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Total Hip Replacement	Arthroscopy Surgery
Total Knee Replacement	Low Back Surgery
Gallbladder Removal	Laparoscopic Hernia
ACL Surgery

Torn Ligaments

Two ligaments in your knees are more prone to injury than others. Your anterior cruciate ligament (ACL), in the center of the knee, is the commonly injured by a twist. Losing control of your skis or falling off a ladder, for example, are both setups for an ACL injury. Your medial collateral ligament (MCL), on the inside of your knee, is vulnerable to blows from the side, common in contact sports like football. Either injury may weaken your knee joint, making it wobbly and causing a variety of symptoms. It=f left untreated, more serious problems can de develop.

A Healthy Knee

The knee joins the upper and lower leg bones (femur and tibia). A cushion of cartilage (meniscus) sits between these bones. The ends of the bones and back of the kneecap (patella) are covered by smooth articular cartilage. This helps the joint move easily. Soft tissues (muscles and ligaments) make the knee stable and strong.

Common Knee Problems

Meniscus Tears

A sudden twist or repeated squatting can tear the meniscus. This may make your knee hurt or swell. Your knee may also catch or lock when you move it.

ACL Ligament Tears

A fall, twist, or blow may tear the anterior cruciate ligament. ACL tears can cause pain, swelling, and an unstable knee.

Cartilage Wear

Aging or injury may wear away articular cartilage. A piece may break off in the joint. You may feel pain, stiffness, or grinding.

Patella Problems

Aging, overuse, or injury may damage cartilage under the patella. This can limit joint movement. Structural problems may cause uneven wearing or pain

Common Treatment Options

Meniscus Removal or Repair

Your surgeon may remove or repair damaged meniscal tissue. Torn tissue on the inside of the meniscal tissue is often removed. Newly torn tissue on the outer edge of the meniscus can often be repaired. This tissue gets enough blood to heal properly.

Ligament Reconstruction

Your surgeon can reconstruct a damaged anterior cruciate ligament. The damaged tissue is replaced with health, strong tissue (a graft). The graft may come from the patellar ligament or from another source.

Cartilage Shaving or Removal

Your surgeon may smooth or shrink rough cartilage by shaving it or using a thermal device. Or, your surgeon may drill exposed bone to make the cartilage grow. Any loose bodies may be removed.

Patella Smoothing or Release

Your surgeon may smooth or shrink bands of cartilage under the paella by shaving them or using a thermal device. If the patella is tilted, your surgeon may clip bands of tissue. This is called a lateral release. It aligns the patella with the femur.

Depending on the nature of the problem, conservative nonoperative methods of treatment often are recommended before shoulder arthroscopy. 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 soft tissue rim (labrum). A smooth, durable surface (articular cartilage) on the head of the arm bone, and 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 collar bone is joined with the breastbone (sternum) by the sternoclavicular joint.

The joint capsule is 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 Tendonitis can occur with overuse form repetitive activities such as swimming, painting or weight lifting. Theses 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 AC joint. The conservative nonoperative treatment is modification of activity, light exercise and occasionally, a cortisone injection. Nonoperative treatment is successful in the majority of cases, but 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 are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting or of falls. Nonoperative treatment with modification of activity is successful in the majority of cases. If you continue to have pain, surgery may be needed. Surgery may be necessary 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 aresubluxations and dislocations. A subluxation is a partial or incomplete dislocation. If your 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 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 AC Joint Separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated nonoperatively with slings or splints. Severe displaced fractures or AC joint separation may require surgical repair.

Fractured Head of the Arm Bone 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 can cause destruction of the shoulder joint and surrounding tissue, as well as 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 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. Your orthopaedic surgeon will discuss with you the best option.

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. An MRI (Magnetic Resonance Imaging) may be helpful in assessing soft tissues in the shoulder. A CT (Computerized Tomography) scan may be used to evaluate the bony parts of your shoulder.

Your orthopaedic surgeon will review the results of your evaluation with you and discuss the best treatment. You and your doctor may agree that surgery is the best treatment option. He will explain the potential risks and complication that may occur. Your doctor may discuss donation your own blood to the used if needed during surgery.

Preparing for surgery

No food or drink after midnight before surgery.

Discuss with your doctor what to do about medications taken in the morning

An hour before surgery, you will be assessed in the preoperative area by a nurse anesthetist or anesthesiologist.

A general anesthetic will be given so that you sleep throughout the entire procedure, or you will remain awake after receiving an injection which prevents you from feeling pain.

Types of Surgical Procedures

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

Arthroscopy allows the orthopaedic surgeon 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 the doctor to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is visualized and diagnosed with arthroscope. Arthroscopy often can be done on an outpatient basis.

Open Surgery may be necessary and, in some cases, 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.

During Surgery

During surgery, your orthopaedist can tighten a torn or stretched capsule, reattach a torn labrum, and repair other damage to your shoulder joint. Tightening or repairing the capsule and the labeum can be done using one of the techniques described above.

Capsule Shift

If the capsule is stretched, your orthopaedist may use surgical thread (sutures) to tighten it. Your doctor folds the excess capsule underneath itself and stitches it together.

Repair to the Glenoid

If the capsule and labrum are torn, your doctor can use sutures to reattach them to the glenoid.

Repair with Surgical Anchors

Instead of putting sutures directly through the glenoid, your orthopaedist may use surgical anchors. Surgical anchors are inserted into small holes drilled in the glenoid. Sutures connected to the top of the anchors are used to reattach the capsule and labrum.

After Surgery

Depending on the procedure, you may go home the same day or spend one or two days in the hospital. Before you go home, you’ll be given instruction about how to care for your shoulder while it’s healing. Your shoulder will heal best if you follow these instructions.

Recovering in the Hospital

After the procedure, your shoulder is covered with a sterile dressing and your arm is immobilized in a sling or brace. Pain medication and cold packs can help make you joint comfortable during the first few hours after surgery. You won’t be able to use your arm, so arrange for someone to drive you home.

Recovering at Hotel

Once you are at your hotel keep your dressing dry and clean. Don’t remove your sling or brace or try to use your arm until your doctor says it’s okay. In the days following the surgery you may visit your orthopaedist or be visited by him or a nurse to have your dressing checked and to schedule when your stitches will be removed.

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 is normal. You should be alert for certain signs and symptoms that may suggest the development of complications

Be sure to call your doctor if you develop any of these symptoms after surgery.

Possible Complications after Surgery

• 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 would drainage is normal and, in fact, desirable)
• Numbness or tingling of the arm or hand.

Prevention of Future Problems

It’s 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 their orthopaedic surgeon and physical therapist will have the best medical outcome after surgery.

A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall creating a bulge you can see and feel. Hernias can develop around the naval, in the groin, or any place where you may have had a surgical incision. Some hernias are present at birth. Others develop slowly over a period of months or years.

There are many different types of hernias. The most familiar type are those that occur in the abdomen, in which part of the intestines protrude through the abdominal wall. This may occur in different areas and, depending on the location, the hernia is given a different name.

An inguinal hernia appears as a bulge in the groin and may come and go depending on the position of the person or their level of physical activity. It can occur with or without pain . In men, the protrusion may descend into the scrotum. Inguinal hernias account for 80% of all hernias and are more common in men.

Femoral hernias are similar to inguinal hernias but appear as a bulge slightly lower. They are more common in women due to the strain of pregnancy .

