ALTY or “Adding Life To Years” is a private orthopaedic hospital in Kuala Lumpur. The hospital, a joint effort between TE Asia Healthcare and our founding group of established orthopaedic surgeons, was established to pursue our dream of making ALTY the orthopaedic hospital of choice. Collectively, we provide a comprehensive solution that works best around you and your lifestyle to ensure optimum mobility.

With that in mind, we aim to efficiently diagnose the cause of your discomfort and provide optimal solutions through our Spine and Joint Clinics. Additionally, we offer comprehensive screening services under HSC Health Screening, our established screening centre, providing accurate and efficient early detection and prevention of health problems.

We specialise in surgical and non-surgical treatments and provide focused care for Orthopaedic and musculoskeletal conditions, among our other medical specialties under one roof. ALTY is also equipped with facilities that aid in the functional recovery of patients, on top of our Malaysia’s first-ever weight-bearing MRI and EOS Imaging System.

Orthopaedic surgery is a medical specialty that deals with the prevention, diagnosis, and treatment of disorders of the bones, joints, tendons, ligaments and muscles. We offer the most appropriate preventive, treatment and rehabilitation options to suit your individual needs. We are here for all your musculoskeletal and healthcare needs.

ALTY Spine Clinic aims at improving your stability and balance to achieve ideal posture at all age. From identifying the cause of your symptoms to providing effective treatment, our team of medical orthopaedic specialists, nurses and rehabilitation therapists, are always ready to work closely with you to treat and manage conditions related to your spine.

Healthy joints help to maintain independence and mobility throughout your life. Our Joint Clinic addresses all health conditions related to joint and bone health. From your knees, hips, wrists all the way to your shoulders, our specialised team of experts focuses on playing an integral role in providing quality prevention and cure throughout your journey with us. We have a dedicated Joint Replacement Program (JRP) which will help you get back on your feet quickly and efficiently.

The diagnostic and imaging services are supported by the radiology team who works closely with our doctors. Diagnostic imaging services are a crucial part of your overall care and help your surgeon understand your condition better. ALTY provides X-ray, CT scan, MRI, ultrasound, bone density scan, mammogram and angiography services. Your doctor will guide you through the options with the aim of getting it right the first time.

The hip joint is a large ball and socket joint that provides mobility and stability to your lower limb.

Hip conditions known to cause pain and stiffness include:

  • Fractures
  • Dislocation
  • Osteoarthritis
  • Osteonecrosis
  • Hip Impingement

Common hip surgeries include:

  • Total Hip Replacement
  • Hip arthroscopy
  • Hemiarthroplasty
  • Fracture fixation

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from your hip joint and replaced with artificial components. The hip joint is one of the body’s largest weight-bearing joints, located between your thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of your joint.

A number of diseases and conditions can cause damage to your articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities. Total hip replacement may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve your symptoms.

The surgery is performed under general anesthesia. During the procedure a surgical cut is made over your hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged arthritic bone is removed using a reamer. The acetabular component is inserted into the socket using screws or occasionally bone cement. A liner made of plastic or ceramic is placed inside your acetabular component. The femur or thigh bone is then prepared by removing your arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to your femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on your femoral stem. The muscles and tendons around your new joint are repaired and the incision is closed. With the Direct Anterior Approach (DAA), no muscles are cut.

After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. Some of the common precautions to be taken include:

  • Avoid combined movement of bending your hip and turning your foot inwards
  • Keep a pillow between your legs while sleeping for 6 weeks
  • Never cross your legs and bend your hips past a right angle (90 degrees)
  • You should avoid sitting on low chairs
  • You should avoid bending down to pick up things; instead a grabber can be used to do so
  • You should use an elevated toilet seat

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement include:


  • Dislocation
  • Fracture of the femur or pelvis
  • Injury to nerves or blood vessels
  • Formation of blood clots in the leg veins
  • Leg length inequality
  • Hip prosthesis may wear out
  • Failure to relieve pain
  • Scar formation
  • Pressure sores

Total hip replacement is one of the most successful orthopedic procedures performed for patients with hip arthritis. This procedure can relieve pain, restore function, improve your movements at work and play, and provide you with a better quality of life.

The knee is one of the largest and most complex joints in the human body. The knee joint is susceptible to traumatic and degenerative conditions.

