{
  "rotator-cuff": {
    "name": "Rotator Cuff Repair",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A rotator cuff repair is an operation to reattach one or more of the tendons that form the rotator cuff — the group of muscles and tendons that stabilise the shoulder and control its movement. The procedure is usually performed arthroscopically (keyhole) or through a small open incision.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgeon makes two or three small incisions around the shoulder and inserts a tiny camera (arthroscope) to view the joint. The torn tendon is identified, prepared, and reattached to the bone using small anchors and strong sutures. Sometimes a ligament is released and bone is shaved to create more space for the repaired tendon. The operation typically takes one to two hours. In some cases, a larger tear may require a mini-open incision of around 3–5 cm."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery may be recommended when a rotator cuff tear causes persistent shoulder pain, weakness, and difficulty with overhead activities or sleeping on the affected side. It is usually considered after non-operative treatments such as physiotherapy and injections have not provided adequate relief, or when the tear occurs after an acute injury and the tendon is at risk of further retraction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many rotator cuff tears can be managed without surgery. Options include physiotherapy to strengthen the surrounding muscles, corticosteroid injections for pain relief, activity modification, and pain medication. Physiotherapy can help the intact tendons compensate for the torn one. Not all tears cause symptoms, and some patients function well without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "You will attend a pre-assessment clinic for blood tests, a heart tracing, and medical review. Inform your team about any blood-thinning medications. Smoking significantly impairs healing — stopping before surgery is strongly advised. You will need to arrange for someone to drive you home, and you should plan for being effectively one-handed for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to reduce shoulder pain and improve strength and function. Approximately 70–80% of patients experience significant improvement in pain and movement. Recovery is gradual, with meaningful improvement at four to six months and continuing gains for 12–18 months. The repair aims to prevent the tear from enlarging and to preserve long-term shoulder function."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Shoulder stiffness is common in the early months and usually resolves with physiotherapy.",
            "freq": "Expected"
          },
          {
            "risk": "Persistent pain",
            "detail": "Around 10–20% of patients experience some ongoing discomfort, though usually less than before surgery.",
            "freq": "Common"
          },
          {
            "risk": "Failure to heal",
            "detail": "The repaired tendon may not fully heal to the bone, particularly in larger tears. This is the most common complication.",
            "freq": "Common"
          },
          {
            "risk": "Nerve block effects",
            "detail": "Temporary numbness and heaviness of the arm from the nerve block, usually resolving within 24 hours.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Frozen shoulder",
            "detail": "Painful stiffness lasting many months. Occurs in approximately 1–2% of patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Occurs in roughly 1% of cases. May require antibiotics or further surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare damage to surrounding structures.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism is uncommon with shoulder surgery but remains a risk.",
            "freq": "Rare"
          },
          {
            "risk": "Re-tear",
            "detail": "The tendon may re-tear, especially with premature heavy loading. Risk depends on tear size.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "The procedure is usually performed under general anaesthesia combined with a nerve block — an injection of local anaesthetic around the nerves in the neck (interscalene block). This provides excellent pain relief for the first 12–24 hours. Your arm may feel numb and heavy as the block wears off. Your anaesthetist will discuss the best approach for you."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Your arm will be in a sling for four to six weeks to protect the repair. During this time, you will be essentially one-handed. Gentle assisted exercises begin early, guided by your physiotherapist. Active movement starts from around six weeks. Strengthening exercises begin at three months. Significant improvement takes four to six months, with full recovery at 12–18 months. Driving is not permitted while wearing the sling. Return to desk work is usually possible at two to three weeks; heavy manual work may take four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing redness, swelling, or discharge from the wound",
          "Fever or feeling generally unwell",
          "Sudden increase in pain not relieved by medication",
          "New weakness or inability to move the shoulder",
          "Numbness that does not resolve after 48 hours"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "You will typically be seen at two to three weeks for wound review and by a physiotherapist. A follow-up with your consultant is arranged at six to eight weeks. Further appointments depend on your progress. Full rehabilitation usually involves regular physiotherapy for several months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long will I need a sling?",
            "a": "Most patients wear a sling for four to six weeks. Your surgeon may advise a shorter or longer period depending on the size of the repair."
          },
          {
            "q": "When can I drive?",
            "a": "You cannot drive while wearing a sling. Driving typically resumes at around six to eight weeks, once you have adequate control of the arm."
          },
          {
            "q": "Will I regain full movement?",
            "a": "Most patients regain good functional movement. The range regained is somewhat unpredictable and may not match the uninjured shoulder, but it is rare to have less movement than before surgery."
          },
          {
            "q": "Can the tendon tear again?",
            "a": "Yes, re-tears can occur, especially with larger tears or if the shoulder is loaded too early. Following the rehabilitation programme carefully reduces this risk."
          }
        ]
      }
    ]
  },
  "subacromial": {
    "name": "Subacromial Decompression",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Arthroscopic subacromial decompression is a keyhole procedure to create more space in the subacromial area of the shoulder by removing a small amount of bone and inflamed tissue. It aims to reduce impingement pain when the arm is lifted.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two or three small incisions are made around the shoulder. A camera is inserted to visualise the joint and the subacromial space. Inflamed tissue (bursa) is removed, and the undersurface of the acromion bone is shaved to create more room for the rotator cuff tendons. The procedure usually takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "This operation is considered when shoulder impingement — pain felt when lifting the arm, especially overhead — has not responded to a prolonged course of physiotherapy (typically at least three to six months) and corticosteroid injections. It may also be performed alongside other procedures such as rotator cuff repair."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Structured physiotherapy remains the first-line treatment and is effective for many patients. Corticosteroid injections can provide temporary relief. Activity modification and anti-inflammatory medication may also help. Current evidence suggests that physiotherapy alone produces results comparable to surgery for many patients with impingement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-assessment includes routine blood tests, a heart tracing, and medication review. Inform your team of any blood-thinning medication. This is usually performed as a day-case procedure. Arrange transport home and support for the first few days."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to reduce pain when lifting the arm overhead and improve function. Most patients experience improvement over the following weeks to months, though response is variable. The benefit is most reliable when combined with a dedicated physiotherapy programme after surgery."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Temporary stiffness is common and improves with physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Persistent pain",
            "detail": "Some patients continue to experience symptoms despite surgery.",
            "freq": "Common"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the shoulder and may extend down the arm.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Frozen shoulder",
            "detail": "Painful stiffness that can develop after surgery and may last many months.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Rare, occurring in approximately 1% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Very rare damage to nerves around the shoulder.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia with a nerve block for pain relief. The nerve block numbs the shoulder and arm for up to 24 hours. Some patients may have the procedure under regional anaesthesia alone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling is worn for comfort for a few days. Gentle exercises start immediately. Most patients return to desk work within one to two weeks and to driving within two to three weeks. Heavier activities resume at six to twelve weeks. Physiotherapy is essential and should continue for at least three months. Full improvement may take three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing redness, swelling, or wound discharge",
          "Fever or feeling unwell",
          "Worsening pain not controlled by medication",
          "New weakness in the arm"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "A wound check is usually arranged within two weeks. A follow-up appointment with your surgeon is typically at six weeks. Physiotherapy is arranged from the first or second week post-operatively."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this different from rotator cuff repair?",
            "a": "Yes. A decompression creates space but does not repair a torn tendon. If a tear is found during surgery, your surgeon may repair it at the same time."
