Orthopedic Surgery

Orthopedic Surgery

Orthopedic surgery or orthopedics at Southern Indiana Surgery Center (SISC) is a specialty of the diagnosis and both non-surgical and surgical treatment of injuries and diseases of the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Orthopedic surgery is a medical specialty encompassing a wide range of treatment procedures concerning the correction of problems affecting the entire musculoskeletal system. The musculoskeletal system is made up of bones, joints, and adjacent soft tissues, including:

• Muscles: Protect and allow bone and joint movement
• Ligaments: Connect the bones
• Tendons: Connect muscles to bones
• Nerves: Transmit impulses to and from the brain and/or spinal cord

When problems or injuries occur that affect any of these areas of the musculoskeletal system, the orthopedic surgeons at Southern Indiana Surgery Center (SISC) are extensively trained to diagnose and treat the condition. Non-surgical methods, such as medications, physical therapy and other rehabilitative options are always the first line of treatment if possible. For more severe injuries or conditions that have been unresponsive to conservative treatments, SISC offers state-of-the-art surgical procedures for all manners of orthopedic problems.

Orthopedic Surgeons at Southern Indiana Surgery Center (SISC)

David J. Licini, MD

Aaron J. Mast, MD

James B. Rickert, MD

Tarek Sibai, MD

Timothy M. Steiner, MD

Jonathan W. Surdam, MD

Otto W. Wickstrom, MD

Orthopedic Surgeries

Knee Surgery

Knee arthroplasty (replacement) is a common orthopedic surgery used to treat damaged knee joints, typically resulting from some type of arthritis (osteoarthritis/wear and tear, rheumatoid/inflammatory arthritis, and post-traumatic arthritis/after an injury). The knee joint can be totally or partially replaced depending on the extent of damage to the joint.

Arthroscopic knee surgery can be performed for knee conditions involving less damage, such as:

• Torn meniscus
• Dislocated kneecap
• Plica syndrome
• Torn ACL (anterior cruciate ligament)
• Damaged cartilage

Shoulder Surgery

Arthroscopic shoulder surgery is utilized to treat a wide range of shoulder conditions. The most common procedure is subacromial decompression surgery (acromioplasty) to treat shoulder impingement syndrome, a condition involving a trapped rotator cuff. Other arthroscopic shoulder surgeries are performed at SISC to treat:

• SLAP tears (labrum repair)
• Shoulder dislocation (Bankart repair)
• Frozen shoulder (capsular release)
• Torn rotator cuff (rotator cuff repair)
• Acromioclavicular joint problems/separated shoulder (AC joint reconstruction)
• Biceps tendon tears (biceps tenodesis or tenotomy)

Shoulder replacement surgery is also performed at SISC to treat severe arthritis of the shoulder joint. Damaged bone and cartilage is replaced with a prosthesis made of a specialized metal ball and plastic socket.

Orthopedic Total Joint Replacement

Total joint replacement is a surgical procedure in which a damaged, dysfunctional, or arthritic joint or joint surface is replaced with a plastic, metal, or ceramic prosthesis. The orthopedic prosthesis is designed to move just as a normal, healthy joint would. Joint replacement surgery is generally recommended when severe joint pain or joint dysfunction is unresponsive to other treatments, such as physical therapy, medication, and lifestyle change. Though total joint replacement can seem like an intimidating step as an option to relieve the pain of arthritis, multi-center trial studies with thousands of patients show excellent long-term benefits from joint replacement. In fact, in patients 55 and older who have had a total knee replacement, 93 percent still have good function 20 years later. For total hip replacements, 95 percent are still functioning well after 20 years.

Arthritis is defined by the wearing out of cartilage lining the joints of the body. When the cartilage becomes worn out, motion becomes limited and painful. Though there are many treatment options available for arthritis, many times surgery is the only solution to achieving full use of the affected joints.

Total joint replacement surgery at Southern Indiana Surgery Center (SISC) involves using cutting-edge prosthetic devices to replace that worn-out cartilage and bone at the end of arthritic joints. This allows the joints to once again function smoothly and without pain. Our arthritis specialists in the DFW area take a patient-centered and compassionate approach to help you return to normal, active living through athletic knee replacement and hip replacement surgery. Shoulders are also commonly treated with surgical procedures.

The most common joint replacement surgeries are performed on the hip and knee; however, successful joint replacement surgeries can be done on other joints including:

• Wrist
• Ankle
• Elbow
• Shoulder

Surgery for Bone Fractures

SISC orthopedic surgeons routinely provide surgical and non-surgical treatment for all manners of bone fractures. Internal fixation is performed in cases in which bones require repositioning with metal plates, screws, or pins placed internally. External fixation involves metal screws or pins placed below and above the fracture site and connected to a bar outside the skin.