Some of the most common causes of knee pain include:

  • Anterior cruciate ligament (ACL) injury
  • Posterior cruciate ligament (PCL) injury
  • Osteoarthritis
  • Meniscus Tear
  • Cartilage Damage

Common Knee surgeries include:

  • Total Knee Replacement
  • Knee arthroscopy
  • ACL reconstruction
  • Knee osteotomy
  • Fracture fixation

The Anterior Cruciate Ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.

ACL reconstruction is a commonly performed surgical procedure. With recent advances in arthroscopic surgery, it can now be performed with minimal incisions and low complication rates.

The ACL is the major stabilizing ligament in the knee. It prevents the tibia (shin bone) moving abnormally on the femur (thigh bone). When this abnormal movement occurs, it is referred to as instability and the patient is aware of this abnormal movement.

Often other structures such as the meniscus, the articular cartilage (lining the joint) or other ligaments can also be damaged at the same time as an ACL injury and these damages to the structures may need to be addressed at the time of surgery.

  • Sports related injuries involving a twisting injury to the knee
  • Due to a sudden change of direction or a direct blow for example a tackle or landing awkwardly

Often there is a popping sound when the ligament ruptures and the feeling of the knee popping out of the joint. The swelling usually occurs within hours. It is rare to be able to continue playing sports with the initial injury.

Once the initial injury settles down, the main symptom is instability or giving away of the knee. This usually occurs with running activities but can occur on simple walking or other activities of daily living.

  • You can often be diagnosed based on your history alone
  • Your examination will reveal the instability of your knee if adequately relaxed or not too painful
  • You may undergo an Magnetic Resonance Imaging (MRI) to look for damage to other structures within your knee
  • At times, the final diagnosis can only be made under anaesthetic or with an Arthroscopy

Initial Treatment

  • Once you encounter an injury, put your knee at rest
  • You may subsequently apply ice to your knee
  • Elevate your leg to reduce swelling
  • Wrap your knees with bandage to minimise swelling and involuntary movements

Long term

Not everyone needs surgery. Some people can compensate for the injured ligament with strengthening exercises or a brace. If you have an ACL injury, it is strongly advised to give up sports involving twisting activities. Episodes of instability can cause further damage to important structures within the knee that may result in early arthritis.

Indications for surgery

  • Young people wishing to maintain an active lifestyle.
  • People who play sports involving twisting activities such as soccer, netball, football
  • People with dangerous occupations for example policemen, firemen, roofers, construction workers.

It is advisable to have physiotherapy prior to surgery to help you regain motion and strengthen the muscles as much as possible.

Surgical techniques have improved significantly over the last decade contributing to reduced complications are quicker recovery than in the past. The surgery is performed arthroscopically. The ruptured ligament is removed and then tunnels (holes) in the bone are drilled to accept the new graft. This graft which replaces your old ACL is taken either from the hamstring tendon or the patella tendon.

The graft is prepared to take the form of a new tendon and passed through the drill holes in the bone. The new tendon is then fixed into your bone with various devices to hold it into place while the ligament heals into the bone (usually 6 months). The rest of the knee can be clearly visualized at the same time and any other damages are dealt with. The wounds then closed often with a drain and a dressing applied.

Post Operation & Rehabilitation

  • Your surgery is performed as a day only procedure or an overnight stay.
  • You will have pain medication by tablet or in a drip (Intravenous).
  • Any drains will be removed from your knee.
  • A splint is sometimes used for your comfort.
  • You will be seen by a physiotherapist who will teach you to use crutches and show you some simple exercises to do at home.
  • Leave any waterproof dressings on your knee until your post-op review.
  • You can put all your weight on your leg.
  • Put ice on your knee for 20 minutes at a time, as frequently as possible.
  • Post-op review will usually be between 7-10 days after surgery.
  • Physiotherapy can begin after a few days or can be arranged at your first post-op visit.
  • If you have any redness around the wound, increasing pain in your knee, fever or feeling unwell, you should contact your surgeon as soon as possible.


Physiotherapy is an integral part of the treatment and it is recommended to start as early as possible. Preoperative physiotherapy is helpful to better prepare your knee for surgery. The early aim is to help you regain range of motion, reduce swelling and achieve full weight bearing.

The remaining rehabilitation will be supervised by a physiotherapist and will involve activities such as exercise, bike riding, swimming, proprioceptive exercises and muscle strengthening. You can begin cycling at 2 months and jogging can generally begin at around 3 months. The graft is strong enough to allow you do sports at around 6 months however other factors come into play such as confidence, fitness and adequate fitness and training.

