Dr Harris Zourelidis, Specialist Orthopaedic Surgeon at Valiant Clinic & Hospital, explains a procedure to a patient Image Credit: Supplied

Surgery is often a difficult option for many patients as it usually requires extensive treatment and recovery period. However, modern developments in surgery and treatments of some conditions such as chronic back pain, arthritis and sports injuries, as well as cataracts are now paving the way for patients to hasten their recovery and improve their health.

Maintaining healthy bones and joints regardless of age is vital to enjoying optimum mobility, especially in places such as Dubai where there are ample opportunities to live an active lifestyle. Disabilities in bones, muscles and joints can be disheartening for those suffering from chronic pain or injured due to sports activities. However, treatments to these conditions do not always require surgery and there are innovative treatments, which can help them experience easier movements.

Valiant Clinic & Hospital has established a Bone & Joint Centre as part of its Orthopaedic Department and Sports Medicine to cater to the complex needs of patients in the region for advanced treatment. These include non-surgical treatment, exercise programmes, and minimally invasive surgery.

Daycare with minimal incision

Knees and shoulders are two of the most common joint problems that Dr Harris Zourelidis, Specialist Orthopaedic Surgeon at Valiant Clinic & Hospital, confirms can be treated under a daycare minimally invasive surgery, where procedures are done through small openings to limit the impact on the soft tissue. The most common knee surgeries are meniscal repair and anterior cruciate ligament reconstruction. For shoulders, it involves the repair of tendons, rotator cuff, and repair of labarum for instability.

He explains that these types of problems require clinical examination, including X-rays, ultrasound and MRI scanning to see the condition of the joints. Prior to the procedure, local anaesthetic will be applied for the relevant nerves to enable long-lasting pain relief and minimise the intake of oral medicine. This is called nerve block.

“During the operation, small incision of 5mm is made and a camera assists us in examining the inner part of the joint,” says Dr Zourelidis. “For torn ligaments, menisci or other tissues, modern implants are used to repair them to enable the patient to start moving the joint without the risk of damaging repaired tissues. Overall, the technique is a combination of minimally invasive operation, local nerve blocking and use of modern implants for strong fixation to enable the patient to go home on the same day after surgery and return to daily activities, such as walking and driving within a week or two, depending on the procedure.”

Relieving chronic pain

For chronic back pain sufferers who have been going back and forth to various specialists to free themselves from pain, Valiant Clinic & Hospital suggests interventional pain management techniques that the hospital provides with a comprehensive and holistic approach, which can also be non-surgical depending on the patient’s condition.

Dr Zbiggy J. Brodzinsky, Consultant Orthopaedic Spine Surgeon at Valiant, says that interventional pain management, which is multidisciplinary, can provide a full range of treatments and services for patients with the goal of reducing or managing pain to improve the patient’s overall quality of life through minimally invasive techniques, especially if patients have exhausted other treatment methods.

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“For back pain sufferers, interventional pain management techniques can be particularly useful," he says. "In addition to a thorough medical history and physical examination, interventional pain management physicians at Valiant have a wide array of treatments that can be used. These often include other treatments such as physical therapy, occupational therapy, and lifestyle modification to further enhance the procedures.”

Valiant Clinic & Hospital’s range of treatments in interventional pain management, led by Dr Mohamed El Toukhy, Consultant Pain Medicine, and Dr Brodzinsky include epidural injections, which use anaesthetic and steroid medications. Determining the source of pain is conducted through various means such as the nerve, root and medial branch blocks, which are injections to determine if a specific spinal nerve root is the source of pain. It can also be used to reduce inflammation and pain. Other options are facet joint injections and discography, which both help identify and examine the source of pain.

Meanwhile, there are pain blockers such as pulsed radiofrequency neurotomy (PRFN), which can be implemented as a minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain. More options include rhizotomy, a procedure which turns off the pain signals to the brain using heated electrodes and are applied to specific nerves that carry pain signals, and spinal cord stimulation, which uses electrical impulses to block pain from being perceived in the brain.