          },
          {
            "q": "How long until the pain improves?",
            "a": "Improvement is gradual over weeks to months. Some patients feel better within a few weeks; others take three to six months."
          },
          {
            "q": "Could physiotherapy alone have worked?",
            "a": "Research suggests physiotherapy is as effective as surgery for many patients with impingement. Surgery is usually reserved for those who have not improved with physiotherapy."
          }
        ]
      }
    ]
  },
  "shoulder-stabilisation": {
    "name": "Shoulder Stabilisation",
    "region": "Shoulder",
    "tag": "Instability",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder stabilisation is a surgical procedure to repair the structures that keep the shoulder joint in place, preventing recurrent dislocations. It is most commonly performed arthroscopically (Bankart repair) but may require an open procedure (Latarjet) for more complex cases.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "In an arthroscopic Bankart repair, small incisions are made around the shoulder. A camera is used to inspect the joint, and the torn labrum (cartilage rim) is reattached to the socket using small anchors and sutures. In a Latarjet procedure, a small piece of bone (coracoid) is transferred to the front of the socket to create a bony block and reinforce the soft tissues. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for patients who experience recurrent shoulder dislocations or instability that interferes with daily activities or sport. It is particularly considered in younger, active patients where the risk of further dislocations without surgery is high."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy to strengthen the muscles around the shoulder can improve stability. Activity modification and bracing may help. However, once the shoulder has dislocated multiple times, non-operative management is less likely to prevent further episodes."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "A pre-assessment appointment will review your health and medications. You will need to fast before surgery. Arrange transport home and plan for wearing a sling for several weeks. If possible, set up your home to manage one-handed for the initial recovery period."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to prevent further dislocations and restore confidence in the shoulder. Arthroscopic Bankart repair has a success rate of approximately 85–90% in preventing further dislocations. The Latarjet procedure has an even higher success rate, often above 95%, and is generally chosen when bone loss is present."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Some loss of external rotation is expected, particularly after a Latarjet. This is rarely functionally significant.",
            "freq": "Common"
          },
          {
            "risk": "Recurrent instability",
            "detail": "There is a residual risk of re-dislocation, approximately 5–15% for Bankart repair, lower for Latarjet.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Post-operative discomfort is expected and usually settles over weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "The nerves around the shoulder may be stretched, particularly with the Latarjet. This is usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Approximately 1% risk. May require antibiotics or further surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Implant issues",
            "detail": "Anchors or screws may migrate or cause irritation. Revision surgery is occasionally needed.",
            "freq": "Rare"
          },
          {
            "risk": "Non-union (Latarjet)",
            "detail": "The transferred bone block may fail to heal in its new position.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Typically performed under general anaesthesia with a nerve block for post-operative pain relief. Your anaesthetist will discuss the options and any specific risks."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Your arm will be in a sling for four to six weeks. Gentle exercises begin within the first week. Active movement starts gradually from six weeks. Strengthening begins at three months. Return to non-contact sport is usually possible at three to four months; contact sport and high-risk activities at six months. Full recovery takes six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing wound redness, swelling, or discharge",
          "Fever",
          "Severe pain uncontrolled by medication",
          "New numbness or weakness in the arm",
          "A sensation that the shoulder has dislocated again"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "You will usually be reviewed at two weeks for wound check, then at six weeks, three months, and six months. Physiotherapy is a critical component and usually begins within the first two weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can I return to contact sport?",
            "a": "Yes, most patients return to sport, including contact sports, at around six months. Your surgeon and physiotherapist will guide you on readiness."
          },
          {
            "q": "What if my shoulder dislocates again after surgery?",
            "a": "Recurrence is uncommon but possible. If it occurs, further surgery may be considered, often a Latarjet if the initial procedure was a Bankart repair."
          },
          {
            "q": "Will I lose any movement?",
            "a": "A small loss of external rotation is common, especially after a Latarjet. Most patients do not notice this in daily life."
          }
        ]
      }
    ]
  },
  "shoulder-replacement": {
    "name": "Total Shoulder Replacement",
    "region": "Shoulder",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A total shoulder replacement (shoulder arthroplasty) is an operation to replace the damaged surfaces of the shoulder joint with artificial components. It is performed for severe arthritis or fractures that cause significant pain and functional limitation. This page covers both conventional and reverse total shoulder replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the shoulder. The damaged ball (humeral head) is removed and replaced with a metal ball on a stem, which is inserted into the upper arm bone. The socket (glenoid) is resurfaced with a plastic component. In a reverse shoulder replacement, the ball and socket are switched — the ball is placed on the socket side and the socket on the arm bone — which allows the deltoid muscle to power the arm when the rotator cuff is deficient. The operation typically takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Shoulder replacement is considered for severe shoulder arthritis causing persistent pain and loss of function that has not responded to non-operative treatment. A reverse replacement is used when there is both arthritis and a large, irreparable rotator cuff tear, or for certain complex fractures in older patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, physiotherapy, activity modification, and corticosteroid injections can manage symptoms in the earlier stages. However, when arthritis is severe and these measures are no longer effective, joint replacement may be the most reliable option for pain relief and functional improvement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "A thorough pre-operative assessment is required, including blood tests, a heart tracing, and imaging. You may need to adjust or stop certain medications. Dental problems should be addressed before surgery to reduce infection risk. Plan for being in a sling and one-handed for several weeks after surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The primary goal is pain relief. Most patients experience a significant reduction in pain and improvement in function. Conventional replacement can provide very good range of movement. Reverse replacement is particularly effective at restoring the ability to lift the arm in patients with rotator cuff deficiency. Modern shoulder replacements typically last 15–20 years or more."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Some limitation of movement is expected, particularly in the early months. Physiotherapy helps restore function.",
            "freq": "Common"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the shoulder and may extend down the arm.",
            "freq": "Expected"
          },
          {
            "risk": "Nerve block effects",
            "detail": "Temporary arm numbness from the nerve block lasting up to 24 hours.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Deep infection occurs in approximately 1–2% of cases and may require further surgery and prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability or dislocation",
            "detail": "More common with reverse replacement. Precautions in the early weeks reduce this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Stretching or damage to nerves around the shoulder. Usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture of the bone around the implant during or after surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Component loosening",
            "detail": "The implant may loosen over time, eventually requiring revision surgery.",
            "freq": "Long-term"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism, though less common with upper limb surgery.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia with a nerve block for pain relief. The nerve block provides numbness to the shoulder and arm for up to 24 hours. Your anaesthetist will discuss the best approach for you."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Your arm will be in a sling for four to six weeks. Gentle passive exercises begin within the first few days. Active movement starts gradually from six weeks. Strengthening exercises begin at around three months. Most patients notice significant improvement by three to six months, with continued gains for up to a year. Driving is typically possible at six to eight weeks. Return to light activities such as swimming and golf is usually achievable."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing wound redness, warmth, swelling, or discharge",
          "Fever or feeling unwell",
          "Severe pain not controlled by medication",
          "New weakness or inability to move the arm",
          "A clunking sensation or feeling that the shoulder has shifted"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review at two weeks, then clinic appointments at six weeks, three months, and one year. Long-term follow-up with imaging may be arranged to monitor the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the difference between a conventional and reverse replacement?",
            "a": "In a conventional replacement, the ball stays on the arm side and the socket on the shoulder blade. In a reverse, these are switched. The reverse is used when the rotator cuff is severely damaged and cannot power a conventional replacement."
