The clinical activity of the Department of Orthopedics is conducted through the following sub-units:

Shoulder and Elbow Unit

The Shoulder Unit at Sheba Medical Center provides state of the art clinical care for all

aspects of shoulder problems including traumatic injuries, instability, rotator cuff disease,

destructive joint diseases and sports related shoulder injuries at all ages.

Outpatient Clinic
The outpatient clinic is open twice a week and services about 300 patients per month.

Patients are referred to us from all over the country for consultation and treatment.

Surgical Activity
The surgical activity of the Should Unit includes open surgery as well as Arthroscopic Surgery.

Operations are performed twice a week. Most of the Arthroscopic Surgery including

instability operations and rotator cuff operations are ambulatory.

Academic Activity
Clinical and basic science research programs are conducted in the unit as well as

teaching programs of medical students, residents in Orthopedics, and residents

in Orthopedic Post Graduate courses at the Tel Aviv University. In addition we accept

fellows from all over the world.

Joint Replacement Service
The Joint Replacement Service treats patients with advanced disease of the hip and the knee joint.

We conduct extensive surgical activity for the knee, hip and ankle joints.

Knee Joint
Corrective osteotomy: 30 operations per year
This treatment is advisable for relatively young patients with mild unicompartmental joint disease.

In cases where the disease is associated with Axis Mal-Alignment of the limb

corrective Osteotomy is proposed. In cases of Varus Mal-Alignment we perform

Valgus High Tibial Osteotomy. In cases of Valgus Mal-Alignment we perform

Supra Condylar Femoral Varus Osteotomy.
Hospital stay: 3-5 days
The leg operated on is immobilized in a long leg cast or knee brace for 6 weeks.
Immediate weight bearing as tolerated.
Expected recovery time: 3-6 months

Unicompartmental Knee Replacement: 5-10 operations per year
This surgery is advisable for middle-aged patients with advanced

unicompartmentalknee disease. It is mainly performed for medial compartment

disease.The Prosthesis used is Cemented Oxford Unicompatmental (Biomet).
Hospital stay: 3-5 days
Immediate weight bearing as tolerated.
No knee immobilization is necessary.
Expected recovery time: 2-3 months

Primary Total Knee Replacement: 150 operations per year
This surgery is advisable for middle aged and old aged patients with advanced tricompartmental knee disease.
We use only Cemented A.G.C. (Biomet) Prosthesis for this surgery.

The Prosthesis used is mainly posterior cruciate retaining.
Cemented A.G.C. (Biomet) Prosthesis
In case of posterior cruciate insufficiency we use the posterior cruciate,

substituting cemented prosthesis Johnson&Johnson, 10 operations per year.
Hospital stay: one week
Immediate assisted weight bearing.
No knee immobilization is necessary.
Expected recovery time: 3-4 months

Revision Total Knee Replacement: 20 operations per year
This surgery is performed to treat failed previous knee replacement due to various etiologies. The Prosthesis used is a stemmed cemented posterior stabilized prosthesis.

We use either the Dual articular prosthesis (Biomet) or the stemmed Posterior stabilized (Johnson & Johnson).
Postoperative recovery - changes greatly according to the indication.

Hip Joint

Primary total hip replacement: 170 operations per year
This surgery is advisable for patients with advanced hip joint disease, who fail to

improve with conservative treatment.
The prosthesis used is mainly cementless prosthesis (95% of the cases).
As cemented prosthesis we use the classic Charnley Prosthesis Depu

Johnson & Johnson.
The cementless prosthesis uses is modular.
Stem - Hydroxyapetite coated corail Landos Depu Johnson& Johnson
Cup - Press fit porous coated
1. Shell - Duraloc Johnson & Johnson
2. Liner polyethylene (enduron) J & J
Head Co Cr 22mm or Co Cr 28 mm
I young patients we use alternative coupling, either highly crossed Polyethylene liner (marraton) with Co Cr 28mm head, or metal-metal articulation
Hospital stay: one week
Assisted weight bearing (walker, cane) for 6 weeks.
Expected recovery time: 3 months

Revision Total Hip Replacement - 50 per year.
This surgery is performed to treat failed previous hip replacement due to various indications.

Whenever possible we use cementless prosthesis for the femoral side. It is usually necessary to select long stem prosthesis with or without distal locking. We use various types of femoral prosthesis according to the situation. The most frequently used is a long stem
hydroxy apetite coated Prosthesis Kar Landos Depue Johnson and Johnson.
On the acetabular side we use cementless prosthesis, similar to primary THR, when primary stability is obtained. In cases where primary stability is not obtained we usually use bone Allograft and Reinforcement ring and cemented Charnley polyethylene cup.

Academic Activity
Basic science research mainly in the fields of cell biology and biomechanics Is conducted in collaboration with the relevant laboratories in Tel Aviv University.

The Spine Deformity Unit

diagnosis and treatment of spinal disease.

