Dr. Scott Smith

Because joints are in constant use, they often wear out over time due to overuse or aging. Joint reconstruction or replacement may be required to relieve the resulting pain and restore function. Most joints in the body, including the neck, shoulders, elbows, wrists, hands, hips, knees, ankles and feet, are synovial, permitting movement and articulation. When these joints suffer traumatic injury, or when the cartilage that normally protects them wears away, surgical repair or replacement may be necessary. Reconstruction and Replacement Surgeries Depending on the extent of the damage, there are several surgical options to repair or replace joints, varying in complexity, durability and recovery time. Joint Replacement Surgery Joint replacement is a complicated procedure, usually performed on the hip, shoulder or knee. Prosthetic joints used in the process are made of plastic and/or metal and are designed to move the same way natural joints do. Joint replacements may be cemented or uncemented. Cemented prostheses are often used in older patient whose bones are weaker and who are less active, while uncemented prostheses are used in younger, more active patients. The procedure with the uncemented device takes longer to heal because it requires growth of the patient's bone, but it results in greater mobility. In either case, the artificial joint typically lasts for 10 to 15 years, so the surgery may have to be repeated. In the case of younger patients, it may have to be repeated two or more times. Arthroscopy Arthroscopy is a minimally invasive procedure that is diagnostic as well as reparative. It is performed with a device called an arthroscope which enables the surgeon to magnify, as well as visualize, the site on a video monitor. The arthroscope is inserted through tiny incisions at the site through which the doctor can also make minor adjustments, such as trimming cartilage, removing bone spurs or releasing tight ligaments. Osteotomy Osteotomy is a procedure during which a section of bone is cut in order to realign the damaged joint. This procedure is typically performed on the knee or hip for younger patients who do not want to have joint replacement surgery yet. Resurfacing Surgery Most commonly performed on the hip, resurfacing is helpful to young patient and patients with medical conditions that make a hip replacement inadvisable. During resurfacing, only damaged cartilage is removed and a metal cap is placed over the ball portion of the hip. Although the surgery is less complex than hip replacement, resurfacing does not have as long a track record and so far it appears to be associated with a higher risk of complications. Arthrodesis Arthrodesis, commonly known as joint fusion, is a surgical procedure during which the surgeon uses various wires, pins, screws and plates to position the bones correctly until they fuse. This fusion will prevent painful movement. If there has been significant bone loss, a bone graft may be necessary. The bone to be grafted may be taken from another area of the patient's body, obtained from a donor bank, or may be made of synthetic material. Small Joint Surgery If joints in the hands or feet become so badly damaged that everyday activities are unmanageable, they may be replaced. In such cases, the goal is to restore enough mobility for the patient to resume performing simple tasks like using utensils or putting on shoes. Joint reconstruction and replacement have provided great relief to patients suffering from chronic severe pain. By restoring movement as well, joint surgeries enable patients to lead more active, productive and comfortable lives.

