Orthopaedics

Orthopaedics

Orthopedics is a surgical specialty that studies and treats the pathology of the musculoskeletal system, bones, muscles, and joints, from where the spinal column and the head are excluded.  It treats two large groups of  pathology; 

Degenerative pathology, resulting from joint wear due to aging or destructive inflammatory conditions (ex-rheumatoid arthritis); 

Traumatic pathology is then divided into two large distinct groups: in a young person a traumatic injury caused by an accident, road, work, or sports; in older patients, resulting from fractures in fragile bones such as proximal fractures of the femur, which are severe and very frequent.

Degenerative diseases predominantly affect the joints that support the weight of the body, especially the knees and hips resulting in arthrosis. An increase in the frequency of these two pathologies results mainly from the improvement in life expectancy in developed societies. This has resulted in people living beyond that to which these joints are naturally prepared, especially if they are subjected to excessive loads.

Once a diagnosis is reached, the next step is to decide when the surgery should take place. The general idea is the later the better, within reasonable limits and according to the patient’s age, pain level, disability, and interference in daily activities. The patient has to be aware that the implant is mechanical and subject to wear and tear, this depends, among many other variables, on the number of cycles to which it will be subjected to. If necessary it can be replaced with another implant known as revision surgery. The components or parts thereof are replaced. The survival rate of primary implants is currently over 90% at 15 years.

The Process

Once the patient is aware of these facts it is the patient who determines the date of the surgery. This intervention lasts approximately 1 hour, with an average hospitalization of 5 days, in which the patient gets out of bed the following day, and is discharged from the hospital when he has acquired autonomy enough to walk with crutches.  

Recovery time

The rest of the recovery is done at home, with or without the help of physical therapy, which is more necessary in knee replacement surgery rather than hip replacement surgery. On average the patient can expect to walk without aid after 2 months.

Hip and Knee Prosthesis

 The object is to relieve pain, increase the patient’s mobility and improve functionality in everyday tasks. The injured joint is removed and replaced with an artificial implant. A hip prosthesis may be total or partial. A partial prosthesis is performed on hip fractures. A first-time surgery is known as “Primary Surgery” and subsequent replacements are known as ”revisions”.  

As hip replacement surgery is becoming more and more common revisions of prostheses are also becoming more common. 

The standard incision size for conventional surgery is between 25 and 15 centimeters. At the moment incision can measure less than 15cm. The size of the incision is determined by the surgeon and also by the patient’s physical condition.

The success of a total hip or knee replacement surgery depends on several factors:

• Practice and experience. The Department of Orthopaedics of the Hospital Particular do Algarve, consists a team of dedicated and experienced surgeons in prostheses of the joints. Our Orthopaedic Surgeons are highly skilled and practice this type of surgery on a routine basis.
• Infection Control. One of the most serious complications in hip or knee prosthesis surgery is postoperative infection. To reduce this risk antibiotics are administered to patients in the pre and postoperative period. Special care is taken in the operating room. The Operating Theatres of the Hospital Particular do Algarve are equipped with special filters in the air conditioning system allowing a constant extraction and ventilation of air.
• Risk of venous thrombosis and pulmonary embolisms. It is a persistent risk in arthroplasty of the lower limbs; All of our patients undergo mechanical prophylaxis with antithrombotic stockings and medication – heparin.
• Rehabilitation. All patients undergo postoperative rehabilitation with the help of physiotherapists. The minimum hospital stay is 5 to 7 days. The total recovery time is predictable by three months.