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CURRENT POSITION 1. Chairman of Post Graduate Fellowship Program, Indonesian Hip & Knee Society. 2.

Clinical Instructor for The Orthopaedic Training Program of University of Indonesia. Medical Consultant of The Faculty of Medicine of Trisakti University, Jakarta.

Knee Replacement / Arthroplasty


Category: Total Knee Replacement

The word 'arthroplasty' means 'reshaping of the joint'. 'Knee arthroplasty' is usually taken to mean 'knee replacement'. Total knee replacement' is somewhat of a misnomer as the knee is not totally replaced but is really only re-surfaced. If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you're sitting or lying down. If medications, changing your activity level and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By resurfacing your knee's damaged and worn surfaces, knee replacement surgery can relieve your pain, correct your leg deformity and help you resume your normal activities. One of the most important orthopaedic surgical advances of the twentieth century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased its effectiveness. How the Normal Knee Works The knee is the largest joint in the body. Nearly normal knee function is needed to perform routine everyday activities. The knee is made up of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength. The joint surfaces where these three bones touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily. All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy

knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness and less function. Common Causes of Knee Pain and Loss of Knee Function The most common cause of chronic knee pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis are the most common forms.

3. Osteoarthritis usually occurs after the age of 50 and often in an


individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Rheumatoid Arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid that over-fills the joint space. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain and stiffness. Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function. Is Knee Replacement for You? The decision whether to have knee replacement surgery should be a cooperative one between you, your family and your orthopaedic surgeon. Reasons that you may benefit from knee replacement commonly include: Severe knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker. Moderate or severe knee pain while resting, either day or night Chronic knee inflammation and swelling that doesn't improve with rest or medications Knee deformity--a bowing in or out of your knee Knee stiffness--inability to bend and straighten your knee Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis. Inability to tolerate or complications from pain medications Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries Most patients who undergo knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient's pain and disability, not age. Knee

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replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis. Realistic Expectations About Knee Replacement Surgery An important factor in deciding whether to have knee replacement surgery is understanding what the procedure can and can't do. More than 90 percent of individuals who undergo knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement won't make you a super-athlete or allow you to do more than you could before you developed arthritis. Following surgery, you will be advised to avoid some types of activity, including jogging and high impact sports, for the rest of your life. With normal use and activity, every knee replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. With appropriate activity modification, knee replacements can last for many years. The Procedure You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia, in which you are asleep throughout the procedure, and spinal or epidural anesthesia, in which you are awake but your legs are anesthetized. The anesthesia team will determine which type of anesthesia will be best for you with your input. The procedure itself takes about one to two hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee. Many different types of designs and materials are currently used in knee replacement surgery. Nearly all of them consist of three components: the femoral component (made of a highly polished strong metal), the tibial component (made of a durable plastic often held in a metal tray), and the patellar component (also plastic). After surgery, you will be moved to the recovery room, where you will remain for one to two hours while your recovery from anesthesia is monitored. After you awaken, you will be taken to your hospital room. Your Stay in the Hospital You will most likely stay in the hospital for several days. After surgery, you will feel some pain, but medication will be given to you to make you feel as comfortable as possible. Pain management is an important part of your recovery, so talk with your surgeon if postoperative pain becomes a

