Specific surgical procedures

Dr Jonker approaches each patient with a holistic and personage style. This personalised approach is reflected in the specific surgical procedures he performs like the Patient Specific (MyKnee) knee replacements, Unicompartmental knee replacements and All-Inside ACL Reconstruction. You can familiarise yourself with the basic aspects of each option in the sections to follow. It is important to remember that several criteria play a role when selecting one of these specific surgical procedures. This could only be done through a comprehensive consultation with Dr Jonker.

Specific surgical procedures for the knee

Patient Specific (MyKnee) knee replacement

The Patient Specific (MyKnee) knee replacement is a total replacement procedure and well-known for its precise instrument function. This procedure tailors an instrument for each patient from a radiological image, i.e. either a magnetic resonance or CT scan of the knee. The application of this procedure reduces trauma and offers a more accurate positioning of the prosthesis. It is a relative quick procedure with limited time under anesthesia. Once the Patient Specific (MyKnee) knee replacement has been identified as the best surgical option, Dr Jonker will inform on the specific process through consultation.

Unicompartmental knee replacement

In some cases, instead of a total knee replacement, a unicompartmental knee replacement (or partial replacement) can be applied to repair knee damage triggered by osteoarthritis. The specific advantages of the unicompartmental knee replacement include that smaller incisions are made, less bleeding and bone loss occur and a quicker recovery is expected in contrast to a total knee replacement. Additionally, there is no interference of the prosthesis with your existing ligaments, tendons or nerves. You will retain normal balance as well as the natural stability of your tendons, ligaments and the healthy part of your knee joint. Your kneecap remains in its natural position which will enable you to regain much of the strength in your quadriceps.

A total knee replacement differs from the unicompartmental knee replacement with regards to the implant positioning. A unicompartmental knee replacement is not always the best option  for example when arthritis has affected both the inner (medial) and outer (lateral) compartments of the knee. On the contrary, if knee osteoarthritis is limited to only one of the compartments of the knee a unicompartmental knee replacement could be a sound option. Consultation with Dr Jonker is critical in order to determine the best surgical option for the knee problems you experience.  

All-Inside ACL reconstruction

The All-Inside ACL reconstruction is a completely arthroscopic technique. It involves the treatment of the anterior cruciate ligament (ACL), which is in the middle of the knee. It is an advanced technique through which Dr Jonker replaces the torn anterior cruciate ligament with tissue taken from the patient self (autograft). The procedure requires that the femur and tibia be infiltrated to allow passage for the graft material to reconstruct this ligament. The procedure provides benefits like minimal risk of inflammation, less post-operative pain and a much quicker recovery. It often reduces swelling and soft tissue hematomas (clotted blood in the tissue). In addition, it can shorten the rehabilitation process.

 Specific surgical procedures for the shoulder

Shoulder pain does not have to limit your activities and interfere with the quality of your life anymore. You can now take action and live your life to the fullest. Depending on the type and extend of the injury or disease, Dr Jonker will perform either arthroscopic, instability or replacement surgery.

Arthroscopic surgery

Rotator Cuff Repair

As a complete rotator cuff tear will not heal, surgery is usually required if you want to return your shoulder to optimal function. In order to repair the rotator cuff, the rotator cuff tendon needs to be reattached to the humerus. Although this can be performed through open, mini open or all arthroscopic procedures, Dr Jonker primarily performs the all arthroscopic procedure with single or double row repair techniques.

Acromioclavicular Reconstruction

Disorder of acromioclavicular and coracoclavicular ligaments is a common injury of the shoulder.  Dr Jonker primarily implements this technique for acute acromioclavicular joint stabilisation as it enables a quick return to activity. It is a simple, reproducible, minimally invasive technique and could be performed through a mini open or arthroscopic procedure (view the animated procedure).

Distal Biceps repair

Through this technique Dr Jonker makes a single anterior incision to repair the biceps tendon. A strong, anatomic repair is achieved through the combination of a cortical button fixation coupled with an interference screw (view the animated procedure).

