Surgical Procedures and Techniques

  • Arthrocentesis is a procedure where a needle is introduced into a joint space to remove joint fluid. This procedure can also be therapeutic if an anesthetic or corticosteroid medication is injected into the joint during the procedure.

  • Arthrodesis. See Fusion.

  • Arthroplasty is a procedure to remove and replace the diseased parts of a painful, dysfunctional joint with biocompatible and high-grade metal alloys, plastics or ceramics. Three methods are in general use: excision, partial (half-joint replacement) and total replacement.
    • Excision arthroplasty (also called resection arthroplasty or Girdlestone procedure). In this method one or both of the articular ends of the bones are simply excised, leaving a gap that fills with fibrous tissue. Hemi (half-joint) arthroplasty. One side of the joint only is replaced by a metal or plastic implant.Total replacement arthroplasty. Both joint surfaces are replaced with artificial components.
    A fourth version of joint replacement surgery is revision joint surgery. This surgery is done when a previous joint replacement wears out. It’s more difficult and takes longer than total joint replacement surgery. More information about:

    Total hip replacement
    Total knee replacement
    Knee implants
    Shoulder joint replacement

  • Arthroscopy (also known as orthopaedic endoscopy) is accomplished with a telescopic viewing device inserted into a joint together with specialized surgical tools through small incisions. The surgeon is able to see inside of the joint on a television screen and identify and repair the defect. Injuries within the joints, such as cartilage tears, ligament strains or tears, and cartilage deterioration, are common conditions that can be helped with arthroscopic surgery. Arthroscopic treatment is also used after fractures to remove scar tissue, chips of bone or cartilage or other foreign objects.

  • Bone lengthening techniques are used to correct limb length discrepancies, short stature, limb deformities, bone defects, nonunions and infections, and joint stiffness (contractures). The procedure may be performed in both children and adults. The bone is cut through a small incision (osteotomy); then an external fixator (see fracture fixation) is placed around the leg. The fixator is used to gradually pull the bone apart, leading to new bone formation (osteogenesis) at the site of the lengthening. The bone ends are separated at a rate of 1 mm per day (1/25 of an inch). Muscles must also elongate to match the increasing length of bone.
    More information on limb length discrepancy.

  • Debridement is a general term for removal of debris and can be used to improve your joints. The process can include irrigation (flushing out the joint with fluids), trimming and smoothing the rough surfaces, and removing bone spurs, inflamed synovial tissue (synovectomy), scar tissue and loose fragments from within the joint. It can be done with arthroscopic or open surgery.

  • Endoscopy. See Arthroscopy.

  • Fusion (arthrodesis) is a process where bones are joined together with bone grafts and internal devices like metal rods to heal into a single solid bone. It is done to improve stability, correct a deformity or treat pain. The downside is that the fused joint loses flexibility. However, a fused joint can bear weight better and is more stable than with a joint replacement. It is frequently performed on ankles, wrists, fingers and thumbs. It can also be done on vertebrae in the spine. It’s used for patients with degenerative disk disease, a stress fracture in one of the vertebrae, to stop the progress of a spinal deformity such as scoliosis and to shore up a weak or unstable spine caused by infections or tumors. Most spinal fusions involve relatively small spinal segments.

  • Grafting. See Transplantation.

  • Lengthening. See Bone lengthening.

  • Meniscus transplantation with donor tissue has just recently become possible for some young patients. Because of its shape and complex microstructure, most of the materials tested as replacements have failed. For transplantation, menisci are obtained from a tissue bank. Potential complications include issues with healing and mechanical load.

  • Nerve release surgery relieves pain, numbness, and tingling and prevents the wasting of muscles that are near the nerve that is affected. Of the peripheral nerve compression/entrapment syndromes, carpal tunnel compression is the most common. The second most common is ulnar nerve compression at the elbow. Other nerve compression syndromes include those involving the tarsal nerves and the posterior tibial nerves at the ankle. Surgery isolates the nerves and frees them up. (Also see spinal decompression.)

