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Orthopedic Treatment

What is Robotic Orthopedic Surgery ?

Robotic Surgery (robotically-assisted surgery) is a minimally evasive procedure that aims to increase the capabilities of surgeons for performing open surgeries. Haptic (surgeon guided) and autonomous are the two robotic systems. The other type of surgery is passive surgery systems which has become popular recently with the surgeons. The surgery enhances the precision of the surgeons and uses surgical robots during the surgery like the active systems. They prepare bony surfaces in orthopedic surgery with greater precision.

Advantages of Robotic Surgery

Hip replacement and knee replacement procedures allow for a number of benefits like-

  • The surgery has the potential for enhanced long-term function
  • The surgery provides for more accurate position of the implant that may result in a more natural feeling after the completion of the surgery
  • The surgery has improved safety and thereby reducing the risk of injury to the neighboring tissues
  • The surgery can also be done in clean room which reduces the chances of infection during the operation
  • There is improved Cosmesis and less scarring
  • There is also less discomfort and post-operative pain
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Robotic Hip Surgery

 

The persistent hip pain for than 3 months can lead to a permanent
problem. Hip impingement, torn labrum and osteoarthritis or arthritis
are the most possible causes of this problem. The various surgeries
such as total hip replacement, arthroscopic hip surgery and hip
resurfacing surgery, can be performed to remove the hip pain. The
most successful orthopedic surgery is the modern robotic surgery.

The aim of hip arthroscopic surgery is to lessen the inflammation and
pain in the hip joint that have been caused by wear, arthritis or injury.
The two surgical procedures that are specially designed to repair the
damaged parts or portions of the hip joint are Arthroscopic hip surgery
and Total hip replacement surgery.

Total Hip Replacement Surgery

 

It is the most common type of orthopedic process. The surgery
engages the removal of the head of the femur (thigh bone) and ball
and socket joint of the affected area is replaced with the advanced
artificial implants. These implants are exceedingly resilient and lasts
for the patient’s entire life. The procedures used to lessen the recovery
time are-

  • Ceramic Hip Implants : The Ceramic hip implants are really
    smooth and are specially designed to lessen the wear and tear of
    the new joint.
  • Direct Anterior Muscle-sparing Hip Arthroplasty : In this,
    the surgeon executes the surgery by working in between the hip
    muscles unlike cutting through the method.
  • Short-stem Hip Implants :These have shorter stems as
    compared to previous models and are designed for small
    incision processes.

Robotic Hip Arthroscopy

This minimally invasive surgery is performed when there is a hip pain coming either from other tissues or damaged cartilage around the hip joint. The aim is to remove the debris from the hip joint and thereby also reducing the inflammation. The surgery can also ease painful symptoms of a large number of problems which is damaging the articular cartilage, soft tissues surrounding the hip joint or labrum.

Total Knee Arthroplasty (Total Knee Replacement)

The serious degenerative ailments of the knee joint are treated with the help of this surgery. The advanced artificial joints are made to mimic the knee’s gliding and rolling motion. With a large number of options, the surgeon modifies the patient’s joint according to age, activity level and body.

Robotic Knee Arthroscopy

With this surgery, the damaged knee is repaired with the help of minimum invasive procedure. In the surgical process, the surgeon uses fiber optic cameras and long tools to study the joint damage. The

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surgery involves few incisions which also decrease the recovery period. The loose bodies are removed from the knee joint and thereby repairing the damaged and torn cartilage and ligaments.

Makoplasty Partial Knee Resurfacing

 

This advanced procedure involves a robotic arm to assist in preparing
and planning the knee to employ knee replacement implants. The
procedure of Makoplasty can relieve the pain of mid-stage knee
Osteoarthritis. Partial knee surfacing (unicompartmental surgery)
focuses on the damaged parts of the knee and helps in providing a
normal knee. The healthy cartilage, ligaments and bones are very well
preserved. The surgery relieves the knee pain, makes the knee strong,
offers natural knee function with better motion and alignment along
with improved balance.

