Orthopedic Surgeries:
Shoulder (Arthroscopic/open)
When the shoulder becomes unstable it is usually due to a tear in the rotator cuff. This occurs most often after an injury such as falling on the shoulder or with some sports activities. Immobilization and physical therapy may be tried first but if the shoulder remains unstable surgery will be needed. This surgery is usually done on an outpatient basis. It may be done under general anesthesia (the patient is put to sleep) or regional (interscalene block) with sedation. The procedure can be done as an open procedure (3" incision) or arthroscopically. The arthroscope is an instrument with a lens and a light on the tip and is smaller than the little finger. The technique to be used will be determined by the injury and will be discussed with the patient prior to surgery. This surgery takes about 2 ½ hours. A sling may be worn after surgery.

Bunions:
A bunion causes the (great) big toe to point toward the smaller toes. There are different types of operations for this surgery and the surgeon will discuss these with the patient before surgery. This surgery usually involves reconstruction of the soft tissues and ligaments of the great toe. There are two bones on either side of the great toe joint and, most of the time, one of these bones is cut and repositioned so that it is in proper alignment. Sometimes the patient will be asked to wear a special shoe or boot after this surgery. The type of anesthesia will be discussed before surgery. Usually it is a local that puts the foot to sleep. IV sedation also will be given. This surgery usually takes about 1-2 hours. The surgeon will discuss walking and activity after the surgery. This procedure is done on an outpatient basis.

Carpal Tunnel Syndrome:
The median nerve, along with other nerves, provides sensation to the palm and wrist. The carpal tunnel through which it passes is shared with several tendons. When these tendons swell they apply pressure to the nerve, causing numbness and tingling. Most commonly these are felt in the thumb, index and middle finger. There is also a ligament (band of tough tissue) that passes over these tendons and nerves. The surgery consists of making a small incision through the ligament. The ligament can then be divided, releasing the pressure on the nerve. This surgery usually takes an hour or less. The anesthesia consists of an injection that will only numb the hand or arm and sedation. After the surgery the patient is taken to a recovery area and when all discharge criteria are met can be discharged home, usually within an hour.

Knee Surgery (arthroscopy) Cartilage/Ligament Repair:
The knee is made of bone, cartilage and ligaments that act to stabilize the knee. When the cartilage or ligament sustains a tear in the tissue, surgery is usually needed to repair it. This procedure is called an arthroscopy, and is performed using an arthroscope, an instrument smaller than the diameter of a small finger with a lens in it and a light at the tip. It is inserted through several small (approximately ½ inch long) incisions and the damaged tissue may be either repaired or removed. It can be performed under a general anesthesia (asleep), a regional (spinal or femoral block), or sometimes a local (numb the site) with sedation.

Kyphoplasty:
A vertebral body compression fracture (VCF) occurs when the vertebral body fractures and collapses. Most VCFs are caused by osteoporosis and cause the spine to shorten and fall forward. This condition, Kyphosis, can make it difficult to walk, cause chronic pain, breathing problems, loss of appetite and make it difficult to sleep.

The kyphoplasty procedure can be performed while under general or local anesthesia. Generally the procedure takes only one hour per fracture treated. The physician makes a narrow, ½-inch incision in the back and creates a very small pathway into the fractured bone. A small, orthopedic balloon is placed through the pathway into the fractured vertebra. Next, the physician carefully inflates the balloon, raising the collapsed vertebra and attempting to restore its height. This is an important step in straightening the spine. The balloon is then removed, leaving a space within the vertebra. The space is filled with a material to support the bone and prevent further collapse. This process creates an "internal cast" that holds the repaired bone in place. In most cases, these four steps are performed on both sides of the vertebral body.

Total Hip Replacement:
An arthroplasty is the replacement of a hip joint. It is done to relieve pain and disability from problems with the hip usually caused from arthritis or a broken hip. The joints that move past each other are replaced. Cartilage is a shiny, white material that makes pain-free, smooth movement of the hip. Movement of the hip is limited and painful when this cartilage is damaged. The patient will be asleep for this surgery or you may have a spinal (numb from the waist down). This surgery takes 1-3 hours and requires admission to the hospital.

To help keep track of your care, download a comprehensive total hip replacement booklet.

Total Knee Replacement:
A total knee replacement is also known as an arthroplasty. These are most often done due to problems around the knee mostly caused by arthritis. It is done to relieve pain and/or disability. Parts of the knee joint actually move past one another and this surgery replaces parts of this joint. The joint is covered with cartilage and this provides pain-free, smooth movement of the knee. When this cartilage is damaged the joint does not work well and is very painful. This pain could cause difficulty in walking, a sense of instability and even a limp. This surgery can take 3 or more hours and a general anesthetic (sleeping) will be given. Admission to the hospital will be required.

To help keep track of your care, download a comprehensive total knee replacement booklet.

General Surgical Information
Prior to the day of the surgery the patient will meet with the pre-op teaching nurse. This nurse will instruct them on when to stop eating, drinking, using tobacco products and what medications (if any) to take the morning of surgery. Any additional testing needed will be ordered during this visit.

The day of surgery the patient will complete their final paper work, have an IV (needle in the vein) started to administer fluids and medications and meet with their surgeon and anesthesiologist.

After surgery the patient will be taken to a special recovery area where blood pressure, pulse, respirations and temperature are monitored. The patient will be encouraged to eat and/or drink before being discharged. When stable, awake and alert, the patient may be discharged home or moved to an inpatient area for further recovery.