Finally, intrathecal pumps can be an option, which involves surgical implantation of pump that delivers pain medications to the precise location in the spine where the pain is located. Another procedure is the percutaneous discectomy or nucleoplasty in which a tissue is removed from the disc to decompress and relieve pressure.

Ankle and foot care

For ankle and foot care, Dr Nathalie Bouffioux, Consultant Orthopaedic Surgeon at Valiant who has more than 20 years of experience in ankle-foot surgery, says a balance between conservative therapies and surgery is important to achieve optimum healing. She provides a customised treatment approach for each patient and gives premium value to the patient-doctor relationship in the care process to fully offer the most accurate care needed.

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“Minimally invasive surgery has been well documented and offers an evidenced-based treatment approach for foot and ankle conditions, showing faster recovery time, minimal scars, and reduced use of pain medications after the operation,” says Dr Bouffioux. “Minor surgical incisions are highly favoured nowadays by specialists as they lessen the trauma impact to the muscles.”

Valiant Clinic & Hospital treats various conditions such as bunions, hammertoes, and big toe arthritis. Foot surgeons today avoid sacrificing a joint by fusion during surgery. In Europe, Dr Bouffioux practised the big toe replacement with pyro carbon prosthesis, rather than fixing the joint (arthrodesis) for cases of painful arthritis of the big toe. This unique procedure is now part of her practice here in Dubai.

Sports therapy for alleviating pain

Valiant Clinic & Hospital’s resident sports therapist Danielle Donnelly identifies shoulder impingement syndrome as the most common cause of shoulder pain, which happens when there is an impingement of tendons or the bursa from the bones, often caused by repeated overhead activity of the shoulder. The common symptoms are difficulty reaching up on the back or pain when stretching the arm upwards, as well as weakness of the shoulder muscles.

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She says conservative management can reduce pain, citing studies that prove how this approach has improved the functioning of the shoulder and avoided the need for surgery. “As a sports therapist, I focus on reducing the pain and improving the function of the joint through a combination of manual therapy and rehabilitative exercises. A good exercise programme would include stretching and controlled articular rotations (CARs), which is a carefully controlled, focused joint circles. During a CARs, you are focused on only moving the joint you are moving and nothing else. You need to improve and wake up the receptors in the areas of the joint that are weak and not functioning properly to ensure permanent optimal flexibility.”

She also recommends ways to strengthen the shoulder muscles such as the rotator cuff and postural muscles. Poor posture leads to a reduction in shoulder movement and therefore is implicated in a number of shoulder conditions. Donnelly also engages in providing sports-specific exercise and modifies current exercise programmes to get patients back to their normal activity or sport of choice.

Gold standard surgery for cataract treatment

As part of Valiant Clinic & Hospital’s continuing efforts to offer advanced surgical procedures, the hospital is also now offering the gold standard technique in the field of cataract extraction, which is the phacoemulsification. It is a procedure that involves the use of ultrasound energy to dissolve and extract the cataract and has been proven successful in millions of patients across the world.

Dr Luisa M. Sastre, Consultant Ophthalmologist at Valiant, however notes that femtosecond laser is also an effective approach as part of the cataract surgery, which involves incisions, capsulotomy and softening of the nucleus. However, it has not been widely used at present due to the cost of the technology, which is still prohibitive for many insurance companies to include in their medical coverage.

“Cataract prevention involves simple habits and practices such as wearing sunglasses when exposed to the sun’s heat as excessive exposure can damage your cornea and retina, which can lead to cataracts,” she says. “A good metabolic control of diabetes is also important, and avoidance of steroids are best ways to protect the eyes from contracting cataracts.”.

Valiant Clinic & Hospital accepts the following insurance: Bupa Oman Insurance, NAS, Mednet, Neuron, Saada, MetLife, NextCare, AXA, Almadallah, Saico Health, Daman, Aetna, MSH International and Inayah TPA.

To book for appointments, call 8008254268, email appointments@valiant.ae or visit www.valiantclinic.com