Robotic Knee Replacement Surgery

 

The surgery is performed to relieve the pain caused by chronic knee
arthritis or knee injury.  The surgical treatment of joint replacement
(reconstructive surgery) is performed to ease the joint pain that has
been caused by  damaged to bone and cartilage. Knee surgery options
are-

  • Arthroscopic Knee Surgery
  • Makoplasty Partial Knee Resurfacing/ Replacement
  • Total Knee Replacement

The knee resurfacing and replacement surgeries are primarily
performed to remove the worn out surfaces of the knee with the help
of latest and advanced implant. These are basically suggested for the
problem of knee arthritis.

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What are Tendons?

Tendons are tough cords of tissue that connect muscles to bones. When you contract (tighten) a group of muscles, the attached tendons will pull on certain bones, allowing you to make a wide range of physical movements.

What is Tendon Repair ?

The surgical procedure where the damaged tendons are repaired. The
tendons are basically a cord like structures that are strong fibrous
connective tissue which connects the muscles to bones. The most affected
areas by tendon injuries are knee, ankle joints and elbow. The purpose is
to restore or repair the normal function the regular function of the joints
by following a tendon laceration.

While tendinitis can occur in any of your body’s tendons, it’s most
common around your shoulders, elbows, wrists, knees and heels.

Some common names for various tendinitis problems are:

  • Tennis elbow
  • Golfer's elbow
  • Pitcher's shoulder
  • Swimmer's shoulder
  • Jumper's knee

If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain

How is tendon repair done?

 

Generally, during tendon repair a surgeon will:

  • Make one or more small incisions (cuts) in the skin over the damaged
    tendon
  • Sew the torn ends of the tendon together
  • Check the surrounding tissue to make sure no other injuries have
    occurred, such as injury to the blood vessels or nerves
  • Close the incision
  • Cover the area with sterile bandages or dressings
  • Immobilize or splint the joint so as to allow the tendon to heal

If there isn’t enough healthy tendon to reconnect, the surgeon may
perform a tendon graft using a piece of tendon from another part of the
body. It may be from the foot or toe, for example. On occasion, a tendon
transfer (moving a tendon from one area to another) may be useful in
restoring function.

Anesthesia (pain medication) is used during tendon repair to prevent the
patient from feeling pain during the surgery.

The types of anesthesia are:

  • Local anesthesia.The area where the surgery is to be performed is
    numbed and pain-free.
  • Regional anesthesiaThe surrounding area and the area where the
    surgery is to be performed is numbed and pain-free.
  • General anesthesia. The patient is unconscious (asleep) and unable to
    feel pain.

Potential risks of having a tendon repair surgery

 

Risk factors for developing tendinitis include age, working in particular jobs or participating in certain sports.

Age

As people get older, their tendons become less flexible — which makes them easier to injure.

Occupations

Tendinitis is more common in people whose jobs involve:

  • Repetitive motions
  • Awkward positions
  • Frequent overhead reaching
  • Vibration
  • Forceful exertion

Sports

You may be more likely to develop tendinitis if you participate in certain sports that involve repetitive motions, especially if your technique isn’t optimal. This can occur with:

  • Baseball
  • Basketball
  • Bowling
  • Golf
  • Running
  • Swimming
  • Tennis

Recovery and care after surgery

Tendon repairs are usually done on an outpatient basis. This means the patient can go home after the surgery. If the patient does stay in the hospital, it’s usually for a short period of time.

Healing can take up to 12 weeks. The injured tendon may need to be supported with a splint or cast to take tension off of the repaired tendon.

Physical therapy or occupational therapy is usually necessary to return movement in a safe manner. Expect movement to return gradually, with some stiffness.

You may need treatment after the surgery to minimize scar tissue. Too much scar tissue can make it difficult to move the damaged tendon.

Tendon repair surgery outlook

Tendon repairs can be very successful if they’re done along with proper physical therapy or occupational therapy. As a general rule, the sooner tendon repair surgery is done after the injury, the easier the surgery is and the easier the recovery.