Professional sportsmen often return at 6 months but recreational athletes may take 10 -12 months depending on motivation and time put into rehabilitation. The rehabilitation and overall success of your procedure can be affected by associated injuries to the knee such as damage to meniscus, articular cartilage or other ligaments.

The following is a more detailed rehabilitation protocol useful for patients and physiotherapists. It is a guide only and must be adjusted according to your needs taking into account pain, other pathology, work and other social factors.

Acute (0 – 2 Weeks)


  • Wound healing
  • Reduce swelling
  • Regain full extension
  • Full weight bearing
  • Wean off crutches
  • Promote muscle control
  • Keep brace on at all times except when doing your exercises

Treatment Guidelines

  • You can reduce pain and swelling with ice, intermittent pressure pump, soft tissue massage and exercise
  • Mobilise your patella
  • You can perform active range of motion knee exercises, calf and hamstring stretching, contraction (non-weight bearing progressing to standing), muscle control and full weight bearing. You may aim for full extension by 2 weeks. Full flexion will take longer and generally will come with gradual stretching. You need to care for your hamstring co-contraction as this may result in hamstring strains if too vigorous. For the next stage, you can continue with light hamstring loading with progression of general rehabilitation. You should avoid resisted hamstring loading should for approximately 6 weeks
  • Gait retraining encouraging extension at heel strike

Stage 2- Quadriceps Control (2-6 Weeks)


  • Full active range of motion
  • Normal gait with reasonable weight tolerance
  • Minimal pain and effusion
  • Develop muscular control for controlled pain free single leg lunge
  • Avoid hamstring strain
  • Develop early proprioceptive awareness
  • Keep brace on at all times except when doing your exercises

Treatment Guidelines

  • You can use active, passive and hands-on techniques to promote full range of motion
  • You may progress to closed chain exercises (quarter squats and single leg lunge) as pain allows. The emphasis is on pain free loading, VMO and gluteal activation
  • Start introducing yourself to gym based exercise equipment including leg press and stationary cycle
  • Water based exercises can begin once your wound has healed, including treading water and gentle swimming avoiding breaststroke
  • Begin your proprioceptive exercises including single standing leg balance on the ground and mini tramp. This can progress by introducing body movement whilst standing on one leg
  • You can do bilateral and single calf raises and stretching
  • You should avoid isolated loading of the hamstrings due to ease of tear. Hamstrings will be progressively loaded through closed chain and gym based activity

Stage 3- Hamstring/Quadriceps Strengthening (6-12 Weeks)


  • Begin specific hamstring loading
  • Increase total leg strength
  • Promote good quadriceps control in lunge and hopping activity in preparation for running
  • Remove your brace

Treatment Guidelines

  • You may begin focal hamstring loading and progress steadily throughout the next stages of rehabilitation
    • Active prone knee flexion which can be quickly progressed to include a light weight and gradually increasing weights
    • Bilateral bridging off a chair. This can be progressed by moving onto a single leg bridge and then single leg bridge with weight held across the abdomen
    • Single straight leg dead lift initially active with increasing difficulty by adding dumbbells with respect to hamstring loading, they should never be pushed into pain and should be carefully progressed. Any subtle strain or tightness following exercises should be managed with a reduction in hamstring based exercises
  • You may perform gym based activity including leg presses, light squats and stationary bike which can be progressively increased in intensity as pain and control allow. It is important to monitor any effusions following exercise and if it is increasing then your exercise should be toned down
  • Once single leg lunge control is comparable to the other side, you can introduce hopping. Hops can be made more difficult by including variations such as forward/back, side to side off a step and in a quadrant
  • You may begin running towards the latter part of this stage. Prior to running certain criteria must be met:
    • No anterior knee pain
    • A pain free lunge and hop that is comparable to the other side
    • The knee must have no effusion
    • Before jogging start having brisk walks, ideally on a treadmill to monitor landing
    • Action and any effusion should be done for several weeks before jogging properly
  • You may increase proprioceptive manoeuvres with standing leg balance and progressive hopping based activity
  • Expand your calf routine to include eccentric loading

Stage Four-Sport Specific (3-6 Months)


