A large number of orthopaedic procedures on joints are performed using an arthroscope, where a fibre optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint. Arthroscopic surgery is less painful than open surgery and decreases the risk of healing problems. Arthroscopy allows access to parts of the joints which can not be accessed by other types of surgery.

This condition occurs when there is abnormal thickening of the deep tissue between the palm of your hand and your fingers. This thickening occurs very gradually and will start to make your fingers curl toward your palm. If this condition gets to the stage where it significantly limits your hand function, surgery may be recommended. This usually involves removal of the thickened tissue, allowing you to straighten your fingers again.

For elderly patients joint replacement surgery is commonly required to treat damaged joints from wearing out, arthritis or other forms of joint disease including rheumatoid arthritis. In these procedures the damaged joint surface is removed and replaced with artificial surfaces normally made from metal (chromium cobalt alloy, titanium), plastic (high density polyethelene) or ceramic which act as alternate bearing surfaces for the damaged joint. These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The hospital has several ways of approaching the procedure for replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation.

Foot and ankle surgeries are operations that help fix problems in your feet and ankles, like broken bones, arthritis, or injuries to the ligaments and tendons. Surgery might be: Arthroscopic: less invasive surgery. The surgeon makes small cuts and uses a tiny camera to see inside. They can then fix or take out the damaged parts. Open: for more complicated problems, the surgeon makes a larger cut to get a better look and fix the damaged parts directly. Joint Replacement (ankle): when the ankle is badly damaged, the surgeon might remove the damaged areas and replace them with parts made of special materials.

Elbow surgery is an operation that helps fix problems in the elbow, like injuries or wear and tear from arthritis. Surgery might be: Arthroscopic: less invasive surgery. The surgeon makes small cuts and uses a tiny camera to see inside the elbow. They can then fix or take out the damaged parts. Open: for more complicated problems, the surgeon makes a larger cut to get a better look and fix the damaged parts directly. Joint Replacement: when the elbow joint is badly damaged, the surgeon might remove the damaged areas and replace them with parts made of special materials.

These clinics are run by most orthopaedic departments for patients that have sustained an injury that has already been treated and further follow-up of that injury is required, to monitor progress of a healing bone, check the position of the bone in a cast and to decide when other steps in management such as re-manipulation of fracture, removal of a cast or change of the management plan is required. Often at these fracture clinics x-rays are taken on arrival. Although an appointment time is given, the time to have x-rays, casts removed, other treatments instigated may take several hours. Other appointments will be quick and efficient if these other procedures are not needed.

Hand and wrist surgeries are operations that help fix problems in your hands and wrists, like broken bones, arthritis, or injuries to the tendons, ligaments, or nerves. Surgery might be: Arthroscopic: less invasive surgery. The surgeon makes small cuts and uses a tiny camera to see inside. They can then fix or take out the damaged parts. Open: for more complicated problems, the surgeon makes a larger cut to get a better look and fix the damaged parts directly.

Between the vertebrae in your spine are flat, round discs that act as shock absorbers for the spinal bones. Sometimes some of the gel-like substance in the center of the disc (nucleus) bulges out through the tough outer ring (annulus) and into the spinal canal. This is known as a herniated or ruptured disc and the pressure it puts on the spinal nerves often causes symptoms such as pain, numbness and tingling. Initial treatment for a herniated disc may involve low level activity, nonsteroidal anti-inflammatory medication and physiotherapy. If these approaches fail to reduce or remove the pain, surgical treatment may be considered. Discectomy This surgery is performed to remove part or all of a herniated intervertebral disc. Open discectomy – involves making an incision (cut) over the vertebra and stripping back the muscles to expose the herniated disc. The entire disc, or parts of it are removed, thus relieving pressure on the spinal nerves. Microdiscectomy – this is a ‘minimally invasive’ surgical technique, meaning it requires smaller incisions and no muscle stripping is required. Tiny, specialised instruments are used to remove the disc or disc fragments. Laminectomy or Laminotomy These procedures involve making an incision down the centre of the back and removing some or all of the bony arch (lamina) of a vertebra. In a laminectomy, all or most of the lamina is surgically removed while a laminotomy involves partial removal of the lamina. By making more room in the spinal canal, these procedures reduce pressure on the spinal nerves. They also give the surgeon better access to the disc and other parts of the spine if further procedures e.g. discectomy, spinal fusion, are required. Spinal fusion In this procedure, individual vertebrae are fused together so that no movement can occur between the vertebrae and hence pain is reduced. Spinal fusion may be required for disc herniation in the cervical region of the spine as well as for some cases of vertebral fracture and to prevent pain-inducing movements.