In some cases, long-term complications may develop. Stiffness may be long-lasting. Some tendon injuries, such as injuries to the flexor tendon in the arm, can be very difficult to repair.

Before surgery, discuss potential outcomes with your doctor so that you have a realistic view of your individual outlook.

Complications

 

Without proper treatment, tendinitis can increase your risk of
experiencing tendon rupture — a much more serious condition that may
require surgical repair.

If tendon irritation persists for several weeks or months, a condition
known as tendinosis may develop. This condition involves degenerative
changes in the tendon itself, along with abnormal new blood vessel
growth.

Prevention

 

To reduce your chance of developing tendinitis, follow these suggestions:

  • Ease up. Avoid activities that place excessive stress on your
    tendons, especially for prolonged periods. If you notice pain during
    a particular exercise, stop and rest.
  • Mix it up.If one exercise or activity causes you a particular,
    persistent pain, try something else. Cross-training can help you mix
    up an impact-loading exercise, such as running, with lower impact
    exercise, such as biking or swimming.
  • Improve your technique.If your technique in an activity or
    exercise is flawed, you could be setting yourself up for problems
    with your tendons. Consider taking lessons or getting professional
    instructions when starting a new sport or using exercise equipment.
  • Stretch.Take time after exercise to stretch in order to maximize
    the range of motion of your joints. This can help to minimize
    repetitive trauma on tight tissues. The best time to stretch is after
    exercise, when your muscles are warmed up.
  • Use proper workplace ergonomics.If possible, get an ergonomic
    assessment of your work space and adjust your chair, keyboard and
    desktop as recommended for your height, arm length and usual
    tasks. This will help protect all your joints and tendons from
    excessive stress.
  • Prepare your muscles to play.play. Strengthening muscles used in
    your activity or sport can help them better withstand stress and loa

The DA Vinci XI Robotic Surgery

 

Robotic Surgery is a leading edge technology that is used in several specialties to carry out the surgical procedures with proven superior patient outcomes. With the Da Vinci System, the surgeons operate through a few incisions by utilizing a high-resolution 3D vision system. It features small wristed instruments that bend and rotates greater than the human hand providing a superior precision and control to the surgeon.

Today, surgeons are using Da Vinci Surgical System on patients who are diagnosed with several complex conditions like urological procedures, cancers of cervix, prostate, lung, uterus, colon/rectum as well as heart disease and fibroid tumors.

As it uses a high-resolution 3D vision system, it allows the surgeons to view anatomical structures in natural colors. It provides a natural hand- eye positioning coordination plus the built in microphone facilitates efficient communication in operation theatre.

Da Vinci Surgery is primarily used in:

  • Urologic Surgery- Robotic kidney transplantation, Female Urinary Incontinence and bladder-surgery.
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  • Cardiac Surgery
  • General Surgery
  • Head and Neck Cancer Surgery
  • Colorectal Surgery
  • Gynecological surgery
  • Thoracic Surgery

How does Robotic Surgery Works & Benifits

 

Robotic Surgery uses robotic systems to aid surgical procedures. During
an operative procedure, the surgeon sits at a control console and observes
the operative field through a video monitor and manually controls the
robotic arms, which replicate hand movement of surgeon. This procedure
makes tiny and keyhole incisions through which a camera and surgical
instruments are placed. The precision is ideal for use in complex

surgeries because it would allow surgeons to avoid nerves and organs.
These small incisions allow the patient to resume his normal activities. In
addition, there is less blood loss, which helps the patients to regain
strength and stamina over a period of time.

  • Small incisions
  • Less blood loss
  • Significantly less pain and reduced use of pain medication
  • Quicker healing time
  • Reduced hospital stay
  • Quick return to work

Are there any risks Involved?

All surgeries have a certain degree of complication associated with them though cosmetic results may vary. The serious and life threatening risks that may require hospitalization could be injury to tissues or organs, bleeding, infection and internal scarring that can cause long lasting dysfunction or pain. Though risks associated with minimally invasive surgery may include: a longer operative time, the need to convert procedure to other surgical techniques, the need for additional or larger incision sites.