Anterior lumbar interbody fusion (ALIF) is a surgical procedure performed to alleviate persistent lumbar pain, or pain in the lower region of the back. Currently one of the most frequently used spinal fusion techniques, ALIF is performed from the anterior of the spine through the abdomen. Interbody fusion refers to the removal of an intervertebral disc, which is replaced with a bone spacer during the fusion process. This method of anterior incision is chosen when the targeted area of the spine is closer to the front of the body or when the level of instability present is not too great. A major advantage of anterior entry is that a larger implant can be incorporated into the procedure. Reasons for ALIF ALIF is performed to treat nerve compression and its associated pain. Such compression of spinal nerves may occur as a result of: Disc degeneration Abnormal curvatures of scoliosis or kyphosis Fracture of one or more vertebrae Spondylolisthesis, slippage of one vertebra over another Spinal stenosis Spinal instability Patients with persistent low back pain, which often radiates down the leg, may be candidates for ALIF if more conservative treatments, such as rest, non-steroidal anti-inflammatories (NSAIDs), physical therapy and corticosteroid injections, have not been effective in relieving their symptoms. The ALIF Procedure The ALIF procedure is performed under general anesthesia with the patient lying face up on an operating table. The surgeon makes an incision on the side of the abdomen near the affected area. The muscles of the back and the nerves do not need to be moved from this approach. The injured disc and any bone spurs or other debris are removed. A bone graft or some bone morphogenetic protein (BMP), an FDA-approved substance that helps to stimulate bone growth, is then attached to connect the affected discs. Any necessary devices to ensure spinal stability as the vertebrae fuse are also implanted. BMP, discovered in the 1960s, is a protein extract found naturally in the body which can also be created artificially. Its use represents an advancement over previous surgeries, since in assists bone fusion and often eliminates the need for either extracting a bone graft from the patient or using a donor bone graft. Recovery From ALIF Patients usually have a smooth recovery from ALIF. After the procedure, they normally remain in the hospital for 3 to 5 days and are able to resume their activities after 6 to 8 weeks. Patients are advised to avoid bending and stretching for 8 weeks and may be restricted from strenuous exercise for a somewhat longer period, depending on their particular circumstances. Patients have to refrain from driving for as long as they require prescribed pain medication. ALIF carries the same risks as other surgical procedures, including risks of excessive bleeding, damage to adjacent tissue, breathing difficulties and adverse reactions to anesthesia or medications.

Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. During an arthroscopic procedure, a device known as an arthroscope is inserted into a small incision in the knee. Through this tube, a thin fiberoptic light, magnifying lens and tiny video camera are inserted, allowing the doctor to examine the joint in great detail. Arthroscopy may be a diagnostic procedure following a physical examination and imaging tests such as MRI or CT scans or X-rays. It may also be used as a method of treatment to repair small injuries in the knee. Knee Arthroscopy as Treatment Relatively minor knee damage is frequently treated using arthroscopic techniques. Most knee damage results from sports injuries or osteoarthritis. During an arthroscopic procedure, the surgeon may be able to treat: Loose bone or cartilage Meniscal tears Torn ligaments Synovitis (swelling of the joint lining) Misalignment of the patella (knee cap) Inflamed tissue In patients with osteoarthritis of the knee, arthroscopy is also used in the removal of dead tissue, a process known as debridement. Benefits of Knee Arthroscopy Because it is minimally invasive, arthroscopy offers the patient many advantages over traditional, more invasive, surgery. These include: No cutting of muscles or tendons Smaller incisions Less bleeding during surgery Less scarring Shorter recovery time Shorter and more comfortable rehabilitation Candidates for Knee Arthroscopy Knee arthroscopy is quickly becoming the ideal procedure for many conditions affecting the knee. Its minimally invasive advantages allow patients to receive fast and simple pain relief, increased range of motion and restored function, while avoiding or delaying the need for joint replacement surgery. Despite its many advantages, arthroscopy is not appropriate for every patient. Some patients, especially those with knee problems that are in difficult-to-see areas, may benefit more from conventional surgery. The Knee Arthroscopy Procedure Knee arthroscopy is performed on an outpatient basis under local or general anesthesia, depending on the type and severity of the condition, as well as the patient's personal preference. During the procedure, the surgeon inserts the arthroscope into the knee through a tiny incision. This instrument is used to identify any damage or abnormalities within the knee, or to confirm the diagnosis of a previous imaging exam. If damaged areas are detected, they can be repaired during the same procedure by inserting surgical instruments into additional small incisions. Recovery from Knee Arthroscopy After a knee arthroscopy , patients often experience swelling and pain for several days. These symptoms can be controlled by the usual home remedies: resting and elevating the leg, applying ice and taking over-the-counter painkillers. Patients are encouraged to get up and walk around as soon as possible after the procedure, although crutches or a cane may be needed for some period of time. Most patients can usually return to work within a week, but will need to undergo physical therapy in order to restore full range of motion to the joint. Most patients can resume light physical activities after a few weeks, although full recovery from knee arthroscopy may take 12 weeks or longer. Risks of Knee Arthroscopy While knee arthroscopy is considered safe for most patients, there are certain risks associated with any surgical procedure. These risks include: infection, blood clots, accumulation of blood in the knee, nerve damage or adverse reactions to medications or anesthesia. In the great majority of cases, the knee arthroscopy goes smoothly.

Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to diagnose or treat certain conditions. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to precisely identify and target joint abnormalities. Orthopedic surgeons may perform a shoulder arthroscopy to diagnose and treat several different conditions of the shoulder. With this type of procedure, patients benefit from less tissue damage, shorter recovery times, less scarring and less post-operative pain than traditional open procedures. The use of this technique also avoids cutting any muscles or tendons in order to gain access to the affected area. Arthroscopy is an ideal treatment option for many patients suffering from shoulder conditions. Candidates for Shoulder Arthroscopy Shoulder arthroscopy, also known as shoulder scope, is often performed to confirm a diagnosis after a physical examination and other imaging tests have been performed. Some shoulder conditions may also be treated during the same procedure by inserting a few additional instruments into the joint area. Arthroscopy may be used to treat conditions that affect the shoulder joint which may include: Rotator cuff tears Labral tears Impingement syndrome Tendonitis Bursitis Joint arthritis Arthroscopy provides many benefits over traditional open shoulder surgery, including smaller incisions, less trauma and shorter recovery times. The Shoulder Arthroscopy Procedure The shoulder arthroscopy procedure is performed while the patient is sedated under general anesthesia, and is usually performed on an outpatient basis. During the procedure, the surgeon will insert the arthroscope into a tiny incision in order to thoroughly examine the cartilage, bones, tendons and ligaments within the joint. Any damaged areas may be repaired during the same procedure by making several other small incisions through which surgical instruments are inserted. The type of repair performed will depend on the patient's individual condition, but may include removing inflamed tissue, reattaching torn tissue or replacing damaged cartilage. Once the repair is completed, the incisions will be closed with stitches and a dressing will be applied to the area. Risks of Shoulder Arthroscopy While arthroscopy is considered safer and less invasive than traditional surgery, there are risks associated with this procedure which may include: Bleeding Blood clots Shoulder stiffness Shoulder weakness Nerve damage and infection are also possible complications associated with the shoulder arthroscopy procedure. Recovery from Shoulder Arthroscopy After surgery, patients can usually return home the same day, although an overnight hospital stay may be required in some cases. Patients are encouraged to ice the shoulder and keep it immobilized in a sling for about a week. Some patients experience mild to moderate pain after this procedure, and medication is often prescribed to control pain. Most patients can return to work within a few days after their procedure, although physical activity may be limited for a longer period of time. Full recovery from the shoulder arthroscopy procedure may take anywhere from one to six months, depending on each patient's individual condition. A physical rehabilitation program helps patients restore function to the joint and ensure that it heals properly. Once the shoulder has fully healed, most patients experience restored function, pain relief, improved range of motion and improved stability of the shoulder.

