UHS Medical Times May 2016

UHS Medical Times 1

e-newsletter | May 2016

Department of Orthopaedics

Dr. Manhal Abduljalil Alaraj

Dr. Ahmed Abaub

MD Orthopedics, Diploma in Orthopedics and Traumatology Surgery (France), Diploma in Athroscopy (France), Diploma in Hand Surgery (France)

MD, MBBCh, FRCS (UK)

Dr. Mahmoud Zerti MBBCh, FRCS (UK)

Consultant Orthopedic Surgeon, Joint Replacement and Sports Injuries Specialist

Consultant Orthopedic Surgeon, Bone Trauma and Joint Replacement Specialist

Senior Specialist Orthopedics and Traumatology Surgeon

The mission of the department is to provide exemplary total care for patients with bone, joint, muscle and associated musculo-skeletal injuries, from diagnosis through to surgery and other treatment modalities including rehabilitation.

On an in-patient and out-patient basis, core services of the department include:

Sports medicine, arthroscopic surgery & minimal invasive surgery Shoulder and elbow surgery Arthroplasty (joint replacement) and reconstructive surgery of knee, hip & shoulder General orthopaedics trauma Paediatric orthopaedics Extra-corporeal shock wave therapy (ESWT) for musculoskeletal disorders Hand surgery

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e-newsletter | May 2016

TOTAL KNEE REPLACEMENT All About Your Knee The knee is a ‘hinge joint’ made up of three bones in a hinge formation: the patella (knee cap), the end of the femur (thigh bone), and the top of the tibia (shin bone). In a healthy knee, cartilage covers the surface of the bones in the knee joint and lets you move smoothly and without pain.

Why Do I Need a Knee Replacement?

Arthritis of the joint is the most common reason for a knee replacement. Arthritis damages the cartilage and roughens the bone surfaces. This damage causes pain on movement and decreases joint movement and strength. Most people have very good results after surgery, including: Less pain Better movement and strength Improved ability to do everyday activities

What Is a Knee Replacement?

When a joint is replaced, the unhealthy or damaged bone is removed and replaced with man-made parts called prosthesis. The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy.

The components may be held in place with bone cement.

A Total Knee Replacement consists of three parts:

The upper metal piece fits into the thigh bone.

The lower metal piece has a plastic surface and fits into the shin bone.

The plastic button may be fitted onto the back of the kneecap. e-newsletter from University Hospital Sharjah

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e-newsletter | May 2016

Causes Arthritis Other causes include

Trauma (fracture) Increased stress e.g., overuse, overweight, etc.

Infection Connective tissue disorders Inactive lifestyle e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time Inflammation e.g., Rheumatoid arthritis

In an Arthritic Knee

Femur

The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.

The capsule of the arthritic knee is swollen The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.

Bone spurs or excessive bone can also build up around the edges of the joint Ligaments

Meniscus

The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.

Diagnosis The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).

Benefits The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family and your local doctor.

The benefits following surgery are relief of symptoms of arthritis. These include

Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.

Pain waking you at night

Deformity- either bowleg or knock knees

Stiffness

* Note that TKR does not necessarily allows you to pray on a floor

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e-newsletter | May 2016

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inammatory medications, modiďŹ cation of your activities, canes, or physical therapy.

Once these have failed it is time to consider surgery. Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.

Surgical Procedure Knee replacement surgery typically takes between one and two hours to complete. This section will provide you with a brief, easy-to-understand description of the surgical procedure: 1. An incision is made extending from the thigh, past the inside edge of the kneecap, and down to the shinbone.

2. The end of the femur is shaped in preparation for sizing the femoral trial component.

3. The top of the tibia is shaped for proper sizing of the tibial trial component.

4. The trial units are put in place and the appropriate implant size is selected.

5. The knee is assessed for alignment, stability, and range of motion.

6. The underside of the kneecap is prepared and patella trial is selected.

7. The trial units are removed and the ďŹ nal femoral, tibial, and patella components are implanted.

8. The incision is closed, a drain is put in, and the post-operative bandaging is applied.

Risks and Complications As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place and also about rehabilitation; recovery time physiotherapy. When can you walk and when can you go back to work.

