Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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In the shoulder, knee, and hip, arthroscopy is the standard. For a rotator cuff repair, the surgeon places small plastic or metal anchors into the bone. Sutures from these anchors are passed through the torn tendon using special needles and tied down to reattach the tendon.
In the knee, meniscus tears are either trimmed back to stable tissue or sutured together. ACL reconstruction involves drilling tunnels and pulling a graft through, fixing it with screws or buttons, all while viewing through the scope.
For hip and knee replacement, MIS techniques focus on sparing muscle. The Direct Anterior Hip approach goes between the tensor fascia lata and rectus femoris muscles, leaving the glutes attached. This eliminates the “hip precautions” (restrictions on movement) required after traditional surgery.
In the knee, partial replacements (unicompartmental) resurface only the damaged part of the joint through a small incision, keeping the healthy ligaments intact. This feels more natural and recovers faster than a total knee.
Robotic arms, like Mako or ROSA, assist the surgeon in bone preparation. The surgeon guides the robotic arm, but the robot restricts the movement to the pre planned safety zone. If the surgeon moves outside the plan, the robot stops.
This haptic feedback ensures bone cuts are accurate to within a fraction of a millimeter. This precision balances the ligaments perfectly and ensures the implant is aligned for maximum longevity.
For fractures, the surgeon uses fluoroscopy (live X ray) to slide rods or plates under the skin. Small “stab” incisions are made to insert screws.
This technique is common for tibia fractures (intramedullary nailing) and distal radius fractures. It stabilizes the bone rigidly allowing for movement, without the massive soft tissue stripping of open plating.
Surgeons now inject biological substances during MIS procedures to speed healing. Platelet Rich Plasma (PRP) or Bone Marrow Aspirate Concentrate (BMAC) is harvested from the patient, concentrated, and injected into the repair site.
This delivers a payload of growth factors and stem cells directly to the healing tendon or cartilage. It is a way to boost the body’s natural response within the minimally invasive environment.
The anesthesiologist plays a key role. Peripheral nerve blocks (like the adductor canal block for knees or interscalene block for shoulders) numb the limb for 18 to 24 hours.
This “pain holiday” breaks the cycle of pain before it starts. It allows patients to wake up comfortable and often go home without needing strong IV narcotics.
Closure in MIS is minimal. Small portals are closed with one or two nylon stitches or sometimes just skin glue and sterile strips.
Waterproof dressings are applied, allowing patients to shower immediately. This simple convenience is a major quality of life factor during recovery compared to keeping a large cast or dressing dry for weeks.
Ice machines (cold therapy units) are standard. They circulate ice water through a pad wrapped around the joint. This delivers constant cold and compression, drastically reducing swelling and inflammation.
Controlling swelling is the key to pain relief and range of motion. A swollen joint is a painful, stiff joint. Mechanical compression helps flush the fluid out of the limb.
Continuous cold therapy units
Pneumatic compression devices for DVT prevention
Control of inflammatory mediators
Reduction of metabolic demand in tissues
Analgesic effect of cooling
Because muscles weren’t cut, they can be used. Patients walking on a total hip replacement or moving a repaired shoulder often start in the recovery room.
Early motion prevents stiffness (arthrofibrosis) and reduces the risk of blood clots. It also sends positive signals to the brain, reducing fear and guarding behaviors.
To go home, patients must meet safety criteria: pain controlled with oral meds, ability to walk or move safely, ability to eat/drink/void, and no signs of complications.
In the MIS model, this often happens in 2 to 4 hours post op. The patient leaves with a comprehensive set of instructions and contact numbers, transitioning the care to the home environment.
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General anesthesia puts your whole brain to sleep; you are unconscious. A regional block creates a “chemical tourniquet” that numbs only the specific nerves going to your arm or leg. You can be awake (with light sedation) and pain free, and the numbness lasts for many hours after the surgery is over.
For knee and hip procedures, you may need a walker or crutches for a few days to a few weeks, depending on the surgery. For meniscus repairs, you might be walking immediately. For complex ligament reconstructions, you might be protected for a few weeks.
Orthopedic implants are made of titanium, stainless steel, or bioabsorbable materials (sugar/acid polymers) that are inert. The body does not “reject” them like an organ transplant. Bioabsorbable anchors eventually dissolve and turn into bone. Metal anchors stay in forever but rarely cause issues.
You can drive when you are off narcotic pain medication and can safely operate the vehicle. For right leg surgery, this requires regaining enough reaction time to brake hard, usually 2 to 4 weeks. For left leg or upper body surgery, it may be sooner, provided you can steer safely.
Arthroscopy portals are tiny (about 1 cm). They heal into small white lines that are often barely noticeable after a year. They are significantly smaller and more cosmetically acceptable than the large scars from open surgery.
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