The clinical care provided by the unit includes:

• The child's spine
• Degenerative disorders in the adult
• Deformity
• Trauma
• Afflictions of the Vertebra

The unit is involved in academic activities and the guiding principles taught to the students and residents include: (1) understanding the basic science behind the clinical aspects of spinal disorders; (2) knowledge of natural history and the clinical course; (3) treatment based on the scientific literature and available outcomes research.

Outpatient Clinic
This clinic is open twice a week and receives 350 patients per month. The outpatient clinic is a consultation and treatment referral center for all of the country.

Surgical Activity
Over 250 surgical procedures are performed annually. These surgical activities includes:

• Decompression with or without fusion as treatment for adult degenerative spine
• Disc Prosthesis - we were the first to introduce this procedure to the country seven years ago. To date, we have performed 44 operations, with an 80% success rate.
• Repair of deformities - one of the most experienced units in the country in the treatment of Scoliosis and Kyphosis
• Trauma - fixation of fractures resulting from road or work accidents
• Resection of vertebrae resulting from various afflictions
• Minimally invasive procedures - Endoscopic Discectomies, Vertebroplasty/Kyphoplasty

Orthopedic Traumatology Unit

The Orthopedic Traumatology Unit treats spine, pelvic, upper and lower limb traumatic injury to bone and soft tissue. These injuries are usually the consequence of high-energy Trauma, particularly road accidents, falls from heights, gun shot wounds and other hostile injury.

In the Orthopedic Division, the corresponding units treat the spine, shoulder, hand and pediatric injuries, and the orthopedic traumatologists treat the multi-Trauma patients, long bone fractures, complex intra-articular fractures and pelvic and acetabular injury.

After primary evaluation in the emergency room, patients with traumatic orthopedic injury receive primary care and are either discharged or hospitalized for further observation and treatment. Some of the patients need urgent surgery and others are admitted to the orthopedic department for further pre-operative evaluation.

Patients who suffer from fracture may sometimes be treated conservatively (non-operatively) but in many cases surgery has the advantage of reducing recovery and rehabilitation time and preventing future disability.

During the surgical procedure we reset the fracture fragments at its original location and stabilize it, to achieve complete healing. Most frequently, stabilization is achieved by means of special stainless steel or titanium screws, plates and nails.

The Foot and Ankle Unit

The Foot and Ankle Unit is one of the newly expanding services in our Orthopedic Department. The service provides state of the art clinical patient care for all aspects of foot and ankle disorders. Trauma - fractures of the ankle, fractures of the talus, fractures of the heel bone (Calcaneus), fractures of the mid foot (Lisfranc injury), fractures of the metatarsal bones and the toes. Problems concerning the big toe - primary and revision surgery of Hallux Valgus (Bunion) and Hallux Rigidus (stiff big toe). Achilles tendon problems - Acute achilles rupture (Percutaneus Suture), chronic achilles rupture, inflammatory conditions of the achilles tendon, problems with the achilles tendon insertion. Nerve problems - Tarsal Tunnel Syndrome, Morton Neuroma. Posterior Tibial Tendon Disorders - adult acquired flat feet. Diabetic neuropathic joint disorders. Ankle and Heel Foot Arthritis - Arthrodesis, Total Ankle Replacement, treatment of Rheumatoid Foot Disorders. Sport injuries to the ankle area - ankle instability, ankle sprains, Osteochondral Lesions of the Talus (OCD), Peroneal Tendon Injury, Ankle Arthroscopy. Heel Pain Syndrome - Plantar Fasciitis. High Arch Feet (Cavus foot) - neurological (Charcot Marie Tooth), and non-neurological. Outpatient Clinic The outpatient clinic serves as a referral center for the entire country for treatment and consultation regarding complex foot and ankle disorders. The clinic operates twice a week, and apart from reviewing new patients, the clinic provides long-term follow up for patients after surgical treatment.

Department at a Glance
Number of Beds - 72 Beds in two Main Departments, 6-10 Beds in Pediatric Department, and 6-10 Beds in Geriatric Department.
Number of Inpatients per Year - 3,900 (including Children)
Number of Outpatients per Year - 36,000 (including Hand Surgery and Pediatric Orthopedics)
Number of Surgeries performed Annually - 4,200 Operations (including 1100 Operations in Hand Surgery)
Director - Dr. Aharon Chechick Dr. Aharon Chechick was born in 1944. He graduated from the Hebrew University Medical School 1971. From 1978-79 he was a Clinical Fellow in degenerative joint disease at the Hospital Cochin in Paris. In 1993 he was appointed the Director of the Joint Replacement Unit at the Sheba Medical Center, and since 1997 he has served as the Director of the Sheba Medical Center Orthopedic Department. He is a senior Lecturer (2001) in Orthopedics at the Tel Aviv University. He specializes mainly in Joint Replacement.
Staff - Dr. Yehuda Amit Dr. Amnon Israeli Dr. Pritsch (perry) Moshe Dr. Ariel Oran Dr. I. Caspi Dr. M. Levinkope Dr. Nachshon Shazar
Address - Southern Side, the Charles Clore Hospitalization Tower
E-mail - Aharon.Chechick@sheba.health.gov.il
Tel - 972-3–530-2623