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What is Orthopedic Oncology?

Orthopedic Oncology is the procedure by which both malignant and
benign tumors occurring in different parts of the body are first
diagnosed and then treated.

Benign Bone Tumor

Benign Bone Tumors (non- cancerous) does not spread to the other
parts of the body. These tumors may destroy the bone and surgical
treatment is required in order to remove the tumor and thereby
restoring the bone health. Types of bone tumors-

  • Benign Lesions
  • Unicameral Bone Cyst
  • Aneurysmal Bone Cyst
  • Osteoblastoma
  • Enchondroma
  • Unicameral Bone Cyst
  • Giant Cell Tumor
  • Osteoid Osteoma
  • Fibrous Dysplasia
  • Chondromyxoid Fibroma
  • Osteochondroma

Malignant Bone Tumor

 

These cancerous tumors require an early treatment at the start of the
disease. Radiotherapy and chemotherapy are the treatments required
either before or after the surgery. The aim of the surgery is to remove
the entire diseased bone in order to avoid amputation and thereby
restoring the appearance and function of the diseased area. Its types
are-

  • Malignant tumors of bone
  • Osteosarcoma
  • Metastatic Carcinoma
  • Chondrosarcoma
  • Ewing’s Sarcoma
  • Metastatic Carcinoma
  • Multiple Myeloma

Lesions of Joints

 

They generally occur in the form of capsules of joints like shoulder,
foot, hip, knee, elbow or wrist. These lesions can develop and harm or
create pain in the joint. The surgical procedure is done to remove the
lesion of the joint and thereby restoring the health and function of the
diseased area. Its types are-

  • Tenosynovial Giant Cell Lesion
  • Pigmented Villonodular Synovitis
  • Synovial Chondromatosis
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Soft Tissue Sarcomas

These tumors mostly arise either in fat or muscle and not in the bone.
They can be both malignant or benign. These tumors are rare and
generally develops in the pelvic area or in the limbs. Radiotherapy and
chemotherapy are the two treatments available that are done either
before or after the surgery. The types are-

  • Malignant soft tissue lesions
  • Liposarcoma
  • Malignant fibrous histiocytoma
  • Rhabdomyosarcoma
  • Fibrosarcoma
  • Synovial cell sarcoma

Bone Cancer Treatment

It is a serious condition where there is a growth of abnormal cells in
the bone that could be benign or cancerous. The abnormal growth
usually occurs in the areas of fast growth and the reason of this bone
tumor is still unknown.  Probable causes could be trauma and radiation

or inherited mutations. In most cases no particular reason is found for
this cancerous condition.

Types of Bone Tumor

 

  • Giant Cell Tumor : This tumor is made up of a great number of
    non-cancerous cells that forms an aggressive tumor. The tumor
    generally occurs near to the end of the bone and close to a joint.
    The knee is the location of a tumor but it can also include flat
    bones like breastbone (sternum) or pelvis, or the bones of the
    legs and arms. The giant cell tumor is usually covered by new
    bony growth.
  • Chondroblastoma :This tumor is of the rare type and affects
    people of every age. It is generally found in the epiphyses of
    long bones before the closure of epiphyseal. The
    Chondroblastoma accounts for five percent of benign bone
    tumors and is found in the centers of ossification. The tumors
    are probably found in the humerus, further in the femur and
    lastly in the tibia. The tumor of Chondroblastomas can be found
    in union with the aneurismal bone cysts.
  • Enchondroma :This tumor initiates from the cartilage and is of
    the type of non-cancerous bone tumor. Cartilage is found in the
    adults and is a type of stringy connective tissue from where
    most bones build up. Enchondroma tumor largely affects the
    cartilage that outlines in the bones.
  • Osteochondroma :Osteochondroma ( osteocartilaginous
    exostoses) is a tumor where there is an overgrowth of bone and
    cartilage close to the end of the bone near the growth plate.
    Osteochondroma mostly affects the long bones in the scapula,
    leg or the pelvis.

