Orthopaedic & Trauma Surgery

These are two areas of specialisation are often related as they can be caused by trauma, accidents, sports injuries, degenerative diseases, infections, tumors and congenital disorders. Orthopaedic specialists deal with conditions involving the musculoskeletal system and may use both invasive surgical and non-invasive as well as non-surgical means to correct and treat the problem.

Orthopaedic Specialist Services

Our mobility is crucial in living an enriched and fulfilled life and plays a vital role in maintaining our overall health. Any injury to our bones and/or muscles can lead to serious health complications especially if left untreated. Gleneagles Hospitals' Orthopaedic Specialist team comprises of a panel of expert surgeons, physiotherapists, occupational therapists and nurses, all working together to ensure your recovery is a speedy and pleasant one.

Joint Replacement Surgery

The latest technology, techniques and procedures are used by top-notch surgeons to replace, reconstruct and preserve your hips, knees as well as shoulder joints.

Spine Surgery

A wide range of spinecare procedures are available including fracture, infections, tumours, deformities (scoliosis, kyphosis, spondylolisthesis) and degeneration.

Minimally Invasive Procedures

Perfect for both diagnostic testing and treatment, procedures such as arthroscopy may be used to review and repair joints that have been diseased or damaged only with a small incision.

Treatment Types

Discectomy

To treat herniated or slipped spinal discs, a discectomy is usually performed and involves the partial removal of the disc which is exerting pressure on the nerve. This can be done as an open procedure or through a keyhole of smaller incisions.

Limb Knee Reconstruction

To restore the functioning of a limb or joint, reconstructive surgery may be required regardless if the deformity is of a congenital or acquired nature.

Total Knee Replacement

A surgical procedure where diseased (arthritic) parts of joints especially with artificial joint components (prosthesis) are completely replaced with artificial (total) ones. This procedure can be used to replace knee joints which have been affected by a wide variety of conditions such as acute osteoarthritis, rheumatoid arthritis, haemophilia, gout and knee related injuries.

Corrective Spine Osteotomy

A spine osteotomy is an invasive procedure which requires a section of spinal bone to be removed to allow for spine alignment correction and is usually performed to correct any abnormal spinal curvature.

Tumour Excision

When tumours are present, a surgical procedure for its removal is carried out. The tumour is then sent for analysis to determine the correct path of further treatment.

Total Hip Replacement

If hips are affected by disease such as arthritis, parts of the joints can be replaced with artificial components. This surgical procedure helps to reduce and alleviate joint pain, improve range of motion and help the patient maintain an active lifestyle comfortably.

Carpal Tunnel Release

When the carpal ligament is causing pressure on the median nerve, a surgical relief may be required. A carpal tunnel release surgery is usually performed through a small incision on the palm near the wrist or via a keyhole. This can be done on a daycare basis and carried out with local anaesthetic.

Trigger Finger Surgery

The repetitive grasping or gripping of certain objects is typically known as trigger finger and may cause a painful locking sensation in one if not more fingers. Two surgical options are available (open or percutaneous) and highly depends on whether the individual's palm is the cause of the affected tendon.

Amputation

Sometimes surgery may require the partial or complete removal of a limb or extremity such as an arm, leg, foot, hand, toe or finger.

Decompression Laminectomy / Laminotomy

A laminectomy is a procedure that helps relieve pressure on the spinal cord or nerve roots which may cause spinal stenosis. This typically occurs when the spinal nerves end up pinched due to active narrowing of the spinal column. Often painful it can also cause numbness or weakness in the legs, back, neck and arms. This surgical procedure is done via an incision in the back where bone and tissue causing such pressure is removed and is effective in treating spinal injuries, herniated discs and spinal tumours.

Knee Arthroscopy

This surgical technique helps diagnose and treat knee joint related issues via a small incision and insertion of a tiny camera. Images taken help surgeons to see the accurate problem and correct it if necessary through separate smaller instrumental insertions. Arthroscopy helps diagnose issues such as torn meniscus or misaligned patellas (kneecaps) and repair ligaments.

List of Orthopaedic Conditions We Treat

Elbow

- Dislocation

- Golfer's elbow

- Tennis elbow

Knees

- Anterior cruciate ligament (ACL) injury

- Anterior knee pain (runner's knee) / chondromalacia patellae (CMP)

- Medial collateral ligament (MCL) injury

- Meniscus tear / knocked knee chondromalacia patellae (CMP)

- Knee arthritis

- Knee bursitis

- Osgood Schlatter disease

- Osteoarthritis (locked knee)

- Patella femoral syndrome (knee cap pain)

- Lateral collateral ligament (LCL) injury

- Patella tendonitis (jumper's knee)

- Posterior cruciate ligament (PCL) injury

Spine

- Degenerative spine condition

- Lumbar spinal stenosis

- Neck pain

- Nerve decompression

- Sciatica (pinched nerve)

