Reconstructive orthopedic surgery is a highly specialized branch of medicine that focuses on the surgical restoration of the musculoskeletal system, which includes the bones, joints, ligaments, tendons, and other tissues. Reconstructive orthopedic surgeons are educated to conduct a wide range of surgical operations to treat patients who have sustained significant injuries as a consequence of sports or physical activity, blunt force trauma (such as a car accident), or aging-related issues, among other things.
Surgeons who perform reconstructive orthopedics aim to improve the patient's quality of life while also restoring the afflicted part of the body to full or near-full functioning. Although all reconstructive surgeons are educated to heal musculoskeletal system injuries in general, some may specialize in a specific area, such as pediatric reconstructive surgery (children), shoulder and elbow reconstruction, or joint replacement, among others.
Reconstructive orthopedic surgeons may undertake a variety of surgeries while delivering therapy. Joint replacement surgeries of the knee or hip are common procedures in reconstructive orthopedics; these treatments are critical to mobility and can dramatically enhance a patient's quality of life. Restoring functioning to injured limbs or regions is the overriding objective of reconstructive orthopedics.
Types of Orthopedic Reconstructive Surgery
There are several types of joint reconstruction surgery that your doctor can recommend, depending on the location of your damaged joint and the extent of the damage. The most common procedures include the following:
Arthroscopy lets your doctor to make modest joint repairs using a small incision and a tiny fiber-optic camera function. It is a non-invasive therapy approach.
This technique allows the surgeon to relieve pressure in a stiff joint, remove bone spurs, and trim tissues that are causing joint damage. This sort of surgery often includes the knees, hips, and shoulders.
- Joint Replacement Surgery
Depending on your situation, joint replacement surgery might be complete or partial. Your doctor will replace your injured joint with a prosthetic during this sort of surgery.
A prosthetic joint is a carefully constructed artificial joint made of medical-grade plastic, metal, and/or ceramic pieces that move like a natural joint. This surgical treatment is more involved than the others and is used to treat significant joint pain or dysfunction in the hip, shoulder, or knee.
Minimally invasive methods include robotic hip and knee replacement surgery. If suitable, medical technology has improved to the point that complete joint reconstruction surgery can be performed as an outpatient procedure.
An osteotomy is the surgical excision of a portion of bone near a damaged joint. When this is done on an arthritic knee, for example, the arthritic bone is reshaped in such a manner that the weight is distributed evenly, offering pain relief and preventing (or postponing) a total knee replacement.
The synovium, or joint lining, can become inflamed. When this happens, the susceptibility can cause harm to the cartilage and bones around it. As a result, a synovectomy entails surgically removing most or all of the afflicted synovium.
- Arthrodesis (Joint Fusion)
Arthrodesis is the fusing of two bones in a diseased joint to inhibit mobility and alleviate discomfort. It is only used when more conservative approaches are no longer effective.
When Reconstructive Orthopedic is Recommended?
Complex reconstructions are quite unusual in general, as are the ailments that necessitate their use. Joint replacements, for example, are extremely dependable operations, and many clinics do a large number of them each year. Having said that, the following are some of the most typical causes for requiring these uncommon procedures:
- Failed Joint Replacement
Replacement joints can fail for a variety of causes, including implant loosening, fracture, and malposition, as well as dislocations, wound complications, tendon injuries, limb length discrepancy, and loss of function. The shoulder, elbow, hip, and knee are the most commonly replaced joints, and hence the most commonly failed joint replacements.
- Prosthetic Joint Infection
Again, to put “common” in context, PJI occurs in just roughly 1% of joint replacements. The diagnosis and treatment of PJI can be complicated, but our team treats numerous of PJI cases annually.
- Massive Bone Loss
Large quantities of bone can be lost when a malignancy, infection, trauma, or problems from previous surgery are present. There is no one-size-fits-all therapy for severe bone loss since several elements must be considered, such as which bone is affected, its proximity to a joint, the degree of bone loss, and any other underlying disorders.
Bone and joint infections are particularly difficult to manage, but it’s important that they are promptly and properly managed to prevent lasting complications. The surgical procedures associated with bone and joint infections are tedious and require a nuanced approach.
- Failed Orthopedic Surgery
Previous surgeries can result in complex situations requiring the use of advanced and sophisticated surgical techniques to restore function and an elevated quality of life.
- Limb-Sparing Surgery
Patients are regularly given amputations for their severe orthopedic diseases, but it is frequently possible to save these limbs with modern surgical methods that provide patients with a greater quality of life than an amputation would.
