Orthopedic surgery can be applied in situations where non-surgical treatments have failed to provide relief from pain or address the underlying condition.

While every patient’s situation is unique, there are some common reasons that orthopedic surgery may be called for:

Severe Trauma or Injury

In cases of severe trauma or injury to the musculoskeletal system, orthopedic surgery may be necessary. These conditions include:

• Fractures that cannot be effectively treated with casting or immobilization alone
• Dislocations
• Severe ligament or tendon tears
• Complex joint injurie

Surgery is performed to realign bones, repair damaged tissues and restore stability and function.

Chronic Pain and Degenerative Conditions

Chronic pain that is caused by degenerative conditions like osteoarthritis, rheumatoid arthritis or spinal disc herniation may require orthopedic surgery after the gauntlet of non-surgical options have been exhausted.

Joint replacement surgeries such as hip or knee replacements can provide significant pain relief and improve mobility for individuals with severe joint damage.

Sports Injuries

Athletes who sustain sports injuries such as torn ligaments (ACL, MCL), meniscus tears or cartilage damage can benefit from orthopedic surgery. Depending on the severity and location of the injury, arthroscopic procedures or reconstructive surgeries may be utilized.

These surgeries intend to restore function, stability and range of motion, allowing athletes to get back in the game.

Congenital or Developmental Abnormalities

Orthopedic surgery may be in order for individuals who suffer from congenital or developmental abnormalities of the musculoskeletal system. These conditions can include scoliosis, hip dysplasia, or limb length discrepancies. Orthopedic surgery can:

• Correct deformities
• Improve function
• Prevent long-term complications

Such surgeries are typically performed on children or adolescents to optimize healthy growth and development.

Infection or Tumor

Orthopedic surgery may be necessary to treat infections or tumors that affect the musculoskeletal system.

Surgeries such as debridement (removal of infected tissues), bone grafting or tumor excision are ways to eliminate infections or remove cancerous or benign tumors. These procedures are essential for:

• Preventing the continuing spread of infection
• Preserving limb function
• Avoiding further potential malignancies

Considerations for Undergoing Surgery

The decision to undergo orthopedic surgery is made on a case-by-case basis, taking into consideration such factors such as the patient’s overall health, lifestyle, and goals.

Orthopedic surgeons, Dr. Matthew Dwyer and Dr. Christopher Phelps, at the Orthopedic Performance Institute will work closely with you to assess your condition, explore more conservative treatment options, and determine whether surgery is the most appropriate course of action.

Contact the Orthopedic Performance Institute in San Antonio or Boerne at (210) 545-7171 for more information or to schedule an examination.

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Your chances of osteoarthritis of the weightbearing joints of the knee and hip increase with age; the condition most often affects middle-aged and older people. Osteoarthritis may first appear between the ages of 30 and 40, though symptoms may not be present in the early stages. Later in life, many Americans will experience joint pain due to arthritis that can make enjoying life very challenging.

When do I need a knee replacement?

When traditional, non-surgical treatment options have failed to manage the pain from an arthritic hip or knee, joint replacement (arthroplasty) can be a valuable tool. The surgeons and staff at Orthopedic Performance Institute are dedicated to combating the effects of osteoarthritis and are determined to guide patients back to an active, enjoyable lifestyle.

We combine patient preparation with advanced surgical techniques, innovative pain management tools, and enhanced rehabilitation strategies to revitalize the lives of patients every day.

Our total joint replacement program allows patients to return to an active, enjoyable life with minimal downtime. The foundation of our program is extensive patient education coupled with comprehensive support to ensure success from the beginning. Prepare to excel!

A knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones are actually replaced.

There are four basic steps to a knee replacement procedure:

• Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
• Position the metal implants. The removed cartilage and bone is replaced with metal 
components that recreate the surface of the joint. These metal parts may be cemented or 
“press-fit” into the bone.
• Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
• Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

What does a joint replacement surgery involve?