A ventral hernia is also called an incisional hernia because it generally occurs as a bulge in the abdomen at the site of an old surgical scar. It is caused by thinning or stretching of the scar tissue, and occurs more frequently in people who are obese or pregnant.

An umbilical hernia appears as a soft bulge at the navel (umbilicus). It is caused by a weakening of the area or an imperfect closure of the area in infants. This type of hernia is more common in women due to pregnancy, and in Chinese and black infants. Some umbilical hernias in infants disappear without treatment within the first year.

A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body. With a hiatal hernia, the stomach bulges upward through the muscle that separates the chest from the abdomen (the diaphragm). This type of hernia occurs more often in women than in men, and it is treated differently from other types of hernias.

Who gets hernias?

According to the National Center for Health Statistics, approximately five million Americans have hernias. Hernias in the groin area (inguinal hernias) are most common in men, primarily because of the unsupported space left in the groin after the testicles descend into the scrotum. Hernias in the femoral area, at the top of the thigh, occur most often in women. They commonly result from pregnancy and childbirth.

Will the hernia go away?

No. An untreated hernia will not get better or go away on its own.

Treatment

Once an abdominal hernia occurs it tends to increase in size. Some patients with abdominal hernias wait and watch for a while prior to choosing surgery. In these cases, they must avoid strenuous physical activity such as heavy lifting or straining with constipation. They may also wear a truss, which is a support worn like a belt to keep a small hernia from protruding. People can tell if their hernia is getting worse if they develop severe constant pain, nausea and vomiting , or if the bulge does not return to normal when lying down or when they try to gently push it back in place. In these cases they should consult with their doctor immediately. But, ultimately, surgery is the treatment in almost all cases.

There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place. With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die.

When the blood supply is cut off, the hernia is termed “strangulated.” Because of the risk of tissue death (necrosis) and gangrene , and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.

Surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine back into place and sew the overlying muscle back together. When the muscle is not strong enough, the surgeon may reinforce it with a synthetic mesh.

Surgery can be done on an outpatient basis. It usually takes 30 minutes in children and 60 minutes in adults. It can be done under either local or general anesthesia and is frequently done with a laparoscope. In this type of surgery, a tube that allows visualization of the abdominal cavity is inserted through a small puncture wound. Several small punctures are made to allow surgical instruments to be inserted. This type of surgery avoids a larger incision.

Prognosis

Abdominal hernias generally do not recur in children but can recur in up to 10% of adult patients. Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated.

Hiatal hernias are treated successfully with medication and diet modifications 85% of the time. The prognosis remains excellent even if surgery is required in adults who are in otherwise good health.

Inguinal Hernia

An inguinal hernia occurs in the groin. The groin is the area between the abdomen and thigh. It is called “inguinal” because the intestines push through a weak spot in the inguinal canal. The inguinal canal is a triangle-shaped opening between layers of abdominal muscle near the groin. Some of the causes of inguinal hernias are: obesity , pregnancy , heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal.

There are two types of inguinal hernias: direct and indirect.

• A direct inguinal hernia occurs when a weak spot develops in the lower abdominal muscles from the normal stresses of living and aging. Tissues push through this weak spot as pressure within the abdomen increases.
• An indirect inguinal hernia is the most common type of inguinal hernia. Normally, an opening in the inguinal canal closes shortly before birth. An indirect hernia develops when this opening does not close, causing abdominal tissues to push through the inguinal canal. Symptoms may be present at birth or may develop later in life. In men, the hernia may push into the scrotum . In women, it may push into the large fold of genital skin (labia).

Indirect hernias are more common in men because the testicles (when they descend) and their blood vessels pass through the inguinal canal, making the opening from the abdomen less likely to close completely. Women are more likely to have an indirect inguinal hernia than a direct hernia.

What causes an inguinal hernia?

An indirect inguinal hernia is caused by an opening that does not close as it should before birth. The cause of a direct inguinal hernia often is unknown. It’s believed to be caused by the wear and tear of daily life and aging.

However, lifting a heavy object or doing other activities that put pressure on the abdominal muscles, such as frequent coughing or straining when urinating or having a bowel movement, are thought to cause a hernia. Excessive weight gain, pregnancy, and constipation also are possible causes.

Older adults and people who are overweight are at a higher risk for direct inguinal hernias than are other people because of increased stress on the lower abdominal muscles.

What are the symptoms of an inguinal hernia?

The main sign of an inguinal hernia is a tender bulge in the groin or scrotum. The bulge may appear gradually over a period of several weeks, or it may form suddenly after you have been lifting heavy weights or coughing, bending, straining, or laughing.

In some cases, you may feel groin pain or other discomfort, especially when bending or lifting. The discomfort may be felt in the scrotum. Some hernias cause a bulge but no pain.

Other possible symptoms include heaviness, swelling, and a tugging or burning sensation in the area of the hernia, scrotum, or inner thigh. Sometimes the discomfort is relieved only by lying down.

You may have nausea and vomiting if part of the intestine bulges outside the abdomen and becomes trapped, or incarcerated , in the hernia.

How is an inguinal hernia diagnosed?

The diagnosis of inguinal hernia is usually based on a medical history and a physical examination. A health professional will ask about your symptoms and will examine your groin area for a bulge. You may be examined while standing and coughing or straining (as if trying to have a bowel movement).

Imaging tests such as abdominal ultrasound and computed tomography (CT) scan also may be done; a CT scan can confirm the type of hernia.

How is an inguinal hernia treated?

Surgery is necessary to repair an inguinal hernia. Two surgical approaches are available.

• Open surgery: The surgeon repairs the hernia through an incision in the groin. A piece of mesh is sewn over the weakened area of the abdominal wall to reduce the risk of the hernia recurring. This is a common method of repairing a hernia. In some cases, the tissue of the abdominal wall can be repaired without using a mesh.
• Laparoscopic surgery: The surgeon inserts a thin, lighted scope into a small incision in the abdomen; instruments to repair the hernia are inserted into another small incision. Mesh also is used in this surgery to reinforce the abdominal wall. Laparoscopic surgery is relatively new. Studies show that people have less pain after this type of surgery and return to work and other activities more quickly than after open repair; however, this surgery is more expensive than open repair.

The risk of a hernia coming back varies for each surgery. Recurrence rates for open surgery range from 1% to 7% for an indirect hernia and from 4% to 10% for a direct hernia; for laparoscopic surgery, the risk of recurrence is up to 6%.

Femoral Hernia

A femoral hernia is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the “femoral canal” – a tube-shaped passage at the top of the front of the thigh. The loop is usually only the size of a grape.

A femoral hernia can cause serious medical problems if left untreated, even if there are no troublesome symptoms to begin with. Treatment is by an operation to return the herniated intestine to its proper place and close the weakness in the abdominal wall.

Femoral hernia

Incisional Hernia

Incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall. Excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing causes the scar tissue to thin or stretch. Because the abdominal wall is weak, the hernia occurs during abdominal strain.

What are the symptoms?

An incisional hernia causes a bulge in the abdominal area. This type of hernia is often painless, but may be tender and can cause discomfort during any type of physical strain, such as lifting or coughing. The bulge may disappear when the patient is lying down, and be more visible when standing up. A hernia can often be pushed gently back into place. This is called a reducible hernia. When a hernia cannot be pushed back into place, it means a piece of the organ has become trapped, or incarcerated. Symptoms include pain, nausea, vomiting, inability to have a bowel movement, and a bulge that remains even when lying down. When a portion of an organ is incarcerated, its blood supply can be cut off, which means the organ’s tissue will die. This condition is called a strangulated hernia. Incisional hernias can increase in size with time.

