Over the last 30 years a large number of orthopaedic procedures on joints have been performed using an arthroscope, where a fibre optic telescope is used to look inside the joint. With 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.

These clinics are run by the Orthopaedic Department for patients who have sustained an injury that has already been treated and further follow-up of that injury is required to monitor progress. Often at these fracture clinics x-rays are taken on arrival to 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. An appointment time will be given. You may be at the clinic for several hours if you require x-rays, plaster/fibreglass casts removed or any other treatments. Fracture Clinics are held at Manukau SuperClinic™ Module 1 on Tuesday, Wednesday and Thursday afternoons.

These clinics are for patients who 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 sometimes other investigations such as ultrasound scans may be taken.

Joint replacement surgery is commonly required to treat joints which are worn out from 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) and plastic surfaces (high density polyethylene) or ceramic which act as alternative bearing surfaces for the damaged joint. The surgeon will discuss the specifics of your operation with you at the time of assessment and booking of surgery. These operations are major procedures which require the patient to be in hospital for several days and are followed by a significant period of rehabilitation at home. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation. All patients waiting to have a joint replacement must be given clearance by an anaethetist before surgery can proceed. Either by reviewing your file or arranging for you to be seen at an outpatient clinic for an assessment. See Pre-Admission Clinic heading. Your surgeon may defer surgery if you have any signs of infection, i.e. bad teeth, bladder or skin infection. Ensure your GP is aware that you are waiting for a joint replacement and they will treat any health concerns. If you are having problems with your teeth, arrange to see your dentist for a check-up and treatment. Orthopaedic surgeons at Middlemore Hospital are skilled in all forms of joint replacement including complex primary and revision surgery, and the latest computer assisted and minimally invasive techniques.

The Orthopaedic Tumour Service investigates, diagnoses and treats tumours which occur in bone and soft tissues (e.g. muscle, fat). Radiologists, pathologists and surgeons work together to identify the type of tumour. Imaging studies such as MRI scan, CT scan and bone scan may be done. If no diagnosis can be made by looking at the scans, then an operation to remove a piece of the tumour (open biopsy) so it can be studied under the microscope, is done. What is a tumour? Tumours develop when cell reproduction becomes erratic and produces abnormal cells which clump together to form a mass. A tumour is a cluster of abnormal cells. If a tumour is malignant (i.e. cancerous) radiotherapy and/or chemotherapy may be required, as well as surgery. What is a benign tumour? A benign tumour doesn’t invade the structures around it and it does not spread to other parts of the body. Examples of a benign tumour are a ganglion, schwannoma and lipoma. Benign tumours may be surgically removed, if they are large or are causing symptoms. If they are not causing problems then they may just be observed for a period of time to ensure they do not change. What is a malignant tumour? A malignant or cancerous tumour invades the structures around it and can spread to other parts of the body through the blood stream and lymphatic circulation. A sarcoma is a primary malignant tumour occurring in bone, muscle or fat. Sarcomas are very rare, making up only 1% of all the cancers diagnosed. Osteosarcoma, Ewing’s sarcoma, liposarcoma and synovial sarcoma are some of the sarcomas which can occur.

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.

A week or two prior to your elective surgery you will be seen in a pre-admission clinic. At this clinic your general health status will be assessed by members of the Orthopaedic Team. If there are any health concerns, your surgery may be delayed or you may be referred onto another specialty such as Anaesthetics or Cardiology. You may also be required to have futher tests. At the clinic you will be given information about your surgery and post-operative rehabilitation. This is your ideal opportunity to ask any questions you may have about your surgery. To clinic visits you need to bring with you: Any letters or reports from your doctor or other hospital. Any X-Rays, CT or MRI films and reports. All medicines you are taking, including herbal and natural remedies. Your pharmaceutical entitlement card. Your ACC number, if you have one.

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.

These are 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.