Patients should plan on a 1-2 night hospital stay after knee replacement surgery. We then allow the patient to fully recover at home with the assistance of in-home physical therapy and nursing services as needed. A successful recovery is accomplished through extensive patient education and preparation combined with minimally invasive surgical techniques, advanced pain management therapies and rehabilitative support. Surgery itself takes about 1.5 hours; patients should plan to be up and walking with the therapist in the hospital on the day of surgery.

How is pain managed during surgery?

General anesthesia, given by IV, is administered by the anesthesiologist for surgery. Oral medications and additional injectable medications may be given as needed for pain or relaxation.

When should I expect to go home?

You can expect to stay 1-2 nights in the hospital. Most patients are then discharged home with oral pain medication. These medications, when taken as directed, typically provide excellent pain relief at home. A physical therapist will walk with you prior to discharge from the hospital to ensure you are stable and comfortable. It is important to follow the discharge instructions that you will be provided after surgery and that will be discussed in detail in this booklet. Specifically follow the instructions for post-operative pain management to ensure adequate pain relief once you are home.

Who is a good candidate for outpatient joint replacement surgery?

The success of total joint replacement surgery is dependent on several factors. One of the most imperative factors is preparation and education of the patient. Our team is dedicated to ensuring our patients achieve their goals of returning to an active, pain free lifestyle but your
understanding, participation and commitment are imperative to the success of your procedure. These guidelines are the basis of our patient selection strategy for joint replacement surgery. Speak with one of our experienced providers to determine if you are a good candidate for joint replacement surgery.

• Good health
• Appropriate body weight (BMI <40)
• Non-smoker
• Arthritis that has failed to respond to conservative treatment

What are the risks associated with joint replacement surgery?

Our surgeons perform hundreds of successful joint replacement surgeries each year and our staff is dedicated to the safety of each of our patients. However, there are potential complications associated with any surgery. Below are some of the risks associated with joint replacement surgery and the precautions we take to minimize these concerns.

Infection. Prior to surgery, your pre-operative testing will help identify active infections and potential sources of infection. These will be treated appropriately. Surgery will not take place if there is any potential active infection present (ex. skin wounds, respiratory infections, bladder infections). During surgery, our team follows meticulous sterile technique. Patients are treated with IV antibiotics and the surgical site is thoroughly cleansed. Post-operatively, we provide detailed instructions regarding wound care and recommend avoiding dental procedures for six months, including routine cleanings due to the increased risk of joint infection.

If you think you’re a candidate for total knee replacement surgery, contact the Orthopedic Performance Institute.

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Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small incision in your skin.

Arthroscopy may be recommended for these shoulder problems:

• A torn or damaged cartilage ring (labrum) or ligaments
• Shoulder instability, in which the shoulder joint is loose and slides around too much or becomes dislocated (slips out of the ball and socket joint)
• A torn or damaged biceps tendon
• A torn rotator cuff
• A bone spur or inflammation around the rotator cuff
• Inflammation or damaged lining of the joint, often caused by an illness, such as rheumatoid arthritis
• Arthritis of the end of the clavicle (collarbone)
• Loose tissue that needs to be removed
• Shoulder impingement syndrome, to make more room for the shoulder to move around

The rotator cuff is a group of muscles and their tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in the shoulder joint and help the shoulder move in different directions. The tendons in the rotator cuff can tear when they are overused or injured.

During the procedure, the surgeon:

• Inserts the arthroscope into your shoulder through a small incision. The scope is connected to a video monitor in the operating room.
• Inspects all the tissues of your shoulder joint and the area above the joint. These tissues include the cartilage, bones, tendons, and ligaments.
• Repairs any damaged tissues. To do this, your surgeon makes 1 to 3 more small incisions and inserts other instruments through them. A tear in a muscle, tendon, or cartilage is fixed. Any damaged tissue is removed.

Procedures

Your surgeon may do one or more of these procedures during your operation.

Rotator cuff repair:

• The edges of the tendon are brought together. The tendon is attached to the bone with sutures.
• Small rivets (called suture anchors) are often used to help attach the tendon to the bone.
• The anchors can be made of metal or plastic. They do not need to be removed after surgery.