Bone Grafts & Robotic Surgery

 

It transplants the bone tissue and the bone grafts are used to rebuild
and repair the diseased bones in knees, spine, hips and at times in
other joints and bones. The bone loss that has been caused by cancers
or fractures can also be repaired with bone grafts. When the body
grafts are accepted by the body then it helps in providing the growth
of new living bone. When the bone graft (transplanted) comes from
the other person then it is termed as an allograft. While in autograft,
the bone comes from either from leg, hips or ribs.

Robotic surgery is a new and minimally evasive procedure used for
treating the cancer. This surgery is more precise surgery as compared
with standard laparoscopy and open surgeries. By using this surgery,
the patients can get more accurate and precise results of the troubled
region which also result in decreased blood loss. Robotic surgery uses
customized treatments which are held by a robotic arm and the
procedure needs small incisions that can lessen the trauma to the
tissues. The procedure is very safe and involves less pain and
complications. The recovery period is also faster and requires a short
stay at the hospital.

 

The Ilizarov Method of Treatment

The Ilizarov Method uses Ilizarov’s Principle of DISTRACTION
OSTEOGENESIS (osteo=bone, genesis=formation). This refers to the
induction of new bone between bone surfaces that are pulled apart in a
gradual, controlled manner. The distraction initially gives rise to
NEOVASCULARISATION (Neo=new, vascular=relating to blood),
which is what actually stimulates new bone formation. In addition, there
is simultaneous histogenesis (histo=tissue) of muscles, nerves and skin; in
bone diseases (osteomyelitis, fibrous dysplasia, pseudo-arthrosis) this
new bone replaces pathological bone with normal bone. This is a
revolutionary concept; diseases for which earlier there was no treatment
are now successfully treated using the Ilizarov Method.
Indications for use

  • Height Increase (for dwarfs)
  • Bone infections
  • Poliomyelitis Sequelae (limb lengthening and correction of deformities)
  • Treatment of non-unions and malunited fractures • Correction of
    deformities, both congenital & acquired, of the limbs
  • Badly comminuted fractures (multiple fragments) in the limbs, even with
    skin loss.
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  • Lengthening of foot stumps, limb stumps and fingers (Amputation/foot formation) The Advantages
  • No skin incision is made as in a conventional operation. Incidents of haemorrhage, tissue trauma and infection are much fewer.
  • The whole procedure is minimally invasive as only wires fix the bones to the rings and there is very little soft tissue damage.
  • The Ilizarov fixator is very versatile; the cylindrical shape of the fixator allows deformities to be corrected simultaneously in 3 dimensions.
  • The patient remains mobile throughout the course of the treatment. Intensive physiotherapy is instituted early; as a consequence, problems of joint stiffness and contractures are rare. Further, the patient's stay in the hospital is considerably reduced.

The Procedure

 

Called TRANSOSSEOUS OSTEOSYNTHESIS
(trans=across). Wires of 1.5 mm diameter are passed percutaneously
(through the skin) through bones by means of a drill. The protruding ends
of these wires are then fixed to rings with special “wire-fixation” bolts.
These rings in turn are connected and fixed to one another by threaded rods. Once it is fixed, the Ilizarov frame affords a stable support to the affected limb. A CORTICOTOMY is then performed; it is an osteotomy (cutting the bone) where the periosteum of the bone is preserved. Adjustments in the rods produce compression or distraction as desired between the bone ends, and simultaneously, deformities are also corrected. The ring fixator is removed at the end of the treatment An Ilizarov apparatus treating a fractured tibia and fibula. The Ilizarov apparatus is used in a surgical procedure that can be used to lengthen or reshape limb bones. In addition, the procedure is often used to treat complex and/or open bone fractures, where conventional treatment techniques cannot be used. It can also be used to treat infected non-unions of bones not amenable with other techniques.

