Arthroplasty surgery (Joint prosthesis)

Arthroplasty surgery is known as joint prosthesis surgery in common. Joints may lose their function because of many reasons. Arthroplasty surgery is the process of re-shaping or re-forming a joint which has lost its functions by surgical ways to make it work again. This method is generally applied on the joints with wide surface.

In arthroplasty surgery, the fiber optic devices are used to examine the inside of joints, and the diagnosis and treatment of the diseases and injuries are ensured. The arthroplasty surgery is done with a couple of small cuts and causes minimal pain, a small scar, and a much more rapid healing process than the open surgery. The arthroplasty surgery depends to the size and area of the operation but it takes approximately an hour. The patients can step on their foot and they can drive after 3 days. The stitches are made from a dissoluble material, so they do not need to be removed. In a wide scale from athletes to housewives,

• Arthroscopies of knee-shoulder-hand and ankle
• Operations of ligament-cartilage-meniscus-tendon
• Cartilage transplantations are applied successfully via modern surgical methods.

Knee replacement

Pains may be experienced because of various reasons in the knees, which bear almost all the weight of the body. Among the most frequent reasons of pain in knees, the wearing outs and degenerations in joint structure take the lead. Knee replacement treatment, which is applied as the last resort in the wearing outs and degenerations in joint structure may enhance the daily functions and living comfort of the patients.

Knee replacement is a special surface coating method consisted of special alloy metals and compressed special plastic implant for the damaged knee joint. The aim is to obtain a joint which can walk every distance and go down-climb up stairs by cutting the contact between the degenerated joint surfaces.

How is knee replacement operation performed?

• Knee replacement surgery is performed with the open surgical method.
• Firstly, the degenerated joint surfaces are cleaned up.
• The operation is like tooth cap. Not the patella but the areas in the edge of the bones are taken out and prosthesis is put on the bone like in the tooth cap process.
• A barrier should be put between the degenerated areas during the knee replacement surgery. Knee replacement is applied for this reason.
• The prosthesis is put on the thigh bone, which is called femur, and shin-bone, named as tibia to make the knee work as previously. Thanks to the prosthesis put on both of the edges of the bones, the bone contact is cut and the pain is eliminated. 
• An alternative method except the open surgery is not applied in knee replacement surgery. The robotic knee replacement operations are also performed with open surgical method.
• A 7-12 cm scar is left in the knee area after the operation.

For which patients is knee replacement applied?

The patient should be strictly examined regarding the complaints and symptoms before the knee replacement surgery.

While taking a decision regarding knee replacement surgery;

• Complaints of the patient
• Findings of the patient
• Radiologic results of the patient should be taken into consideration.
• The aim of knee replacement is comfort. One of the most significant factors is the patients’ inability to walk as much as they need. The restriction of the distance which was walked previously is among the symptoms of knee replacement surgery.

If the patient

• Cannot go down-climb up stairs
• Cannot sit and stand up on a chair
• Wakes up with pain during night
• Has some voices from inside of the knee
• Takes painkillers frequently (every day or every other day)
• If the degeneration of the knee is seen on the x-ray results, knee replacement provides benefits.
• The patients become immobile because of the pain they experience in their knees. They cannot even go to the street for shopping or walking. There are even ones who cannot go to the toilet because of the pains. Knee replacement is suitable for the patients who think their life is restricted and comfort is distorted.

The very poor results in x-ray, magnetic resonance (MR) or Computerized Tomography (CAT scan) are also determinants but the knee replacement is not suggested to the persons who do not have frequent pain in spite of the advanced degeneration on the radiologic screening results.

These complaints are the signs that the degeneration in the knee joint is in its final stage. The patients should be positive about the knee replacement. The success ratio decreases in the patients who decided to have knee replacement surgery because of the insistence of their family or relatives.

The complaints, examination findings and x-ray results should be compatible while taking a decision regarding knee replacement.

What should be done before knee replacement surgery?

• The patient should have a general examination before the knee replacement surgery. Taking the medical history of the patient is important to have information on the general health condition, existing complaints and findings of the patient.
• If there are some additional diseases in the patient, these diseases should also be checked.
• A general physical examination should be made to evaluate the knee movement width, muscle strength and the general condition of the leg before taking a decision about the surgery. In order to determine the degree of the shape distortion of the degeneration in the knee, the needed radiologic screening processes should be completed.
• It should be detected if the patient has any infection spot. The surgery should be decided after the examination of various branches like dentistry, internal diseases and dermatology.
• The patient is requested to be washed with a special soap on the day before the operation. This is important to expel all the microbes in the body which may cause an infection after the operation.
• Shaving of the area where the knee replacement operation will be performed is completed before the operation.
• The doctor should inform the patient on when to stop eating and drinking before the operation. The operator doctor should be given the list of medication which has been used by the patient.
• All the equipments which may be needed by the patient should be placed in the areas where the patient can reach comfortably.
• The things which may be tumbled on while walking at home should be removed.  
• If possible, the areas like couches, closets, showers should be added armlets.
• If the house is double-layered, preferring the lower layer is important for the initial period after the operation.

How many hours does it take to have a knee replacement operation?

Knee replacement operation takes a duration between 45 minutes to 1 hour. But the processes like entrance and leaving the operation room and anaesthesia are added, the operation becomes 2-3 hours.

What should be noted after knee replacement operation?

Knee prostheses vary in type and shape but if the implant is needed to be a durable one, there are some rules.

• The knee joint movement will be almost normal but the movements like crouching down should be abstained.
• The movements like performing salaat or sitting cross-legged should not be done.
• Using Turkish style toilet shortens the expected life of knee replacement.
• The factors which accelerate the wearing-out of knee replacement should be abstained to extend the expected life of the product. The current design and shape varieties allow the 120-130 degree angle to bend if all the necessary exercises are made in a correct and appropriate manner. But the positions of performing salaat or engaging with gardening activities while crouching down toilet shorten the expected life of knee replacement.
• Activities like walking, running, swimming, playing tennis or riding a bike can be comfortably made after the operation.
• If the expected life of the prosthesis is wanted to be extended, a regular exercise and weight control must be ensured.
• In the partial knee replacement operations, the activities like performing salaat or crouching down can be done more easily, but not every patient is suitable for the partial knee replacement operations.
• The patients who had a knee replacement operation should inform their doctors when they have a tooth treatment or another surgical intervention later.