          },
          {
            "q": "How long does a shoulder replacement last?",
            "a": "Modern shoulder replacements typically last 15–20 years or more. Longevity depends on activity level, implant type, and individual factors."
          },
          {
            "q": "What activities can I do afterwards?",
            "a": "Most patients return to gentle activities including swimming, golf, and gardening. High-impact or heavy overhead activities are generally discouraged."
          }
        ]
      }
    ]
  },
  "reverse-shoulder": {
    "name": "Reverse Shoulder Replacement",
    "region": "Shoulder",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A reverse total shoulder replacement is a specialised form of shoulder arthroplasty where the ball and socket components are placed in the opposite positions to a conventional replacement. This allows the deltoid muscle to power arm movement when the rotator cuff is irreparably damaged.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front or side of the shoulder. A metal ball (glenosphere) is fixed to the shoulder blade socket, and a plastic cup-shaped component is placed on the top of the arm bone. This reversed configuration allows the deltoid muscle rather than the rotator cuff to lift and rotate the arm. The operation takes approximately one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "This procedure is recommended for patients with shoulder arthritis combined with a large, irreparable rotator cuff tear (cuff tear arthropathy), or for certain complex fractures in older patients where the rotator cuff is unlikely to function. It may also be used for failed previous shoulder surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, gentle physiotherapy, activity modification, and injections may manage symptoms. However, when the combination of arthritis and rotator cuff deficiency causes severe pain and loss of function, surgery is often the most effective option."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-operative assessment includes blood tests, cardiac screening, and medication review. You should plan for wearing a sling and being one-handed for several weeks. Arrange for help at home during the initial recovery period."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The reverse replacement is particularly effective at relieving pain and restoring the ability to lift the arm overhead — something that is often impossible with a deficient rotator cuff. Most patients experience excellent pain relief and improved function for activities of daily living."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited rotation",
            "detail": "Internal and external rotation may be more limited than with a conventional replacement.",
            "freq": "Common"
          },
          {
            "risk": "Scapular notching",
            "detail": "Wear of the bone on the shoulder blade beneath the implant. Usually does not cause symptoms.",
            "freq": "Common"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the shoulder and upper arm in the early weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Instability or dislocation",
            "detail": "Slightly higher risk than conventional replacement. Occurs in approximately 2–5% of patients. Precautions help reduce this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection in 1–2% of cases. May require revision surgery and prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Stretching of nerves during surgery. Usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant, particularly of the acromion.",
            "freq": "Rare"
          },
          {
            "risk": "Component loosening",
            "detail": "May occur over time, potentially requiring revision.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under general anaesthesia, usually with a nerve block for post-operative pain relief. Your anaesthetist will explain the specific risks and benefits."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling is worn for four to six weeks. Gentle exercises begin early with guidance from a physiotherapist. Active movement starts gradually from six weeks. Driving resumes at around six to eight weeks. Most patients notice significant functional improvement by three to six months. Full recovery may take up to a year."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing redness, warmth, or discharge from the wound",
          "Fever or feeling systemically unwell",
          "A sensation that the shoulder has 'clunked' or shifted",
          "Severe pain unresponsive to medication",
          "New weakness or numbness in the arm"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review at two weeks, then follow-up at six weeks, three months, and one year. Long-term surveillance may include periodic X-rays to monitor the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why can't a standard replacement be used?",
            "a": "A conventional replacement relies on the rotator cuff to power the shoulder. If the rotator cuff is irreparably damaged, a reverse replacement uses the deltoid muscle instead."
          },
          {
            "q": "Will I be able to lift my arm overhead?",
            "a": "Most patients can lift their arm well above shoulder height after a reverse replacement, which is one of its main advantages."
          },
          {
            "q": "How long does a reverse replacement last?",
            "a": "Current evidence suggests longevity similar to conventional replacements — typically 15–20 years, though long-term data is still accumulating."
          }
        ]
      }
    ]
  },
  "acj-excision": {
    "name": "AC Joint Excision",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Acromioclavicular (AC) joint excision is a procedure to remove a small amount of bone from the end of the collarbone where it meets the shoulder blade, relieving pain from arthritis or injury at this joint. It is usually performed arthroscopically.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure is typically performed arthroscopically through small incisions. A few millimetres of bone are removed from the outer end of the collarbone (clavicle) and sometimes from the acromion, creating a small gap that prevents the arthritic bone surfaces from rubbing together. This gap fills with scar tissue over time. The procedure often takes 30–45 minutes and is frequently combined with subacromial decompression."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when AC joint arthritis or osteolysis causes persistent pain at the top of the shoulder, typically worsened by reaching across the body or pressing on the joint. It is considered when injections, physiotherapy, and activity modification have not provided lasting relief."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Corticosteroid injection into the AC joint, anti-inflammatory medication, physiotherapy, and activity modification. Injection often provides diagnostic confirmation and temporary relief."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is usually a day-case procedure. Plan for limited use of the arm for a few days to weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve localised AC joint pain. Most patients experience good pain relief, particularly with activities that previously provoked symptoms."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent aching",
            "detail": "Some discomfort at the AC joint may persist, particularly with heavy loading.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary shoulder stiffness improving with physiotherapy.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Instability of the AC joint",
            "detail": "If too much bone is removed, the joint may become unstable. This is rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Approximately 1% risk.",
            "freq": "Rare"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Rare but can occur following any shoulder procedure.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually general anaesthesia with a nerve block. Can sometimes be performed under regional anaesthesia alone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling is worn for comfort for a few days. Active movement is encouraged early. Most patients return to normal activities within four to six weeks. Physiotherapy may be recommended to restore full movement and strength. Heavy lifting and overhead work may take six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound infection signs: redness, swelling, discharge",
          "Fever",
          "Worsening pain despite medication"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review at two weeks, followed by a consultant review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the gap in the bone cause problems?",
            "a": "No. The gap fills with scar tissue and the joint remains stable. The ligaments holding the collarbone in place are preserved."