- Non-Union of fractures
A fracture that doesn’t heal correctly can cause significant pain and trouble with mobility. Surgery to fix these complex fractures can be demanding, but a team proficient in these procedures can help restore function for patients.
Preoperative Consultation with Your Surgeon
When you see your surgeon, utilize the following checklist to convey the relevant information about you and your orthopaedic condition to your surgeon and surgical team.
- Orthopaedic Issue. Describe how it started, how it hurts you, and what therapies you've tried.
- Medical Background. List all of your prior and present medical issues (diabetes, hypertension, respiratory issues), as well as how they were addressed.
- History of the Family. List any diseases or health disorders that impact your family, as well as any complications that occurred during surgery or anesthesia.
- Current Medications. List the drugs you're taking, as well as the doses. Include any over-the-counter drugs or dietary supplements you regularly use.
- Sensitivities and allergies List. any medications, dietary allergies, and environmental allergies (such as pollen or bee stings). If you've ever had an allergic response, such as a rash, swelling, or difficulty breathing, tell your surgeon. Some drugs and foods may cause you to be sensitive even if you are not allergic to them. Include these drugs and meals on your list, along with a description of any adverse effects you've experienced.
- X-rays, Images, Operative Notes and Lab Tests. Bring copies of medical records, operative notes, x-rays, CT scans, MRI studies, and lab test results — especially those that relate to your orthopaedic problem.
- Questions or Concerns. Make a list of the questions you have concerning your health and the procedure. Talk about them with your surgeon and surgery team. It is critical that you understand the aims of the operation, how the procedure will be performed, any potential risks or problems, and the recovery plan.
Before Orthopaedic Reconstructive Surgery
1. Bring to the hospital:
- A list of all prescriptions, OTC drugs, herbs, and vitamins that you use.
- A list of your medicine and dietary sensitivities and allergies.
- Your insurance card.
- Copies of any legal papers, such as a medical power of attorney or a living will.
- The name and phone number of your primary contact while you are in surgery, or the name and phone number of the person who will be picking you up if you are having same-day surgery.
- Besides a small amount of cash and no valuables or jewelry. Most hospitals supply everything you need, including toothbrushes, bed sheets, and slippers. Men may like their own razor, while women may prefer some cosmetics but not scent.
2. An I.D. band will be given to you. Hospitals may have two patients with the same name, but your number is unique to you. If the band comes off, be sure to have it replaced.
3. Before surgery your doctor and healthcare team will ask you many questions. You may be asked some questions — such as your drug allergies and identification of the surgical site —several times. This repetition is planned, and you should expect these questions from your team. Some questions that you may be asked include:
- Do you have diabetes and take diabetic medications?
- Do you take any blood thinners?
- Do you or any member of your family have a history of problems with surgery — such as adverse reactions to anesthesia — or problems with medications?
4. Your doctor will go through, explain, and then ask you to sign a permission document that details the planned surgical treatment.
5. Your doctor will discuss the surgery location with you before marking the appropriate spot on your skin.
6. Before you enter the operation room, give your mobile phone, reading glasses, hearing aids, and other personal possessions to a friend or family member. When you are awake and recuperating, these items will be returned to you.
What Happens During Different Orthopedic Reconstructive Procedure?
- You will be put in the best possible posture for the operation. This might be on your back or side. The functioning limb will be put in a positioning device, and a tourniquet may be applied to reduce blood loss and improve vision inside the joint.
- Another method for improving your visibility inside your joint is to fill it with sterile fluid. This increases the space around the joint.
- For the viewing device, a tiny incision is created. Additional tiny incisions surrounding the joint allow the surgeon to insert surgical equipment for grasping, cutting, grinding, and suction as needed for joint repair.
- Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.
- Your procedure might take place in an outpatient facility or a hospital.
- The procedure used by your surgeon differs based on the type of surgery and the joint that has to be replaced. You will be sedated shortly before your treatment. This assures that you will not experience discomfort during the arthroplasty procedure.
- Incisions (cuts) are made by your surgeon, and the injured joint is removed. The joint is then replaced with an artificial joint. They seal the wounds with stitches, staples, or surgical glue. Your provider applies a bandage on the joint. A brace or sling may also be required.
- Some joint replacement treatments can be performed by surgeons utilizing minimally invasive methods. These methods need fewer incisions and specialized instruments.
- The recovery time for minimally invasive procedures can be less than it is for traditional procedures. Your surgeon will recommend the most appropriate procedure for you.
- First, you’ll receive anesthesia. Your surgeon may choose to:
- Numb only the surgical area (with regional anesthesia).