  • Improve leg strength
  • Develop running endurance speed and change of direction
  • Advanced proprioception
  • Prepare for return to sports and recreational lifestyle

Treatment Guidelines

  • Controlled sports specific activities should be included in your progression of running and gym loads. Increasing effusion post running that isn’t easily managed with ice should result in a reduction in running loads
  • You should include advanced proprioception with controlled hopping and turning and balance correction
  • You should monitor potential problems associated with increasing loads
  • No open chain resisted leg extension exercises unless authorised by your surgeon

Stage Five-Return to Sport (6 Months Plus)


A safe return to sporting activities

Treatment Guidelines

  • Full training for 1 month prior to active return to your competitive sports
  • You should prepare for body contact sports. Begin with low intensity one on one contests and progress by increasing intensity and complexity in preparation for drills that one might be expected to do at training
  • Improve your running endurance leading up to a normal training session
  • Full range, no effusion, good quadriceps control for lunge, hopping and hop and turn type activity. Circumference measures of your thigh and calf to be within 1 cm of other side

Risks & Complications

Complications are not common but can occur. Prior to making the decision of having this operation, it is important you understand these so you can make an informed decision on the advantages and disadvantages of surgery. These can be medical (anaesthetic) or surgical complications

Medical (Anaesthetic) complications

Medical complications include those of the anaesthetic and your general well-being. Almost any medical condition can occur so this list is not complete. Complications include:

  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attacks
  • Strokes
  • Kidney failure
  • Pneumonia
  • Bladder infections
  • Infection or nerve damage due to nerve blocks
  • Ongoing health concerns and prolonged hospitalization.

Surgical complications

The following is a list of surgical complications. These are all rare but can occur. Most are treatable and do not lead to long term problems.

  • Infection

Infection can happen in approximately 1 in 200 cases. Treatment involves either oral or antibiotics through the drip, or rarely further surgery to wash the infection out.

  • Deep vein thrombosis

These are clots in the veins of the leg. If they occur you may need blood thinning medication in the form of injections or tablets. Very rarely they can travel to your lung (Pulmonary Embolus) which can cause breathing difficulties.

  • Excessive swelling & Bruising

This is due to bleeding in your soft tissues and will settle with time.

  • Joint stiffness

Can result from scar tissue within your joint, and is minimized by advances in surgical technique and rapid rehabilitation.

  • Graft failure

The graft can fail the same as a normal cruciate ligament does. Failure rate is approximately 5%. If your graft stretches or ruptures, it can still be revised if required by using allograft or tendons from your other leg.

  • Damage to nerves or vessels

These are small nerves under your skin which cannot be avoided and cutting them leads to areas of numbness in your leg. This normally reduces in size over time and does not cause any functional problems with your knee. Very rarely there can be damage to more important nerves or vessels causing weakness in your leg.

  • Hardware problems

All grafts need to be fixed to your bone using various devices (hardware) such as screws or staples. These can cause irritation of your wound and may require removal once the graft has grown into the bone.

  • Donor site problems

Donor site means where the graft is taken from. In general, either your hamstrings or patella tendon are used. There can be pain or swelling in these areas which usually resolves over time.

  • Residual pain

This can occur especially if there is damage to other structures inside your knee.

  • Reflex Sympathetic Dystrophy

An extremely rare condition that is not entirely understood which can cause you unexplained and excessive pain.

Anterior Cruciate Ligament reconstruction is a common and has a high successful rate. In the hands of experienced surgeons who perform a lot of these procedures, 98% of people have a successful result. It is generally recommended for patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting.

The above information hopefully has educated you on the choices available to you, the procedure and the risks involved. If you have any further questions, you should consult your surgeon.


Total Knee Replacement (TKR) is a common procedure for knee arthritis. We are the only hospital in Malaysia with a Joint Replacement Program (JRP) where you will receive dedicated care throughout your journey with us.

In an Arthritic Knee

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

The diagnosis of osteoarthritis is made based on history, physical examination & X-rays.

The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family and your local doctor. The benefits following surgery include relief from:

  • 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

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, physical therapy or modification of your activities, for example using a cane to walk.

If the above treatments or lifestyle modifications do not offer long-lasting solution, surgery could be your next option. Most patients who have TKR are between 55 to 80 years of age. However each patient is assessed individually and occasionally patients as young as 20 or as old as 90 are also operated on with good results.