Patients may think like “Will the prosthesis restrict my movements?” before the operation of knee replacement but the operation is performed to make them more comfortable and increase their quality of life. The patients with no weight control and the ones who do not make enough exercise may experience problems after the operation.

May any blow, trauma or aggressive sports harm knee replacement?

Knee prosthesis is a quite durable implant. Getting harmed because of a trauma is a quite low possibility for the prosthesis. The thing which may occur is a fracture or breakage on the bone tissue which the prosthesis is connected in case of trauma and aggressive sports. In this case, the broken bone needs a treatment. However, if the breakage causes a loosening of prosthesis, it should be taken off and replaced with a new one. Extremely aggressive sports are not recommended after the operation.

When to walk after the knee replacement surgery?

This is the most wondered question together with when to climb up stairs. Informing the patients regarding the process after the operation is quite important.

• After the knee replacement operation, the patients are made stand up on the same day or in the next morning. The aim is to make the patient walk with the prosthesis and without any pain. The patient should be mobilized immediately because we want to increase their comfort. The patients should be informed to prepare themselves for this situation.
• It is recommended to use a walking stick during the first walk after the operation. A knee which is immobile quite a long time is mobilized again with an operation, so the patients should be taught how to walk again.
• The walking distance after the operation depends on the patients. Here, the limit is the patient. It is allowed to walk the distance which the patient feels good while walking.
• 1 or 2 days after the knee replacement operation, the patient is ensured to climb up stairs. This situation also depends on the expectations and desires of the patient but after the double-sided knee replacement operations, the patient is expected to climb up stairs 2 days after the operation.
• The walking stick is recommended for only a short time to ensure the balance.
• The patient is expected to leave the walking stick 2 weeks after the operation.
• The patients are sent home 3-4 days after the operation.
• Normally it is healthier to do their own things in the toilet and kitchen for the patients at home. Besides, preparing a sickbed, lying down all the day are not suitable options. Serving to the patients may make their mobilization harder.
• Going out is completely okay when the patients are at home. The aim is to mobilize the patient.

What are the symptoms of loosening in knee replacement?

• Generally the bone leaves the prosthesis as a reason of the loosening. The loosening may be because of infection or a non-infectious separation between the bone and prosthesis. 

The symptoms of loosening in knee replacement are:

• Pain as the initial symptom. In the early stage, a pain occurs when the patient makes a step. Then this pain may be experience while lying down.
• Strange voices coming from the area while moving may be a symptom of loosening.
• If the shape of the leg starts to change, this may indicate a loosening of the prosthesis. Shape alterations like an X leg, O leg may be experienced.
• Another significant symptom is not being able to bend the knee unlike previously.

On the other hand, it has been seen as a result of the investigations that only 3-10% of the patients have loosening cases within the first 10 years after the operation.

May any case like rejection of prosthesis occur in the body?

Prostheses with metal may not be suitable to be applied onto the persons who have metal allergy, the ones who cannot wear ring or necklace and develop a skin allergy when they do so. These patients can use ceramic prostheses. Apart from metal allergy, there is no case of body rejection against the prosthesis. It is frequently seen that the infections in prosthesis are regarded as body rejection falsely. The immunosuppressive drugs should not be used after the operations of knee replacement.

Can the ones who had knee replacement operation have MR and CAT scan?

To have MR and CAT scan is an area of curiosity for the ones who had knee replacement operation. All the knee replacements used in the last 20 years are suitable to have an MR and CAT scan.

May the knee replacement become disjointed?

While the possibility is too low, knee replacement may disjoint. This may happen especially by an accident or falling onto the knee. This situation, which is frequently described as detachment is actually the degeneration of the plastic which has been put to prevent the two metals from grinding each other. Then the plastic material between is worn out, this section may also be replaced.

Can varsity socks be used after knee replacement surgery?

Varsity socks are used in order not to experience any blood clotting problem within the first 3 weeks after the knee replacement operation. Besides, blood thinners are also used. After 3 weeks, there may be no need to use varsity socks and blood thinners.

Is taking out the stitches of knee replacement painful?

Generally the degradable stitches are used in the knee replacement operations, so there is no need to take out the stitches. In the rare cases when the conventional stitches are used, the stitches are taken out with local anaesthesia if needed and the patients feel no pain during the process.

What is the expected life of knee replacement?

Actually the compressed special plastic material in the knee replacement has an expected life, not the prosthesis itself. The new generation prostheses may be used up to 25 years but the point here is how the patients used it and whether they follow the rules. The expected life of prosthesis may be much longer if the patients exercise regularly and ensure the weight control.

In which age is knee replacement applied?

There is no age limit for knee replacement. There is also no weight limit for the patients to have knee replacement operation. In the past, mostly the people in advanced ages were preferred for prosthesis but now renewal of prosthesis is easier so this approach is debatable. In fact, the surgery of prosthesis is a comfort enhancement. If the complaints, findings and x-ray screening necessitate prosthesis, it may be applied. Besides, prosthesis operations come to the agenda in young people because of rheumatic diseases. On the other hand, prosthesis is not applied on all the patients with degenerated joints. Prosthetic surgery should be the last resort if possible when the other treatments do not work.

Can stem cell treatment be applied instead of knee replacement?