          },
          {
            "q": "Can I return to weight training?",
            "a": "Most patients return to weight training, though it may take two to three months before heavy pressing movements are comfortable."
          }
        ]
      }
    ]
  },
  "frozen-shoulder-mua": {
    "name": "Manipulation Under Anaesthesia for Frozen Shoulder",
    "region": "Shoulder",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Manipulation under anaesthesia (MUA) is a procedure to improve movement in a stiff, frozen shoulder by gently and controlled stretching of the joint capsule while the patient is under anaesthesia. It may be combined with arthroscopic capsular release.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under general anaesthesia or a nerve block, the surgeon gently moves the shoulder through its full range of motion, breaking the thickened, contracted joint capsule that is restricting movement. In many cases, an arthroscopic capsular release is also performed — the surgeon uses keyhole instruments to divide the tight capsule under direct vision. The procedure typically takes 15–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "MUA is considered when frozen shoulder (adhesive capsulitis) causes severe stiffness and pain that has not responded to a prolonged course of physiotherapy, pain management, and possibly a corticosteroid injection. It is most commonly offered when the condition has been present for several months and the stiffness significantly limits daily activities."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Frozen shoulder is a self-limiting condition that eventually resolves on its own, typically over 12–30 months. Treatment options include physiotherapy, pain medication, corticosteroid injections (into the joint or under image guidance), and hydrodilatation (injection of fluid to stretch the capsule). Many patients improve without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is a day-case procedure. You will need someone to take you home and should arrange for help as your arm may be sore after the manipulation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to rapidly restore range of motion. Most patients experience a significant improvement in movement immediately after the procedure. Maintaining this improvement requires dedicated physiotherapy in the following weeks. The outcome is generally better when combined with arthroscopic release."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain after the procedure",
            "detail": "The shoulder may be sore for several days after manipulation. Pain relief is provided.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence of stiffness",
            "detail": "Some patients experience a return of stiffness if physiotherapy is not maintained.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fracture",
            "detail": "Very rare risk of fracture of the humerus during manipulation, particularly in patients with weakened bone.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare stretching of nerves or vessels during the manipulation.",
            "freq": "Rare"
          },
          {
            "risk": "Shoulder dislocation",
            "detail": "Extremely rare during controlled manipulation.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia with a nerve block to provide pain relief afterwards. The nerve block allows you to begin exercises in comfort on the day of surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive physiotherapy begins immediately — ideally on the day of the procedure while the nerve block is active. You will be given exercises to perform at home several times daily. Improvement depends heavily on commitment to the exercise programme. Most patients notice significant gains within the first few weeks. Return to normal activities is usually within two to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain not controlled by medication",
          "New weakness or inability to move the arm",
          "Signs of wound infection if arthroscopic release was performed",
          "Excessive swelling of the arm"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Physiotherapy begins immediately. A follow-up with your surgeon is typically arranged at six weeks to assess progress."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the frozen shoulder come back?",
            "a": "In most cases, the improvement is maintained with continued exercises. A small proportion of patients experience some recurrence of stiffness."
          },
          {
            "q": "Is the manipulation painful?",
            "a": "You are under anaesthesia during the procedure and will not feel it. Post-operative discomfort is managed with pain relief and the nerve block."
          },
          {
            "q": "How quickly will I see improvement?",
            "a": "Movement is improved immediately. Maintaining and building on this improvement requires daily exercises for several weeks."
          }
        ]
      }
    ]
  },
  "proximal-humerus": {
    "name": "Proximal Humeral Fracture Fixation",
    "region": "Shoulder",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "This operation involves fixing a broken upper arm bone (proximal humerus) near the shoulder joint using a metal plate and screws, or occasionally nails or wires. It is performed when the fracture is displaced or unstable and is unlikely to heal satisfactorily without surgical intervention.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front or side of the shoulder. The fracture fragments are realigned into their correct position and held in place with a metal plate and screws, or sometimes an intramedullary nail. In some cases, particularly in older patients with poor bone quality, a shoulder replacement (hemiarthroplasty or reverse replacement) may be more appropriate than fixation. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the fracture is significantly displaced (the bone fragments have moved out of position), is in multiple parts, or involves the joint surface. Without surgery, these fractures may heal in a poor position, leading to ongoing pain, stiffness, and weakness."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many proximal humeral fractures are minimally displaced and can be managed with a sling, pain relief, and gradual physiotherapy. Your surgeon will advise whether surgery is necessary based on the fracture pattern and displacement seen on X-rays and CT scans."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Fracture fixation is often performed within days of the injury once the necessary scans and pre-operative assessments are complete. Standard pre-assessment is performed. You should fast before surgery and inform the team about all medications."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the alignment of the bone and allow earlier, more predictable rehabilitation. Successful fixation improves the likelihood of regaining good shoulder movement and function. However, outcomes vary depending on fracture severity, bone quality, and patient factors."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Very common after proximal humeral fractures regardless of treatment. Physiotherapy is essential.",
            "freq": "Expected"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected around the fracture site and may persist for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate and screws may be felt under the skin and occasionally cause irritation.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the humeral head, causing the bone to collapse. Risk depends on fracture pattern.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "The bone may not heal, or may heal in a poor position. May require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw penetration",
            "detail": "Screws may migrate into the joint, particularly in weakened bone. May require removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection or deep infection around the metalwork.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "The axillary nerve is close to the surgical field. Injury is uncommon but can cause numbness or weakness.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia with a nerve block. The nerve block provides pain relief for up to 24 hours after surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling is worn for two to six weeks depending on the fixation. Gentle exercises begin early under physiotherapy guidance. Active movement starts once the fracture is showing signs of healing, usually at four to six weeks. Full recovery takes three to six months or longer. Some loss of movement is common, particularly overhead reach."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound infection signs: redness, swelling, discharge, or fever",
          "Increasing pain or a 'grinding' sensation in the shoulder",
          "New numbness or weakness in the arm or hand",
          "Significant bruising extending down the arm"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at two weeks, six weeks, and three months to monitor fracture healing. Physiotherapy is a key component of recovery."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the plate need to be removed?",
            "a": "Not routinely. Plates are only removed if they cause irritation or other problems after the fracture has fully healed."
