Knee replacements, together with hip replacements, are probably the most successful operations of our times. It aims to relieve pain and improve function by replacing the existing destroyed bone surfaces of the knee with metal and polyethylene. These materials provide a smooth surface for joint articulation and thereby relieve pain. Potential complications include infection, fracture and implant loosening over time. Infection is the most feared complication as it is very difficult to eradicate in the presence of a prosthetic joint. However, all precautions are taken to prevent this, and it only occurs less than one percent of the time. Careful pre-operative planning is essential with clinical examination, appropriate X-rays, optimization of medical conditions such as diabetes and hypertension , eradication of any infections etc. It is important not to shave the area before surgery as this may increase the risk of infection. As with any mechanical device, it may wear out over time and may need to be revised. Bear in mind that any revision joint replacement is more complicated and riskier than the initial one. However, revisions are usually only required 15 to 20 years later, depending on how active the patient is. Please discuss this surgery in detail with your Orthopaedic surgeon to see if it is appropriate for you. 

We live in an unsafe environment; interpersonal violence and motor vehicle collisions are very common, often resulting in broken bones. More and more fractures are being treated surgically, as functional results are usually better, rehabilitation is quicker, and fewer long term complications occur in surgically fixed fractures. Fractures involving joints are more likely to be fixed surgically as perfect reduction is necessary to prevent joint stiffness and arthritis. Often screws, plates and metal rods are used to fix fractures. Patients often have concerns regarding these implants; however, they are quite safe and do not usually cause any problems in themselves. Sometimes they need to be removed after the fractures have healed. Children’s fractures are usually less complicated to treat and heal quicker, with fewer requiring surgery. Plaster casts are often used to treat children’s fractures. Of course, each fracture is different and must be assessed by a specialist to determine the appropriate treatment. 

Meniscal Debridement or Repair: 

Patients develop meniscal tears as a result of injury or as a result of degeneration. This manifests itself as pain and locking in the knee and it is necessary to either repair the meniscus or remove the torn tissue if it cannot be repaired. This procedure is done arthroscopically via a few small incisions and is often done as a day case. Patients are fully ambulant after the procedure.  

Ligament Reconstruction of the Knee: 

Due to injury usually from sporting activities, there are a number of ligaments that can be damaged around the knee the most common being the Anterior Cruciate Ligament (ACL). Some of the ligament injuries can be managed conservatively but the ACL and the ligaments on the outer aspect of knee will usually require reconstruction. 

ACL reconstruction is done arthroscopically via a few small incisions and patients have a choice as whether to reconstruct their ACL with tendon graft which we harvest from another area around the knee or reconstruct with tendon harvested from a cadaver which we obtain from a tissue bank. Patients require bracing after the procedure and intensive rehabilitation. 

Acromioplasty: 

Acromioplasty is done for patients with impingement and rotator cuff problems of the shoulder. The main problem with impingement is difficulty with overhead activities. Left untreated it can lead to tears in the rotator cuff tendons in the shoulder. The procedure is done arthroscopically via a few small incisions and space is created for the rotator cuff tendons by shaving some bone off the acromion. 

Rotator Cuff Repair: 

When tears develop in the rotator cuff due to impingement and degeneration or due to acute injury, it is important to have these tendons repaired so as regain adequate movements to the shoulder and to prevent premature arthritis of the shoulder which can be a debilitating condition. The procedure is done arthroscopically via a few small incisions and the rotator cuff is then sutured back onto the bone via advanced instruments and implants that we have at our disposal these days. 

Shoulder Stabilization: 

When patients have shoulder dislocations, there is an element of instability that persists especially in young adults. As a result of the dislocation, tissue is torn off the socket of the shoulder joint and this may not heal back with conservative treatment. Thus, it becomes important to repair this tissue back onto the socket to stabilize the shoulder. The procedure is done arthroscopically via a few small incisions and the tissue is the repaired back to its original position via advanced instruments and implants that we have at our disposal these days. 

Carpal Tunnel Release: 

Carpal tunnel syndrome occurs when there is pressure on the median nerve in your wrist resulting in pain and numbness to fingers. Release involves creating more space for the median nerve by dividing the ligament (transverse carpal ligament) that overlies this nerve. It is a minor procedure, done as a day case and would usually heal without complications in 1 week. 

De Queveins Tenosynovitis Release: 

This condition occurs when the sheath and pulley of the tendons moving the thumb, become contracted and results in severe pain when moving the thumb and wrist. Release involves dividing this sheath. Symptoms improve almost immediately. This is done as a day case and would usually heal without complications in 1 week. 

Ankle Arthroscopy: 

Arthroscopy is a procedure where a thin camera is inserted into a joint, in this case the ankle joint. It is a minimally invasive procedure, usually performed via two tiny incisions over the front of the ankle joint. The inside of the ankle is then seen magnified on a monitor in real time. It can be used to treat a variety of conditions that may cause ankle pain, such as cartilage defects (osteochondral lesions), ankle ligament injuries, ankle impingement, ankle arthritis and removal of loose bodies in the joint. In ankle impingement pain caused by bone or soft tissue in the joint can be debrided off easily. Cartilage defects can be removed and drilled with a specially designed device to stimulate new cartilage growth. Although this new cartilage is not the same as normal joint cartilage, it does usually provide some relief. This procedure is performed under general anesthetic and is usually a day procedure. Most patients can walk out of hospital on the same day with minimal pain. 

Hallux Valgus Correction: 

Hallux valgus is the condition where the big toe deviates outwards, usually causing a painful bunion. The pain is the usual cause for presenting for treatment. Each case is carefully examined and classified together with X rays to plan the best operation. There are over a hundred operations described for this condition. Quite often simple changes in footwear (lose the high heels!) can be sufficient to effect pain relief. If surgery is decided upon, it will usually involve one or two osteotomies (cutting the bone to shift it to a better position and holding it with a screw or plate); together with a soft tissue release. Sometimes if there is arthritis in the joint, then a fusion may be the best and most reliable option. A fusion is a procedure where the joint is “stuck together” to lose all movement and therefore reliably achieve pain relief. It is a reliable procedure for pain relief if pain is severe and pre-existing arthritis is present.