How is it diagnosed?

To diagnose an incisional hernia, a doctor must perform a physical examination. Your doctor will look for a bulge in the abdominal area and may ask you to cough as he puts light pressure on the area. Coughing causes the hernia to bulge out further.

What is the treatment?

Patients with incisional hernias can wear a special type of belt, called a truss, to support the hernia and keep it from bulging out. They should also avoid any activities that cause abdominal strain. However, most patients elect surgery to repair incisional hernias and avoid the possibility of a strangulated hernia. The procedure to repair a hernia involves pushing the piece of the organ back into place and repairing the abdominal wall so the organ cannot push through again. Hernia surgery, called herniorrhaphy, used to involve a large incision and a long recovery period. However, many hernia repairs can now be performed through laparoscopic surgery.

The surgeon uses a special viewing instrument called a laparoscope, inserted through a small incision in the abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to push the organ into place and repair the abdominal wall. The surgeon may use a procedure called hernioplasty to reinforce the entire weakened area with synthetic material, like a tire patch. Laparoscopic hernia surgery can be performed on an outpatient basis. Incarcerated and strangulated hernias require emergency surgery and hospitalization. Laparoscopic surgery may not be recommended for very large hernias.

Umbilical Hernia

Umbilical hernias are protrusions of bowel related to the belly button (umbilicus). Congenital umbilical hernias form through the gap where the umbilical cord vessels enter the abdomen during fetal life. They are usually present at birth but may not be noticed until the umbilical cord separates and heals. They rarely cause symptoms and 90 per cent disappear during the first few years of life as umbilical scar tissue contracts and thickens. Repair is not usually attempted until the child is at least two years old.

Acquired umbilical hernias are common in the obese. Those hernias that protrude through umbilical scar tissue are usually caused by conditions that raise pressure inside the abdomen and distend it. This causes the bellybutton to bulge outwards. Treatment is not necessary unless the hernia is large or giving rise to unpleasant or painful symptoms.

Acquired para-umbilical hernias protrude through a gap to one side of the umbilical scar and convert the belly button into a crescent-shaped slit. These do need repair as they cause pain and swelling around the umbilicus and can strangulate.

A hiatal hernia is treated differently. Medical treatment is preferred. Treatments include:

Treatment of hiatus hernias involves losing weight, which often improves symptoms, eating little and often (rather than large meals), avoiding bending or lying down after meals, giving up smoking and raising the head of the bed slightly to prevent reflux during sleep. Some patients find they can only sleep at night if propped fully upright.

There are also several types of medications that help to manage the symptoms of a hiatal hernia. Antacids are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly if symptoms are severe; surgery to repair the hiatus hernia is undertaken. This is a major operation in which the protruding stomach is brought back down into the abdomen and tethered into place.

Diagnosis of Hiatus Hernia

Hiatus hernias are investigated by passing a flexible telescope down the throat while the patient is under light sedation. This procedure is called oesophagoscopy or gastroscopy. Occasion-ally, a barium X-ray is also used to see whether there is reflux of stomach contents into the esophagus.

Alternative treatment

There are alternative therapies for hiatal hernia. Visceral manipulation, done by a trained therapist, can help replace the stomach to its proper positioning. Other options in addition to H2 blockers are available to help regulate stomach acid production and balance. One of them, deglycyrrhizinated licorice (DGL), helps balance stomach acid by improving the protective substances that line the stomach and intestines and by improving blood supply to these tissues. DGL does not interrupt the normal function of stomach acid.

As with traditional therapy, dietary modifications are

important. Small, frequent meals will keep pressure down on the esophageal sphincter. Also, raising the head of the bed several inches with blocks or books can help with both the quality and quantity of sleep.

Medication, changes in daily activity and exercise may all play a role improving your mobility and relieving your pain. Most lower back pain problems, such as those caused by improper lifting, will disappear in a few days or weeks with care that doesn’t require surgery

Other pain, caused by the wear and tear of daily living that affects the vertebrae and disks in your back, may require surgery. You and your orthopaedic surgeon will discuss what the best treatment for you is. The following information will help you understand how your spine works, the causes of some and leg pain and the benefits limitations of surgery to relieve pressure on nerves in your spine and or to stabilize your spine. You’ll learn what is involved in making the decision for surgery, what to expect during and after surgery and how to avoid complications after surgery.

Normal body movement-walking, standing, sitting, twisting and bending- is possible because of the unique structure of the spinal column.

There are 24 vertebrae in three upper segments of the spinal column. These three segments create three natural curves of the back: the curves of the neck area (cervical), chest area (thoracic) and lower back (lumbar). The lower segments of the spine (sacrum and coccyx) are made up of a series of vertebrae that are fused together.

Between the vertebrae are disks, which are cushioning pads that absorb pressure and allow spine movement.

The spinal column is held in alignment or balance by ligaments, cartilage and muscles that surround and protect the spinal cord membranes and the nerves that branch out to your legs, arms and all parts of your body.

Displacement (herniation) of the disk can lead to low back pain as well as pain and numbness in the legs (sciatic pain) and weakness of the muscles in one or both legs.

When the vertebrae are aligned, a canal is formed by the vertebral arch (lamina) that contains the spinal cord. Nerves pass through opening (foramina) of the adjoining vertebrae and into your arms and legs.

The muscles and ligaments attached to the vertebrae need to be kept in good condition to enable the spine to withstand the stresses of daily activity. A well-balanced, flexible spine is less likely to develop low back pain and is less likely to require medical treatment.

As a result of wear and tear on the spine, ligaments and disks, the disk may begin to protrude or collapse and put pressure on the never root leading to a leg or foot, causing pain in those areas (sciatica).

The problem can be aggravated by associated conditions, such as narrowing (stenosis) of the canal or shifting of the vertebra (spondylolisthesis), one upon the other.

You also may have low back pain from improper lifting of an object, a fall or sudden twisting. Most back pain from these causes is due to overuse of muscles and disappears in a few weeks.

Is Low Back Surgery for You?

If you have persistent back pain or pain in your thigh, buttock or leg: numbness or tingling in your leg; and/or weakness in your leg, and it doesn’t respond to conservative, no operative treatment, your family doctor can refer you to an orthopaedic surgeon for an evaluation.

You and you orthopaedic surgeon will determine whether you would benefit from low back surgery which relieves pressure on the nerves in the spinal cord and/or stabilizes the spine.

The Orthopaedic Evaluation

The orthopaedic evaluation consists of four components;

• A medical history, in which your orthopaedic surgeon gathers information about your general health and asks about your symptoms.
• A physical examination to assess the stability, strength, alignment and motion of your back, as well as neurological evaluation.
• Diagnostic tests such as X-rays, which may be obtained to evaluate the bones and structure of your spine. An MRI (Magnetic Resonance Imaging) may be arranged to provide more detailed information about the spine. MRIs are not X-rays and use no radiation to create images. A myelogram also may be requested. A myelogram uses X-ray imaging and an injected dye to define bony and soft tissue structures affecting the nerve root. )
• Other imaging studies such as a CAT scan also may be ordered which provides details about the bones and soft tissues not seen on regular X-rays.