  • Reconstructive surgery is a very broad category and can range from knee ligament (ACL) reconstruction to total joint replacement to limb lengthening to transplantation.

  • Replantation refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body. Damaged tissue is carefully removed; bone ends are trimmed and rejoined; arteries, veins, nerves, muscles, and tendons are sewn back together; areas without skin are covered with skin that has been taken from other areas of the body; uncovered nerves, tendons, and joints may be covered by a free-tissue transfer, where a piece of tissue is removed from another part of the body, along with its artery and veins. The goal of replantation surgery is to give the patient back as much use of the injured area as possible.

  • Spinal decompression.
    • Diskectomy involves the removal of a portion of a disk to relieve pressure on a nerve. It can be done as an endoscopic discectomy (or percutaneous arthroscopic diskectomy), a microdiscectomy or an open diskectomy. An incision is made, and the herniated disk and any loose pieces are removed. Ideally, just the fragment of disk that is pinching the nerve will be removed, leaving some of the disk intact.
    • Laminotomy and laminectomy involve removing a small amount of the bone over the spinal canal (lamina) to eliminate a source of compression on the spinal cord or nerve root in any part of the back. This source of compression may be part of a herniated disk, vertebra fragment, spinal cord tumor, aneurysm, narrowing of the spinal canal (spinal stenosis) or rough protrusion of bone called a bone spur. During a laminotomy just a portion of lamina is removed to relieve pressure on a nerve or allow the surgeon access to a disk that’s pressing on a nerve. A laminectomy involves removal of the entire lamina.
    • Foraminotomy and foraminectomy are commonly done to treat narrowing of the spinal canal (spinal stenosis), lateral disk herniations or facet arthritis. The foramen is the space in the vertebrae where the nerve roots exit on their path to a specific tissue or organ.  In both surgeries, this opening is expanded by removing bone and soft tissue to provide more space for the exiting nerve roots. When surgery involves removing a large amount of bone and other tissue, it is called a foraminectomy.
      In many cases a combination of techniques are used to ensure a proper decompression of the nerve elements.

  • Thermal capsulorrhaphy (also called Electrothermally-Assisted Capsule Shift or ETAC and thermally assisted capsulorrhaphy or TAC). This fairly recent technique uses heat to tighten the ligaments. It was first used for patients whose shoulders were unstable, but is now being used to supplement other arthroscopic procedures for the repair of injuries where the ligaments have been pulled away from the bone. A small probe that uses radio frequency (RF) electromagnetic energy is inserted into the joint, touches the ligaments and causes them to heat and then shrink. As the heated area heals, dead cells are replaced and collagen is partially replaced. While the RF procedure is not suitable for all patients, it’s become popular because of its simplicity and it’s ease for shortening multiple ligaments at one time. Complications are the same as for normal surgery–recurrent instability and/or loss of motion.

  • Total joint replacement. See arthroplasty.

  • Transplantation of bone, muscle or articular cartilage can be done whenever there is a hole to be filled.
    • Autografting is the most widely performed method of orthopaedic transplantation. It involves moving bone, cartilage cells, or tendon (all three on occasion) from one part of the body to another. Sometimes autograft bone is mixed with allograft tissue to make sufficient volume. Muscle transfer may be necessary if a large area is affected.
    • Allografting involves implanting a matched graft from a donor.
    • Cartilage cell (chondrocyte) culture and transplant involves growing multiple cartilage cells in a culture in the laboratory. A piece of the patient’s own cartilage is harvested arthroscopically from a non–weight-bearing area and sent to a laboratory that expands the cells in vitro for 3 weeks to yield a population of about 12 million cells. The cells are then reimplanted. The chondrocytes will eventually produce a form of cartilage that is very much like the original articular cartilage.
    • Examples of bone transplant situations would include bone tumors or infection, articular cartilage defects, and fracture non-unions and in cases of where particles of debris from a joint replacement cause bone to weaken and disappear (osteolysis). Allograft tendon may be used to reconstruct an anterior cruciate ligament (ACL); Achilles, hamstring or patellar tendon; or stabilize an ankle.
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