problem. Walking and knee movement are important to your recovery and will begin immediately after your surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery. Possible Complications After Surgery The complication rate following knee replacement is low. Serious complications, such as a knee joint infection, occur in less than 2 percent of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit your full recovery. Blood clots in the leg veins are the most common complication of knee replacement surgery. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood. Although implant designs and materials as well as surgical techniques have been optimized, wear of the bearing surfaces or loosening of the components may occur. Additionally, although an average of 115 degrees of motion is generally anticipated after surgery, scarring of the knee can occasionally occur and motion may be more limited. This is particularly true in patients with limited motion before surgery. Finally, while rare, injury to the nerves or blood vessels around the knee can occur during surgery. Your Recovery at Home The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery. Wound Care You will have stitches running along your wound or a suture beneath your skin on the front of your knee. The stitches will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried. The wound may be bandaged to prevent irritation from clothing or support stockings. Diet Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some pain with activity and at night is common for several weeks after surgery. Your activity program should include: A graduated walking program to slowly increase your mobility, initially in your home and later outside Resuming other normal household activities, such as sitting and standing and walking up and down stairs Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery. Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery. Avoiding Problems After Surgery Blood Clot Prevention Follow your orthopaedic surgeon's instructions carefully to minimize the potential of blood clots that can occur during the first several weeks of your recovery. Warning signs of possible blood clots in your leg include: Increasing pain in your calf Tenderness or redness above or below your knee Increasing swelling in your calf, ankle and foot Notify your doctor immediately if you develop any of these signs. Preventing Infection The most common causes of infection following knee replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection. For the first two years after your knee replacement, you must preventive antibiotics before dental or surgical procedures that could bacteria to enter your bloodstream. After two years, talk to orthopaedist and your dentist or urologist to see if you still preventive antibiotics before any scheduled procedures. Warning signs of a possible knee replacement infection are: Persistent fever Shaking chills Increasing redness, tenderness or swelling of the knee wound Drainage from the knee wound take allow your need

Increasing knee pain with both activity and rest Avoiding Falls A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails or someone to help you until you have improved your balance, flexibility and strength. How Your New Knee Is Different You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery. Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated. After surgery, make sure you also do the following: Participate in regular light exercise programs to maintain proper strength and mobility of your new knee. See your orthopaedic surgeon periodically for a routine follow-up examination and X-rays, usually once a year.

Arthroscopy
Category: Arthroscopy

Arthro means joint and scope, to see or visualize. It literally means to see inside the joint. The indications (reasons for performing an arthroscope) are varied. They include cartilage, meniscal, and ligamentous damage. Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are

made by engineers in electronic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future. Sometimes, the arthroscope is used to determine the cause of joint pain. Occasionally, x-rays, physical exams, MRI scans and various other techniques cannot determine the cause of knee pain. Arthroscopy, since it sees inside the knee, can help determine what may be the problem. This is called a diagnostic arthroscopy because it helps to diagnose the problem. The arthroscope can also be used to aid in the treatment of various fractures and assist in surgeries such as ACL reconstruction. Two to four small incisions are strategically placed. Instruments are inserted through one and the camera through another. Sometimes other small incisions (called portals) are used to facilitate fluid drainage of the joint or to allow additional instruments to be introduced into the joint. During an arthroscopy, sterile fluid is pumped into the joint to keep the joint large enough so the camera and instruments can fit in the joint space. It also helps to keep the camera lens clean and free of debris. As techniques become more advanced and surgeons become more experienced with arthroscopic procedures, more and more procedures that previously required large incisions can be done with the arthroscope. The arthroscope can also help minimize incision requirements for other surgeries, too. Because of the less invasive manner of the arthroscope, healing occurs quicker and recovery is shortened considerably. Knee arthroscopy, as well as arthroscopy of other joints, has revolutionized orthopaedic surgical patient care. Recovery after arthroscopy The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and adhesive strips can be applied to cover the small healing incisions. Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it takes several weeks for the joint to maximally recover. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function. It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes and others who are in good physical condition may in some cases return to athletic activities within a few weeks. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality.

Ligament Injury: ACL Reconstruction


Category: Ligament Injury

Anterior cruciate ligament (ACL) reconstruction is the most common type of surgery for a completely torn acutely or chronic insufficient ACL with associated instability. ACL-deficient knees are at marked risk for developing meniscal injury. The loss of meniscal tissue is associated with degeneration. On the other hand, an isolated ACL tear without meniscal or chondral injury may not predispose to arthritis. It is rare to be able to repair the torn ACL by simply reconnecting the torn ends.