Stem cell treatment is not an alternative to knee replacement. Stem cell therapy is not applied on the patients above the age of 60 as a worldwide procedure. It is quite hard to obtain stem cells in the sufficient amount and quality in this age group. In the patients who need a knee replacement, many parts of the joint are disordered. Stem cell application is mostly preferred when there is cartilage damage only in one part of the knee and the other parts are solid. The treatment logics of stem cell and knee replacement are different. Some injections like hyaluronic acid injection may be applied on the patients who cannot have knee replacement surgery but stem cell is not preferred mostly. Stem cell treatment can only be applied in some cartilage damages and in the patients who are suitable for knee replacement. In these patients, there is a lot of joint and cartilage damage.

Robotic prosthetic surgery

The robotic technologies are making progress in the sphere of health as well as the other areas. The MAKOplasty robotic technology which took an important place also in the orthopedics comes to the forefront with its advantages. Besides the easiness in application for the surgeons in comparison with the other methods and sensitive touch comfort, this method also increases the living quality of the patients quite a lot.

What is robotic prosthetic surgery?

In the robotic prosthetic surgery which is known as robotic orthopedics surgery in common, the robot does not perform the operation contrary to the common belief. The robotic system which is used in prosthetic surgery enables a pre-operation planning for the patient on a 3-d model. Having made a special plan for the patient before the operation, the doctor has an opportunity to get the same result after every case besides a correct a sensitive surgery with “The robotic prosthetic surgery” computerized control and direction module.

How is the robotic prosthesis surgery applied?

With a special software under the control of the doctor, it is decided to the style of the operation, location of cuts, type and size of the prosthesis on a pre-operation tomography and all the fine adjustments are done. The process is started in the light of the pre-operation plan, bones of the patients are introduced to the robot by the help of sensors, the final adjustments are done, cut angles are determined and cuts are applied. Then the control of ligament balance is tested on the patient both virtually and with test prosthesis. Finally, the needed final adjustments are made and then the prosthesis is put.

For the patient, the preparation process is not different from any other operation. The robotic devices have been designed to enable the doctor to act more comfortably, prevent the tissues of the patient from getting harmed more and ensure the comfort of the post-operation period.

When is robotic prosthetic surgery performed?

With robotic technology, many processes of prosthesis surgery can be applied in the area of orthopedics and traumatology.

•  Robotic total hip replacement operation. Replacement of the damaged joint in the patients with advanced osteoarthritis or damaged hip joint can be performed with robotic prosthesis surgery.
• Robotic unicondylar knee replacement (Partial knee replacement). Partial knee operations can be performed if only a part of the knee is affected from the osteoarthritis. Partial knee operations are successfully performed with robotic prosthesis surgery.
• Robotic knee replacement surgery. Knee replacement surgery is a special surface coating method consisted of special alloy metals and compressed special plastic implant for the damaged knee joint. Knee replacement operations are performed successfully with robotic prosthesis surgery.
• Patella prosthesis surgery (patellofemoral)

It is also expected that the robotic prosthesis surgery will be used in the shoulder, spine and tumour surgeries.

What are the advantages of Robotic Prosthetic Surgery?

In comparison with the conventional method, the advantages of Robotic Prosthetic Surgery in knee and hip replacement operations are;

• Returning to daily life happens in a shorter period,
• The duration of discharge from hospital decreases,
• Possibility of haemorrhage is less,
• Need to use painkillers is less,
• The expected life of the prosthesis can be longer.

Hip replacement surgery

Total hip arthroplasty or total hip replacement as known in common is the operation of renewal of the damaged joint of the persons who have osteoarthritis or damage in their hip joint. This operation has a 70 year history and it reached its modern state with the developments in technology, operation method and equipment.

In which age can be the hip replacement operation performed?

The operation is performed mainly after the middle age. There is no upper age limit for this operation. It may be performed on any person who has completed or about to complete their bone development. It is an operation which eliminates pain-limping-shortness with quite decent results and exact solutions in the persons between the ages 20-40 especially regarding the problems of developmental hip dysplasia or avascular necrosis, which is the bloodshot of the femoral head.

The illness groups where the hip replacement applied are osteoarthritis, the sequels of childhood illness like hip or growth plate dislocation, rheumatic diseases, inflammation sequels, tumours, advanced age hip fractures and bone necrosis after the problem of bloodshot in general.  If the persons with these diseases could not benefit from other treatments or it is predicted so, these persons are the candidates of hip replacement operation.

How is hip replacement operation performed?

• If the persons do not have an active infection (like urinary tract, throat or tooth infection), blood samples are taken for the preparations of operation and an anaesthetist is consulted.
• If there is no obstacle, the patients are hospitalized on the operation day or the day before.
• Illnesses like diabetes or blood pressure are not obstacles against this operation but they should be taken under control.
• Smoking is not recommended because it may increase the risk of infection.
• The operation can be done under general anaesthesia or only anaesthetising from the waist while the patients are awake.
• A 10-20 cm skin cut is used according to the preference of the surgeon for the operation.
• After taking the damaged bones out and putting the prostheses, capsule, facia, subcutaneous tissues and skin are stitched.
• The patients are taken to the service room bed.
• The patients are allowed to eat averagely 4-6 hours after the operation.
• The patients are made to walk in the same evening or on the next day after the operation.
• The patients have to use varsity socks and walker in this period.
• Medical dressing is applied once in 2 days.

 

What are the symptoms of the patients who need total hip replacement?

• Severe pain is the most frequently seen symptom. It starts initially while walking, and then starts to happen while resting or even during sleep.
• Restriction in movement
• Limping
• And shortness in leg are quite common symptoms and findings.

Can stem cell treatment be applied instead of hip replacement surgery?

The patients who will have the stem cell treatment should be selected very carefully. In the patients who have to get the hip replacement, stem cell treatment does not affect the operation but in some selected cases, the treatment may be applied after explaining the objective results.

Who cannot have a hip replacement?

Contrary to the common belief, this operation can be successfully performed on the young women who plan to get pregnant. Besides this;

• Persons with poor personal hygiene, dementia or mental illness
• The individuals with active infection in their hips
• The ones who have an advanced stage of insufficiency in their arterial or venous blood vessels
• The ones who have muscle paralysis around hips caused by neurological diseases are not the suitable candidates for this operation.
• Most importantly, it is not suitable to have a hip replacement if the surgeon is not experienced or the conditions of the health institution are insufficient, and if the best implants will not be used.