Discussion by you and your orthopaedic surgeon of the findings of the physical and diagnostic examination and the treatment for you condition. Initially, medication and physical therapy may be prescribed to reduce inflammation at the site of the pain and to strengthen the muscles supporting eh spinal column. If you are overweight, a weight reduction program may be suggested. In addition, you will be encouraged to begin a regular aerobic exercise program once your problem has been corrected.

Preparing for Surgery

You may be asked to stop taking certain medicine or to stop smoking. Depending on your age and general medical fitness, you may be asked to undergo a general medical checkup.

Medication

Some medicines may affect the results of your surgery. They may cause bleeding or may interfere with the effects of your anesthesia. These medications include aspirin and no steroidal anti-inflammatory drugs. Your doctor may ask you to stop taking the medication before your surgery.

Donating Blood

Donating blood usually is not necessary for most low back surgery that does not include fusing vertebrae together. However, there is always a chance that some blood loss will occur during surgery. Your doctor will discuss the advantages and disadvantages of donating your own blood compared with using someone else’s blood.

Advance Planning

You will be able to walk after surgery, but you may need to arrange for some help with washing, dressing and activities, such as cleaning, laundry and shopping, for a few days after your surgery. Your orthopedic surgeon will probably recommend that you don’t drive a car for a period of time after surgery.

Your Surgery

Patients usually are admitted to the hospital on the day of surgery.

After admission, you will be taken to the preoperative preparation area where you will be interviewed by a doctor from the anesthesia department, who will review your medical history and physical examination reports. You and your doctor will discuss the type of anesthesia to be used. The most common types of anesthesia used for low back surgery are general (you are asleep for the entire operation or spinal (you may be awake but have no feeling from your waist down). The surgical procedure usually takes one to three hours, depending on you problem. Your orthopaedic surgeon will remove a portion of bone and ligament overlying the nerve roots and will remove displaced disk material to relieve pressure on the nerve roots. Fusion is sometimes done at the same time, if instability (spondylolisthesis) is present.

When your surgery is completed, you will be moved to the recovery room, where you will be observed and monitored by a nurse until you awake from your anesthesia. You will have an intravenous (IV) line inserted into a vein in your arm. You also may have a catheter inserted into your bladder to make urination easier.

When you are fully awake and alert, you will be taken to your hospital room. Your IV and catheter will be removed soon after.

Your Hospital Stay You will feel some pain at the site of your surgery.

Your doctor will prescribe api9n medicines to help reduce this discomfort. You ill be encouraged to breathe deeply and to cough frequently to avoid fluid build-up in your lungs. You may be given a small machine called an incentive spirometer to help you.

You will be encouraged to begin walking on the same evening after your surgery or the next day to help speed your recovery.

Physical Therapy

A physical therapist may instruct you on how to walk up and down stairs without assistance, how to sit properly and how to maintain good spinal balance. You also should exercise your legs in bed to help prevent blood clots. A follow-up program of physical therapy may be prescribed, depending on the situation.

Possible Complications after surgery

The incidence of complications after low back surgery is low. Major complications that can occur include, but are not limited to, infection, heart attack, stroke, blood clots and recurrent disk herniations. Although rare, new nerve damage can occur as a result of this surgery. These complications may result in pain and prolonged recovery time.

Recovery

Woulnd Care Your wound may be closed with stitches (sutures) or stapes, which will be removed approximately two weeks after surgery. If the wound is clean and dry, no bandage is needed. If drainage continues after you are home, the would should be covered with a bandage and a call made to your surgeon.

Diet Some loss of appetite is common. Eating well-balanced meals and drinking plenty of fluids is important. Your doctor may recommend iron supplement pills or vitamins before and after your surgery.

Activity Loss of energy is frequently experienced after major surgery, but this improves over time. An exercise program designed to gradually increase your strength and stamina may be prescribed. Initially, your doctor will recommend that you should only participate in walking. Later, he will encourage you to swim or use an exercise bile or treadmill to improve your general physical condition.

Avoiding problems after surgery

It is important that you carefully follow any instructions from your doctor relating to warning signs of blood clots and infection. These complications are most likely to occur during the first few weeks after surgery.

Warning signs of possible blood clots include the following:

• Swelling in the calf, ankle, or foot
• Tenderness or redness, which ay extend above or below the knee
• Pain in the calf
• Occasionally, a blood clot will travel through the blood stream and may settle in your lungs. If this happens, you may experience a sudden chest pain and shortness of breath or cough. If you experience any of these symptoms, you should notify your doctor immediately.
• Infection following spine surgery occurs very rarely. Warning signs of infection include:
• Redness tenderness and swelling around the wound edges
• Drainage from the would
• Pain or tenderness
• Shaking chills
• Elevated temperature usually above 100 degrees if taken with an oral thermometer

If any of these symptoms develop you should contact your doctor.

After Recovery

After you have recovered from your low back surgery, you may continue to have some achy pain in your lower back; this may be persitent. You can reduce the pain by staying in good physical condition. If you are overweightk you should enroll ina program to help you lose weight and keep it off.

Your doctor will evaluate you after your surgery to make sure that your recovery in progressing as expected.

Advantages and Limitations of Arthroscopy

Once the knee was the sole beneficiary of arthroscopy, but now a variety of joints can enjoy its advantages. With arthroscopy, you surgeon can reach a more accurate diagnosis, prescribe appropriate treatment, and perform many surgical procedures. Because the work is done through small incisions, it is usually a same day procedure and there is less trauma to the tissue, which makes for better healing. But arthroscopy is no the perfect solution for every condition. In addition, full recovery includes a period of healing and rehabilitation which may take a few weeks, or up to one year depending upon your condition.

Understanding arthroscopy

An arthroscope is an instrument that allows you doctor to look directly into the joint that’s bother you. Because arthroscopy revealed things never seen before, it was initially used as a superb diagnostic tool.

Eventually, the technique progressed to include surgical procedures.

The arthroscope contains magnifying lenses and glass fibers that beam light into the joint and relay a magnified image to an eyepiece or TV monitor. The arthroscope, fluid tubes and surgical instruments are inserted through tiny incisions called portals. The joint is continuously irrigated to keep the visual field clear and distend the area so the surgeon has room to work.

This distension causes some soreness after arthroscopy, even when it is used only for diagnosis, and not for surgery.

Specially designed surgical instruments are used to remove, repair, or reconstruct the damage tissue. Techniques include trimming tissue, removal of “loose bodies” (fragments of cartilage or bone), suctioning debris, smoothing rough surfaces, and sewing and stapling cartilage and ligaments.

Your arthroscopy experience

Before doing arthroscopy, a complete evaluation is needed to have as accurate a diagnosis as possible. This may include a medical history, physical exam and diagnostic tests. On the basis of these, arthroscopy may then be indicated to confirm the diagnosis. In many cases, your surgeon will be able to correct the problem at the same time as you diagnostic excision.

History

Your doctor may ask you questions such as Where is the pain? Did it begin gradually or suddenly? How were you injured was there swelling soon after.

Physical Exam

Your doctor will manually examine your joint to look for a decreased range of motion, swelling, instability, and signs of muscle atrophy and tenderness.

Diagnostic Tests

Recommended diagnostic tests may include routine or special x-rays, CT scans, bone scans, or MRI’s Their results may indicate nonsurgical treatment or arthroscopy.