However, in very specific injuries when the ACL is detached from the femoral attachment site (such as in certain types of skiing accidents), it may be possible to perform a primary repair. Nevertheless, the mainstay of ACL tear management is reconstruction. Most surgeons now favor reconstruction of the ACL using a piece of tendon to replace the torn ACL. Successful ACL reconstruction is dependent on a number of factors, including surgical technique, post-operative rehabilitation and associated secondary ligament instability. Today, ACL reconstruction is usually performed with arthroscopic assistance. The surgeon uses a graft, to replace the torn ACL. The graft may be taken from elsewhere in the patient's extremity (autograft), harvested from a cadaver (allograft) or may be synthetic. AutograftAutograft is the most widely performed orthopedic ACL reconstruction. The technique involves moving (harvesting) the patients own tissue. Commonly used autografts are the mid-third of the patellar tendon with bone attached at both ends, one or two medial hamstrings, or the quadriceps tendon with bone at one end. Results are somewhat similar and secondary effects are unique to the harvest site. Surgeon preference is the primary factor in selection. Allograft An allograft is tissue that is harvested from a cadaver. (Donor

tissue is kept at a tissue bank where it is screened for infection and then stored-most commonly frozen.) The advantage of using an allograft is that the patient's own tissue is not disturbed and thus there is no harvest site morbidity. SyntheticThe advantages of synthetic grafts are the lack of harvest site morbidity, off the shelf availability, and no disease transmission. However, the failure rates of synthetic grafts tested in the USA were unacceptable. Synthetic grafts currently have inherent mechanical properties that do not closely resemble the normal ligament and as they are not living, they cannot repair themselves, as can natural ligaments. ProcedureACL reconstruction is usually not performed until a few weeks after the injury as studies have shown improved results when the knee has recovered from the acute injury response. That is, the knee has had resolution of swelling, pain and the patient has regained near full motion and strength. During the procedure: The patient is anesthetized using general or spinal/epidural. Arthroscopy allows determination of associated injuries, which are usually treated at the same setting (e.g., meniscal tears or chondral trauma). The space in the knee where the PCL and ACL reside, the notch, is often narrow and in those cases it is widened (notchplasty) to accommodate the graft. Then through a small separate accessory incision, a tunnel is drilled through the tibia (lower leg bone) and through the femur (the upper bone) in the same position as the original ligament attachment sites. The graft is fashioned to fit into these tunnels. The graft is fixed to the femur and tibia (upper and lower leg bones) by a variety of means. Once secure, the graft is checked for proper tension. RecoveryWhile resting during the first 3 or 4 days, efforts are directed at minimizing the swelling and reestablishing quadriceps function. During this time elevation of theknee, leg and ankle are emphasized. Moving frequently increases blood flow return from the extremity (e.g. ankle pumps). 7. 8. Crutches are used to walk bearing weight as per doctor's orders. The emphasis is on a normal gait without limping. Wear comfortable shoes. Stay within your safe range of motion as directed by your doctor. Bathe and shower after surgery as your surgeon directs. Most surgeries are being done on an outpatient basis, although some patients stay overnight. After surgery, you will begin a rehabilitation program. The patient alone may do rehabilitation, with a certified athletic trainer or with a physical therapist. Formal therapy usually last 2-12 weeks and then is followed by a home program which will last until full strength and agility are achieved which usually takes four to six months. Following the rehabilitation, you may be placed on a return to sport program using a functional progression approach.

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Complications/Risks Graft failure due to re-injury, graft specific factors, tunnel placement, tensioning, or fixation methods Blood clots (very rare) Surgical wound infection Risk of developing arthritis Weakening of muscles Lack of full range of motion See Your Doctor If: Pain, swelling, redness, drainage or bleeding increases in the knee. You experience any symptoms suggestive of infection or concerns of a blood clot.