- Scoliosis

- Slipped disc

- Spondylolisthesis (misaligned backbone)

Sports Injury

- Degenerative spine condition

- Lumbar spinal stenosis

- Neck pain

- Nerve decompression

- Sciatica (pinched nerve)

- Scoliosis

- Slipped disc

- Spondylolisthesis (misaligned backbone)

Paediatric Orthopaedics

- Bowing of the knee (genu varum)

- Clubfoot -Dwarfism

- Greenstick fractures

- Growing pains

- In-toeing gait

- Limb length discrepancy

- Torticollis (wry neck)

Ankles & Feet

- Achilles tendonitis

- Arthritis

- Cartilage damage

- Diabetic foot problem

- Dislocation

- Fractures

- Gout

- Plantar fasciitis (foot pain)

- Sprains

- Tendonitis

Hands & Wrists

- Carpal tunnel syndrome

- De Quervain’s tenosynovitis (painful wrist condition)

- Ganglion cysts

- Hand arthritis

- Hand fractures

- Hand trauma

- Trigger finger

- Wrist ligament injury

Musculoskeletal Tumour

- Benign tumour

- Metastasis

- Primary cancers of the bones (bone tumour)

- Primary cancers of the soft tissues

Shoulders

- Cuff tears

- Frozen shoulder

- Rotator cuff injury

- Shoulder dislocation (chronic)

- Shoulder instability

- Shoulder tendonitis

Hips

- Hip arthritis

- Hip bursitis

- Hip dislocation (congenital)

- Hip fractures

- Lumbar pain

- Osteonecrosis

- Snapping hip syndrome

Types of Diagnostic Tests

Electromyogram (EMG)

To evaluate the electrical activity and muscular response times to nerve stimulation, EMG diagnostic tests are recommended as they can help detect muscle and nerve disorders as well as those that affect their connectivity.

EMGs require the insertion of sometimes one if not more electrode needles through the skin into muscle tissue in order to record electrical activity of the muscles.

Needle (Open Biopsy)

Bone biopsy procedures require bone samples to be taken and scrutinised for abnormal cell activity.

Needle biopsies require a small incision of the skin and a needle is inserted into the bone to retrieve a sample. But fret not as this biopsy is performed under local anesthesia.

Open biopsies however require a much larger incision of the skin and a piece of bone is surgically removed instead. But relax, this procedure is performed under complete general anesthesia.

Physical Examination

A battery of joint tests to examine fluid collection (sweling) and range of motion especially in warm, red and tender (inflamed) joints.

Imaging Diagnostic Techniques

Computerised Tomography (CT) Scan

This is a diagnostic imaging method which makes use of x-rays to digitally produce cross sectional images of one's bones, blood vessels and soft tissues within the body.

Diagnostic Ultrasound

Also known as sonography, this is a non-invasive technique which makes use of high-frequency sound waves to produce digital images of structures inside the body. High resolution imaging enables our specialists to detect any tendon tears, tiny calcifications as well as foreign bodies.

Dual Energy X-ray Absorptiometry (DXA)

This procedure utilises x-rays to assess factors such as bone density when diagnosing for osteoporosis. DXA is also capable to predict an individual's level of fracture risk which is useful for post-treatment monitoring.

Magnetic Resonance Imaging (MRI)

As a noninvasive imaging technique, the MRI utilises magnetic fielding and pulses of radio waves to produce pictures of bones as well as soft tissues. Because the MRI doesn't use x-rays it currently has no known side effects. The MRI can also be used to effectively diagnose and assess a wide array of medical conditions that affect soft tissues.

Magnetic Resonance Arthrography (MRA)

Similar to the MRI, MRA however produces much better images due to a contrast solution (gadolinium) being injected into the affected joint, allowing its structures and soft tissues to highlight tears and defects. The MRA is usually used to determine joint conditions and can efficiently detect any ligament, tendon as well as cartilage related diseases.

Positron Emission Tomography (PET) Scan

This medical imaging procedure allows for more detailed information on organ functions or systems in the body. PET Images provide the specialist with physiological information regarding the bone and is mainly used to detect issues such as abnormal bone growth associated with tumours or other abnormalities.

Blood Tests

Common diagnostic tests that include the extraction and analysis of inflammatory markers (e.g. CRR, ESR and WBC) in one's blood to determine the type of arthritis present. Other types of blood tests will look for specific antibody types such as anti-CCP (anti-cyclic citrullinated peptide) and RF (rheumatoid factor).