Indications for Arthroscopy

There are a number of reason why your surgeon may recommend arthroscopy after the orthopedic evaluation. It may also be needed to confirm a diagnosis, or to obtain a diagnosis that was not possible with other means. Arthroscopy may also be indicated when your pain, instability, and inability to use the joint persist despite nonsurgical treatment.

Pre-Op

Your doctor will indicate which preop lab tests you require, such as blood tests, urinalysis, x-ray, and EKG. You will have either local, regional, or general anesthesia, depending upon the joint in which the arthroscopy will be performed and your general physical condition. You will be advised no to eat or drink anything after midnight the night before surgery, and to wash the area well beforehand.

The Procedure

The exact extent and duration of your arthroscopy is unpredictable until the procedure is underway. It may take anywhere from a half hour to several hours.

Post-OP

Recovery Room

A nurse will monitor your progress while the anesthesia wears off and recovery begins. Your joint will be bandage, and possibly elevated, with an ice pack to reduce pain and swelling. You will be encouraged to do certain exercises to improve your circulation and keep the joint mobile.

Home (Hotel) Recovery

Follow your doctor;s instructions about keeping the area elevated above heart level and taking pain medication. You may be instructed to rest and apply an ice pack for the first day. Check with your doctor about when you can take a shower; avoid soaking in a tub or pool. Be sure to continue the recommended exercises.

Follow-up and Rehabilitation

During follow-up appointments, your doctor will inspect the area, remove any stiches, and plan your rehabilitation. You may be shown exercises to do at home, or physical therapy may be recommended. In either case, the goal is to restore your joint to its fullest potential.

The gallbladder is a pear-shaped structure that is found attached to the liver. The bile duct is a tube that transports bile from the liver to the small intestine. The gallbladder is attached to the bile duct by a small tube called the cystic duct. Bile is collected in the gallbladder between meals and empties into the bile duct through the cystic duct during a meal.

What is the bile duct?

The bile duct is long tube-like structure that connects the liver to the intestine. The liver makes bile that is required for the digestion of food. The bile from the liver is transported to the intestine by the bile duct.

The top half of the bile duct is associated with the liver while the bottom half of the bile duct is associated the pancreas through which it passes on its way to the intestine. It opens in the part of the intestine called the duodenum into a structure called the Ampulla.

Blockage of the bile duct by a cancer or scarring from injury prevents the bile from being transported to the intestine and the bile accumulates in the blood. This condition is called jaundice and the skin and eyes becomes yellow from the accumulated bile in the blood. This condition also causes severe itchiness.

Reasons for Removal of Gallbladder (Cholecystectomy)

A cholecystectomy may be performed if the gallbladder contains gallstones (cholelithiasis), is inflamed or infected (cholecystitis), or is cancerous.

Gallbladder inflammation or infection may cause pain which may be described as follows:

• is generally located on the right side of the upper abdomen
• may be constant or may become more severe after a heavy meal
• at times, may feel more like fullness than pain
• may be experienced in the back and in the tip of the right shoulder blade

Other symptoms of gallbladder inflammation or infection include, but are not limited to, nausea, vomiting, fever, and chills.

The symptoms of gallbladder problems may resemble other medical conditions or problems. In addition, each individual may experience symptoms differently. Always consult your physician for a diagnosis.

There may be other reasons for your physician to recommend a cholecystectomy.

About the Laparoscopic Cholecystectomy Procedure

A cholecystectomy is the surgical removal of the gallbladder. Using advanced laparoscopic technology, it is now possible to remove the gallbladder through a tiny incision at the navel.

The technique is performed as follows. The patient receives general anesthesia. Then a small incision is made at the navel (point A) and a thin tube carrying the video camera is inserted. The surgeon inflates the abdomen with carbon dioxide, a harmless gas, for easier viewing and to provide room for the surgery to be performed. Next, two needle-like instruments are inserted (points B). These instruments serve as tiny hands within the abdomen. They can pick up the gallbladder, move intestines around, and generally assist the surgeon. Finally, several different instruments are inserted (point C) to clip the gallbladder artery and bile duct, and to safely dissect and remove the gallbladder and stones. When the gallbladder is freed, it is then teased out of the tiny navel incision. The entire procedure normally takes 30 to 60 minutes. The three puncture wounds require no stitches and may leave very slight blemishes. The navel incision is barely visible.

What Are the Benefits?

The main benefit of this procedure is the ease of recovery for the patient. There is no incision pain as occurs with standard abdominal surgery. The patient is up and about the same day. In fact, up to 90% of patients go home the same day. The remainder are usually discharged the next day. And within several days, normal activities can be resumed. So the recovery time is much quicker. Also, there is no scar on the abdomen.

What is the recovery period and how soon can you go back to work?

Patients will probably be able to get back to normal activities within a week’s time, including driving, walking up stairs, light lifting and work. Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation. In general, recovery should be progressive, once the patient is at home.

Most patients are fully recovered and may go back to work after seven to ten days. Often, this depends on the nature of your job since patients who perform manual labor or heavy lifting may require two to four weeks of recovery.

What Are the Complications?

While the procedure seems very easy for the patient, it is still abdominal surgery. And, even though infrequent, it still carries the same risks as general surgery. Current medical reports indicate that the low complication rate is about the same for this procedure as for standard gallbladder surgery. These complications may include:

• In about 5 to 10% of cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed.
• Nausea and vomiting may occur after the surgery.
• Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery.

Quite uncommonly, a diagnostic error or oversight may occur.

Are there Other Treatment Options?

Depending on the size, number, and chemical makeup of gallstones, there is another way to treat the condition. If the stones are small, they may be dissolved with long-term drug therapy lasting 12 to 18 months. A problem with this option is that recurrence of gallstones is frequent, so the problem may not be permanently solved. When symptoms are bad, it is usually unwise to wait because a major complication may occur.

Who Can’t Have the Procedure?

Surgeons are finding that cases previously felt to be unsuitable for laparoscopy can now be done safely with this technique. Still, there are instances in which the surgeon will not recommend the procedure. At times, pregnancy or previous surgery in the upper abdomen (which may cause adhesions) may require conversion to the standard surgery requiring a skin incision. In each instance, the surgeon will weigh the benefit for the patient against the risks, always considering other medical problems and always making the recommendation that is in the patient’s best interest.

To understand knee replacement surgery it is important to understand how your knee works. Your knee joint works like a hinge at the junction of two bones, the thigh bone and the shin bone. The ends of the bones are covered with a thick layer of soft, white cartilage. If this cartilage is damaged or worn away, the underlying bones rub together, causing pain and lack of mobility.

Total knee replacement will help an individual return to their personal independence, often pain free. It may also straighten the leg; improve stability and the function of the joint. In a total knee replacement, the surface of the joint is replaced with metal and plastic surfaces which can function similar to normal joint. This is accomplished by surgically trimming the ends of the bones and replacing them with new metal and plastic surfaces. Essentially, a total knee replacement is a “resurfacing” of the joint. Most of the ligaments, tendons and muscles around the knee joint are retained. The new joint’s surfaces mimic the natural knee it replaces.

Before a total knee replacement surgery you will need the following:

1. You will need a thorough dental examination to ensure you do not have any dental problems and infections which could travel through your bloodstream and infect your hip replacement. Any infection needs to be treated before your surgery.
2. You will need an examination by an internist to specify any medical problems you may have that could interfere with your total knee replacement.