Meniscus Rupture
Category: Meniscus Injury

The meniscus is a disc-like cushion of cartilage located between the two bones of the leg (the femur and tibia). There are two menisci in each knee. These discs bear up to 70% of the load across the knee. The meniscus may be injured when the knee is bent or twisted while bearing weight. Meniscal injury can also be a result of overuse. Repetitive squatting or kneeling can cause meniscal wear and make it more likely to tear. Depending on the extent of the injury, the meniscus can be sewed back together or the injured area can be removed. As techniques of surgery are become more advanced and surgeons become more experienced with arthroscopic procedures of the knee, more and more procedures that previously required large incisions can be done with the arthroscope. In the case of meniscal injury, the meniscus can be seen and evaluated with the arthroscope. Repairable damage can be addressed and non-repairable damage can be removed. The decision between repair and removal can be difficult. The meniscus is thought to play a much larger role in keeping the knee healthy and stable than previously thought. Preservation of the most amount of the meniscus is desired. ProcedureMeniscal repairs, when possible, can be done through the arthroscope but rarely may still require a formal incision. Arthroscopic sewing techniques and instrumentation used for meniscal repair are being improved. When the meniscus requires removal, the minimum amount can be removed through the arthroscope. A meniscus transplant can be sewn in to replace meniscus cartilage that was previously removed. Previously, a total meniscectomy (meniscus removal) was thought to alleviate the problems the meniscus injury caused. Now, removal is as

limited as possible (called a partial meniscectomy). Long term results of total meniscal removal caused early arthritis, which is minimized with partial meniscectomies. This is facilitated through the arthroscope. Follow up with your doctor if:Pain, swelling, redness, drainage or bleeding increases in the knee or if you experience any symptoms suggestive of infection such as fever.

Cedera Meniscus

Meniscus adalah bantalan sendi lutut berbentuk seperti cincin dan berfungsi sebagai penahan benturan. Cedera pada struktur ini sangat sering terjadi dan sebagian besar karena olah raga. Biasanya berupa cedera saat lutut terpuntir (twisted knee) mendadak. Olah raga yang sering menyebabkan cedera menicus, antara lain sepakbola/futsal, tenis, badminton dan bola basket. Gejala yang timbul sering dianggap sebagai 'keseleo' biasa karena pasien masih bisa jalan. Namun keadaan akan menjadi buruk karena akan timbul gejala nyeri di sendi yang makin hebat, sehingga jalan menjadi pincang; sendi lutut sulit untuk digerakkan, tidak dapat diluruskan dan tidak dapat dilipat dan terkadang pasien merasa ada yang bergerak-gerak di dalam sendi. Diagnosis hanya dapat ditegakkan dengan menggunakan pemeriksaan MRI.Pengobatan dapat mulai dengan yang sederhana seperti istirahat, obat-obatan sampai pada keadaan yang parah diperlukan tindakan operasi Arthroscopy.

Cedera Ligamen ACL

Anterior Cruciate Ligament (ACL) adalah urat di dalam sendi yang menjaga kestabilan sendi lutut. Cedera ACL sering terjadi pada olah raga high-impact, seperti sepak bola, futsal,

tenis, badminton, bola basket dan olah raga bela diri. Pada umumnya ACL dapat cedera pada keadaan ketika sedang lari mendadak berhenti kemudian berputar arah sehingga menyebabkan lutut terpuntir atau lompat dan mendarat dengan posisi lutut terpuntir. Pada saat cedera biasanya pasien akan mendengar suara seperti ada yang patah dalam sendi. Saat itu tiba-tiba pasien merasa 'kehilangan tenaga' dan langsung jatuh. Kadangkadang setelah beberapa saat, pasien dapat berjalan kembali tetapi pincang, sendi lutut sulit digerakkan karena nyeri, dan diikuti dengan bengkak. Namun sering, setelah cedera 1-2 hari, pasien dapat jalan seperti biasa. Keadaan ini bukan berarti ACL sudah sembuh. Pada perkembangannya pasien akan merasakan bahwa lututnya tidak stabil, gampang 'goyang' dan sering timbul nyeri. Dengan cedera ACL pasien akan sulit sekali untuk dapat melakukan aktifitas high-impact sports, seperti main bola, futsal, basket atau badminton. Sebagian besar Cedera ACL Ligamen memerlukan tindakkan operasi Arthroscopy agar pasien dapat pulih seperti sedia kala. Standar operasi Arthroscopy ACL Reconstruction yang kami pakai adalah Arthroscopic ACL Double Bundle Reconstruction. Tehnik ini telah kami lakukan lebih dari 200 kali sejak tahun 2007. Tehnik operasi ini sangat populer di USA, Eropa dan Jepang karena dengan tehnik ini, hasilnya sangat memuaskan pasien. Saat ini tehnik operasi ini dipakai sebagai standard untuk operasi cedera ACL atlet-atlet papan atas kelas dunia, misalnya Tiger Wood.

