Operative methods
In many instances, particularly where it is found that the non-operative methods are not helping, surgery may be indicated. There is a whole range of orthopedic operations relating to the different tissues of the musculo-skeletal system:
Muscles and tendons – some conditions e.g. strokes, cerebral palsy and other neurological diseases cause a muscle shorten which can lead to a fixed deformity of a joint. In these situations its attached tendon can be divided or lengthened to allow correction of the deformity and, hopefully, improved function of the limb.
With some joint injuries, particularly as a result of a sporting or automobile accident, where there has been a tear or avulsion of an associated ligament it is necessary to operate to repair the tear or reattach the avulsed portion to the bone.
Muscle/tendon transfer – In similar conditions, where one group of muscles is stronger than its opposing group, a similar deformity can occur. The important issue is to obtain a balance of the opposing muscles acting over the deformed joint. In this case a tendon of a strong muscle can be rerouted onto the other side to supplement the weaker muscles and obtain balanced action over the joint which will correct the deformity and aid function. Most but not all injuries to tendons are surgically repaired.
Bones – Operations on bone bone usually involves cutting it with a saw before manipulating the fragments into the required positions (reduced). Once repositioned the cut bone is unstable and has to be stabilised (fixation). Fixation is usually done with an internal metal implant such as a wire, pin, screw, plate or rod. Alternatively an external device such as a cast or traction apparatus is occasionally used. The same techniques are used to fix fractures (traumatic breaks) of the bone, the break having been caused by an external force rather than a saw.
Bones are often cut (osteotomised) to correct a deformity which has occurred and straighten them into their correct alignment. Similarly bone can be cut close to a joint in order to realign the joint surfaces and improve its function. Bone tissue and can be taken from one site and applied to another site in order to fill a deficit in the recipient bone (bone grafting). Where there is a inequality of length of the limbs, a short long bone can cut and then slowly lengthened over the next few months, using special external fixators, until both limbs are of equal length. The healing of the bone is usually inherit within this technique.
Joints – The articulating surfaces of a joint are frequently damaged by a sporting injury, an automobile accident or even just a fall with the underlying bone having been crushed and broken. When this occurs it is necessary to operate and reconstitute the broken parts of the joint and restore the damaged joint suface as much as possible. If the joint is left without attention the bone is likely to heal in a displaced position, leaving a deformed painful joint which has limited function.
In addition to injury, degeneration of a joint’s surface can occur as a result of a generalised disease, such as Rheumatoid arthritis, or a previous injury. With progressive degeneration the joint surface is ultimately lost, the joint becoming painful and difficult to use. If this occurs and the joint does not respond to non-operative measures the only option is often surgery. In this respect an osteotomy of the adjacent bones, or fusion of the affected joint has been effective in the past but, more recently the damaged surfaces of the affected joint are replaced by an ‘artificial joint’ made of a combination of metal and plastic or ceramic parts.
Nerves – injuries to a ‘peripheral nerve’ i.e. a nerve which has left the spine and entered the trunk or limbs can affect the structure of the nerve in one of three ways. The injury may be mild and the nerve merely slightly contused (neuropraxia) in which case it is likely to fully recover. A more severe injury will crush the nerve such that the internal fibres are severely damaged but the nerve itself is still intact (axonotmesis). Recovery, if it occurs, may take several years. Severe compression, lacerating or traction injuries may result in the nerve being divided (neurotmesis) with no hope of regaining function without intervention. If surgery is contemplated early repair may allow the nerve to be sutured in continuity, otherwise the damaged area must be excised and joined by a series of ‘cable’ grafts. The final result of such surgery is never certain.
Tumors – Secondary (or metatstatic) tumors seeding to bone are relatively common. Surgery in these cases is usually palliative, aimed at reducing pain or preventing complications such as the bone fracturing.
Primary tumors of the musculo-skeletal system are relatively uncommon. Benign tumors can often be removed ‘in toto’. For malignant tumors surgery, in conjunction with chemotherapy and radiotherapy, is frequently conducted. The aim many of these operations is palliative but in some cases it is possible to both remove the growth and to reconstitute the affected area or bone in order to preserve function as well as the hope of gaining a cure.
Tissue engineering and regenerative medicine (TERM).
Exciting developments appear to be taking place with regard to the healing of the tissues of the body damaged or destroyed by injury or degeneration. Over the last few years promising research has taken place which shows that under the right circumstances some undifferentiated cells of the body can be stimulated and made to multiply and differentiate into cells specific for the area. Following this process these cells can be inserted into the affected area in which they produce the to replace the tissues in the damaged area with relatively normal cells which then with normal, or as close to normal as can be obtained; the aim of which is to restore the damaged tissue or prevent progression of the disease.
Complications of Orthopedic Surgery
Although an Orthopaedic operation may bring about great improvement in your condition – taking away the pain and allowing you to return to a relatively normal way of life – surgery is not without its hazards. Some of the general potential complications are outlined below:
Anaesthetic agents or can affect the heart and blood vessels, leading to vascular collapse in susceptible individuals with subsequent damage to the heart or brain.
Excessive bleeding can occur during the procedure, again leading to vascular collapse with potential for harm to the individual.
Despite the area of surgery being cleaned and draped with care, operations expose the underlying tissues to infection by bacteria and other micro-organisms. This complication, particularly if it occurs after the insertion of an orthopaedic device, can be difficult to eradicate.
Venous thrombosis can occur, with the risk of pulmonary embolism.
Post operative chest infections, wound infections and other complications can occur.
Unexpected mishaps can happen.
Implants, if inserted, can be mal-placed, may shift, or may break.
Not all surgical procedures are curative.
N.B. You should therefore not approach any operation or injection in a blasé manner and your expectations for the result should be realistic. Before any surgery you should discuss the pro’s and con’s of the procedure with your surgeon and its possible outcomes. You must understand the aim of the operation, and its potential benefits weighed against its possible disadvantages and/or complications.