliosis, but absorbable stitches are used for idiopathic scoliosis, the most common type. Patient controlled analgesia is maintained for 2 days to manage the pain. If no complication occurs, patients are discharged 3 to 4 days after the surgery in average. Patients allowed taking a bath 10 days later. Patients can start going to school 3 weeks later in average. Patients usually do not need corset after the surgery.

All surgeries are performed with micro-surgical methods under microscopic visualization and recently, endoscopic methods are used; in this discipline, training and expertise of surgeons are as important as the availability of technical equipment.

At Our Hospitals, Neurosurgeons, Neurologists and Physiatrists cooperate in the field of Spine Surgery.

  • Minimally Invasive Surgical Interventions
Micro-surgical treatment of Cervical, Thoracic and Lumbar Disc Hernia

Surgical Treatment of Stenotic Spinal Canal

Spondylolisthesis Surgery

Fully Endoscopic Management of Pain

Spine Tumors

Spinal Cord Tumors

Surgical Treatment of Head and Spine Traumas

Cerebral Tumor Surgery (Adult and Pediatric)

Endoscopic Pituitary Gland Surgeries

Cerebrovascular Surgery

Hydrocephalus Surgery

Congenital Disorders

It is really important that the postoperative patients or patients, who are planned to undergo operation, are assessed with respect to various therapy and follow-up options.

Minimally invasive procedures may shorten hospital stay. Hospital stay varies depending on the condition of the patient and the procedure, but spinal surgery patients are usually discharged to home within 2 to 3 days.

It is believed that minimally invasive procedures cause less postoperative pain than conventional methods, while muscles and soft tissues are untouched. Recently, modern pain management modalities make management and relief of pain easier.

Your doctor may recommend physiotherapy to accelerate recovery and strengthening. This will depend on the procedure and your overall physical condition. Special exercises will help you to be strong enough to engage in work and daily life activities.

You will be educated on correct body posture while sitting, standing and walking.

Time required to start doing daily life activities after the surgery varies depending on the surgical procedure and your condition. Your doctor will postoperatively assess you to ensure that recovery proceeds as expected.