Orthopedic Hand Surgery at SISC

Southern Indiana Surgery Center offers specialized treatment for a wide range of hand and wrist injuries, from simple to the most complex conditions. Our expert orthopedic hand surgeons are highly skilled in dealing with the intricate anatomy involved with hand and wrist surgery.

Common hand/wrist procedures performed at SISC include:

• Carpal tunnel release: The carpal ligament is cut to alleviate the compression on the median nerve.
• Trigger finger release (tenolysis): The affected tendon sheath (A1 pulley) is cut to allow the flexor tendon to glide more smoothly and extend properly.
• Tendon repair: Extensor or flexor tendons in the hand can become ruptured, torn, or severed due to injury. Partial tears may not require surgery, but in cases in which the ends of the tendons are not touching, surgical repair is necessary. During the procedure, your hand surgeon will suture the ends of the divided tendon through a small incision in the hand, wrist, or finger.
• Joint replacement surgery: Finger, knuckle, and wrist joints can be replaced with artificial structures to reduce pain, restore motion, and improve hand function. The most common reason for needing joint replacement surgery is severe osteoarthritis or rheumatoid arthritis.
• Joint fusion (arthrodesis): Joint fusion is performed to alleviate pain, improve stability, or correct deformities. The procedure involves the alignment of the bones into a natural position, then allowing them to grow (fuse) together. While some mobility is sacrificed, the hand or wrist joint remains reasonably functional.
• Ganglion cyst removal: A ganglion cyst (common non-cancerous lump typically in the hand or wrist) often does not need treatment, however, if it is recurring after aspiration or unaffected by other conservative methods, surgery may be recommended. Surgical treatment involves removal of the cyst and its root, which can be part of the joint capsule or tendon sheath.
• Hand fasciotomy: Treatment for acute compartment syndrome in the hand or forearm can involve a fasciotomy, a procedure which relieves the compartment pressure to prevent further, irreversible damage. Incisions may be made in the hand, forearm, and fingers to accomplish the pressure release. Fasciotomy may also be utilized in treating Dupuytren’s contracture to divide the thickened cords of tissue in the hand to increase finger movement. A more extensive procedure (subtotal palmar fasciectomy) which entails removal of abnormal tissue or cords may also be performed to treat Dupuytren’s.
• Trapeziectomy: A small bone (trapezium) in the wrist at the base of the thumb is removed as a treatment for arthritis in the thumb joint.

Orthopedic Sports Medicine at SISC

Sports medicine is a multidisciplinary specialty which focuses on injuries and musculoskeletal problems that can occur due to sports, recreational activities, or exercise. The sports medicine experts at Southern Indiana Surgery Center are board certified orthopedic surgeons extensively trained in the most advance techniques to treat the full spectrum of athletic injuries in both adults and children.

Sports medicine at SISC incorporates diagnosis, treatment, and rehabilitation, as well as injury prevention and pain management. While many sports injuries can be treated non-operatively, in cases where surgery is necessary, SISC employs the least invasive, cutting-edge methods available in order to return our patients to normal athletic activity as safely and swiftly as possible.

Common Sports Injuries Treated at SISC

Anterior Cruciate Ligament (ACL) Tear

The anterior cruciate ligament (ACL) which stabilizes the knee joint can become torn as a result of an acute force to the knee, such as pivoting, twisting, or landing hard. This can occur while jumping, changing directions, or stopping suddenly during sports activities. A torn ACL will result in knee instability and, in most cases, requires ACL reconstruction to restore stability. ACL reconstruction is performed arthroscopically by removing the torn ligament and replacing it with a piece of tendon from another area in the leg.

Medial Collateral Ligament (MCL) Tear

The medial collateral ligament (MCL) is located on the inside of the knee and can become torn from a sharp blow to the outer part of the knee. When the injury is severe and the ligament is pulled away from the bone, surgical repair may be necessary. MCL repair involves suturing the torn ligament and fixating it to the bone with suture anchors or screws.

Meniscus Tear

The meniscus is a rubbery, C-shaped disc of cartilage in the knee which provides shock absorption. The meniscus can become torn in any number of ways, even simple activities, especially with age. A torn meniscus can cause swelling, stiffness, pain, and instability. Since most meniscus injuries occur where blood supply is low, healing naturally can be difficult. Arthroscopic surgical options, depending on the location and severity of the tear, include:

• Partial meniscectomy: Removal or trimming of the torn portion of the meniscus
• Meniscus repair: Suturing the torn pieces together and allowing them to heal
• Total meniscectomy: Complete removal of the meniscus, typically only used for large, lateral meniscus tears

Labral Tears

The labrum is the cartilage in the shoulder that surrounds the socket and stabilizes the joint. The labrum can be torn due to repeated overhand motion, such as pitching, serving, or throwing a ball or swimming. Types of labral tears include:

• Superior labrum anterior posterior (SLAP) tear: Cartilage tear is located in the upper portion of the socket
• Bankart tear: Cartilage tear is at the front of the socket, often caused by shoulder dislocation.

