An orthopaedic surgeon is a child specialist?

The origin of the term 'orthopaedics' dates back to the 17th century, when French physician Nicolas Andry published a book on skeletal disorders called Orthop├ędie.

Due to the widespread prevalence of bone deformities in children then, thanks to rickets, the term ('ortho' meaning straightening and 'paedos' meaning 'children') originally referred to the 'straightening of bent bones in children'!

Today, the term refers to a variety of musculo-skeletal disorders that may result from accidents, sports injuries, trauma, tumors, infection, ageing and metabolic disorders.

What is a 'bionic knee'?

Sounds better than 'total knee arthroplasty', doesn't it? Why not just say 'knee replacement' or better still, 'artificial knee'?

In knee replacement surgery - either total or partial - worn, damaged, diseased or deformed surfaces of the knee joint are replaced with artificial materials. An artificial knee usually has two components - metal (such as titanium) and plastic or polythene.

This type of surgery is commonly performed on elderly patients who suffer from debilitating pain due to osteoarthritis. Individuals who suffer major knee trauma, which causes substantial damage to the joint and surrounding tissues, are also candidates for knee replacement.

Knee replacement surgery is one of many types of joint replacement surgeries. The other frequently performed procedure is hip replacement, which is often performed on the elderly who fall and break a hip. Joint replacement more rarely includes implanting an artificial joint in the shoulder, elbow or ankle.

What is arthroscopy?

This is a 'walk-in, walk-out' procedure that has reduced major surgery to a day-care 'operation' and has patients up and about in a matter of hours. The term 'arthroscopy' is derived from 'arthro' (meaning 'joint' and 'skopein' meaning 'to look'). It means 'to look inside a joint'.

Arthroscope: An arthroscope is a type of endoscope. It is a narrow tube with a lens at the end. An arthroscope is inserted into the joint through a small incision in the skin. Light is shone through the arthroscope on the joint and with fibre-optics, an image is then transmitted back from the site onto a monitor, which is viewed by the surgeon.

During an arthroscopy, the surgeon inserts tiny, pencil-size instruments into the joint through a second incision. The procedure is thus performed by viewing the monitor, not the joint! This is therefore called a 'minimally invasive' surgical procedure.

Advantages: Compared to an X-ray, arthroscopy provides a precise diagnosis. There is also minimal damage to cartilage, ligaments and connective tissue surrounding the joint and recovery time is minimal.

For What: Did you know that an entire knee cap can be removed through arthroscopy? This procedure is also used to repair torn cartilage, reconstruct damaged ligaments, remove loose debris in and around joints and trim damaged cartilage. Damage is common as a result of trauma as well as degenerative diseases such as osteoarthritis.

Arthroscopy is also used to restructure and resurface joints and the surrounding soft tissues. It can be performed on any joint in the body.

Arthroscopy-assisted fracture surgery can be used for femur and wrist fractures. Sometimes arthroscopy is combined with 'open' surgery.

Can you grow cartilage?

Grafting: Cartilage can be grafted from a healthy, non-weight bearing area of the knee to replace damaged cartilage. In this procedure, performed with an arthroscope, a small cylindrical 'plug' of cartilage along with the bone is removed from a healthy area. The plug is then placed in a hole, from where the damaged cartilage was removed.

When many plugs are placed close to each other, it gives the appearance of a mosaic. The procedure is thus called 'mosaic plasty'. When only two or three large plugs are used, the procedure is called Osteochondral Autograft Transfer System or OATS. After a period of time, these plugs fuse with the surrounding tissue and bone and the damaged area is thus repaired.

In The Lab: Tissue engineers are also able to grow cartilage in the lab and implant this 'paste' into damaged knees. This cartilage is grown from cartilage-producing cells in the human body.

Stem Cells: Scientists are now experimenting with doing away with the lab procedure to grow new cartilage inside damaged joints! Biomedical engineers are researching stem cells (cells that differentiate into different types of cells depending on the triggers) to grow cartilage from them.

These stem cells are harvested from human bone marrow and are called mesenchymal stem cells. On their own, these cells differentiate into bone, cartilage, muscle and adipose tissue. If the research is successful, scientists could find a way to encourage the body to grow its own cartilage inside damaged joints.

Is a rotator cuff injury a wrist injury?

The rotator cuff is a shoulder injury, where the rotator cuff - a tendinous sheath that helps move or rotate the shoulder dynamically - is damaged. This type of injury, which may take place due to a fall, is often misdiagnosed as a painful frozen shoulder.

What is a frozen shoulder?

There is a popular tendency to label all types of painful and stiff shoulders as a 'frozen shoulder'. This is incorrect. As is the case with any joint, there are many muscles in the shoulder joint. It is important to diagnose which muscle is damaged before labelling the injury a 'frozen shoulder'.

This is a condition where the 'adhesive capsulitis' (the capsule of tissue surrounding the shoulder) is affected and damaged, leaving scar tissue that is inelastic. The causes of a frozen shoulder are unclear and usually do not involve injury. Among the many reasons are lack of fluid in the joint or an autoimmune disorder. Did you know that heart disease and Parkinson's disease are also associated with an increased risk for developing a frozen shoulder?

What is ACL reconstruction?

The Anterior Cruciate Ligament or ACL is one of four ligaments that stabilise the knee. ACL reconstruction, usually performed through arthroscopy, is a procedure that repairs or reconstructs a damaged or torn ACL. The ligament is reconstructed using a tendon graft that is passed through the inside of the knee joint and secured to the upper leg bone or femur and one of the two lower leg bones or tibia. The tendon used for reconstruction is usually taken from the patient's own patella, hamstring or quadriceps.

What is the difference between a tendon, ligament and cartilage?

A tendon is a band of tissue that connects muscle to bone; a ligament is an elastic band of tissue that connects bone to bone and provides stability to a joint; and cartilage is a soft, gel-like padding between bones that acts as a cushion. It protects joints and facilitates movement.

What is tuberculosis of the spine?

Tuberculosis spondylitis is a condition when the mycobacterium tuberculosis attacks the spine, causing the bones to fracture and vertebrae to collapse. It is usually accompanied by abscesses and tissue formation, which narrow the spinal canal, causing neurological damage as well.

Patients usually experience back pain, loss of appetite, fever, lack of balance, clumsiness and sometimes even paralysis. This condition is diagnosed using several types of tests including an MRI, blood and bone investigations as well as neurological tests. A comprehensive medical history is also important.

Surgery is recommended only in severe cases, where tuberculosis leads to spinal deformities. An orthopaedic surgeon mainly stabilises the spine with rods and screws. This takes the pressure off the nerves and alleviates the neurological symptoms.

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