 

Instability surgery

Shoulder instability means that your shoulder either dislocate or subluxate repeatedly during exercise or active movement. Subluxate means the joint moves more than it is suppose to but does not move out of joint. There are various causes to instability of the shoulder, which will determine the type of treatment. The options we provide include Bankart repair and Latarjet and are performed through arthroscopic techniques.

Arthroscopic stabilisation (Bankart repair)

Dr Jonker will perform a Bankart repair to restore the over stretched or torn labrum and capsule deep within the shoulder joint. This is usually done by using sutures and small bone anchors. An arthroscope is inserted through a small skin incision from the back of the shoulder. Special instruments are inserted through portals from the front of the shoulder. This enables Dr Jonker to see the operation on a television screen (view the animated procedure).

Congruent Arc Latarjet

The Latarjet technique has the advantages of improving both bony and soft tissue problems with a strong fixation, allowing early active rehabilitation. This procedure is mainly performed when there is some bone loss from the front of the glenoid (as a result of a bony bankart lesion or repeated dislocations wearing away the front of the glenoid). The procedure involves the transfer of coracoid with its attached muscles to the deficient area over the front of the glenoid to replace the missing bone. The transferred muscle acts as additional muscular support to prevent further dislocations. The procedure has a high success rate because of its triple effect which refers to 1.) a better or totally restored glenoid contact surface; 2.) the conjoint tendon that stabilises the joint when the arm is externally rotated; and 3.) the repaired capsule (View the animated Latarjet procedure). Through this procedure it is also possible to address other problems in the joint such as a rotator cuff tear or SLAP tear. It is a less invasive procedure with lesser risk of post-operative problems. The Latarjet procedure has become an important surgical procedure for treating shoulder instability because of its ability to deal with bony defects of the glenoid.

Replacement surgery (TornierOR)

A shoulder replacement can reduce or eliminate shoulder pain and allow you to regain extended motion. It is a reliable procedure supported by various scientific.

Studies show that patients nearly doubled their arm rise level after surgery. Although studies prove that shoulder replacement reduces pain and improves mobility, results will vary based on specific individual conditions. Dr Jonker will explain the outcome you could expect based on your age, physical condition and specific shoulder problems.

Primary Shoulder Replacement

With a primary shoulder replacement, the ball (humeral head) of the shoulder joint is replaced with an implant that includes a stem with a smooth, rounded metal head. The socket (glenoid) is replaced with a smooth, rounded plastic cup that fits the head of the ball perfectly (see picture 6). In general, you can expect to achieve near normal range of motion following shoulder replacement surgery. However, if you have severe restricted motion which has been present for many years, you may be unable to achieve full motion despite an accurately performed operation and dedicated physiotherapy. Still, you can expect to achieve about 75% of normal motion (view how the primary shoulder replacement works).

Reverse Total Shoulder Replacement

If shoulder arthritis occurs with torn rotator cuff muscles, another specific surgical procedure, known as a reversed shoulder replacement, may be recommended. This means that the normal structure of the shoulder joint is reversed. Thus, the ball and socket configuration is inverted, meaning that the ball portion of the implant is attached to the glenoid (where the socket normally is), and the artificial socket is attached to the humeral head (where the ball normally is) in the form of a plastic cup (see picture 7). This composition allows the stronger deltoid muscles of the shoulder to bear much of the work of moving the shoulder which increases the joint stability. A reversed procedure is often indicated for patients with compromised rotator cuff function (see how it works).

DrH-231Non-surgical treatments

Dr Jonker collaborates closely with other healthcare professionals like physiotherapists, biokinetics and orthotists. This interdisciplinary approach is specifically applied to provide non-surgical treatment and medical management for injuries and/or the degeneration of joints. Visit the  Potchefstroom Sentrum vir Sportgeneeskunde en Ortopedie website for more information on Dr Jonker’s involvement in Sport medicine and rehabilitation.