          },
          {
            "q": "Will I regain full movement?",
            "a": "Some loss of movement is common after proximal humeral fractures, even with surgery. Physiotherapy helps maximise recovery, but overhead reach may remain somewhat limited."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at around six to eight weeks, once you can comfortably control the steering wheel. This depends on your individual progress."
          }
        ]
      }
    ]
  },
  "tennis-elbow": {
    "name": "Tennis Elbow Release",
    "region": "Elbow",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tennis elbow release is a surgical procedure to treat chronic lateral epicondylitis (tennis elbow) that has not responded to non-operative treatment. It involves removing or releasing the damaged tendon tissue at the outer elbow.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (3–5 cm) is made over the outer aspect of the elbow. The damaged, degenerate portion of the common extensor tendon origin is identified and excised. The remaining healthy tendon is repaired. Some surgeons also release the tendon from the bone. The procedure can also be performed arthroscopically. It usually takes 30–45 minutes and is performed as a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered when tennis elbow causes persistent pain at the outer elbow that has not responded to at least six to twelve months of non-operative treatment, including rest, physiotherapy, bracing, and possibly injections."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "The vast majority of tennis elbow cases resolve without surgery. Options include activity modification, eccentric strengthening exercises, forearm bracing, anti-inflammatory medication, corticosteroid injection, and shockwave therapy. Studies suggest approximately 80–90% of patients improve without surgery within 12 months."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is a day-case procedure usually under general or regional anaesthesia. Arrange transport home and plan for limited use of the affected hand for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve pain and restore grip strength. Surgery is successful in approximately 80–85% of patients, though improvement may take several months to be fully realised. It is important to have realistic expectations — some patients continue to experience mild symptoms."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Around 15–20% of patients may not achieve complete pain relief.",
            "freq": "Common"
          },
          {
            "risk": "Temporary weakness",
            "detail": "Grip strength may be reduced initially and takes weeks to months to recover.",
            "freq": "Expected"
          },
          {
            "risk": "Wound tenderness",
            "detail": "Scar tenderness at the incision site, usually settling over weeks.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Uncommon wound infection, usually managed with antibiotics.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Small sensory nerves near the incision may be damaged, causing numbness.",
            "freq": "Rare"
          },
          {
            "risk": "Elbow instability",
            "detail": "Very rare if excessive tissue is released. Careful surgical technique prevents this.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Can be performed under general anaesthesia, regional arm block, or local anaesthesia depending on surgeon and patient preference."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "The arm is rested in a sling for comfort for a few days. Gentle movements begin immediately. Strengthening exercises start at around four to six weeks. Return to desk work is usually within one to two weeks. Manual work and sport may take three to six months. Full recovery can take up to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound infection: redness, swelling, discharge",
          "Increasing pain not relieved by medication",
          "New numbness around the elbow or hand"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks. Physiotherapy as needed to restore strength and function."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why wasn't surgery offered sooner?",
            "a": "Tennis elbow resolves without surgery in the majority of patients. Surgery is reserved for cases that have not improved after at least six months of dedicated non-operative treatment."
          },
          {
            "q": "Can tennis elbow come back after surgery?",
            "a": "Recurrence after surgery is uncommon but possible. Maintaining forearm conditioning and avoiding repetitive strain helps prevent this."
          },
          {
            "q": "When can I return to racquet sports?",
            "a": "Usually at three to six months, depending on recovery. A gradual return with physiotherapy guidance is recommended."
          }
        ]
      }
    ]
  },
  "ulnar-nerve": {
    "name": "Ulnar Nerve Decompression",
    "region": "Elbow",
    "tag": "Nerve",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ulnar nerve decompression at the elbow is a procedure to relieve pressure on the ulnar nerve as it passes through the cubital tunnel on the inner side of the elbow. This nerve is responsible for sensation in the ring and little fingers and powers many of the small muscles in the hand.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the inner side of the elbow. The ulnar nerve is identified and the tight structures compressing it are released. In some cases, the nerve is moved (transposed) to a new position in front of the elbow to prevent it from being stretched during bending. The procedure typically takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when cubital tunnel syndrome causes persistent or worsening numbness and tingling in the ring and little fingers, hand weakness, or difficulty with fine movements, and has not responded to non-operative management. It is particularly important when nerve conduction studies show significant compression or when there is muscle wasting in the hand."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Night-time elbow splinting to prevent prolonged bending, activity modification, avoidance of prolonged elbow leaning, and nerve-gliding exercises. These measures may be effective for mild cases."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is usually a day-case procedure. Plan for limited use of the hand for a week or two after surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to prevent further nerve damage and relieve symptoms. Tingling and pain usually improve relatively quickly. Numbness may take weeks to months to improve, and recovery is more complete when surgery is performed before symptoms become severe. In advanced cases, some residual numbness or weakness may persist."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "The incision site may be tender, particularly when leaning on the elbow. This usually settles.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete recovery",
            "detail": "Numbness and weakness may not fully resolve, especially if nerve compression was long-standing.",
            "freq": "Common"
          },
          {
            "risk": "Temporary soreness",
            "detail": "Pain and swelling around the elbow in the early weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Paradoxical worsening of symptoms or new nerve damage is rare but possible.",
            "freq": "Rare"
          },
          {
            "risk": "Subluxation of nerve",
            "detail": "If the nerve was released but not transposed, it may slip in and out of the groove.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection, usually manageable with antibiotics.",
            "freq": "Rare"
          },
          {
            "risk": "Elbow stiffness",
            "detail": "Temporary limitation of movement.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia or regional arm block. Local anaesthesia may also be used in some cases."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A bulky dressing or light splint is applied for the first week. Gentle finger and wrist movements are encouraged immediately. The dressing is reduced and sutures removed at 10–14 days. Most patients return to light activities within two weeks and to full duties within four to six weeks. Heavy manual work may take longer."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening numbness or weakness in the hand",
          "Wound redness, swelling, or discharge",
          "Fever",
          "Significant increase in pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review and suture removal at 10–14 days. Follow-up with the surgeon at six weeks. Nerve recovery is monitored over the following months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does the nerve take to recover?",
            "a": "Improvement in tingling and pain may be noticed within days. Numbness in the fingers can take weeks to months. Muscle weakness may take longer and may not fully recover if compression was severe."
          },
          {
            "q": "Is this the same nerve as the 'funny bone'?",
            "a": "Yes. The ulnar nerve runs behind the medial epicondyle — the 'funny bone' — and is responsible for the electric shock sensation when you knock this area."
          },
          {
            "q": "Will I need to change how I use my elbow?",
            "a": "Avoiding prolonged elbow leaning and keeping the elbow from bending fully for long periods (such as during sleep) can help prevent recurrence."