What is the expected life of hip prosthesis?

The prosthesis is expected to be used lifelong when an experienced surgeon places a high quality material at a decent institution. Although there are many factors in this issue, the prosthesis is expected to be durable at least for 15 years if the quality has not been compromised. There are some patients with a hip prosthesis which worked more than 30 years. When the prosthesis completes its life, not all of it but only the connectors may be replaced in the patients who had their routine follow-ups regularly. In some cases when the prosthesis has completed its life, all of it may be replaced, included the main parts which have been put on the bone. In both cases, the physical life of the new prostheses can be same as the first ones.

Walking after hip replacement

Because the complaints like restriction of movement, pain and limping are eliminated after the operation, the patients are made walk the day after the operation. They are walked with walkers initially and the walker or walking stick is left in the duration of 2-3 weeks.

Partial knee replacement

Contrary to the common belief, osteoarthritis is the degeneration, even extermination of the cartilage in the joint. Cartilage tissue works like a pillow in the knee and absorbs the burdens.

If the osteoarthritis affects only a single part of the knee (commonly the inside of the knee), partial knee replacement is the golden standard treatment method. So, how will it be understood if partial knee replacement is suitable for the patient? It is not difficult to make a diagnosis and assess the suitability of the patient. The operation can be decided with the history, examination and x-ray results which had been taken afoot. Sometimes MR results are also demanded to determine the type of prosthesis and finalize the decision.

In general, partial knee replacement is performed like this:

After a small cut on the frontal are of the knee, the joint capsule is opened and the inner bones of the degenerated knee are cleaned. All the anatomic structures are protected in the frontal and external area of the knee. Small implants which are holding onto the femur and tibia are put instead of the degenerated bones and a special polyethylene intermediate is placed between the two implants. Then the capsule, subcutaneous area and skin are stitched and the operation is finished.

What are the complaints of the patients before having partial knee replacement?

The most frequent symptom is pain. The typical pain which increases because of movement is the most frequent reason of consultation. Pain is alleviated with rest. While the disease advances, the pain starts to wake the patient up. Besides the pain,

• Restriction in movement
• Timidity
• Feeling of seizure
• Swellings are the other complaints.

Advantages of partial knee replacement

Partial knee replacement is performed with a much smaller cut than the total knee replacement. Risk of inflammation is lower, healing is more rapid, bleeding is less, and the patients can return their daily life more actively and independently because the anatomic structures and ligaments in the frontal and outside area of the knee are protected. On the other hand, this process should be performed with experienced persons.

How long does it take to have partial knee replacement?

This operation takes 30 min-1 hour if the experienced persons perform as a team.

Is there any age limit for the operation?

The most important risk in osteoarthritis is age. After the ages 40-50, this risk increases, so partial knee replacement can be applied after the middle age. One in every three persons has osteoarthritis during lifetime and this is the most frequent reason of being disabled in elderly group. Women have 3 times higher risk of having osteoarthritis. Weight, family history, figure disorders, previous knee operations (especially meniscus operations) and trauma are the most important risk factors.

When people start walking after partial knee prosthesis replacement?

The period after the operation is when the surgeon is happiest and the patient got rid of the problems like “Will I be worsened? Will I be able to move, walk? …” etc. The patients can walk on the same day or a day after the operation with giving full load. It is enough to use walking sticks for only 1-2 weeks.

 Is physical therapy needed after partial knee replacement?

It is usually not needed for the patients who exercise regularly after the operation but physical therapy is recommended for the persons who are unable to exercise. 

How long does it take to heal after the partial knee replacement?

Healing is so rapid, the skin scars are healed at the end of the 2nd week and then the patients are allowed to take a bath. 

Can we climb up stairs after partial knee replacement?

2 weeks after the operation the patients climb up stairs without a support, and in the first two weeks they can also do so with walking sticks.

What are the symptoms of infection after partial knee replacement?

Although the risk of infection is much lower than the total knee replacement, the indications of infection are redness in the scar area, rise of heat, pain and discharge from the scar for a long time. In this case, a physician should be immediately consulted.

 May pain and swelling be experienced after partial knee prosthesis? How long does the pain last?

The first day after the operation is the period when the pain could be intense. So it is aimed to make the patients comfortable in the first night with effective methods. Some minor pains may be experienced later and they all disappear within a month. The pains are never long lasting and severe and the pains which wake the patients up and prevent them from walking are not seen. Swelling is also not seen or felt slightly for a couple of days.

Are varsity socks used after partial knee replacement operation?

The patients are recommended to use varsity socks for the first 3 months and blood thinners for the first 2 months.

What is the expected life of partial knee replacement?

If the patient is suitable for the operation, if the surgeon is experienced in partial knee replacement, if the material is of high quality and the conditions of the operation room are convenient for the operation, the partial knee prosthesis is expected to be durable for a long time. The expected life of partial knee prosthesis is like the total knee prosthesis and it is aimed to be durable at least for 15-20 years. This period may be longer and the aim is to make it durable for the lifetime. When there is degeneration or loosening, it can be revised with total knee prosthesis conveniently.

Is it normal to hear voices from the knee after partial knee replacement? What are the indications of loosening?

After this operation, there may be some rare voices without pain according to the type of the operation. On the other hand, extreme pains and voices which increase with movement are the indications of loosening. In this situation, the patients should immediately consult the doctor but these are so rare complications. A loosening is never expected during the earlier period and the reason for this loosening should be investigated, too.

Can stem cell treatment be applied instead of partial knee replacement surgery?

The questions of whether the infections of lubricants, PRP’s or stem cell can be applied instead of partial knee replacements are asked frequently.

The injections are the most frequently preferred treatment methods in case of knee osteoarthritis. Informing the patients on this issue is quite important. Injections alleviate the pain, increate the movement and walking distance, decelerate the advancement of the disease but the disease cannot be exterminated.