Perkapuran Lutut
Perkapuran sendi (osteoarthritis) tidak sama dengan pengeroposan tulang (osteoporosis). Perkapuran adalah penyakit di dalam sendi, sedangkan osteoporosis adalah

penyakit di tulang. Osteoporosis atau pengeroposan tulang tidak memberikan gejala, tidak menyebabkan nyeri, kecuali jika terjadi patah tulang karena tulang rapuh. Sebaliknya, perkapuran sendi (osteoarthritis) selalu menimbulkan nyeri, terutama di sendi lutut. Perkapuran pada sendi lutut biasanya akan timbul pada usia lebih dari 50 tahun. Keluhan-keluhan yang diderita pasien osteoarthritis berupa: 11. Nyeri, yang bisa bertambah hebat dengan bertambahnya aktifitas. 12. Pada keadaan lanjut, nyeri tetap timbul walaupun sedang istirahat. 13. Sendi Lutut menjadi kaku dan tidak dapat dilipat / ditekuk dengan sempurna. 14. Sering tungkai jadi berbentuk 'O' atau 'X'. 15. Timbul bunyi di sendi lutut setiap kali bergerak. 16. Timbul bengkak. Pengobatan Perkapuran (Osteoarthritis/OA) sendi lutut sangat beragam, tergantung dari tingkat keparahan perkapuran itu sendiri. Ada dua faktor yang sangat berpengaruh untuk terjadinya perkapuran sendi lutut: Usia (> 50 tahun) dan Berat badan (gemuk). Pada kasus perkapuran sendi lutut yang dini, pengobatan mulai dengan pengurangan berat badan, beberapa latihan khusus lutut, pemakaian alat bantu seperti tongkat dan fisioterapi. Pada kasus perkapuran yang lebih lanjut, perlu ditambahkan beberapa obat-obatan.

Pada tahap berikutnya dimana pengobatan-pengobatan di atas tidak memberikan hasil yang memuaskan, kadang-kadang diperlukan tindakan pembedahan / operasi. Operasi untuk perkapuran sendi lutut yang sederhana adalah Arthroscopy atau sering dikenal sebagai operasi 'Teropong Sendi Lutut'.

Arthroscopy adalah tindakan bedah sayatan kecil (Minimal Invasive Surgery), operasi ini hanya memerlukan luka kurang dari 1 (satu) cm. Operasi ini akan membersihkan 'kotoran' atau debri yang dihasilkan oleh proses pengapuran. Sering operasi Arthroscopy disebut 'Patient Friendly Surgery' karena setelah operasi pasien tidak memerlukan alat bantu misalnya tongkat atau gips dan pasien dapat cepat pulih kembali ke aktifitas normal. Di Rumah Sakit Pondok Indah, kami memakai High-Definition Arthroscopic Camera System yang memberikan nilai diagnostik yang sangat akurat untuk tindakan pembersihan yang maksimal. Namun pada kasus-kasus perkapuran lanjut, sering kali pasien terpaksa harus menjalani operasi Total Knee Arthroplasty atau 'Ganti Sendi' agar dapat kembali melakukan aktifitasnya sehari-hari.

Sebelum operasi

Sesudah operasi

Operasi Total Knee Arthroplasty di Rumah Sakit Pondok Indah menggunakan sistem Navigasi atau yang dikenal sebagai 'Computer Asissted Surgery' untuk mendapat hasil operasi dengan ketepatan tinggi sehingga memberikan hasil fungsi lutut yang optimal.
Material Standard Material Oxinium

Kami juga menggunakan jenis material implant Total Knee Arthroplasty yang terbaik saat ini yaitu Oxinium sebagai standard. Operasi ini berlangsung kira-kira 1 (satu setengah) jam, pasien tidak dibius umum, hanya bius setempat.