- Numb your body from the waist down (with spinal anesthesia).
- Put you to sleep (with general anesthesia).
- Numb the surgical site only (with local anesthesia).
- Following that, your surgical team sterilizes the region around the surgical site using an antibiotic solution. A surgical cloth is draped over the wound.
- Your surgeon creates a skin incision. Guide wires are used to define the region of bone to be removed (often wedge-shaped, but depends on the procedure). The specified region of bone is removed using a special surgical saw.
- The gap in your bone is filled by pulling the bone edges together after your surgeon removes the segment of diseased or damaged bone. Depending on the specifics of your osteotomy treatment, a bone graft may be put into the area where the bone was removed.
- Pins, screws, staples, plates or rods hold the bone in place or realign the bone as it heals. This metal may be temporary or may be permanently placed.
- First, you’ll receive anesthesia. Your surgeon may choose to:
Synovectomy can be performed either openly or arthroscopically.
- Open synovectomy: In this form of synovectomy, a skin incision near the joint is made, and the soft tissue is meticulously dissected. The aberrant synovial membrane layer will be found and removed. Any loose bodies and debris in the joint cavity will be removed. Any adhesions or scar tissue must also be removed. The soft tissue and skin will be sutured back together. A compressive dressing will be applied to the wound.
- Arthroscopic synovectomy: 3-4 tiny incisions will be made on the skin near the joint in this procedure. The surgeon inserts a tiny tubular equipment called an arthroscope with a camera at one end through one incision, allowing the surgeon to observe the joint inside on a screen. Small surgical devices used to cut and remove extra synovium will be inserted into the remaining wounds. Electrocautery is used to control bleeding. After the synovectomy, the skin incisions will be sutured. Over the wound, a compressive dressing is put.
After Reconstructive Surgery
- Remain aware of the medical care you get. Inform your doctor, nurse, or any healthcare professional if something does not seem right, such as the sort of medicine you are taking.
- Expect medical personnel to introduce themselves to you. Keep an eye out for their identifying badges.
- Check to see if your carers have cleaned their hands. The most important technique to avoid the transmission of infection is to wash your hands.
- Help prevent medication errors:
- Make sure health care professionals confirm your identity by checking your wristband or asking your name before giving you any medications or treatments.
- Know what time of day you usually get a medication. Tell your nurse or doctor if a regular medication is missed.
- Be able to identify your pills before swallowing them. Your regular medications may have a different color or shape in the hospital.
- Do not take pills from home. They may duplicate the medications you are getting in the hospital, or they may conflict with them. Tell your physician if you are not getting your regular pills.
- Prevent falls.
- Surgery and postoperative medicines can make even the best athlete feel weak and unsteady.
- Some medicines and extra intravenous fluids may cause a need to empty your bladder frequently. Do not be embarrassed to ask for help. Do it early, before it is urgent. Allow time for busy staff to get there.
- Serious falls occur when patients try to be independent and do not ask for help.
- At night, many people need more help than they do during the day. To ensure your safety, turn on lights, wear glasses, and use non-skid shoes if getting out of bed.
- Wheelchairs should be securely locked before getting in and out.
- Hot water in a shower can lower your blood pressure and cause fainting.
- Visitors should be encouraged to wash their hands before and after their visits.
- Visits from sick friends and family members should be avoided. Children are notorious cold spreaders.
- If personnel move your bedside table or mobile stand, request that they replace it before departing. Otherwise, your water, personal items, phone, or even the call button may be inaccessible.
- Food servers should not simply leave your tray, but instead arrange it such that it is easily accessible.
- Do not be worried if the electronics in your room begins to ping or buzz. It's generally something as easy as your IV signaling the nurse that it's time for a refill.
The musculoskeletal system is treated via orthopedic reconstructive surgery. This includes bones, joints, muscles, ligaments, cartilage, tendons, nerves, and connective tissue, which connects different sections of the body. Orthopedic procedures are divided into two categories: those that repair and reconstruct musculoskeletal components, and those that replace sections of that system, most notably joints.
A musculoskeletal issue in any portion of the body can have a significant influence on a person's daily activities. Surgery to repair or reconstruct the affected body part is a typical therapy for many orthopedic injuries and disorders.
When providing care, reconstructive orthopedic surgeons may perform a wide range of operations. Common operations performed in reconstructive orthopedics include joint replacement surgeries of the knee or hip; procedures such as these are vital to mobility and can vastly improve a patient’s quality of life. Again, the overarching goal of reconstructive orthopedics is to restore functionality to affected limbs or areas.