Your doctor will schedule a preadmission evaluation which may include some or all of the following.

• Medical history
• Anesthesia interview
• Blood and urine tests
• Electrocardiogram
• X-rays

During the first six weeks after surgery, while the muscles and tissues around your knee are healing, you will need to follow certain activity restrictions. To help you during your recovery SSI can arrange the following.

• A bi lingual nurse
• A physical therapist
• An apartment/house/hotel with easy access, dvd player and a large selection of movies
• Cleaning and laundry services
• Food shopping and preparation
• Massage therapists
• Tours of the island }

What’s Wrong with my Knee?

Joint replacement procedures (also called arthroplasties) are done when a patient experiences severe, incapacitating hip pain due to osteoarthritis, rheumatoid arthritis or injury. The old joint is replaced with a new mechanical joint called a prosthesis.

The knee is a hinge joint where the large bone in your lower leg (or tibia) connects with the end of the thigh bone or femur. A healthy knee has smooth cartilage that covers both the end of the tibia and the end of the femur. The smooth cartilage allows the two bones to glide together when you bend your knee. Your knee joint is surrounded by muscles and ligaments to support your weight and allow your joint to work smoothly.

Severe pain and decreased movement can result as the cushion of cartilage wears away in a knee joint affected by osteoarthritis or other diseases. The joint bones rub against each other, becoming rough, pitted and irritated.

A knee prosthesis is comprised of smooth surfaces, much like a healthy knee. The femoral component caps the end of the thigh bone; the tibial component covers the underside of the knee joint surfaces and allows you to move and walk easily without pain.

What are the risks involved in having a total knee replacement?

We want you to understand the benefits and risks of knee replacement surgery. The ultimate goal is for you to regain function of your knee with minimal pain and discomfort. Most people recover smoothly from surgery. However, complications are possible. These occurrences are rare and are almost always treatable.

Complications you should be aware of:

Blood clots may occur when blood flow is slowed due to the break in activity you will experience after your surgery. The following measures are helpful in preventing this condition:

• Ankle pump exercises after surgery
• Elastic stockings or foot pumps to improve circulation
• Elastic stockings or foot pumps to improve circulation
• Medication to thin your blood
• Getting out of bed several times each day starting either the day of surgery or the next day

Even with the best of care, it is still possible for blood clots to form. It is important that you watch for any signs of blood clots and let medical staff know immediately if you experience any of the symptoms listed below:

• Swelling
• Redness
• Pain
• Tenderness and warmth in the calf or lower leg

Infection is a possibility with any surgery.

• With joint replacement surgery, infection may be at the incision (the surface) or inside your body around your prosthesis. To help prevent infections, you will be given IV antibiotics after surgery.
• It is also possible to get an infection at home, after you leave the hospital. Again, antibiotics generally take care of these types of infections, but in rare cases, additional surgery may be needed to remove an infected prosthesis for replacement with a new one.

Dental Injury

• Teeth may become chipped, loosened or dislodged during your surgery and recovery period. Please let your anesthesia team know of any dental problems you may have.

Reactions to anesthesia or pain medication are other types
of complications that can occur.

• Please let your doctor or anesthesiologist know if you have ever experienced a reaction during a previous surgery.

Nerves close to the joint replacement may be damaged.

• Over time, these nerves may improve, or completely recover.

Knee prosthesis loosening

• Many years after your joint replacement, your prosthetic knee may become loose. Surgery may need to be performed to revise the joint replacement.

Knee Prosthetic wear

• Some wear is common on all joint replacements. Surgery may be needed to revise the joint replacement when the wear is severe. The lifetime of your knee replacement should be between 13 and 15 years.

Knee Prosthetic breakage

• While very rare, the metal or plastic joint in a replacement may break. Again, surgery would be required to revise the joint if this occurs.

Blood donors are routinely screened for:

• Blood type
• Infections
• HIV (the AIDS virus)
• Hepatitis B and C: an infection of the liver and the blood
• Syphilis: a sexually transmitted disease that is also carried by blood
• HTLV: a virus that causes certain infection

Other possible risks include:

• Fever
• Chills
• Rash, itching or hives
• Infection

A Positive Approach

Preparing mentally for your knee replacement surgeryis just as important for you and your family or support person as it is for your surgeon and the rest of the medical team involved in your knee replacement procedure. Because of medical advancements, total joint replacement surgery is possible to relieve your pain and discomfort and improve your activity level.

It is important to remember that the pain and activity limitations after knee replacement surgery will be different than what you are experiencing now, and they will be short term. A significant portion of the recovery process is using your new joint by walking and doing the exercises that your doctor orders.
Depending on your condition, your recovery and exercise plan will be tailored to meet your needs. Each patient recovers differently and joint replacement revisions often progress at a slower pace than the initial surgery.

Your stay in the hospital will be short and your recovery will be continued after discharge in your home, with family, or at an extended care – rehab center. It is important for you to make a commitment to follow your doctor’s instructions and work on your exercise plan after surgery in order to benefit most from the joint replacement. If you or your family need support, either physically or emotionally, coping with surgery and recovery, please talk with the staff.

*The improved lifestyle after recovery is worth the risk and stress of surgery!

The family’s role in your recovery

Your family and friends are very important in helping you during your recovery after your knee replacement surgery. They can help:

• Stock up on canned and frozen or packaged food
• Your family and friends are very important in helping you during your recovery. They can help:
• Stock up on canned and frozen or packaged food
• Move food to cabinets between your waist and shoulder level, helping you avoid reaching and bending
• Prepare a room with all the needed supplies so that you can rest during the day
• Remove rugs and other clutter for safe walking
• Run errands, grocery shop, and drive you to follow-up doctor’s appointments
• Arrange for needed equipment

*Surgery is your primary path toward getting yourself back to being the person you want to be , so don’t let any unnecessary delays stand in your way!

Going Home after Knee Replacement

Discharge instructions

• You will be given written discharge instructionsand prescriptions for any medications needed after discharge.
• We will go over these instructions with you. If there is any information that you do not understand, please ask the staff before you leave.

Recovery

• The past few weeks you have prepared for your knee replacement surgery, waited to enter the hospital, undergone surgery, learned to walk with your new joint, and made plans for going home.
• You are stable enough to be discharged from the hospital. For the next six to eight weeks, you will continue to heal and recover from surgery. You should balance periods of activity with periods of rest.
• Do not try to overdo or push yourself to the point of pain or exhaustion.

Medication

• Resume medications that you were taking before surgery unless instructed otherwise by your doctor.
• You will be given a prescription for pain medication.
  As your pain decreases, you may take Tylenol .
• Your doctor may prescribe medication to prevent blood clots from forming, such as aspirin or Warfarin (Coumadin).
• If you are on Warfarin, it is important to closely follow instructions that your nurse or doctor gives to you.

Activity

• Follow the activity guidelines and exercises as instructed by your doctor or physical therapist.

Hip precautions:

• Limit sitting to 30 – 45 minutes at a time.
• Use your walker or crutches. You may also be instructed to wear a special knee brace which can be removed when sitting or lying in bed.
• Watch for signs of infection and swelling.
• We recommend limiting stairs to one flight up and down per day.
• Use your adaptive equipment and do your exercises to regain strength and function!

Walking

• Use your walker or crutches for each step when walking. Progress to use of a cane when directed by your therapist or physician. You may feel that you can walk without an aid, but the bones take six to eight weeks to heal.
• Walk daily for increasing distances, allowing for rests between activities.