Prosedur Pelayanan Operasi Arthroscopic ACL Reconstruction

Konsultasi dengan Dr. Andre Pontoh . Pada saat konsultasi, pasien akan diwawancara mengenai riwayat cedera dan keluhan-keluhan yang timbul. Kemudian dilakukan pemeriksaan klinis pada lutut yang cedera. Untuk mendapatkan data lebih terinci tentang keadaan di dalam lutut, pasien akan dikirim ke bagian Radiologi untuk dilakukan pemeriksaan X-Ray (Rontgent) dan MRI. Setelah pemeriksaan X-Ray dan MRI telah dilakukan, pasien Agar kembali konsultasi ke Dr. Andre Pontoh untuk dilakukan evaluasi kembali. Jika dari semua pemeriksaan sudah menunjukan adanya cedera pada ACL dan pasien ingin melakukan operasi, jadwal operasi dapat diberikan pada saat konsultasi atau pasien dapat menghubungi (021) 7693184 setidak-tidaknya 1 (satu) minggu sebelum jadwal operasi. Setelah jadwal operasi ditentukan, pasien harus melakukan pemeriksaan laboratorium darah dan pemeriksaan X-Ray dada untuk menilai kondisi tubuh dalam persiapan tindakan anestesi. Pada pasien-pasien dengan resiko, misalnya ada penyakit lain dan pasien dengan usia lebih dari 40 (empat puluh) tahun, maka pasien diharuskan untuk periksa ke dokter spesialis lain, misalnya dokter Spesialis Jantung dan Dokter Spesialis Penyakit Dalam. Pada hari operasi, pasien diharapkan sudah hadir di RS Pondok Indah pada Jam 08:00 pagi, sebelum jam 08:00 pasien masih diperbolehkan untuk makan/minum, setelah itu pasien harus puasa. Setiba di RS Pondok Indah, pasien langsung menuju bagian admission yang berada di lobby gedung C untuk mengurus administrasi dan segera akan diantar ke ruang rawat. Di ruang rawat pasien akan dilakukan beberapa pemeriksaan klinis dasar seperti pengukuran tekanan darah dan suhu

tubuh. Disamping itu pasien akan dipasang infus untuk diberi antibiotik guna pencegahan terjadi infeksi pada saat dilakukan operasi. Pasien juga akan dikunjungi oleh dokter Anestesi untuk dilakukan evaluasi. Beberapa saat sebelum operasi, pasien akan dibawa menuju ruang operasi yang terletak di lantai 2 gedung A. Pasien akan diterima oleh perawat kamar operasi dan dibawa ke ruang persiapan operasi untuk menunggu dilakukan operasi, pasien juga akan kembali dilakukan pemeriksaan klinis dasar. Di ruang persiapan pasien akan bertemu lagi dengan Dr. Andre Pontoh dan dokter anestesi. Kemudian pasien akan dimasukkan ke ruang operasi. Disini pasien akan dibius dan dioperasi. Operasi Arthroscopic ACL Reconstruction biasanya berlangsung sekitar 1 (satu) jam. Segera setelah operasi selesai, pasien akan dikeluarkan dari kamar operasi dan dikirim ke ruang pemulihan, disini pasien akan dipantau sampai keadaan pasien stabil. Setelah keadaan pasien sudah baik, segera pasien dibawa kembali ke ruang rawat. Setelah pasien sadar, pasien dapat mulai minum dan makan. Setelah operasi pasien tidak boleh menekuk/melipat lutut selama satu minggu. Selama satu minggu akan dipasang penyangga untuk mempertahankan lutut tetap lurus. Pada saat ini, pasien sudah mulai dengan beberapa latihan lutut yang sederhana. Selama di ruang rawat pasien masih mendapat obat-obatan berupa antibiotik dan anti-nyeri lewat infus, dan pasien akan dimonitor kondisi tubuhnya. Pasien akan menginap satu malam.