Hand surgery can restore function, relieve pain and improve the appearance of the hands for patients suffering from injury or arthritic disease. Such surgery is usually performed under general anesthesia or local anesthesia with sedation on an outpatient basis. Many hand surgeries may be performed laparoscopically, allowing patients to benefit from smaller incisions, less scarring and bleeding, and shorter recovery times. Hand Surgery Procedures There are several types of surgical procedures performed on the hand. Depending on the type and the extent of the damage, injured tissue may be removed from the joint, tendons and ligaments may be repositioned, a joint may be fused, nerves of tendons may be repaired, or the entire joint may be replaced with a prosthetic. Arthrodesis or Fusion Arthroscopic arthrodesis (fusion) is a surgical procedure used to treat severe cases of degenerative osteoarthritis. This procedure involves fusing the bones of the affected joint in order to manage pain. During arthrodesis, all cartilage is removed from a joint and two or more bones are joined so they do not move. Fusions may be performed with screws, plates or pins or a combination of these materials. While the patient will have somewhat limited movement after arthrodesis, the surgery provides more joint stability and excellent pain relief. Arthroscopy Arthroscopy is a minimally invasive procedure that allows for careful examination and minor repairs of a joint. An arthroscope, a thin tube with a miniature camera attached to it, is inserted through a small incision, allowing the surgeon to view and treat the joint by removing torn cartilage or bone fragments. Osteotomy Osteotomy is a procedure used to remove a section of bone near a damaged joint. This procedure involves involves cutting or repositioning the bone to restore proper alignment and treat osteoarthritis. Synovectomy Synovectomy is a procedure that removes the synovium, or the tissue lining of the joints, to reduce pain and swelling. It is used to treat patients with rheumatoid arthritis and may also be effective at slowing the progression of the disease. Repairing Flexor Tendons Flexor tendons attach the bones of the fingers to the flexor muscles, the muscles that help the fingers to bend. When a flexor tendon is partially torn, the fingers may still bend, but the movement will be painful. There is increased likelihood that the flexor tendon may eventually tear all the way through, resulting in complete inability to move the finger joints. In order for a cut tendon to heal, surgery must be performed. Even with surgery, complete normal function does not normally return. Physical therapy may assist in releasing scar tissue and increasing mobility after surgery. Nerve Injury Repair Hand nerves are delicate and may be damaged not only by cutting, but by pressure or stretching. Injured nerves disrupt transmission of signals between the hand and the brain, causing loss of feeling and muscle dysfunction. In order to repair a nerve, the hand surgeon has to sew the torn ends of the nerve together, a very delicate procedure in which every effort is made to line up nerve fibers precisely. At times, where there is missing nerve tissue, a nerve graft is necessary to re-establish contact between the two ends of the nerve. When a nerve repair operation is performed, the nerve fibers eventually regenerate and function normally, but this may take a long time, sometimes years. When a graft has been done, there may be some permanent loss of feeling in the area from which the nerve graft was taken. During recovery from nerve injury repair, it is common to experience a pins and needle sensation which eventually passes as healing takes place. Risks of Hand Surgery As with any type of surgical procedure, there are certain risks associated with hand surgery, including: Adverse reaction to anesthesia Nerve damage, loss of sensation Blood clots Postsurgical infection Limited range of motion These risks are considered rare, especially when the surgery is performed by a skilled and experienced hand surgeon. Recovery from Hand Surgery After hand surgery for the treatment of arthritis, patients may experience mild to severe pain for which oral medication is typically prescribed. Depending on which surgery has been performed, the hand usually requires immobilization for a few days to a few weeks as it heals. Patients typically require a course of physical therapy in order to restore as much function and range of motion as possible.

Disorders of the foot develop from a wide range of causes, many of which can be treated with reconstructive foot surgery. Reconstructive surgery can help repair congenital defects, diseases and injuries, often alleviating aesthetic concerns at the same time as it relieves serious medical symptoms and restores normal function. While conservative treatments are frequently the first response to foot disorders, in many cases, reconstructive surgery may be the best available option. Most often, reconstructive foot surgery can be performed outpatient, with minimally invasive techniques, sometimes right in the doctor's office. Reasons for Reconstructive Foot Surgery Reconstructive foot surgery can be used to treat a wide range of foot problems which, while they may result from physical trauma to bone or muscle, may also stem from disorders of various body systems that interfere with circulation, tissue health or locomotion. Patients may require reconstructive foot surgery because of: Hereditary or traumatic deformity Vascular disease Metabolic disorder Tumor Infection Arthritic disease Surgery can involve any part of the foot and may involve skin, tendon, bone, joint, ligament or muscle repair. Screws, pins, wires and plates may be required to help the foot heal and ensure full recovery. Common Types of Reconstructive Foot Surgery The type of surgical procedure performed depends on the type and severity of the problem, but, regardless of type, the surgical goal is to alleviate pain and restore weight-bearing stability, function and normal appearance. Types of reconstructive foot surgery commonly performed include: Hammertoe repair Bunionectomy Endoscopic plantar fascia release Fasciotomy Open ankle fusion Ankle replacement (arthroplasty) Toe or ankle amputation Tumor removal Removal of ganglion cyst Recovery time varies, depending on the specific surgical procedure performed. For most varieties of reconstructive foot surgery, the patient's foot will have to be immobilized with a bandage or cast for a period of several weeks to many months and the patient may require crutches until the foot can bear weight. After surgery, a program of physical therapy will be necessary to assist the patient in regaining full strength and range of motion.