Sitting

• Do not sit longer than 30 minutes at a time. Get up, walk, and change positions.
• On long car trips, stop at 30 minute intervals. Get out and move around.
• With lack of movement, your knee may become stiff, swollen, and you are more prone to blood clots.
• Use a pillow or chair cushion on all low chairs.
• Use a raised toilet seat if instructed to do so.
• Do not rest in recliners. The reclining position does not aide circulation or reduce swelling.

Stairs

• If you need to use stairs, we recommend making only one trip up and down each day. Be careful and hold onto the railing or another person for support when using the stairs.

Sports

• Do not participate in sports during the first three months after your knee replacement surgery.
• Do not use exercise equipment, whirlpools or spas until your doctor tells you it is okay. Please talk with your doctor about the type of sports you like to do.
• You may eventually resume some sports that do not put your knee at risk, such as golfing, swimming, bicycling and dancing.

Sexual activity

After knee replacement surgery, many people are worried about resuming sexual activity. In reality, the pain and stiffness associated with your bad knee before surgery probably already interfered with intercourse.

Since your surgery will help decrease most of that discomfort, you may now be more comfortable during sexual activity. You may resume sexual activities as soon as you feel able.

Water beds

• If you have a water bed, tell your physical therapist.

Driving

• Do not drive until your doctor tells you it is okay.

Care of your wound

• If your wound was closed with staples,arrangements will be made to remove the staples that hold your incision together.
• Wash your incision gently with soap and water and pat it dry.
• You may shower if you have a walk-in shower.
• Do not take a bath.
• Do not use lotions on your incision until your doctor okays it.

Signs of infection

Each day with your bath/shower, look at your incision for the following signs of infection:

• Redness
• Swelling
• Drainage
• If you notice any of these signs, call your doctor immediately.

Antibiotics

• An infection in another part of your body (lungs, kidneys, mouth, skin, etc.) could possibly spread to your new joint.
• Contact your family doctor and orthopaedic
  surgeon with any type of infection.
• To protect your joint you may need to take antibiotics before certain procedures, such as dental care or a surgical procedure.

Swelling

• Swelling (also called edema) is common after surgery. Swelling may or maynot occur in the hospital or after you are home and more active.
• The most common areas for swelling are the foot, ankle, knee, and at times, the thigh.
• To decrease swelling, lie with your operative leg elevated so that your foot is higher than your heart. This can be done during your rest periods for at least 45 minutes, 2-3 times during the day. Also, place a cold pack on the affected area for 20 to 30 minutes.

Compression stocking (if ordered)

• Wear your white compression hose during the day for two weeks.
• Wear them as much as possible, especially during the day.
• Compression hose should be removed at night as they can cause pressure sores on heels.

Follow-up

• If staples were used to close your incision, an appointment for staple removal will be made for you prior to discharge.
• You will need to contact your surgeon’s office to schedule a six-week follow-up appointment.

To understand hip replacement surgery it is important to understand how your hip works. Your hip is essentially a ball and socket joint that allows movement in many different directions. The ball is your upper end of the thigh bone that fits into the socket of your pelvis. When your hip joint is healthy you can walk and move your leg easily and without pain. When the cartilage wears away, the bones rub together, causing pain, stiffness and limited mobility.

An artificial joint can relieve your pain and improve your mobility.

An artificial joint is a metal ball and stem that replaces the worn head of the thigh bone and a metal cup and plastic liner replaces the worn socket of your pelvis. There are two types of total hip replacements-cemented and cementless. Cemented total hip replacements use a bone cement called polymethylmethacrylate to hold the implants in place. A cementless total hip replacement uses an implant that has a rough surface which will allow your own bone to grow into them. Your doctor will choose the best type of hip replacement for you.

Before hip replacement surgery you will need the following:

1. You will need a thorough dental examination to ensure you do not have any dental problems and infections which could travel through your bloodstream and infect your hip replacement. Any infection needs to be treated before your surgery.
2. You will need an examination by an internist to specify any medical problems you may have that may interfere with your hip replacement surgery.

Your doctor will schedule a preadmission evaluation which may include some or all of the following.

• Medical history
• Anesthesia interview
• Blood and urine tests
• Electrocardiogram
• X-rays

During the first six weeks after surgery, while the muscles and tissues around your hip are healing, you will need to follow certain activity restrictions. To help you during your recovery SSI can arrange the following.toro meccanico gonfiabile

• A bi lingual nurse
• A physical therapist
• An apartment/house or hotel with easy access
• Cleaning and laundry services
• Food shopping and preparation
• Massage therapists
• Tours of the island

What’s Wrong with my Hip?

Joint replacement procedures (also called arthroplasties) are done when a patient experiences severe, incapacitating hip pain due to osteoarthritis, rheumatoid arthritis or injury. The old joint is replaced with a new mechanical joint called a prosthesis.

A healthy hip consists of a smooth ball on the end of the thigh bone which fits into the end of the hip socket to form the “ball and socket” joint. A layer of cartilage cushions the ends of these bones, allowing the ball to glide easily within the socket.

A problem hip can be the result of wear and tear to the cushion of cartilage in the hip joint due to osteoarthritis or other diseases. Without the cushion of cartilage, the joint surfaces become irritated and pitted as bone rubs against bone.

The hip prothesis consists of a specially designed ball and socket that replace your worn hip joint. The ball and stem replace the worn ball of your thigh bone. A cup replaces the rough hip socket. The prosthesis has smooth surfaces that fit together and allow the ball to move easily and painlessly within the socket, much like a healthy hip.

What are the risks involved in having a total hip replacement?

We want you to understand the benefits and risks of hip replacement surgery.  The ultimate goal is for you to regain function of your knee with minimal pain and discomfort.

Most people recover smoothly from surgery. However, complications are possible. These occurrences are rare and are almost always treatable.

Complications you should be aware of:

Blood clots may occur when blood flow is slowed due to the break in activity you will experience after your surgery. The following measures are helpful in preventing this condition:

• Ankle pump exercises after surgery
• Elastic stockings or foot pumps to improve circulation
• Medication to thin your blood
• Getting out of bed several times each day starting either the day of surgery or the next day

Even with the best of care, it is still possible for blood clots to form. It is important that you watch for any signs of blood clots and let medical staff know immediately if you experience any of the symptoms listed below:

• Swelling
• Redness
• Pain
• Tenderness and warmth in the calf or lower leg

Infection is a possibility with any surgery.

• With joint replacement surgery, infection may be at the incision (the
  surface) or inside your body around your prosthesis. To help prevent
  infections, you will be given IV antibiotics after surgery.
• It is also possible to get an infection at home, after you leave the hospital.
  Again, antibiotics generally take care of these types of infections, but in
  rare cases, additional surgery may be needed to remove an infected prosthesis
  for replacement with a new one.

Dental Injury

• Teeth may become chipped, loosened or dislodged during your surgery and recovery period. Please let your anesthesia team know of any dental problems you may have.

Reactions to anesthesia or pain medication are other types
of complications that can occur.

• Please let your doctor or anesthesiologist know if
  you have ever experienced a reaction during a previous surgery.

Nerves close to the joint replacement may be damaged.

• Over time, these nerves may improve, or completely recover.
  Please let your doctor or anesthesiologist know if
  you have ever experienced a reaction during a previous surgery.