The best non-surgical injection therapy is stem cell treatment but it is not quite possible to say this stops the disease in the long run according to the up-to-date data.

When the rate of success is compared with the operation, partial knee replacement has no alternative. So if there is a suitable indication, the golden standard is partial knee replacement but to take the right decision, the complaint, history, examination and tests results of each patient should be evaluated separately.

Sports Traumatology

Sport is an engagement which increases the organic immunity of the body, develops, protects and sustains the physiologic capacity of the systems. On the other hand, insufficient preparations before taking up cause injuries. Knee joint is among the top degenerated areas which are suffered from the sportive traumas. The other most frequent injuries happen in ankle, hip, pelvic area, shoulder joint, foot thigh, spin elbow joint, wrist and hands. The immediate diagnosis and treatment of the sports injuries are made in the department of Sports Traumatology.

The duration of treatment can be longer if an immediate and correct action is not taken after sports injuries.

The knee joint injuries, meniscus rupture, injuries of anterior posterior cruciate ligaments can be frequently experienced during sports. Arthroscopic surgical applications are performed in case of these kinds of injuries. The injuries of knee joint, dislocation, tissue squeeze or cartilage traumas may also be experienced. Hip arthroscopy is performed in the treatment of these injuries.

Among the shoulder joint injuries, there are shoulder squeeze syndrome and shoulder dislocation. Shoulder arthroscopy accelerates the healing process in case of these injuries.

Torn meniscus and its treatment

Known as athlete injury in common, torn meniscus can be experienced by everyone.

The main knee joint is consisted of 3 bones: Femur, tibia and patella. Because the joint faces are not very compatible with each other, the knee joint is empowered with the ligaments, cartilages and meniscuses. There are 2 meniscuses in each knee, namely medial and lateral. In the shape of a “C”, meniscuses are the elastic structures which have dense collagen fibre to enable resistance against compression. Working as a shock absorber between the knee joint bones, they increase the compatibility between the bones, scatter the burden onto a wider area and protect the joint cartilages from the high pressure.

How is the treatment of meniscus ruptures?

If the non-surgical treatments cannot prevent the complaints like pain and lock, surgical treatment should be taken to the agenda.

The surgical treatments,

• Total meniscectomy which includes taking the entire meniscus. This process causes decent results in the short term but then causes arthritis in the long run.
• Partial meniscectomy which includes taking only the torn piece of meniscus.
• Meniscus repair. In some cases, the torn pieces can be stitched to each other and repaired. The repair depends on the type of rupture and general condition of the meniscus. This process has decent results but the healing process is longer and the repair is limited to the suitable patients. It is recommended for the patients who have an active life and a decent meniscus tissue. Orthopaedist surgeon always plans to stitch the meniscus but if the meniscus is ruptured so much then they choose partial meniscectomy.
• Meniscus transplantation can be also performed in some suitable patients.

Anterior cruciate ligament treatment

Anterior cruciate ligament ruptures, which are known as a problem of athletes, can be seen in everyone from every age. This problem is observed mainly after the movements of sudden turns and stops in contact sports and decreases the movement capacity and daily activities when not treated.

Knee joint is consisted of femur, tibia and patella and there are different ligaments to tie them each other. There are 4 main ligaments to keep them together and constant. Besides them, the anterior and posterior cruciate ligaments are intertwined with each other, forming an X. These ligaments control the backward and forward movements of the knee. The anterior cruciate ligaments enable the stability to turn while preventing the leg bone from slipping onto the femur.

 Anterior cruciate ligament reconstruction

The solution of anterior cruciate ligament injuries in the persons with an active/sportive life is surgery. Before offering this option, the orthopedics and traumatology specialist will investigate:

• Your age
• Whether you will continue sportive activities
• Whether there are multiple injuries of cruciate ligaments and a meniscus rupture and,
• A Loosening in the knee at the time of examination
• The effect of the injury on your daily life

Anterior cruciate ligament arthroscopy

The surgical process is performed with the close (arthroscopic) surgical method. From a 1 cm cut, a small camera is placed into the knee. Using one or more cuts, the ruptured anterior cruciate ligament is re-formed by using a different tendon or ligament.

The main aim of the arthroscopic surgery is to prevent a potential knee twist, eliminate the feeling of distrust in the knee and obtain a knee which can be used in sportive activities.

It is quite rare to stitch the ruptured anterior cruciate ligaments back together. The ruptured anterior cruciate ligaments are re-structured by using another tendon or ligament, named graft, from the body of the patients or a cadaver.

The grafts can be obtained via various ways:

• The hamstring tendons in femoral area are a common graft source and the most frequently applied method
• The repairs done by using knee tendon (patellar tendon) have been left because of the problems they caused during and after the operation.
• Sometimes the quadriceps tendon from the area of knee to the thigh is used
• A graft from cadaver (allograft) may also be used, this method should be preferred in case of repetitive or multiple ligament injuries.

All the graft sources have some advantages and disadvantages. The specialist orthopedics and traumatology doctor can decide easily to use the correct graft in the arthroscopy.

In the anterior cruciate ligament ruptures, using the patient’s own grafts give better results than the grafts of cadaver. There is no risk of compatibility problems and carriage of a disease but these tissues are limited with respect to amount and size, on the other hand, the grafts of cadaver have no such limits. Especially in the cases with multiple ligaments, the ligaments and tendons from a cadaver are preferred. A minimal disease risk, compatibility problems and the high cost are the disadvantages of the grafts of a cadaver.

Paediatric Orthopedics And Traumatology

The follow-up and treatment of walking disorders, foot problems, congenital deformities, shortness, developmental hip dysplasia and spine disorders of the children below the age of 16 are performed by the experienced specialists of orthopedics.

The most commonly seen orthopedic problem in children is limping. Causes of limping may vary according to the age group.