          }
        ]
      }
    ]
  },
  "elbow-arthroscopy": {
    "name": "Elbow Arthroscopy",
    "region": "Elbow",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Elbow arthroscopy is a keyhole procedure used to diagnose and treat conditions within the elbow joint, including removal of loose bodies, treatment of stiffness, and management of early arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small incisions are made around the elbow. A camera (arthroscope) is inserted to view the joint. Depending on the findings, the surgeon may remove loose fragments of bone or cartilage, release tight capsule to improve movement, remove inflamed tissue, or smooth rough joint surfaces. The procedure usually takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Elbow arthroscopy may be recommended for removal of loose bodies causing catching or locking, treatment of elbow stiffness (arthroscopic arthrolysis), early osteoarthritis management, or evaluation of unexplained elbow symptoms that have not responded to non-operative treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, anti-inflammatory medication, corticosteroid injections, and activity modification. For loose bodies that cause intermittent symptoms, observation may be appropriate."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is typically a day-case procedure. You may need a sling for a few days afterwards."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of loose bodies typically provides rapid symptom relief. Arthroscopic release for stiffness can significantly improve range of motion. For arthritis, the procedure may reduce pain and improve function, though it does not cure the underlying condition."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling and bruising",
            "detail": "Expected around the elbow for the first one to two weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary stiffness",
            "detail": "The elbow may feel stiff initially, improving with exercises.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Important nerves pass close to the elbow. Temporary nerve irritation occurs in 1–2% of cases. Permanent injury is rare.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Approximately 1% risk of joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Arthroscopy may not resolve all symptoms, particularly in advanced arthritis.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under general anaesthesia, usually with a regional arm block for post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early movement is encouraged to prevent stiffness. A sling is used for comfort for a few days. Physiotherapy is usually started within the first week. Most patients return to normal activities within two to six weeks, depending on the procedure performed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, swelling, or redness around the elbow",
          "Fever",
          "New numbness or tingling in the hand",
          "Inability to move the fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks. Physiotherapy as directed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the loose bodies come back?",
            "a": "Removed loose bodies do not return, but new ones may form over time if there is ongoing arthritis."
          },
          {
            "q": "How quickly will my movement improve after capsular release?",
            "a": "Improvement is often immediate, but maintaining it requires dedicated exercise. Some patients use a continuous passive motion device."
          }
        ]
      }
    ]
  },
  "elbow-replacement": {
    "name": "Total Elbow Replacement",
    "region": "Elbow",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Total elbow replacement (elbow arthroplasty) is an operation to replace the damaged surfaces of the elbow joint with artificial components. It is most commonly performed for severe rheumatoid arthritis, complex fractures in older patients, or failed previous surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made at the back of the elbow. The damaged joint surfaces are removed and replaced with metal and plastic components fixed into the humerus (upper arm bone) and ulna (forearm bone). The components are usually linked together and cemented into place. The ulnar nerve is identified and protected throughout. The operation typically takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Elbow replacement is considered for severe inflammatory arthritis (such as rheumatoid arthritis), complex distal humeral fractures in older patients where fixation is unlikely to succeed, post-traumatic arthritis, and revision of previous failed surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Disease-modifying medication for rheumatoid arthritis, pain relief, physiotherapy, corticosteroid injections, and activity modification. For fractures, non-operative treatment or fixation may be alternatives depending on the pattern."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment including medication review. Patients on immunosuppressive drugs for rheumatoid arthritis may need to adjust these before surgery. Plan for limited arm use for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The primary goal is pain relief and restoration of functional elbow movement. Most patients experience excellent pain relief. The replaced elbow allows comfortable use for daily activities but has a permanent lifting restriction, typically limited to around 5 kg repetitively."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lifting restriction",
            "detail": "A permanent weight-lifting limit of approximately 5 kg to protect the implant from early loosening.",
            "freq": "Expected"
          },
          {
            "risk": "Ulnar nerve irritation",
            "detail": "Temporary numbness or tingling in the ring and little fingers is common after surgery.",
            "freq": "Common"
          },
          {
            "risk": "Swelling and bruising",
            "detail": "Expected around the elbow in the early weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Elbow replacement has a higher infection rate than hip or knee replacement, approximately 3–5%. Deep infection may require removal of the implant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant loosening",
            "detail": "The components may loosen over time, particularly with excessive loading.",
            "freq": "Long-term"
          },
          {
            "risk": "Ulnar nerve injury",
            "detail": "Permanent nerve damage is uncommon but can cause weakness and numbness.",
            "freq": "Rare"
          },
          {
            "risk": "Wound healing problems",
            "detail": "The skin over the elbow is thin and more prone to healing difficulties.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant, more common in patients with weak bone.",
            "freq": "Rare"
          },
          {
            "risk": "Triceps weakness",
            "detail": "Weakness of the muscle that straightens the elbow. Usually recovers.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under general anaesthesia, usually with a regional nerve block for post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "The arm is elevated and supported after surgery, usually in a back-slab or light splint for a few days. Gentle movement begins early. Most patients stay in hospital for one to two nights. A physiotherapy programme guides gradual return of movement and function. The permanent lifting restriction must be observed to protect the implant. Driving is usually possible at six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, warmth, discharge, or breakdown",
          "Fever or feeling unwell",
          "New or worsening numbness in the hand",
          "Sudden loss of movement or a 'grinding' sensation",
          "Significant swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review with X-rays at six weeks, three months, and one year. Long-term follow-up is important to monitor the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is there a weight limit?",
            "a": "Elbow replacements experience high forces during lifting. Exceeding the limit accelerates wear and loosening. The 5 kg limit applies to repeated lifting; occasional heavier loads may be acceptable."
          },
          {
            "q": "How long does an elbow replacement last?",
            "a": "With careful use, an elbow replacement typically lasts 10–15 years. Revision surgery is possible but more complex than the primary procedure."
          },
          {
            "q": "Can both elbows be replaced?",
            "a": "Yes, but the operations are done at separate times to allow recovery from one before proceeding with the other."