Keesokan harinya, pasien dipersiapkan untuk pulang. Pasien dapat berjalan dengan menggunakan bantuan satu tongkat, posisi lutut tetap lurus selama satu minggu. Jika kondisi tubuh

pasien baik, pasien dapat pulang sebelum Jam 12 siang. Selama minggu pertama di rumah, pasien pasien tidak boleh terlalu banyak jalan untuk mencegah pembengkakkan lutut. Balutan dan penyangga di lutut harus dipertahankan, jangan sampai basah. Latihan lutut seperti yang sudah diajarkan harus dilakukan dengan disiplin. Pasien kembali kontrol ke Jakarta Knee Center 1 (satu) minggu setelah operasi, pada saat kontrol, balutan dan penyangga lutut dibuka dan pasien boleh mulai latihan menggerakkan lututnya. Pasien harus kembali kontrol ke Jakarta Knee Center 2 (dua) minggu setelah operasi, pada saat ini luka operasi sudah kering dan pasien harus bertemu dengan Dr. Carmen (Spesialis Kedokteran Olahraga) untuk program-program latihan. Setiap bulan minimal 1 (satu) kali pasien harus kontrol ke Jakarta Knee Center dan pada akhir bulan keenam, diharapkan pasien sudah siap untuk kembali ke aktifitas high-impact.
Joseph Pilates mengajar murid-muridnya ke pusat diri untuk berkomitmen pada setiap sesi latihan dengan memberikan perhatian, penuh konsentrasi, dan memperhatikan apa yang terjadi di seluruh tubuh mereka, mulai dari jari kaki hingga kepala. Para muridnya belajar untuk mengendalikan otot-otot di setiap gerakan. Prinsip-prinsip ini membantu orang lebih memahami bagaimana melakukan pendekatan latihan dan memahami tubuh mereka dengan cara yang lebih berhati-hati dan penuh perhatian. Di bawah ini merupakan serangkaian Prinsip-prinsip Pilates.

Pernafasan
Latihan pertama dalam seri alas Pilates adalah ratusan. Disebut ratusan karena melibatkan penghirupan nafas sebanyak lima hitungan dan membuang nafas sebanyak lima hitungan. Ini juga melibatkan teknik pernapasan khusus di mana satu kali menarik

nafas terutama menggunakan interkostalis di antara tulang rusuk (yang menghasilkan pengembangan dan penyempitan tulang rusuk). Dengan mengatur napas kita, dapat membantu menenangkan pikiran. Pilates mengajarkan bahwa melakukan pernapasan mendalam akan memberikan oksigen pada darah dan membuang kotoran tubuh. Hasil positif dari latihan pernapasan adalah bebas dari kelelahan, stres, dan kurang konsentrasi.

Memusatkan perhatian
Pilates mengajar orang untuk bergerak dari pusat mereka. Dia menciptakan pembangkit listrik. Saat ini kita sering mendengar otot inti, yang juga mengacu pada pusat seseorang atau inti tubuh. Ketika gerakan dimulai dari pusat (perut, otot punggung, dan otototot sekitar panggul), akan membantu memberikan stabilitas dan kekuatan yang lebih. Untuk secara efektif bergeser dari pusat, seseorang harus tahu bagaimana bernapas dengan benar, dan bagaimana mengontrol otot, yang membawa kita pada prinsip berikutnya, kontrol.

Kontrol
Seorang indvidu tidak hanya harus mengetahui bagaimana terlibat dan mengontrol aktivasi otot dan napas saat mereka bergerak, gerakan mereka juga harus mencerminkan hal ini melalui ketepatan dan gerakan terkontrol. Seorang individu juga harus mampu mengontrol keseimbangan antara ketegangan dan relaksasi.