Anterior cervical discectomy and fusion is a combined surgical procedure to decompress spinal nerves and stabilize the cervical spine. This surgery is performed to relieve pain, numbness and weakness in the neck and upper back and to provide stability in this portion of the spine. As the name indicates, this procedure is performed through an incision at the front, or anterior, of one side of the neck. With this surgical approach, the disc can be accessed without disturbing the spinal cord, the neck muscles and uninvolved spinal nerves. The operation is performed under general anesthesia. The cervical spine begins at the base of the skull and consists of seven vertebrae with discs between them. One of the most important parts of the body, the neck is also the most articulate portion of the spine, moving more freely and in more directions than the other sections. Beyond that, the cervical spine is also responsible for protecting the spinal cord and providing support to the skull, which in turn protects the brain. Because of the neck's vital functions, injury or disease of the cervical spine is a very serious condition. Reasons for an Anterior Cervical Discectomy and Fusion An anterior cervical discectomy and fusion is considered when there has been severe damage to the upper spine following a fracture or when a congenital abnormality or degenerative disease has weakened the area badly. This may occur as a result of osteoarthritis or a herniated disc. An anterior cervical discectomy and fusion is usually performed when a patient is experiencing debilitating pain because cervical nerves are being compressed or when there is excessive motion between the vertebrae of the cervical spine. The Anterior Cervical Discectomy and Fusion Procedure During the cervical discectomy, a disc that has been herniated or ruptured is surgically removed. The discectomy eliminates pressure on the compressed nerve and so relieves the pain and other symptoms such compression causes. During the cervical fusion portion of the surgery, two or more damaged vertebrae are joined through the use of a bone graft so that they will eventually grow together. The bone graft is used as a spacer to keep the bones from rubbing against each other during the process. The bone graft is either taken from another part of the patient's body, usually the hip, or is harvested from a donor bank. While a material known as morphogenetic protein may be used to replace a bone graft in other spinal fusion surgery, it is not used in the anterior cervical procedure since it can sometimes cause swelling and interfere with swallowing. The fusion increases spinal stability and decreases the pain associated with misaligned cervical movement. Typically, a metal plate and screws are used to increase stability as the bones fuse. This process usually takes from 3 to 6 months. Immediately following the surgical procedure, the patient is fitted with a cervical collar for extra support of the neck region. Risks of an Anterior Cervical Discectomy and Fusion Procedure Although this procedure is considered a safe one, there are risks associated with any spinal surgery. These may include: danger of infection, excessive bleeding, blood clots, injury to the spinal cord, nerves or arteries, and the possibility of adverse reactions to anesthesia. Recovery from a Posterior Cervical Fusion Typically, after surgery is complete, the patient remains in the hospital overnight, although some patients may be permitted to leave the same day and some may have to remain in the hospital for a day or two longer. Full recovery usually takes from 4 to 6 weeks and during this time the patient's activities are restricted. The patient has to refrain from driving, bending, lifting, pushing, pulling or reaching. In most cases, sexual activity is also restricted. A program of physical therapy is normally recommended to promote a more successful recovery and to achieve maximum postsurgical mobility.