          }
        ]
      }
    ]
  },
  "radial-head": {
    "name": "Radial Head Replacement",
    "region": "Elbow",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Radial head replacement involves replacing the broken head of the radius bone at the elbow with a metal implant. It is performed when a radial head fracture is too badly damaged to be fixed with screws.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the outer side of the elbow. The shattered radial head is removed and replaced with a smooth metal prosthesis that is press-fit into the remaining bone. This restores the stability of the elbow and forearm. The operation usually takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Replacement is recommended when the radial head is fractured into multiple fragments that cannot be reliably fixed with screws (a comminuted fracture), particularly when elbow stability depends on preserving the radial head."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Simple radial head fractures are usually managed without surgery — with a sling, pain relief, and early movement. If the fracture can be fixed with screws (open reduction internal fixation), this may be preferred over replacement. Complete removal of the radial head (excision) without replacement is sometimes an option but may lead to elbow instability."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is usually performed within days of the injury. Standard pre-operative assessment and fasting are required."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore elbow stability, allow early movement, and prevent long-term complications of radial head loss such as elbow instability and wrist pain. Most patients regain good function, though some loss of rotation is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Some loss of full extension and rotation is common after elbow fractures.",
            "freq": "Common"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation around the elbow that can limit movement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected in the early weeks after surgery.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Implant loosening",
            "detail": "The replacement may loosen over time, particularly with heavy use.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "The posterior interosseous nerve is at risk. Temporary weakness of finger extension is uncommon.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around the implant.",
            "freq": "Rare"
          },
          {
            "risk": "Ongoing instability",
            "detail": "If associated ligament injuries are not adequately addressed.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with or without a regional arm block for post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early movement is critical to prevent stiffness. A sling is used for comfort initially but gentle exercises start within a few days. Physiotherapy guides the rehabilitation. Most patients return to light activities within four to six weeks. Full recovery takes three to six months. Some loss of elbow extension or rotation is common."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Fever",
          "Increasing stiffness or loss of movement",
          "New numbness or weakness in the hand",
          "Clicking or instability at the elbow"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review at two weeks. X-rays and surgeon review at six weeks and three months to monitor healing and implant position."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the metal head need to be replaced?",
            "a": "In many patients the implant functions well long-term. If it loosens or causes problems, it can be revised or removed once the ligaments have healed."
          },
          {
            "q": "Will I regain full movement?",
            "a": "Most patients regain a functional range of motion. Some loss of full extension and rotation is common after radial head fractures."
          }
        ]
      }
    ]
  },
  "olecranon-fixation": {
    "name": "Olecranon Fracture Fixation",
    "region": "Elbow",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Olecranon fracture fixation is an operation to repair a break in the bony point of the elbow (the olecranon) using metalwork such as a plate and screws, or a tension band wire. This fracture disrupts the triceps mechanism and prevents straightening the arm.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the back of the elbow. The fracture fragments are realigned and held in place with a plate and screws, or with two wires and a figure-of-eight wire loop (tension band wiring). The triceps tendon attachment is restored. The operation usually takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Most olecranon fractures that are displaced require surgery because the triceps pulls the fracture apart, preventing healing and making it impossible to straighten the elbow against gravity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced fractures may be managed in a cast or splint with close monitoring. In elderly patients with low functional demands, non-operative management may be considered. However, most displaced fractures require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is usually performed within days of the injury. Standard pre-operative assessment and fasting are required."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the ability to straighten the elbow and return to normal function. Most patients achieve good functional outcomes, though some loss of full extension is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prominent metalwork",
            "detail": "The olecranon has very little soft tissue covering. Wires and plates can be felt and may cause irritation. Metalwork removal is common.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of full elbow extension is common after this fracture.",
            "freq": "Common"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected in the early weeks and gradually improving.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Metalwork failure",
            "detail": "Wires can break or migrate. This may require removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The fracture may fail to heal, requiring further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around the metalwork.",
            "freq": "Rare"
          },
          {
            "risk": "Ulnar nerve irritation",
            "detail": "The ulnar nerve runs close to the olecranon and may be irritated.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a regional arm block for pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early gentle movement is started within the first few days to prevent stiffness. Heavy lifting is avoided for six to twelve weeks while the fracture heals. Physiotherapy guides rehabilitation. Most patients return to normal activities within two to three months. Metalwork removal is a common secondary procedure if the plate or wires cause irritation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound infection signs: redness, discharge, or warmth",
          "Fever",
          "Wires protruding through the skin",
          "Sudden loss of elbow movement",
          "New numbness in the ring and little fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. X-rays and surgeon review at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the metalwork need to be removed?",
            "a": "Approximately 30–50% of patients choose to have prominent metalwork removed after the fracture has healed, usually at around 12 months."
          },
          {
            "q": "Will I get full movement back?",
            "a": "Most patients regain a good functional range. Some loss of the last few degrees of full extension is common but rarely causes functional problems."
          }
        ]
      }
    ]
  },
  "carpal-tunnel": {
    "name": "Carpal Tunnel Decompression",
    "region": "Hand & Wrist",
    "tag": "Nerve",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Carpal tunnel decompression is a procedure to relieve pressure on the median nerve as it passes through the carpal tunnel at the wrist. It is the most commonly performed peripheral nerve operation in orthopaedics and hand surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is usually performed under local anaesthetic as a day-case procedure. The surgeon makes a small incision in the palm of the hand, over the carpal tunnel. The transverse carpal ligament (the roof of the tunnel) is divided to relieve the pressure on the nerve beneath. The skin is closed with stitches and a light dressing is applied. The procedure typically takes 15 to 20 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when carpal tunnel syndrome causes persistent or worsening symptoms — typically numbness, tingling, and pain in the thumb, index, and middle fingers — that have not responded to non-operative treatment, or when nerve conduction studies show significant compression. It is particularly important to consider surgery if there is muscle wasting or constant numbness."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Mild cases may respond to wrist splinting (especially at night), activity modification, corticosteroid injection into the carpal tunnel, and anti-inflammatory medication. Surgery is generally recommended when symptoms are persistent, progressive, or when nerve compression is confirmed on testing."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "As this is usually a day-case procedure under local anaesthetic, preparation is straightforward. Eat and drink normally unless otherwise advised. Inform your surgeon about any blood-thinning medications. Remove rings and jewellery from the affected hand. Arrange for someone to drive you home."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve the numbness, tingling, and pain caused by nerve compression. Night-time symptoms often improve within days. Numbness in the fingers may take weeks or months to resolve, and recovery is usually more complete when surgery is performed before symptoms become severe. In cases with advanced nerve damage, some residual numbness or weakness may persist."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "Common in the palm and usually settles over weeks to months.",
            "freq": "Common"
          },
          {
            "risk": "Temporary grip weakness",
            "detail": "Normal in the early recovery period and improves with use.",
            "freq": "Expected"
          },
          {
            "risk": "Pillar pain",
            "detail": "Aching in the heel of the hand on either side of the scar. Can persist for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Wound infection",
            "detail": "Small risk, generally manageable with antibiotics.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Injury to the median nerve or its branches is rare but could cause numbness, weakness, or chronic pain.",
            "freq": "Rare"
          },
          {
            "risk": "Incomplete release",
            "detail": "Uncommon but may require repeat surgery if symptoms persist.",
            "freq": "Rare"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "A rare complication causing prolonged pain, swelling, and stiffness.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon injury",
            "detail": "Damage to the tendons within the carpal tunnel is very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Most commonly performed under local anaesthetic injected into the palm and wrist. You will be awake during the procedure but should not feel pain. Some units offer regional anaesthesia (arm block) or, rarely, general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Move the fingers and wrist gently from the day of surgery. The dressing is usually reduced after a few days, and stitches are removed at 10 to 14 days. Most people return to light activities within a week and to full duties within four to six weeks. Heavy manual work may take longer. Driving is usually possible once you can grip the steering wheel comfortably."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling in the hand",
          "Discharge or oozing from the wound",
          "Fever or feeling generally unwell",
          "New or worsening numbness after the initial post-operative period",
          "Inability to move the fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "A wound review is usually arranged at 10 to 14 days for suture removal. Further follow-up depends on recovery. Most patients do not require formal physiotherapy."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the symptoms come back?",
            "a": "Recurrence after surgery is uncommon. If symptoms return, it is usually because of scarring around the nerve rather than re-narrowing of the tunnel."
