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Friday, 09 August 2013 00:00

ACL Reconstruction In A Child - Operation

 

An ACL rupture is one of the most common sports injuries and it is recommend to reconstruct a torn ACL to prevent future osteoarthritis. In this video, Professor Munjed Al Muderis demonstrates an ACL Reconstruction in a child.

Published in Surgery

 

An ACL rupture is one of the most common sports injuries and it is recommend to reconstruct a torn ACL to prevent future osteoarthritis.

In this video, Professor Munjed al Muderis demonstrates an ACL Reconstruction using a tendon graft from the hamstring.

Published in Surgery

 

In this video Professor Munjed Al Muderis performs a Total Knee Replacement using Navigation Technology.

Published in Surgery

In this video Professor Munjed Al Muderis is performing a hip arthroscopy and demonstrating access to the neck of femur in order to achieve a closer inspection of the "Ganz" lesion, or Bump.

Published in Surgery

The key defining feature of minimally invasive hip surgery compared with traditional hip surgery is the surgical approach taken. In minimally invasive hip surgery the surgeon does not have to cut muscles to access the hip. Therefore it is a minimally invasive, muscle sparing surgery which utilises an alternative approach to traditional Total Hip Replacement.

Traditionally the surgeon makes the hip incision laterally (on the side of the hip) or posteriorly (at the back of the hip). Both of these approaches involve cutting major muscles to access the hip joint. However, with the Anterior Approach Hip Replacement the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting through any muscles.

 

The benefits of an Anterior Hip Replacement compared to the traditional approaches taken in hip replacement surgery include:

  • Muscles do not need to be cut or detached from the pelvis or femur
  • Smaller incision, minimal soft tissue trauma, less scarring
  • Recovery from an anterior hip replacement surgery is much quicker than traditional hip replacement surgery
  • Less post-operative pain than traditional hip replacement surgery
  • Faster healing time resulting and earlier mobilisation. This results in being able return to daily activities quicker
  • Less post-operative restrictions and a decreased hospital stay

 

Published in Information

Professor Munjed Al Muderis is a Sydney based orthopaedic surgeon specialising in hip and knee surgery. This video provides a look at the surgical procedure of a Total Hip Replacement using the Direct-Anterior Approach performed by Professor Munjed Al Muderis. 

This video is Part 3 of a four part video series that provides a detailed look at the process of a total hip replacement by Professor Munjed Al Muderis covering each stage from the initial pre-surgery consultation to recovery. 

Click here to view Part 1 - Initial Consultation

Click here to view Part 2 - Preparing for Surgery

Click here to view Part 4 - Recovery 

Published in Clinical Images

This video follows a patient who has undergone a Minimally Invasive Total Hip Replacement from the initial consultation, surgery and recovery to two week post surgery.

It is Part Four of four part video series that provides a detailed look at the process from pre-surgery to recovery of a total hip replacement by Professor Munjed Al Muderis.

Click here to view Part 1 - Initial Consultation

Click here to view Part 2 - Preparing for Surgery

Click here to view Part 3 - Operation

 

The following is what can be expected post Minimally Invasive Total Hip Replacement surgery:

Day 1: Exercises in bed, up with physiotherapist (drains in) during the late am or pm at physiotherapist discretion using forearm support frame and weight baring as tolerated.  Sit out of bed as tolerated.

Day 2 on: Progress mobility with physiotherapist.

Day 3: Commence hydrotherapy at physiotherapist discretion and commence crutches if able.

Day 4: Doctor will order removal of the drain. Once the drain is removed the dressing will be changed and reviewed twice daily. Waterproof dressings will be applied for showering and hydrotherapy with steri-strips reapplied as necessary.

Day 4-6: Education handouts will be given detailing ‘Care of hip’ and ‘Home Exercise program’. Stair practice and discharge information will be provided. By this stage patient should be able to get out of bed, sit in a chair and use the toilet independently.

Day 5-7: If the patient is independent they will be discharged directly home. Patient may be discharged earlier if being transferred to a rehabilitation facility. Follow up appointment is to be made with Professor Al Muderis for six weeks time from discharge and outpatient physiotherapy/hydrotherapy is to be commenced.

 

The following post-operative medications are to be expected to be prescribed following your hip replacement: 

  • Endone (as per doctors orders) then panadeine forte (as per doctors orders)
  • IV antibiotics as ordered, Fragmin daily until discharge as ordered by the doctor
  • Patient to wear anti-embolic stockings for six weeks

 

Post-op precautions:

It is important that you avoid any movements that will stress, damage or lead to dislocation of your new hip:

  • For the first six weeks it is recommended you sleep with a pillow between your legs
  • Avoid crossing your legs and bending your hip past a right angle
  • Avoid low chairs and bending over to pick things up. Grabbers can be helpful with this along with shoe horns
  • Avoid the combined movement of bending your hip and turning your foot in as this can lead to dislocation

 

Concerns:

Please contact the office if you are worried about your level of pain, have significant bleeding or have fever or redness around the surgical site.

If you require assistance after hours please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

Published in Post Surgery

This video follows a patient preparing to undergo a minimally invasive anterior approach Total Hip Replacement from consultations through to final pre-surgery checks and hip templating.

It is Part 2 of a four video series that provides a detailed look at the process from pre-surgery to recovery of a total hip replacement by Professor Munjed Al Muderis. 

Click here to view Part 1 - Initial Consultation

Click here to view Part 3 - Operation

Click here to view Part 4 - Recovery 

 

The following is what can be expected prior to minimally invasive anterior approach hip replacement surgery:

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery:

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

The area to be prepared extends from the iliac crest (hip bone) laterally down the hip and thigh to the knee (i.e. side of leg only). The pubic/genital region is not touched.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery

Hip Replacement Surgery (Hip Arthroplasty) for hip arthritis has developed throughout the last 300 years from rudimentary surgery, to modern total hip replacement. This animation demonstrates a total hip replacement using Femoral Neck Preserving Implants.

The key defining feature of minimally invasive hip surgery compared with traditional hip surgery is the surgical approach taken. In minimal invasive hip surgery the surgeon does not have to cut muscles in order to access the hip. Rather than accessing the hip from the posterior (back) or laterally (side), the surgeon approaches the hip from the anterior (front), sparing the muscles of the glute. 

During surgery the patient is placed supine (on their back), on a specialised operating table that enables the surgeon to perform the hip replacement anteriorly. Flouroscopic imaging is used throughout the surgery to ensure the accuracy of component positioning and to minimise leg length inequality.

An incision approximately 10cm long is made to the front of the hip. The muscles are then pushed aside to access the hip joint to begin the replacement. At no time during the surgery are any muscles cut.

The femur is separated from the acetabulum (hipbone socket).The acetabulum is prepared using a specialised instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented.

A liner which can be made of plastic, metal or ceramic material, is then placed inside the acetabular component.

The arthritic femoral head is cut off and the bone prepared.

The femoral component is then inserted into the femur. The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The artificial components are fixed in place.

The incision is then closed and dressed. 

Published in Information