 

The device is a specialized form of external fixator, a circular fixator,
modular in construction. Stainless steel rings are fixed to the bone via
stainless steel heavy-gauge wire (called “pins”). The rings are connected
to each other with threaded rods attached through adjustable nuts. The
circular construction and tensioned wires of the Ilizarov apparatus
provide far more structural support than the traditional monolateral
fixator system. This allows early weightbearing. The frame can be used to
support a fractured limb, but it is most commonly used to correct
deformity through callotasis. The procedure consists of an initial surgery,
during which the bone is surgically fractured and the ring apparatus is
attached. As the patient recovers, the fractured bone begins to grow
together. While the bone is growing, the frame is adjusted by means of
turning the nuts, thus increasing the space between two rings. As the
rings are connected to opposite sides of the fracture, this adjustment, done
daily, moves the now-healing fracture apart by approximately one
millimetre per day. The incremental daily increases result in a
considerable lengthening of the limb over time. Once the lengthening
phase is complete, the apparatus stays on the limb to facilitate healing.
The patient can move about on crutches and pain is lessened. Once
healing is complete, a second surgery is necessary to remove the ring
apparatus. The result is a limb that is significantly longer. Additional
surgery may be necessary, in the case of leg lengthening, to lengthen the
Achilles tendon to accommodate the longer bone length. The major
advantage of this procedure is that because the apparatus provides
complete support while the bone is recovering the patient can remain
active aiding recovery. A further use is of bone transport, whereby a
defect in a long bone can be treated by transporting a segment of bone, whilst simultaneously lengthening regenerate to reduce the defect and finally dock with the other segment, producing a single bony unit. While the Ilizarov apparatus is minimally invasive (no large incisions are made,) it is not free of complications. Pain is common and can be severe, but is treatable with analgesics. Careful attention to daily cleaning and hygiene is necessary to prevent pin site infection. Other complications include swelling and muscle transfixion.

 

Bone Fracture Treatment Procedure

The Ilizarov method is widely used to treat complex and/or open bone
fractures. This method is preferred over conventional treatment options
(such as internal fixator or cast) where there is a high risk of infection or
the fracture is of such severity that internal fixators are unworkable.

The following case study illustrates the Ilizarov apparatus treatment
procedure for a fractured limb. The photographs are of the same patient
during the course of treatment. If other individuals desire to post images,
please create a separate gallery/case-study.

Advantages of the Ilizarov Method

 

The Ilizarov method carries many advantages over other methods for
limb reconstruction. One of
the main advantages of distraction osteogenesis is that it is effective in
mature as well as young
bone, which means treatment using this principle is not limited to
children, but works equally as well
in adults.
The Ilizarov external circular fixator is a very useful tool for many
reasons:

  • The modular design of the apparatus allows the frame to be custom built
    for each individual
    patient. 5 Rebecca Littlewood
  • The circular nature of the frame both enhances stability and evenly
    distributes the stress
    across the corticotomy and the distraction gap.
  • The structure and strength of the frame allows weight bearing
    throughout the treatment,which is beneficial to the patient both in terms of day to day mobility and
    helping to build
    muscle strength and prevent joint stiffness (Mencio, 1992).
  • When the frame is applied to the limb during surgery, only wires fix the
    bones to the rings,
    and no other skin incisions are made, which reduces the risk of bleeding,
    infection, and
    damage to the surrounding soft tissues.
  • It holds fragments of bone together to allow them to unite when
    traditional methods of
    fixation are unable to give proper hold on the fracture fragments, and
    allows significant
    compression in the case of non‐unions.
  • It allows bone fragments to be pulled apart. This results in osteogenesis
    and can be used for
    limb lengthening or for regenerating bone which has been removed due to
    traumatic loss,
    tumour or infection, for example. (Rallis Orthopedic Hospital, 2010)

Russian studies of the Ilizarov method (Popova and Khodesecich, 1984)
as cited by (Ilizarov &
Rozbruch, 2007) showed that the use of this system reduced treatment
time, the cost of treatment,
and disability payments significantly. When used for the treatment of
fractures and post traumatic
non‐unions, primary disability was decreased by 3‐5 times, and 8 fold
compared with traditional
treatments in the case of open fractures. This meant that more patients
were able to return to work
sooner, which is advantageous for the economy of the country.

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