Local Complications

Infection Stiffness in the Knee Wear Wound Irritation or Breakdown Cosmetic Appearance

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Leg length inequality Patella problems Ligament injuries Damage to Nerves and Blood Vessels

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e-newsletter | May 2016

TOTAL HIP REPLACEMENT What is a Hip Joint ?

The hip joint is a “ball and socket joint” – it can move in many directions. The ball is the top of the thigh bone and fits into the socket of the pelvis. In a healthy hip, a layer of cartilage covers the ball and socket, acting as protection between them. This allows smooth, pain free movement in all directions.

Why Do I Need a Hip Replacement ?

Arthritis of the joint is the most common reason for a hip replacement. Arthritis damages the cartilage and roughens the bone surfaces. This damage creates pain on movement and decreases joint flexibility and strength. Most people have very good results after surgery, including:

Less pain Better movement and strength Improved ability to do everyday activities

Hip replacement has become necessary for your arthritic hip: this is one of the most effective operations known and should give you many years of freedom from pain.

Once you have arthritis which has not responded to conservative treatment, you may well be a candidate for total hip replacement surgery.

Arthritis Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons, often the definite cause is not known. When the articular cartilage wears out, the bone ends rub on one another and cause pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older (Osteoarthritis).

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e-newsletter | May 2016

Other causes include

Trauma (fracture) Childhood disorders e.g., dislocated hip, Perthe’s disease, slipped epiphysis Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis Increased stress e.g., overuse, overweight Avascular necrosis (loss of blood supply) Infection Connective tissue disorders Inactive lifestyle- e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time Inflammation e.g., Rheumatoid arthritis

In an Arthritic Hip

The cartilage lining is thinner than normal or completely absent The degree of cartilage damage and inflammation varies with the type and stage of arthritis The capsule of the arthritic hip is swollen The joint space is narrowed and irregular in outline; this can be seen in an X-ray image Bone spurs or excessive bone can also build up around the edges of the joint The combinations of these factors make the arthritic hip stiff and limit activities due to pain or fatigue

Diagnosis The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis)

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e-newsletter | May 2016

Indications THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.

You should consider a THR when you have Arthritis confirmed on X-ray

Pain not responding to analgesics or anti-inflammatories Limitations of activities of daily living including your leisure activities, sport or work Pain keeping you awake at night Stiffness in the hip making mobility difficult

Benefits Prior to surgery you will usually have tried some simple treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking sticks, physiotherapy.

The decision to proceed with THR surgery is a cooperative one between you, your surgeon, family and your local doctor.

Benefits of surgery include Reduced hip pain Increased mobility and movement Correction of deformity Equalization of leg length (not guaranteed) Increased leg strength Improved quality of life, ability to return to normal activities Enables you to sleep without pain

Surgical Procedure An incision is made over the hip to expose the hip joint The acetabulum (socket) is prepared using a special 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.

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e-newsletter | May 2016

The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference.

The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic.

The hip is then reduced again, for the last time. The muscles and soft tissues are then closed carefully.

Risks and complications As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to the hip Medical Complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications include Allergic reactions to medications Blood loss requiring transfusion with its low risk of disease transmission Heart attacks, strokes, kidney failure, pneumonia, bladder infections Complications from nerve blocks such as infection or nerve damage Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death

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e-newsletter | May 2016

Specific complications include Infection Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1% to 2%, if it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Dislocation This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. It a dislocation occurs it needs to be put back into place with an anaesthetic. Rarely this becomes a recurrent problem needing further surgery.

Blood clots (Deep Venous Thrombosis) These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.

Damage to nerves or blood vessels Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.

Wound irritation Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.

Leg length inequality It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side. e-newsletter from University Hospital Sharjah

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e-newsletter | May 2016

Wear All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements survive 15-20 years.

Failure to relieve pain Very rare but may occur especially if some pain is coming from other areas such as the spine.

Unsightly or thickened scar Limp due to muscle weakness Fractures (break) of the femur (thigh bone) or pelvis (hipbone) This is also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery. Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Summary Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan- it may help to restore function to your damaged joints as well as relieve pain.