Ages of 1-3: The most common causes of limping in toddlers are minor traumas. These traumas may cause pain without causing any swelling. Also the pains with temporary synovitis or reactive arthritis and a slight oedema caused by simple viral infections experienced may reveal themselves as limping.

Ages of 3-10: In this age group, temporary synovitis or reactive arthritis with oedema caused by simple viral infections as a cause of limping are more common than trauma. In this age group, traumas are more apparent. The problems which may cause swelling or sensitivity can be detected from the outside.

10 and older: Traumas are the main reasons of limping in this age group and a previous trauma can be clearly depicted by the family and child.

Apart from this, there can be flatfoot or claw foot cases as a reason of limping, besides the shortness of some muscle groups.

The disorders which cause limping in children are:

• Microbial bone inflammation
• Juvenile Rheumatoid Arthritis
• Neurovascular diseases
• Congenital hip dislocation
• Tumours
• Temporary synovitis
• Perthes disorder
• Leg inequality
• Slipped capital femoral epiphysis 
• Osteochondritis dissecans
• Osteoid osteoma

Another orthopedic problem which is common among children is fractures caused by traumas. In this case, the new methods can provide benefits for children.

Which benefits do the new methods in fracture treatment provide for children?

• The problems of wound, sweating, heat rash because of the big plaster casts have been eliminated. The plaster casts which are more suitable for children are used now.
• The children who are a part of the competition system should be admitted to a decent high school for a qualified university. This necessitates the successful results in the tests and a regular attendance. The new technologies and operations performed in fracture treatment enables them to return to the school in a short period.
• For the children who have a potential of being good athletes, the risk of becoming distanced to the sports for a long time due to the fracture is also eliminated.

Hand And Microsurgery

Thanks to the microsurgery, the veins and nerves smaller than 1mm can be operable with extremely small needles and yarns. As a result, the severed organs like hand, arm, foot, leg can be put together again and the planted organs can feel again via the repairment of the extremely thin nerves. The problems like acute soft tissue traumas (vein, tendon, nerve cuts, the skin and muscle tissue losses, amputations caused by squeezing), hand and wrist pains, trigger finger, nerve entrapments, tennis elbow, ganglion cysts are diagnosed and treated in the best manner.

The disorders and operations under hand and microsurgery are;

• Severe hand and arm
• Tendon, nerve, vein injuries
• Fractures in hand and finger
• Congenital hand anomalies
• Nerve entrapments
• Hand tumours
• Trigger finger disease
• Dupuytren’s contracture

 

Treatment of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a disease occurred as a result of the entrapment of the nerve which passes from the wrist in the canal it passes through. The “Carpal Tunnel” is covered with a thick layer in the level and upper area of wrist. In this channel, there are tendons and median nerve which enables the movement of fingers. The median nerve enables some fingers (thumb, index, middle and auricular) to feel and do some movements. The suppression of the nerve causes carpal tunnel syndrome.

How is the treatment of carpal tunnel syndrome?

Firstly, the works which force the hand so much should be abstained. In case of the persons who use their hands and fingers at work, the wrist should not be kept twisted. Besides, the muscles should be strengthened by doing some wrist, hand and finger exercise. Keeping these areas mobile is the crucial point to be protected.

In the treatment of carpal tunnel syndrome, local painkiller and oedema solvent gels are beneficial. Besides, the hand-wrist braces to be used only at night and corticosteroid injections around the nerve also provide a safe and effective treatment. A complete healing can be provided for the persons whose complaints continue despite the medication and other treatment by an approximately 15-minute-simple operation under local anaesthesia. After 2 weeks of hand rest, the patients return to their daily lives.

Limb lengthening and leg length discrepancies

X legs, the functional disorders caused by leg discrepancies and shortness are the problems which can be treated with Ilizarov method today. Thanks to this method which has been successfully applied at Memorial Health Group Orthopedics and Traumatology Departments, the leg length discrepancies can be equalized with the compensation of shortness, shortening of the long leg and lengthening the short leg. Besides, the Ilizarov method is also applied successfully in the treatments of soft tissue losses, curvature and shortness caused by knit failures in bone fractures.

The main solution methods of knit failure are the “distraction osteogenesis” depicted by Ilizarov, which is the method of formation of a new bone while stretching the repair-ancillary tissue on the edges of the broken bones, and lengthening, reformation of the bone holes as the fruits of this term. With the tool named as Ilizarov external fixator, along with the bone reformation application by stretching the repair-ancillary tissues, also the acute shortening and lengthening from another part of the bone are performed.  The Ilizarov method enables the lengthening while correcting the curvature and the knitting is realized while the joint junctions are protected without restricting the daily activities. Thanks to this method, also other structural or functional disorders like the bone holes and infection are corrected and shortness is compensated.

In which diseases is the Ilizarov method performed?

• In the close and open bone fractures
• In the fractures which did not knit together
• In the bone lengthening process (in the cases of height enhancement, poliomyelitis sequel, after trauma and infections, shortness and leg length discrepancy caused by the early closure of the growth plate)
• In the treatment of arm and leg length discrepancies,
• In the bone losses (which generally occur after tumor, trauma or infection)
• In the untreated developmental hip dislocation,
• In podiatric diseases,
• In the bone infections,
• In the restriction of joint movement,
• In the metabolic diseases
• And the structural disorders of bones.

Orthopedic Oncology

Like the other cancer types, bone tumours and soft tissue cancers are also frequent cancer types which threaten life. The exact reason of bone tumours is not known but instant, genetically altered food or the agriproducts which are grown up with unsuitable pesticides, pollution, cell phones and the other devices with electromagnetic waves are blamed.

Bone cancer which is frequently encountered in the legs and arms, is seen in the parts near the knee bones of legs and femur, and in the parts near the shoulder joint of arms. Sometimes it is also seen in different bones like pelvis, scapula or jaw. Bone tumour may not be detected in the beginning and occurs with an ordinary but consistent bone pain. It may cause swellings in the bones right under the skin, like tibia or ribs. Sometimes it is noticed with bone fractures.