  • Your surgeon will send you for routine blood tests and any other investigations required prior to your surgery
  • You will be asked to undertake a general medical check-up with a physician
  • You should have any other medical, surgical or dental problems attended to prior to your surgery
  • You will attend our special Joint Replacement Program and Classes.
  • You will need to make arrangements for help around the house prior to surgery
  • You should cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
  • You should cease any naturopathic or herbal medications 10 days before surgery
  • You should stop smoking prior to surgery

Day of Surgery

  • You will be admitted to the hospital, usually on the same day or the day before surgery
  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your Anesthetist, who will ask you a few questions
  • You will be given hospital clothes to change into and have a shower prior to surgery
  • The operation site will be shaved and cleaned
  • Approximately 30 minutes prior to surgery you will be transferred to the operating room

Each knee is unique and we take this into account by offering different implant sizes for your knee. You may also be a candidate for robotic knee replacement surgery which offers more precision and better outcomes. You can discuss this with your orthopaedic surgeon.

Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet may be applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours.

The surgeon cuts down to the bone to expose the bones of the knee joint. The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs or a specialized robot. Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. The patella (knee cap) may be replaced depending on a number of factors.

The real components are then inserted with or without cement and the knee is again checked to make sure things are working properly. The knee is then carefully closed with stitches and the knee dressed and bandaged.

Post Operative Treatment

When you regain consciousness, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital signs. You may have a button to press for pain medication through a machine called a PCA machine (Patient Controlled Analgesia).

Once stable, you will be taken to the ward. The post-op protocol is surgeon dependent, but in general you will sit out of bed and start moving you knee and walking within a day or two of surgery. The dressing will be reduced the next morning to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist.

To avoid lung congestion, it is important to breathe deeply and use a triflow which will be provided to you. Your orthopaedic surgeon will use one or more measures to minimize blood clots in your legs, such as aspirin, inflatable leg coverings, stockings or injections into your abdomen to thin the blood clots or DVT’s, which will be discussed in detail in the complications section.

The long term results of knee replacements depend on how much work you put into it following your surgery. Usually, you will remain in the hospital for 2-3 days. Then, depending on your needs, either return home or proceed to a rehabilitation facility. You will need physical therapy on your knee following surgery. You will be discharged with a walker and will usually progress to a cane at six weeks.

Your sutures are sometimes dissolvable but if not, are removed at approximately 10 days. The extent of bending your knee varies, but by 4 weeks your knee should be able bend to 100 degrees. The goal is to obtain 115-125 degrees of movement.

Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be reasonably comfortable to walk by 6 weeks. More physical activities, such as sports previously discussed, may take 3 months to do comfortably.

When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements, especially if there are lot of stairs in your house.

You will have regular checkups with your surgeon who will assess your progress. You should continue to see your surgeon regularly to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized with X-ray.

You are always at risk of infections especially with any dental work or other surgical procedures where bacteria can get into the blood stream and find their way to your knee. If you ever have any unexplained pain, swelling or redness or if you feel generally unwell, you should see your doctor as soon as possible.

Risks & 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 local specific to the knee. Medical complications include anesthetic complications. Almost any medical complication can occur so this list is non-exhaustive.

Complications include:

  • Allergic reactions to medications
  • Blood loss requiring transfusion with low risk of disease transmission
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
  • Infection or nerve damage due to nerve blocks

Serious medical problems can lead to ongoing health concerns or prolonged hospitalization.

Local Complications


Infection can occur with any operation. In the knee, this can be superficial or deep. Infection rates vary. If it occurs, it can be treated with antibiotics but might require further surgery. Very rarely your new knee may need to be removed to eradicate infection. At ALTY, we focus on successful outcomes and low infection rate.

Blood Clots (Deep Venous Thrombosis)

Blood clots 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 doctor.

Stiffness in the Knee

Ideally your knee should bend beyond 120 degrees but occasionally, the knee may not bend as well as expected. Sometimes manipulations are required. This means going back to the operating room where the knee is bent for you while you are and under anesthetic.


The plastic liner eventually wears out over time, usually 15 to 20 years and may need to be changed.

Wound Irritation or Breakdown

The operation will always cut some skin nerves, so you will inevitably have some numbness around the scar. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.

Cosmetic Appearance

The knee may look different than it was because it has been put back into the correct alignment (straightened) to allow proper function.

Leg length inequality

This is due to the fact that a corrected knee is straighter.