ORTHOPAEDIC TEAM AT UHS QUALIFICATIONS Dr Abaub basic medical education is from Tripoli University, he had his USMLE and ECFMG certificate in 1998 as well as the Q1 and Q2 Qualifying Canadian exams.

After his residency and on-job-training in Orthopedic Surgery in Strasbourg University.

He underwent specialist training in Arthroscopic Surgery of knee and shoulder.

Dr Abaub is holding several diplomas in Orthopedic Surgery including Arthroscopy and Shoulder Surgery.

EXPERIENCE

Dr. Ahmed Abaub MD, MBBCh, FRCS (UK) Consultant Orthopedic Surgeon, Joint Replacement and Sports Injuries Specialist

Dr Abaub a Fellow of the royal college of surgeons of Edinburgh (UK) is a French and Canadian trained surgeons, he was resident in Strasbourg University training Orthopedic Program and was exposed to a wide and extensive pathologies of the shoulder, hip and knee.

He had University diplomas while following the training program of shoulder (Paris-University), Arthroscopy (Strasbourg) and Knee surgery (Strasbourg, Paris).

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An extensive training was in particularly on shoulder instability and rotator cuff tendinopathies in Haute-Pierre University Hospital.

He completed his higher training in University of Montreal (Canada) Maisonneuve-Rosemont University Hospital, where he did a clinical fellowship of lower limb Recontructive Surgery, primary and revision arthroplasty of hip and knee, periacetabular and knee osteotomies.

He is a member of the American Academy of Orthopedic Surgery and other societies.

SPECIAL INTEREST All aspects of Hip and Knee Surgery including Primary, Primary Complex and Revision Arthroplasty Surgery, Arthroscopic Surgery of Knee and Shoulder, Including Ligament Recontruction of the Knee, Meniscal Surgery Including Repair, Chondral Grafting, Shoulder Instability and Rotator cuff Disease.

LANGUAGE KNOWN Arabic, English and French

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e-newsletter | May 2016

ORTHOPAEDIC TEAM AT UHS QUALIFICATIONS Dr Zerti finished medical school from Tripoli University and went to complete his followship from Royal College of Edinburgh.

EXPERIENCE

Dr. Mahmoud Zerti MBBCh, FRCS (UK) Consultant Orthopedic Surgeon, Bone Trauma and Joint Replacement Specialist

Dr. Zerti is UK board certified in orthopedics with extensive experience in the area of arthroplasty surgeries.

He offers comprehensive evaluation and treatment ranging from conservative management to surgical intervention. He specializes in treating all types of orthopedic conditions, including those of the upper extremity, lower extremity, and spine. He specializes in minimally invasive treatment of the shoulder and knee, including rotator cuff repair and dislocation repair in the shoulder, as well as meniscus and ligament reconstruction in the knee.

Prior to joining University Hospital Sharjah, he was the Consultant Orthopaedic Surgeon and Head of Orthopaedic Unit in Central University Hospital, Tripoli, Libya. He has also worked in various hospitals in UK and gained significant exposure in the management of orthopaedic and trauma cases.

Dr. Zerti has published and presented his research at numerous local, national, and

Arthroplasty of Knees, Hips and Ankles

Elective Foot and Ankles Surgeries Arthrodesis of Ankle and Foot Correction of Foot Deformaties Metaphalangeal Joint Replacement Primary and Revision Joint Replacements of Hip and Knee Specializes in Minimally Invasive & High Flexion Knee Joints Unicondylar Knee Replacement or Partial Knee Replacement Osteotomy and Realignment of Knee ACL Reconstruction Trauma Surgery

LANGUAGE KNOWN Arabic and English

SPECIAL INTEREST

Dr. Manhal Alaraj achieved his Doctor of Medicine (M.D) degree from Damascus University, Syria and before relocation to France; he undertook his certificate of specialization in Orthopaedics surgery from Ministry of Health, Syria.