The malign bone tumours should be taken off with surgical intervention in most cases. Surgery is usually performed with radiation and chemical therapy to reduce the risk of spread or repetition. This approach is named as organ rescue operation. Operation is needed to take some of the cancerous bone but sometimes amputation is needed. On the other hand, reformation or replacement of the bone is possible in most cases.

On the other hand, soft tissue cancers are seen in muscles, fatty tissues, connective tissues and nerves. Because soft tissue is everywhere in the body, the cancer can be seen in every part of the body. As the tumour is growing in the soft tissue, there may be swellings and lumps in the body. Then it can create pain if any pressure is applied on the nerves and muscles. Among the factors which cause the disease, genetic transition, a long run insufficiency of lymph system, encountering with the chemicals like vinyl chlorides and arsenic, traumas can be counted.

Biopsy is vital for a final diagnosis, the staging of tumour and planning the treatment. While biopsy can be performed directly or via ultrasounding, it can be also performed via CT, with a special biopsy needle. The soft tissue sarcoma is evaluated under 4 stages according to the look and type of spread in the body. Stage 1 and 2 are local. In stage 3, the tumour has spread into the nearest lymph glands, and in stage 4, all over the body. Pet-CT is vital in staging.

Tumour is frequently settled in the arms and legs, so an orthopedic oncology specialist should intervene. General surgery, thoracic surgery, plastic surgery and vascular surgery have important contributions regarding the tumours in head-neck, chest, abdomen and pelvic area. Radiotherapy is important in the deactivation of tumour growth. Early diagnosis, team work and treatment by the specialist doctors of orthopedic oncology are quite vital.

Foot And Ankle Surgery

Ankle, which bears most of the load in the body, has a quite complicated structure. Ankle is a joint which is formed by tibia, fibula and talus bones. There are also some cartilages which prevent the friction of bone surfaces. The injuries of ankle may be caused by the bone structure or the cartilages between the connective tissues, soft tissues and bones. In general, many cases of ankle injuries are caused by sprain. The ankle injuries which are generally attributed to the athletes can be experienced by every person even if they are not engaged in sports. The treatment may depend on the severity of the injury and expectations of the patient.

Ankle sprain is the most common ankle injury among the urgent consultations of the persons, it is experienced both in daily life and sportive activities. The ankle problems may not be always caused by sprain. There may be

• Fractures and breakages caused by trauma
• Lateral ligament ( ATFL, CFL )  injuries
• Achilles tendon degeneration
• Cartilage lesions

Which persons are suffered from ankle injuries most frequently?

Ankle injuries can be seen in everyone. Its reasons can be:

• These are generally known as athlete injures but they can be experienced in daily life, while walking, or even going down from the pavement.
• Especially in the sports like basketball or volleyball which contain a lot of jumps, ankle injuries can be experienced. Contrary to the common belief, football is in the second rank among the sports which cause ankle injuries, but these injuries may be experienced in every branch of sports.
• As the traumatic ankle injuries may be experienced in sportive activities, there are also traumas which occur in accidents, fallings, skiing, or while descending from the pavements or stairs.
• There are also some ankle problems caused by excessive usage. The activities on unsuitable surface or injuries caused by excessive pressure may be seen even if the equipment is sufficient. The problems caused by excessive usage may reveal themselves in the form of inflammation in tendons, soft tissue problems, repetitive oedema, synovitis, bone oedema, stress fracture and so on.  Some partial or total ruptures may also be seen in the muscles.
• Ankle injuries may also be seen in the persons who start sportive activities without any preliminary exercise, caused by the collagen tissue alterations after 35-45 years old.

 

What are the indications of ankle injuries?

The indications may vary according to the type and severity of the injury. The indications may be,

• Swelling. In all the injury cases of ankle, swelling happens after a short time.
• Pain. Pain is the most frequently encountered indication together with swelling. The pain may vary according to the type of injury. Simple sprains and injuries cause less pain, while the injuries like ligament severance or fracture cause severe pain which may prevent the patients from stepping onto their foot.
• Hearing a voice like severance in the foot. A voice can be heard because of the tendon severance or muscle rupture during the activity.
• Purpleness. Purpleness can occur within the first 24-48 hours because of the bleeding. The purpleness may spread onto the heel and toes.
• The indications may be similar to each other in ankle injuries. Especially the symptoms of sprain and fracture are quite similar to each other. It is important to consult an orthopedics and traumatology doctor to detect the problem in time.

How is the treatment of ankle injuries?

The aim is making the patients to return to their daily life as immediately as possible.

The initial treatments are:

• Applying ice: This helps the alleviation of swelling and also pain. A thin towel or muslin should be put between the ankle and ice to prevent any problems on skin. The ice can be applied for 15-20 minutes. This can be repeated for 3-4 times a day.
• Elevation: Putting a pillow or something like that under the foot can alleviate the pain and swelling.
• Rest: Not giving any weight on the foot according to the type of injury accelerates the healing process. The type of rest can be different according to the injury type. 
• Bandage: The ankle can be wrapped with an elastic or simple bandage. It is important not to wrap the ankle so tight to be ensured on the blood circulation.
• These are the immediate treatments in case of ankle injuries. The patient may apply these treatments to themselves if they are able to step on their foot.
• The hot water application which is common among people may cause problematic results. In ankle sprain or acute traumas, hot applications should be abstained. The correct application is the cold one. The warmness may cause a relax feeling initially but then the swelling may worsen caused by the widening of the veins.
• There is no harm in applying olive oil, centaury oil or painkillers on the harmed area.
• If the complaints are not alleviated, the injury may be more serious. Especially in the 3rd stage injuries, there may be problems caused by the function disorders of ankle ligaments if the suitable treatments are not applied.

According to the stage of the injury:

• The ankle can be stabilized with plaster casts or splints,
• Special boots can be worn,
• Or surgical methods can be performed.
• In the advanced stage ankle injuries, physical therapy applications may be preferred according to the type and severity of the injury.