An extremely rare condition where the ends of the knee joint lose contact with each other or the plastic insert can lose contact with the tibia (shinbone) or the femur (thigh bone).

Patella problems

The patella (knee cap) can dislocate. This means it moves out of place and it can break or loosen.

Ligament injuries

There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem.

Damage to Nerves and Blood Vessels

Nerves and blood vessels are rarely damaged at the time of surgery. If recognized they are repaired, but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

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 will help to restore function to your damaged joints as well as relieve pain.

TKR is one of the most successful operations available today. It is an excellent procedure to improve the quality of life, take away pain and improve function. In general, 90 to 95% of knee replacements survive for 20 years, depending on age and activity level.

Surgery is only offered once non-operative treatments have failed. It is an important decision to make and ultimately it is an informed decision between you, your family, your surgeon and medical practitioner.


Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro-, meaning joint, and -skopein, meaning to examine.

The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.

The arthroscope is a fibre-optic telescope that can be inserted into a joint (commonly the knee, shoulder and ankle) to evaluate and treat a number of conditions. A camera is attached to the arthroscope and the picture is visualized on a TV monitor. Most arthroscopic surgery is performed as day surgery and is usually done under general anaesthesia. Knee arthroscopy is common, and millions of procedures are performed each year around the world.

Arthroscopy is useful in evaluating and treating the following conditions

  • Torn floating cartilage (meniscus): The cartilage is trimmed to a stable rim or occasionally repaired
  • Torn surface (articular) cartilage
  • Removal of loose bodies (cartilage or bone that has broken off) and cysts
  • Reconstruction of the anterior cruciate ligament
  • Patello-femoral (knee-cap) disorders
  • Washout of infected knees
  • General diagnostic purposes

Some of the knee conditions treated using arthroscopic surgery includes:

  • Meniscal cartilage tears
  • Cartilage tears
  • Articular cartilage (surface) injury
  • Anterior cruciate ligament Injuries
  • Patella (knee-cap) injuries
  • Inflammatory arthritis of knee
  • Isolated cartilage defects in younger patient

 Patient Information

Please stop taking aspirin and anti-inflammatory medications 5 days prior to your surgery. You can continue taking all your other routine medication. If you smoke you are advised to stop a few days prior to your surgery.

You will be admitted on the day of surgery and need to remain fasted for 6 hours prior to the procedure.

The limb undergoing the procedure will be marked and identified prior to the anaesthetic being administered.

Once you are under anaesthetic, the knee is prepared in a sterile fashion. A tourniquet is placed around the thigh to allow a ‘blood – free’ procedure.

The arthroscope is introduced through a small (size of a pen) incision on the outer side of the knee. A second incision on the inner side of the knee is made to introduce the instruments that allow examination of the joint and treatment of the problem.

Patients have some discomfort in the throat as a result of the tube that supplies oxygen and other gasses. Please discuss with the specialist anaesthetist if you have any specific concerns.

Risks related to arthroscopic knee surgery include:

  • Postoperative bleeding
  • Deep vein thrombosis
  • Infection
  • Stiffness
  • Numbness to part of the skin near the incisions
  • Injury to vessels, nerves and a chronic pain syndrome
  • Progression of the disease process

Following your surgery you will be given an instruction sheet showing exercises that are helpful in speeding up your recovery. Strengthening your thigh muscles (quadriceps and hamstrings) is most important. Swimming and cycling (stationary or road) are excellent ways to build these muscles up and improve movement.

The shoulder is one of the most mobile joints in your body. Ironically, it’s also one of the most commonly injured joints in the upper limb due to its mobility.

Some of the most common problems associated with the shoulder are:

  • Osteoarthritis
  • Rotator cuff tear
  • Impingement
  • Instability

Common shoulder surgeries include:

  • Shoulder arthroscopy
  • Rotator cuff repair
  • Shoulder replacement
  • Shoulder fracture fixation
  • Frozen shoulder manipulation

Located in close proximity with the shoulder, your elbow joints are prone to traumatic and ‘repetitive’ overuse injuries.

Common conditions of elbow include:

  • Fractures
  • Dislocations
  • Osteoarthritis
  • Tennis elbow
  • Golfers elbow

Common elbow surgeries include:

  • Elbow fracture fixation
  • Elbow arthroscopy
  • Elbow replacement
  • Elbow ligament reconstruction

The spine provides stability and structure to your body. A healthy spine allows you to be mobile and pain free. The spine also protects vital organs such as the spinal cord, a column of nerve that connects the brain to the rest of your limbs.

