Orthopaedics

Framework for Success

At HIMAHEALTH, we offer the most comprehensive orthopaedic department in the region and one of the finest in the United States. Our U.S. board-certified surgeons hold advanced degrees from some of the finest universities in Puerto Rico and the U.S., and their specialized training and residencies at top-name hospitals have provided knowledge and experience in the latest procedures and techniques.

Among the specialties that our orthopaedic physicians have trained in are: traumatic orthopaedics, joint replacement, arthroscopy and the full gamut of spinal procedures, including minimally invasive disc repair to total spine rebuilding or surgical scoliosis correction. You’ll find our techniques and technologies on a par with the finest specialized orthopaedic surgery centers anywhere in the world.

As an orthopaedic patient, you can expect our HIMAHEALTH physicians to perform a complete review of your preadmission films and files from your referring physician, along with updated diagnostic tests upon your arrival. The appropriate procedure will be prescribed, the surgery performed and the follow up done by your physician. He/she may prescribe physical therapy immediately following your procedure, as well as once you are home where your referring physician will be briefed on your procedure and your files updated.

HIP REPLACEMENT

In cases where the joint has severe damage or is causing substantial pain, a joint replacement may be indicated. Many times this joint damage is caused as a result of hip fractures. This orthopaedic procedure replaces the old bone joint with a long-lasting prosthetic implant.

KNEE JOINT PROCEDURES

KNEE REPLACEMENT
When knee pain and functionality can no longer be relieved with anti-inflammatories or arthroscopic procedures, knee replacement may be indicated. The old bone joint is replaced with a prosthetic joint and pain-free mobility is restored.

ARTHROSCOPY MENISCECTOMY
Many times the meniscus cartilage is torn as a result of a sports or work-related injury. The usual repair is a minimally invasive outpatient surgical procedure using an arthroscope to treat a torn meniscus cartilage in the knee. Only the torn segment of the meniscus is removed. Some patients require assistance from physical therapists postoperatively. The average time of return to all activities is 4-6 weeks after the surgery.

ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT
Reconstruction of the anterior cruciate ligament performed on individuals whose activities are compromised by instability of the knee and who have failed to respond to nonsurgical treatment options. Repair of the anterior cruciate ligament usually involves replacement of the ligament by an autograft, allograft or synthetic ligament. Autografts are the method of choice because they are grafts from the actual patient and less prone to complications.

VALGUS KNEE REPAIR
Valgus alignment shifts the load-bearing axis to the outside, causing increased stress across the lateral (outer) compartment of the knee. Valgus deformities require a lateral collateral ligament and popliteus, in that order, to be released from the epicondyle on the femur. More release can be obtained by taking down the intramuscular septum and lateral gastrocnemius. The posterior cruciate ligament plays a role in maintaining high valgus deformities. Thus, resection of this ligament is usually required. A lax medial collateral ligament may also contribute to this type of deformity.

ACL RECONSTRUCTION
Anterior cruciate ligament (ACL) reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament located in the knee to restore its function after injury. The torn ligament is removed from the knee before the graft is inserted. The surgery is performed arthroscopically.

SHOULDER REPLACEMENTS

ROTATOR CUFF REPAIR
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder. These muscles and tendons hold the arm in its ball-and-socket joint and help the shoulder to rotate. The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury. Rotator cuff repair is a type of surgery to fix a torn tendon in the shoulder. The procedure can be done with a large open incision or with shoulder arthroscopy, which uses small button-hole sized incisions.

SPINAL CONDITIONS AND PROCEDURES

Our world-class spine surgeons specialize solely in diseases and treatment of the spine. From the cervical (or neck region) down through the thoracic (middle section) to the lumbar (bottom or base) region of the spine, HIMAHEALTH physicians have performed every conceivable form of surgery to alleviate pain and restore mobility, posture and movement in this critical area.

We offer unparalleled training and expertise in the treatment of degenerative disc disease, herniated disc, osteoporosis, osteoarthritis, sciatica, scoliosis, spondylolisthesis, stenosis, trauma and tumors. And we’ve matched that expertise with the latest advances in treatment options, such as advanced implants, prosthesis, grafts, bio-molecular treatments, robotic surgery platforms, and CyberKnife® technology. Our procedures and results rival the top spine centers in the world.

We also feature the use of spinal cord monitors during operations. Monitors can detect the slightest disturbance to the delicate spinal cord structure and provide early warning of a possible infringement on the cord’s integrity as the surgeon is operating in that area. This technology is providing early warning and thus helping to create better outcomes in previously difficult procedures.

SPINAL FUSION
Spinal fusion is a surgical procedure used to correct problems with the bones (vertebrae) of the back (spine). The spine is stabilized by fusing together two or more vertebrae, using bone grafts and metal rods and screws. This procedures is also known as spondylodesis or spondylosyndesis. Supplementary bone tissue (either autograft or allograft) is used in conjunction with the body's natural osteoblastic processes. This procedure is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the vertebrae themselves.

LAMINECTOMY
Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. There are many variations of laminectomy. In the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. The traditional form of laminectomy (conventional laminectomy) excises much more than just the lamina, the entire posterior backbone is removed along with overlying ligaments and muscles. The usual recovery period is very different depending on which type of laminectomy has been performed – days in the minimal procedure and weeks to months with conventional open surgery.

Among the spine procedures that are performed at HIMAHEALTH are:

Cervical Spine:

• Anterior Cervical Discectomy, Fusion (ACDF)
• Cervical Laminectomy, Fusion
• Cervical Laminoplasty
• Posterior Cervical Laminotomy

Lumbar Spine:

• Anterior Lumbar Interbody Fusion (ALIF)
• Laminectomy, Fusion
• Lumbar Laminectomy
• Lumbar Partial Discectomy
• Lumbar Vertebral Body Replacement
• Minimally Invasive Approach
• Minimally Invasive Discectomy (Percutaneous Disc Removal)
• Posterior Lumbar Interbody Fusion (PLIF)

Thoracic Spine:

• Derotation with Instrumentation
• Thoracic Laminectomy and Instrumentation
• Thoracic Vertebral Body Replacement (Anterior)