Stem Cell Treatment

Stem cells are a kind of main cells in the human body and they evolve to the different cells according to the need of body. Thee special cells may help to form healthy new tissues in the body. Stem cell treatment may also help to the repair of cells in the damaged tissues. These are the adult type stem cells. Contrary to the common belief, PRP and stem cell treatment are distinct from each other. The stem cells obtained from the adipose tissues of a person can be used in the treatment of many diseases of that person.

Stem cell may be also obtained from the adult tissues like embryonic tissues, adipose tissues, and bone marrow. Adipose tissues have and advantage of collecting, isolating and multiplying more stem cells than especially the bone marrow. Causing less discomfort in patients, it is also easier to obtain stem cells from the adipose tissues, and they have a capacity to multiply more, so the adipose tissue can be regarded as an ideal stem cell source. The stem cells cultivated from the adipose tissues have a strong structure; they have a capacity to evolve to many cells and structures including the vascular ones. They support the vein construction, they are easy to obtain and they are short of the materials which stimulate the immune system, so they cause minimum problems in the patients. So they are ideal in regenerative medicine. Collecting the adipose tissues starts with the careful selection of the focus area. The most frequent donor areas are exterior femoral, abdominal and hip areas. During the process under local anaesthesia, approximately 30 ml lipid is taken by aspiration via special injections. These injections with the collected material are cleaned for 2-3 times with the physiological saline solution, closed and kept for 30 minutes. Then the liquid on the surface is taken off, the sediment is obtained, the injections with the remained lipids are sent to a laboratory under sterile conditions. The multiplied stem cells are kept in a suitable place. They are injected into the needed area. The stem cells obtained from the adipose tissues which are distilled with collagenous enzyme can evolve to many cellular types like the adipose tissue, cartilage, bone, skeletal muscular system, neuronal cells, endothelium cells, cardiomyocytes and plain muscle tissues.

Stem Cell Treatment in Orthopedics and Traumatology

• Joint cartilage damages
• Knee osteoarthritis
• Tendon problems with prolonged healing process
• Fractures which did not knit together
• Ligament injuries including sprain
• Avascular neuroses
• As an accelerating therapy in sports injuries
• Cartilage patch

How many sessions does it take to have the stem cell treatment?

The amount and time of sessions is planned according to the patients in the orthopedics in traumatology. Bu the results may vary according to the situation of the patients and disease.

How is stem cell obtained?

In the orthopedic diseases, stem cell is obtained from the adipose tissues or bone marrow via a special process. The accurateness and method is quite important regarding the liveliness and quality of stem cell.

The process should be carried under special laboratory conditions in order not to carry any possible disease for not to transplant the unwanted cells. Stem cells are generally given via injection method. There are also surgical methods to realize this situation.

Local or general anaesthesia is applied according to the application of stem cell.

In the surgical method, the obtained stem cells are placed on the sheet-shaped carriers called matrix and then they are placed ın the damaged area to heal it. The stem cells are waited to evolve the cartilage structure.

Is the process of obtaining stem cells is painful?

Sedation is used to prevent the patients form feeling any pain. Patients may feel a slight pressure in the process. In the treatment, different painkillers are used according to the injection and surgical method. 

How many times can stem cell be applied?

The stem cell treatment for the orthopedic diseases depends on the problem and the method of stem cell. While more than one session may be applied, a single session may also be sufficient.

The follow up procedure also depends on the process applied. After the surgical method, the follow up may be executed via radiological methods like MR. The most suitable follow up method is the pain level of the patient.

Why Should I Have My Orthopedics and Traumatology Operation at Memorial?

Many different methods can be used in the orthopedic diseases, either together or separately. All the treatment methods in the orthopedic diseases are performed at the Memorial Health Group successfully. It should not be forgotten that the treatment of orthopedic diseases must be performed by specialist doctors and a multidisciplinary approach. The respective surgical operations should be performed at a well-equipped hospital, with and experienced team and buy using all the opportunities of advanced technology. These three important components are existent at Memorial.

The treatment method is determined by a council of specialist doctors as special to the patient and it is aimed to apply the most modern and best therapy to the patients.

Shoulder And Elbow Surgery

The pain felt while carrying a bag, dressing up or reaching to a high place may make the life unbearable. The other reasons of shoulder pain can be sedentary lifestyle, vitamin D deficiency, obesity, a stressed and depressive mood.

Besides the shoulder diseases, the problems experienced in elbow also affect the life in a negative way. Looking unimportant, these problems can make carrying an item, driving, eating or even combing hair difficult. Except the traumas, simple pressures during the day may also cause elbow problems. Besides the ones in the sectors where hands and arms are under pressure, housewives, teachers, athletes and even the instrument players are under the risk regarding elbow problems.  

The problems frequently experienced in shoulder and elbow can be categorized as:

• Arthrosis of shoulder and elbow
• Frozen shoulder
• Shoulder dislocation
• Shoulder impingement syndrome
• Rotator cuff rupture
• Golfer’s elbow
• Elbow restrictness
• Olecranon Bursitis in shoulder

Problems in shoulder and elbow can be treated with arthroscopic and open surgical methods.

Shoulder Ruptures

There are 4 rotator cuff muscles which play an important role in the healthy movement of shoulder. The most frequent ruptures are seen in these muscles. The ruptures are caused by various movements in shoulder joints, being compelled too much and the structural alterations in the muscles of this area by aging. Especially the anatomic structure of the shoulder bone over this muscle group can squeeze the muscles and cause the corruption, degeneration, erosion and ruptures in the long run by aging, especially after a sudden force and long-run activities.

If the rupture is in the advanced stage named as complete rupture, it is beneficial to have an immediate surgical intervention in order not to have an advanced movement restriction and more pain, and these ruptures do not recover themselves. Some patients do not completely understand the seriousness and reject surgical treatment in this stage. So they need to know the efficiency will be lower when they encounter with much bigger surgical processes in the future.