Arthroscopic surgery for labral tears may involve removal of the torn portion of the labrum or reattachment with sutures.

Rotator Cuff Tear

The rotator cuff is a grouping of shoulder muscles and tendons that maintain stability and allow motion in the shoulder joint. When one of the rotator cuff tendons or muscles is torn, the result is pain and decreased range of motion, especially with overhead movement. Rotator cuff injuries can occur with repetitive arm motion, such as during tennis or baseball. Complete rotator cuff tears generally require surgical repair. Rotator cuff surgery involves reattaching the torn tissue to the head of the upper arm bone (humerus). In cases of partial tears, surgical treatment may only entail trimming the loose tissue (debridement). Both procedures can be performed arthroscopically.

Shoulder Separation/Acromio-clavicular (AC) Joint Injury

The acromio-clavicular (AC) joint connects the top of the shoulder blade (acromion) to the collar bone (clavicle). The AC joint can become bruised, sprained, or completely torn. A direct fall onto the shoulder is often the cause of shoulder separation. AC injuries classified as grades IV through VI typically involve torn ligaments and require surgical repair. Shoulder (AC) separation surgery involves arthroscopically realigning the shoulder blade and clavicle and repairing the ligaments.

Shoulder Dislocation

The ball and socket of the shoulder can become separated partially or completely during sports activities, falls, or acute injuries. Partial dislocations can spontaneously return to normal position, however complete dislocations require medical attention. Athletes who experience a shoulder dislocation are highly susceptible to recurring shoulder injuries. Arthroscopic shoulder surgery can be utilized to repair the damaged cartilage and ligaments to stabilize the shoulder joint.

Ulnar Collateral Ligament (UCL) Injury

The ulnar collateral ligament (UCL) is located on the inner elbow and connects the humerus to the ulna. Pitchers are especially susceptible to a UCL injury due to repetitive stress during the throwing motion, although other athletes who twist and bend the elbows repeatedly are also at risk. When the UCL becomes torn, the ligament stretches until it is unable to hold the arm bones together during physical activity involving the repetitive motion. UCL reconstruction is commonly referred to as Tommy John surgery, named for the pitcher who first underwent the procedure in 1974. During Tommy John surgery, the damaged ligament is reinforced with a tendon from another part of the body. The tendon is passed through tunnels drilled in the ulna and humerus and woven in a figure 8 pattern, incorporating the remnants of the damaged UCL.

The sports medicine orthopedists at SISC understand that any athletic injury can hamper sports performance and/or limit enjoyment of recreational activity. Our goal is to help all levels of athletes achieve their highest possible potential in a healthy, pain-free manner through technically advanced treatment of injuries by our sports medicine experts.

Spine Surgery

SISC orthopedic surgeons routinely perform discectomy procedures to treat ruptured or herniated discs. A portion of the problematic disc is removed to alleviate pressure on nearby nerves. Spinal fusion may also be utilized to correct problems with the vertebrae, such as:

• Spinal stenosis
• Spondylolisthesis
• Degenerative disc disease
• Scoliosis
• Fractured vertebra
• Tumors
• Herniated disc
• Infection

Depending on the location of the spinal problem, your orthopedic surgeon may approach the spine from the front (anterior) of the lower abdomen (lumbar fusion) or front of the neck (cervical fusion). Other options are posterior approach performed from the back and lateral approach from the side. Other spinal surgeries include:

• Laminectomy: Removal of part of the vertebral bone (lamina), usually to alleviate spinal stenosis pain
• Spinal decompressions: Varied procedures to relieve spinal cord pressure or nerve root pressure

Hip Surgery

Hip arthroplasty (replacement) is performed to replace a damaged hip joint with a prosthesis (artificial joint). Hip replacement is often performed in patients with severe arthritis pain or a fractured hip. Hip arthroplasty can be done with an anterior or posterior approach. In cases of less severe hip joint damage, hip arthroscopy may be performed to identify and treat hip problems such as:

• Extra bone formation
• Inflamed hip tissue
• Damaged cartridge

Disclaimer: These pages are not intended to provide medical or surgical advice or physician instruction on medical care or treatment. If you are a patient, consult with your doctor about treatment options that may be appropriate for your medical condition.