Ketelitian
Setiap gerakan yang dirancang Pilates memiliki tujuan yang telah dipikirkan dengan baik. Akhirnya kecermatan yang dikerjakan pada tiap gerakan akan melatih mereka untuk menerapkannya dalam kehidupan sehari-hari. Setiap tubuh orang berbeda, jadi bagaimana mereka melakukan pendekatan suatu gerakan mungkin akan sedikit bervariasi berdasarkan fisik, kekuatan, dan keterbatasan mereka.

Aliran

Meskipun latihan Pilates tidak dirancang untuk dilakukan sesuai dengan perasaan, seperti seseorang yang akan menari, mereka seharusnya memiliki irama dan aliran kualitas yang baik. Gerakan harus berkesinambungan, dan memiliki transisi yang solid. Hal ini akan membantu memastikan pengembangan kekuatan seseorang serta stamina.

Fokus
Untuk merangkum semua bagian prinsip ini bersama-sama dan menerapkannya pada gerakan, kita harus fokus. Tidak ada dalam kamus, seseorang dapat berlatih Pilates dengan baik sambil menonton televisi, membaca buku atau majalah, atau bahkan hanyut dalam lagu. Di satu sisi, fokuskan batin pada napas, dan pusat individu, sambil melakukan gerakan dengan tepat terkontrol, dan gerakan yang lembut elegan akan menyatu dengan kesadaran. Ini membantu orang memperdalam hubungan mereka dengan diri mereka sendiri, yang membawanya pada rasa kesejahteraan yang lebih besar, baik secara fisik, maupun mental, dan bahkan mungkin spiritual. (Tysan Lerner/The Epoch Times/feb)

PILATES adalah salah satu bentuk olahraga yang dikembangkan Joseph Hubert Pilates pada awal abad ke-20. Semenjak itu, pilates mulai menyebar dan dikenal banyak orang, termasuk di Indonesia. Banyak yang menggemari pilates karena cara ini dinilai mampu memperbaiki postur tubuh yang kurang sempurna sehingga tercipta tubuh yang ideal. Sang penemu yang berkebangsaan Jerman memercayai bahwa pikiran kitalah yang memengaruhi otot. Maka itu, ia pun menyebut teknik dalam pilates sebagai contrology. Tak hanya membetuk tubuh, pilates juga mampu memperbaiki masalah yang berhubungan dengan kelainan tubuh indah. Pilates berfokus pada membangun fleksibilitas, kekuatan, daya tahan, dan kooordinasi sistem tubuh, tapi tampa menambah massa otot. Orang yang rutin melakukan latihan pilates biasanya akan merasakan bentuk tubuhnya lebih bagus dan tak mudah cedera. Rangkaian latihan pilates biasanya dilakukan di sebuah alas yang disesuaikan dengan bentuk tubuh. Prinsip dasar latihan ini

mementingkan konsentrasi, pernapasan, dan gerakan. Ada dua cara melakukan latihan pilates yakni dengan alas dan menjadikan berat badan sendiri sebagai tumpuan. Atau, menggunakan alat untuk memperkuat tubuh. Sebelum mencoba latihan ini, ada beberapa poin yang mesti Anda ingat: 1. Periksakan diri atau berkonsultasi dulu dengan dokter guna mengetahui apakah Anda cocok melalukannya. 2. Pastikan instruktur memahami keinginan dan kebutuhan serta kemampuan diri Anda untuk berlatih. Dan, berikut adalah beberapa manfaat yang bisa Anda dapatkan dari latihan pilates: 1. Tubuh lebih fit 2. Mampu membantu merehabilitasi tubuh pascapemulihan 3. Pilates sangat berguna bagi yang memiliki profesi sebagai atlet dan penari 4. Melenturkan tubuh bagi perempuan hamil dan setelah melahirkan 5. Mampu mempertahankan kelenturan tubuh lansia dan bisa dilakukan anak-anak mulai usia 12 tahun. 6. Pilates membantu meningkatkan dan menciptakan keseimbangan antara kekuatan dan fleksibilitas 7. Kewaspadaan diri meningkat sehingga tubuh stabil dan tak mudah cedera 8. Meningkatkan kooordinasi tubuh. (Pri/OL-06)