Surgery for impingement syndrome:

• Damaged or inflamed tissue is cleaned out in the area above the shoulder joint.
• A ligament called the coracoacromial ligament may be cut.
• The underside of a bone called the acromion may be shaved. A bony growth (spur) on the underside of the acromion often causes impingement syndrome. The spur can cause inflammation and pain in your shoulder.

Surgery for shoulder instability:

• If you have a torn labrum, the surgeon will repair it. The labrum is the cartilage that lines the rim of the shoulder joint.
• Ligaments that attach to this area will also be repaired.
• The Bankart lesion is a tear on the labrum in the lower part of the shoulder joint.
• A SLAP lesion involves the labrum and the ligament on the top part of the shoulder joint.

At the end of the surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and the repairs that were made.

Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues.

After the Procedure

Recovery can take 1 to 6 months. You will probably have to wear a sling for the first week. If you had a lot of repair done, you may have to wear the sling longer. You may take medicine to control your pain. When you can return to work or play sports will depend on what your surgery involved. It can range from one week to several months.

Physical therapy may help you regain motion and strength in your shoulder. The length of therapy will depend on what was done during your surgery.

Outlook (Prognosis)

Arthroscopy often results in less pain and stiffness, fewer complications, a shorter (if any) hospital stay, and faster recovery than open surgery.

If you had a repair, your body needs time to heal, even after arthroscopic surgery, just as you would need time to recover from open surgery. Because of this, your recovery time may still be long. Surgery to fix a cartilage tear is usually done to make the shoulder more stable. Many people recover fully, and their shoulder stays stable.

Dr. Chris Phelps and Dr. Matthew Dwyer are board certified, expertly-trained surgeons who routinely perform arthroscopic shoulder surgery.

If you feel that you’re a candidate for arthroscopy shoulder surgery and would like an evaluation of your condition, contact Orthopedic Performance Institute in San Antonio at 210-545-7171 or www.orthopedicperformance.com for a consultation.

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• Bones
• Cartilage
• Muscles
• Ligaments
• Tendons

Common knee problems affect flexibility, performance and the ability to bear weight without pain.

POINTS TO CONSIDER ABOUT KNEE PROBLEMS

1. Knee problems can be caused by injury, obesity and various diseases, including osteoarthritis, bursitis and gout.
2. Men, women, and children can all develop knee problems. They can affect all races and ethnic backgrounds.
3. The symptoms of knee problems depend on the type of injury or disorder, but most all of them trigger pain and can limit your range of movement.
4. Don’t try to fight through the pain. Contact a physician if you are experiencing these symptoms:

—You can’t bear weight on the knee
—It’s visibly swollen
—You can’t fully extend or flex it
—You can see an obvious deformity
—Pain, redness and swelling are accompanied by a fever
—You feel as if your knee might give out when you try to walk

TREATMENT OF KNEE DISORDERS

The course of treatment for knee problems depends upon its source. Is the source obvious, like a sports injury, or is it something more difficult to see — if at all — such as the development of osteoarthritis?

A qualified orthopedic surgeon will diagnose your specific knee ailment by taking a medical history, performing a physical exam and ordering tests to pinpoint the exact cause of your pain. Then, the doctor will be able to put together the best course of action for you.

Regarding knee pain, Dr. Alexandra Matthews, Sports Medicine Specialist for the Orthopedic Performance Institute says, “I encourage my patients to never suffer in silence! There have been numerous advancements in the treatment of knee pain, and many ways to treat pain without surgery are available. Two of the latest options include peripheral nerve stimulation — where you use a small simulator to keep the nerve from firing in pain, and Platelet Rich Plasma (PRP) injections — where you use your own blood to heal your knee pain.”

At Orthopedic Performance Institute, our physicians are experts in diagnosing and treating all types of knee ailments. Our mission is to alleviate your pain and get you back on your feet as quickly as possible. If you’re experiencing any of the above warning signs of knee problems, make an appointment today.

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