Some of the most common conditions affecting the spine include:

  • Arthritic disorders
  • Failed back surgery
  • Nerve compression
  • Scoliosis
  • Spinal stenosis
  • Whiplash
  • Spinal instability – spondylolisthesis
  • Cervical and lumbar disc herniations – “Slipped Disc”
  • Spinal infections
  • Vertebral Compression Fractures (VCF)
  • Spinal fractures due to trauma
  • Spinal tumours

Diagnostic Options

  • X-ray
  • Computerized Tomography (CT) scan
  • Diagnostic ultrasound
  • Dual energy X-ray Absorptiometry (DXA)
  • Electromyogram (EMG) or Nerve Conduction Velocity (NCV) testing
  • Magnetic Resonance Imaging (MRI)
  • Magnetic Resonance Arthrography (MRA)
  • Needle or open biopsy
  • Positron Emission Tomography (PET) scan
  • Bone scans
  • Discography
  • Selective Nerve Root Block (SNRB)
  • Joint injections

Note: Most common diagnostic tools in the spine are X-ray, MRI, CT-Scan with 3D reconstruction and Electromyography (EMG).

Treatments for spinal conditions range from non-invasive approaches such as braces and physical therapy to modern surgical methods such as spinal injections and spinal surgery. Your treatment plan will be tailored by our specialists to manage and address the cause of your symptoms.

  • Non-surgical treatment:
    Some spinal injuries can be treated without surgery. Below are some treatment options that our specialists may recommend during your treatment.

    • Spinal orthosis / bracing
    • Ice or heat therapy for injuries
    • Injections such as corticosteroids or nerve blocks for pain
    • Medications such as anti-inflammatories (NSAIDs), pain relievers, or muscle relaxers
    • Physical therapy
  • Surgical treatment:
    In certain indications, surgery is recommended as an option to manage your spine condition.  Our spine surgeons are familiar with the latest surgical techniques including minimally invasive surgery and robotic navigation.  Some of the procedures of spinal surgery are listed below:

    • Radiofrequency ablation / Percutaneous laser disc decompression
    • Endoscopic or open micro-discectomy
    • Endoscopic spinal decompression and fusion
    • Spinal laminectomy / Spinal decompression
    • Minimal invasive / Open spinal instrumentation and fusion
    • Scoliosis / Deformity corrective surgery
    • Vertebroplasty and Kyphoplasty
    • Artificial disc replacement
    • Corrective spine osteotomy

The spine team at ALTY takes a holistic approach to your care.  Our dedicated doctors, nurses and allied health professionals are here to help you all the way from diagnosis, treatment to post-surgical care.

Spinal injury is a debilitating condition. Our team of experts will work closely with you to help regain mobility after spinal injury. Your doctor will recommend a rehabilitation program to help optimise your recovery. Our expert team of allied health professionals is here to guide you along the way.

Our hands serve many purposes such as to write, draw, eat, dress and many other activities.

Hands are also prone to injuries and overuse conditions such as:

  • Carpal tunnel syndrome
  • DeQuervains tenosynovitis
  • Trigger finger
  • Trigger thumb
  • Fractures and dislocations

Common hand surgeries are:

  • Carpal tunnel decompression
  • Trigger finger release
  • Fracture fixation
  • Wrist fusion
  • Scaphoid fixation

Each foot is made up of 26 bones, 30 joints and more than 100 muscles, tendons, and ligaments. The unique anatomy of the foot and ankle works together to provide you with support, balance and mobility.

Common conditions affecting the foot and ankle region include:

  • Achilles tendinitis
  • Osteoarthritis
  • Cartilage damage
  • Diabetic foot problem
  • Dislocation
  • Plantar fasciitis (foot pain)
  • Fractures
  • Gout
  • Sprains
  • Tendonitis (tendinitis)


Common foot and ankle procedures include:

  • Bunion surgery
  • Ankle fusion
  • Ankle ligament reconstruction
  • Flat foot correction
  • Diabetic foot surgery
  • Fracture fixation

Thonburi Bamrungmuang Hospital is represented by GPT Overseas Medical & Dental Travel

Contact our office on 0418428909 or +61 418428909 (from outside Australia): Email –