Abnormalities of the Fingers and Toes and Growth Abnormalities Ankle and Elbow Disorders Arthroscopy Arthritis and Osteoporosis Minimally invasive corrective surgery Bone Tumors, Muscular Dystrophy and Cerebral palsy Club Foot and Unequal Leg Length Knee, Hip, Shoulder, and Elbow Replacement Ruptured Disks, Sciatica, Low Back Pain, and Scoliosis Torn Ligaments, Sprains, and Strains Tendon Injuries, Pulled Muscles, and Bursitis

EXPERIENCE

MD Orthopedics, Diploma in Orthopedics and Traumatology Surgery (France), Diploma in Athroscopy (France), Diploma in Hand Surgery (France)

SPECIAL INTEREST

QUALIFICATIONS

In France, he took diploma of Arthroscopy from University Hospital Bichat, Paris and diploma of hand surgery from University of Saint Antoine, Paris focusing on hand and upper limb surgery. He also took various courses specialized in Orthopedic and Traumatology Surgery, Arthroscopy, Microsurgery from various Universities in Paris, France.

Dr. Manhal Abduljalil Alaraj

international meetings on topics involving the knee, hip and shoulder. He is a member of the British Orthopaedic Association, Libyan Orthopedic Association, Association of Osteosynthesis and Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT).

Dr. Manhal Alaraj is French Board Certified, Senior Specialist Orthopedics and Traumatology Surgeon with particular experience in hip and knee arthroplasty, knee arthroscopy and orthopedic trauma surgery.

He was trained in Paris, France for 4 years before returning back to Syria to practice his expertise.

LANGUAGE KNOWN Arabic, English and French

Senior Specialist Orthopedics and Traumatology Surgeon

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e-newsletter | May 2016

SCOPE OF SERVICES AT UHS MEDICAL SERVICES

SURGICAL SERVICES

CARDIOLOGY

NEUROPHYSIOLOGY

Anesthesiology

Bariatric Surgery

24-Hour BP Monitoring

Electroencephalogram (EEG)

Aviation Medicine

Ears, Nose and Throat Surgery

24-Hour Holter Monitoring

Electromyography (EMG)

Cardiology

General Surgery

2D/3D Echo

Evoked Potential Test

Critical Care

Neurological Surgery

3D Transesophageal Echo

Brain Auditory Evoked Potential

Dermatology

Obstetrics and Gynecologic Surgery

CT coronary Angiography

(BAEP)

Emergency Medicine

Ophthalmic Surgery

Somato Sensory Evoked Potential

Endocrinology

Orthopedic Surgery

Dobutamine Stress Echo for Ischemia and Viability Studies

Family Medicine

Pediatric Surgery

Gastroenterology

Plastic and Reconstructive Surgery

Internal Medicine

Urologic Surgery

Medical Oncology

Vascular Surgery

Neonatology Nephrology Neurology Pediatrics Psychiatry Pulmonology Rheumatology MEDICAL DIAGNOSTICS IMAGING (MDI) 128 Channel CT Scan with Coronary and Cardiac Facility

PATHOLOGY & LABORATORY MEDICINE

Interventional Cardiology Stress Test

(SSEP) Visual Evoked Potential ( VEP) Nerve Conduction Studies (NCS)

Treadmill Stress Test

AUDIOLOGY

OTHER SPECIALTY SERVICES

Biochemistry

Acoustic Reflex Threshold

24/7 Emergency Services

Blood Transfusion Medicine

Auditory Brainstem Response

Ambulance

Cytology

Auditory Steady State Response

Hemodialysis

Hematology

Cochlear Implant Mapping

Physiotherapy

Histology

Electrocochleography

Pharmacy

Immunology

Free Field Audiometry

Sharjah Breast Centre

Microbiology

Hearing Aid Fitting and Programming

Phlebotomy

Newborn Hearing Screening

Bone Densitometry

Otoacoustic Emission

Digital X-Ray and Fluoroscopy

Pure Tone Audiometry (PTA)

Mammography and Guided Breast Intervention

Speech Audiometry

MRI 1.5 TESLA

Tinnitus Evaluation

Ultrasound

Tympanometry

Vascular Interventional Lab

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