Hip Prosthetic wear

• Some wear is common on all joint replacements, but if this wear is severe, surgery may be needed to revise the joint replacement.

Hip Prosthetic breakage

• While very rare, the metal or plastic joint in a replacement may break. Again, surgery would be required to revise the joint if this occurs.

Hip Prosthetic loosening

• Many years after your joint replacement, your prosthetic hip can loosen from the bone. Surgery may need to be performed to revise the joint replacement.

Other possible risks include:

• Chills
• Fever
• Rash, itching or hives
• Infection
• Trouble breathing and a fast heart beat
• Chest pain

Blood donors are routinely screened for:

• Blood type
• Infections
• HIV (the AIDS virus)
• Hepatitis B and C: an infection of the liver and the blood
• Syphilis: a sexually transmitted disease that is also carried by blood
• HTLV: a virus that causes certain infection
• Other testing
• Jaundice (yellowing of the skin due to liver problems)

A positive approach
Preparing mentally for your hip replacement surgeryis just as important for you and your family or support person as it is for your surgeon and the rest of the medical team involved in your hip replacement procedure. Because of medical advancements, total joint replacement surgery is possible to relieve your pain and discomfort and improve your activity level.

It is important to remember that the pain and activity limitations after hip replacement surgery will be different than what you are experiencing now, and they will be short term. A significant portion of the recovery process is using your new joint by walking and doing the exercises that your doctor orders.

Depending on your condition, your recovery and exercise plan will be tailored to meet your needs. Each patient recovers differently and joint replacement revisions often progress at a slower pace than the initial surgery.

Your stay in the hospital will be short and your recovery will be continued after discharge in your home, with family or at an extended care rehab center. It is important for you to make a commitment to follow your doctor’s instructions and work on your exercise plan after surgery in order to benefit most from the joint replacement. If you or your family need support, either physically or emotionally, coping with surgery and recovery, please talk with the staff.

*The improved life-style after recovery is worth the risk and stress of surgery!

The family’s role in your recovery

Your family and friends are very important in helping you during your recovery yourhip replacement surgery. They can help:

• Stock up on canned and frozen or packaged food
• Move food to cabinets between your waist and shoulder level, helping you avoid reaching and bending
• Prepare a room with all the needed supplies so that you can rest during the day
• Remove rugs and other clutter for safe walking
• Run errands, grocery shop, and drive you to follow-up doctor’s appointments
• Arrange for needed equipment

*Surgery is your primary path toward getting yourself back to being the person you want to be , so don’t let any unnecessary delays stand in your way!

Going Home after Hip Replacement

Discharge Instructions

• You will be given written discharge instructionsand prescriptions for any medications needed after discharge.
• We will go over these instructions with you. If there is any information that you do not understand, please ask the staff before you leave.

Recovery

• The past few weeks have been full: you have prepared for your hip replacement surgery, waited to enter the hospital, undergone surgery, learned to walk with your new joint, and made plans for going home.
• You are stable enough to be discharged from the hospital.
• For the next six to eight weeks, you will continue to heal and recover from surgery. You should balance periods of activity with periods of rest. Do not try to overdo or push yourself to the point of pain or exhaustion.
• Resume medications that you were taking before surgery unless instructed otherwise by your doctor.
• You will be given a prescription for pain medication.
• Your doctor may prescribe medication to prevent blood clots from forming, such as aspirin or Warfarin® (Coumadin®). If you are on Warfarin®, it is important to closely follow instructions that your nurse or doctor gives to you.

Activity

• Follow the activity guidelines and exercises as instructed by your doctor or physical therapist.

Hip precautions

• Do not cross your legs
• Do not bend your hip to more than a 90o angle
• Do not lean forward more than 90o (such as reaching your feet/covers, or picking up an object on the floor)
• Keep legs 6-10 inches apart
• Use an elevated toilet seat
• Use a cushion for all low chairs

Walking

• Use your walker or crutches for each step when walking. Progress to use of a cane when directed by your therapist or physician.
• You may feel that you can walk without an aid, but the bones take six to eight weeks to heal.
• Walk daily for increasing distances, allowing for rests between activities.

Sitting

• Do not sit longer than 30 minutes at a time. Get up, walk, and change positions.
• Use a pillow or chair cushion on all low chairs.
• Use a raised toilet seat.
• On long car trips, stop at 30 minute intervals. Get out and move around.
• With lack of movement, your hip may become stiff, swollen, and you are more prone to blood clots.
• Do not rest in recliners. The reclining position does not aide circulation or help reduce swelling.

Stairs

• If you need to use stairs, we recommend making only one trip up and down each day. Be careful and hold onto the railing or another person for support when using the stairs.

Sports

• Do not participate in sports during the first three months after your hip replacement surgery.
• Do not use exercise equipment, whirlpools or spas until your doctor tells you it is okay. Please talk with your doctor about the type of sports you like to do.
• You may eventually resume some sports that do not put your hip at risk, such as golfing,
  swimming, bicycling and dancing.

Sleeping

• Avoid sleeping on your side until your doctor okays it. If (when) you sleep on your side, sleep on your non-operative side, placing a pillow between your knees to keep your operative side from crossing midline.

Water beds

• If you have a water bed, tell your physical therapist.

Sexual Activity

After hip replacement surgery, many people are worried about resuming sexual activity. The following guidelines are designed to address some of the more common issues.

Please speak with your physician if you have any specific questions or concerns.

Resuming sexual activities
It is generally safe to resume sexual activity 6 – 8 weeks after post hip replacement surgery as long as you are not having significant pain or stiffness in your hip joint.

Effect of hip replacement on sexual relations

In reality, the pain and stiffness associated with your bad hip before surgery probably already interfered with intercourse.

Since your surgery will help decrease most of that discomfort, you may now be more comfortable during sexual activity.
Safe positions and precautions
There are certain guidelines to follow:

• Do not bend at the hip more than 90°
• Do not move the leg toward the midline
• Do not rotate the leg inward
• Combination of the above activities

Driving

• Do not drive until your doctor tells you it is okay.

Care of your wound

• If your wound was closed with staples, arrangements will be made to remove the staples that hold your incision together.
• Wash your incision gently with soap and water and pat it dry.
  You may shower if you have a walk-in shower.
• Do not take a bath.
• Do not use lotions on your incision until your doctor okays it.

Antibiotics

• An infection in another part of your body (lungs, kidneys, mouth, skin, etc.) could possibly spread to your new joint. Contact your family doctor and orthopaedic surgeon with any type of infection.
• To protect your joint you may need to take antibiotics before certain procedures, such as dental care or a surgical procedure.
• Swelling (also called edema) is common after surgery. Swelling may or may not occur in the hospital or after you are home and more active. The most common areas for swelling are the foot, ankle, knee, and at times, the thigh.
• To decrease swelling, lie with your operative leg elevated so that your foot is higher than your heart. This can be done during your rest periods for at least 45 minutes, 2-3 times during the day.

Compression stocking (if ordered) and foot pumps

• Foot pumps will be ordered for you after your surgery and must be on at all times while you are in bed.
• Wear your white compression hose during the day for two weeks. Wear them as much as possible, especially during the day.
• Compression hose should be removed at nightas they can cause pressure sores on heels.

Follow-up

• If staples were used to close your incision, an appointment for staple removal will be made for you prior to discharge.
• Continue using your medical equipment and doing your exercises until your doctor evaluates you and gives you new instructions.