Clinical Excellence: Value-Driven Outcome (VDO)

Total Knee Replacement (TKR)

Knee surgery, particularly Total Knee Replacement (TKR), is a complex procedure, especially for those suffering from knee osteoarthritis. At Gleneagles Hospital Kuala Lumpur, we recognize the challenges and prioritize the patient's voice in our approach to outcomes. We meticulously evaluate each TKR surgery at 3-month and 6-month intervals, utilizing the Knee Society Score (KSS) to measure and compare results against Minimal Clinically Important Difference (MCID) and Substantial Targets.

This precision-driven approach ensures that the impact of TKR transcends the surgical realm, resulting in significant improvements in both quality of life and mobility. This exemplifies our commitment to comprehensive and transformative orthopaedic care.

Patient’s Journey

Patient visits doctor to determine if TKR is recommended.

Patient is referred for same-day pre-operative physiotherapy.

PROMs (KSS) survey and pre-operative physiotherapy are conducted for the patient in rehab.

Patient undergoes surgery in GKL

Physiotherapy is administered for the patient during admission until discharge.

The patient attends physiotherapy sessions for three months.

*3 months post-surgery PROMs (KSS) survey is conducted again to assess the patient's progress.

The patient continues physiotherapy sessions for an additional three months.

*6 months post-surgery PROMs (KSS) survey is conducted to monitor the patient's progress.

Patient Reported Outcome Measures (PROMs) Survey

Through our Patient Reported Outcome Measures (PROMs) Survey, we carefully measure our patient’s perception of health and functional well-being post-TKR surgery. PROMs are standardized questionnaires completed by patients, providing insights into health perception and functional well-being. The hospital conducts these surveys before and after treatment to understand any changes in the patient’s condition and quality of life. Working closely with patients and clinicians, PROMs give us a full picture of our patients' health and identify opportunities for continuous improvement.

Minimal Clinically Important Difference (MCID)

When it comes to knee surgery, Gleneagles Hospital Kuala Lumpur uses a benchmark called Minimal Clinically Important Difference (MCID). Our aim is for patients to see a minimum score increase of 9 points at 3 months and 40 points at 6 months post-surgery.

One notable achievement is reaching a 100% rate in the MCID benchmark within 3 and 6 months post-surgery, underscoring substantial improvements in pain reduction, daily function, and overall quality of life.

KSS Reference:

The Knee Society (https://www.kneesociety.org/the-knee-society-score)

MCID Reference:

Van der Wees, P.J., Wammes, J.J.G., Akkermans, R.P. et al. Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry. BMC Musculoskelet Disord 18, 97 (2017). https://doi.org/10.1186/s12891-017-1455-y

Lizaur-Utrilla, A., Gonzalez-Parreño, S., Martinez-Mendez, D. et al. Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 28, 1473–1478 (2020). https://doi.org/10.1007/s00167-019-05543-x

https://d-nb.info/1212656903/34

Anterior Cruciate Ligament Reconstruction (ACLR)

Anterior Cruciate Ligament Reconstruction (ACLR) is a surgical intervention aimed at replacing a damaged ligament, requiring a delicate blend of precision and excellence. At Gleneagles Hospital Kuala Lumpur, our commitment extends beyond technical proficiency to encompass stringent adherence to quality indicators.

Our 2023 performance statistics not only reflect exceptional results but also demonstrate our unwavering focus on patient safety. By surpassing international benchmarks in key areas such as prophylactic antibiotic administration, blood transfusion rates, complications, readmission prevention, and post-operative rehabilitation, we continuously strive to assure our patients of a level of care that goes above and beyond established standards.

Patient’s Journey

Patient visits doctor to determine if ACLR is recommended.

Patient is referred for same-day pre-operative physiotherapy.

PROMs (KSS) survey and pre-operative physiotherapy are conducted for the patient in rehab.

Patient undergoes surgery in GKL

Physiotherapy is administered for the patient during admission until discharge.

The patient attends physiotherapy sessions for three months.

*3 months post-surgery PROMs (KSS) survey is conducted again to assess the patient's progress.

The patient continues physiotherapy sessions for an additional three months.

*6 months post-surgery PROMs (KSS) survey is conducted to monitor the patient's progress.

ACLR Surgery Outcomes: Insights from 2023 Data Analysis

ACLR International Benchmark Reference:

Annals of Medicine and Surgery: Analysis of postoperative complications following elective arthroscopic surgeries of the knee- a retrospective cohort study

The Knee: Complications following anterior cruciate ligament reconstruction in the English NHS

Knee Surgery, Sports Traumatology, Arthroscopy: Inpatient admission following anterior cruciate ligament reconstruction is associated with higher postoperative complications

Knee Surgery, Sports Traumatology, Arthroscopy: Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction

Arthroscopy, Sports Medicine, and Rehabilitation: Operative Time Less Than 1.5 Hours, Male Sex, Dependent Functional Status, Presence of Dyspnea, and Reoperations Within 30 days Are Independent Risk Factors for Readmission After ACLR

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