These are clinics for patients that have been referred by their doctor for an orthopaedic opinion on a specific concern. These clinics are usually attended by a specialist orthopaedic surgeon who will be available to advise on diagnosis and management. Often at the clinics x-rays will be taken, if not already taken and sometime other investigations such as ultrasound scans may be taken.

Knee surgery is an operation that helps fix problems in your knee, like an injury, arthritis, a torn ligament, or damaged cartilage. Surgery might be: Arthroscopic: less invasive surgery. The surgeon makes small cuts and uses a tiny camera to see inside the knee. They can then fix or take out the damaged parts. Open: for more complicated problems, the surgeon makes a larger cut to get a better look and fix the damaged parts directly. Joint Replacement: when the knee is badly damaged, the surgeon might remove the damaged areas and replace them with parts made of special materials.

These are growths or masses that develop in bone or soft tissue such as muscles or nerves. They may be benign (noncancerous) or malignant (cancerous and spreading to surrounding tissue and to other parts of the body). Treatment of musculoskeletal tumours ranges from just monitoring for benign tumours to various combinations of radiotherapy, chemotherapy and surgery for malignant tumours.

Orthopaedic deformities can be congenital or acquired as the result of injury, infection or tumour. Resulting in crooked limbs or discrepancies in limb length, such deformities can affect appearance and function and can often cause significant pain. Osteotomy is the division of a crooked or bent bone to improve alignment of the limb. These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned. Some of the more common orthopaedic deformities are: Intoeing Bow legs (genu varum) Club foot (talipes) Developmental dislocation of the hip Bunions Limb length discrepancy

Otherwise known as degenerative arthritis. OA occurs when there is a breakdown of the cartilage, leaving the bones unprotected. It is very common and usually affects people as they get older. You can get it at any age and are more likely to if you have previously injured a joint, or are overweight. The symptoms can be very mild with just occasional pain with activity. Worsening symptoms include pain with activity and stiffness with rest. Joints can become swollen and restricted in movement. Joints can change shape as the bone changes in response to loss of protection. You otherwise feel well. The diagnosis is made on the basis of the history, examination findings and sometimes x-rays. The severity of joint damage seen on x-ray does not always correlate with the degree of pain you experience. Treatment includes guided exercises, weight reduction if needed, pain relief and sometimes surgery. For more information see www.arthritis.org.nz

Osteotomy is the division of a crooked or bent bone to improve alignment of the limb. These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned.

Scoliosis is where there is a sideways curve in the spine. In most cases the scoliosis is mild and no treatment is required. Treatment, if necessary, may include use of a brace or surgery in severe cases.

Shoulder surgery is an operation that helps fix problems in your shoulder, like torn muscles or tendons or wear and tear from arthritis. Surgery might be: Arthroscopic: less invasive surgery. The surgeon makes small cuts and uses a tiny camera to see inside the shoulder. They can then fix or take out the damaged parts. Open: for more complicated problems, the surgeon makes a larger cut to get a better look and fix the damaged parts directly. Joint Replacement: when the shoulder is badly damaged, the surgeon might remove the damaged areas and replace them with parts made of special materials.

Clinics for specific parts of the body or specific conditions. Examples of these will be an orthopaedic tumour clinic or a spinal clinic. Here the patients with specific problems are seen by the appropriate doctors and support staff for their special needs.

In many cases tendons will be lengthened to improve the muscle balance around a joint or tendons will be transferred to give overall better joint function. This occurs in children with neuromuscular conditions but also applies to a number of other conditions. Most of these procedures involve some sort of splintage after the surgery followed by a period of rehabilitation, normally supervised by a physiotherapist.