          },
          {
            "q": "How soon will I notice a difference?",
            "a": "Night-time tingling often improves within the first few days. Numbness may take several weeks or months to resolve."
          },
          {
            "q": "Can both hands be done at the same time?",
            "a": "It is possible, but most surgeons recommend one hand at a time so you retain full use of the other during recovery."
          },
          {
            "q": "Do I need to wear a splint?",
            "a": "A rigid splint is not usually necessary. A bulky dressing is applied after surgery. Your surgeon will advise if a splint is recommended."
          }
        ]
      }
    ]
  },
  "trigger-finger": {
    "name": "Trigger Finger Release",
    "region": "Hand & Wrist",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Trigger finger release is a minor surgical procedure to treat a finger or thumb that catches, clicks, or locks when bent. It involves dividing the tight pulley at the base of the affected finger to allow the tendon to glide freely.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (1–2 cm) is made in the palm at the base of the affected finger. The A1 pulley — a tight band of tissue through which the tendon passes — is carefully divided. This allows the tendon to move smoothly without catching. The skin is closed with stitches. The procedure takes approximately 10–15 minutes and is performed as a day case under local anaesthetic."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the finger catches, locks, or is painful, and has not responded to non-operative treatment. It is particularly appropriate when the finger becomes locked in a bent position or when symptoms interfere with daily activities."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Corticosteroid injection into the tendon sheath is often effective and may be tried first. Splinting and anti-inflammatory medication may help mild cases. In patients with diabetes, injections are less effective and surgery may be recommended earlier."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Eat and drink normally. Remove rings from the affected hand. The procedure is performed under local anaesthetic as a day case. Arrange transport home as the hand will be bandaged."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to eliminate the catching and locking of the finger. Success rates are very high — over 95% of patients experience complete resolution of triggering. The finger can be used for light activities from the day of surgery."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "The incision site may be tender for a few weeks. Scar massage helps.",
            "freq": "Common"
          },
          {
            "risk": "Temporary stiffness",
            "detail": "Some stiffness in the finger is normal initially and improves with use.",
            "freq": "Common"
          },
          {
            "risk": "Swelling and bruising",
            "detail": "Expected in the palm for the first week.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Wound infection is uncommon and usually managed with antibiotics.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "The digital nerves run close to the pulley. Injury is rare but could cause numbness in the finger.",
            "freq": "Rare"
          },
          {
            "risk": "Bowstringing",
            "detail": "Very rarely, the tendon may bow during bending if the wrong pulley is released. Careful technique prevents this.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "Triggering may recur in a small number of patients.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under local anaesthetic injected into the palm. You will be awake and should not feel pain during the procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Gentle finger movements are encouraged immediately. The dressing is reduced after a few days. Stitches are removed at 10–14 days. Most patients return to normal activities within two to three weeks. Heavy gripping and manual work may take four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Increasing pain in the hand",
          "New numbness in the affected finger",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Suture removal at 10–14 days. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can I use my hand straight away?",
            "a": "Yes, gentle use is encouraged from the day of surgery. Avoid heavy gripping for a few weeks."
          },
          {
            "q": "Will the trigger finger come back?",
            "a": "Recurrence is uncommon after surgery. If it occurs, repeat surgery is usually straightforward."
          },
          {
            "q": "Can multiple fingers be treated at once?",
            "a": "Yes, more than one finger can be released in the same operation if needed."
          }
        ]
      }
    ]
  },
  "dupuytrens": {
    "name": "Dupuytren's Fasciectomy",
    "region": "Hand & Wrist",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Dupuytren's fasciectomy is an operation to remove thickened tissue (fascia) in the palm of the hand that is pulling one or more fingers into a bent position. It aims to straighten the affected fingers and restore hand function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the palm and sometimes extended into the affected finger. The thickened, contracted cord of fascia is carefully dissected away from the surrounding tendons, nerves, and blood vessels, and removed. The skin is closed, sometimes with a skin graft if the contracture is severe. A splint or dressing is applied. The operation takes 30–90 minutes depending on the extent of disease."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the contracture prevents the finger from straightening fully, causing functional problems such as difficulty putting the hand flat on a table, putting on gloves, or gripping objects. Surgery is generally considered when the contracture reaches approximately 30 degrees or more at the metacarpophalangeal joint, or when the proximal interphalangeal joint is affected."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Needle fasciotomy — a procedure where a needle is used to divide the cord through the skin without open surgery. Collagenase injection (where available) to dissolve the cord. These are less invasive but carry a higher recurrence rate. Observation is appropriate for disease that is not causing functional limitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-assessment may be required depending on your health. This is usually a day-case procedure. Remove rings from the affected hand. Plan for limited hand use for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to straighten the affected finger and improve hand function. Most patients achieve significant improvement in finger position. However, Dupuytren's is a progressive condition and recurrence is possible over time. Complete straightening may not always be achievable, particularly when the contracture has been present for a long time."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "Dupuytren's disease may recur in the same or different fingers over time. The recurrence rate varies but can be 20–50% over 10 years.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Finger stiffness is common after surgery and requires dedicated physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing issues",
            "detail": "The skin in the palm may heal slowly, particularly if a skin graft is needed.",
            "freq": "Common"
          },
          {
            "risk": "Swelling and bruising",
            "detail": "Expected in the hand for the first few weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "The digital nerves may be displaced by the disease and are at risk during surgery. Numbness in the finger can result.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vessel injury",
            "detail": "The digital arteries may also be displaced and at risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection requiring antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "A rare complication causing chronic pain and stiffness.",
            "freq": "Rare"
          },
          {
            "risk": "Flare reaction",
            "detail": "Excessive swelling and stiffness in the early weeks that delays recovery.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under general anaesthesia, regional arm block, or sometimes local anaesthesia with a tourniquet. Your surgeon and anaesthetist will advise the best option."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A splint is usually worn at night for several weeks to maintain the correction. Hand therapy (physiotherapy) is essential to regain movement and prevent stiffness. Stitches are removed at 10–14 days. Light activities resume within two to three weeks. Full recovery typically takes six to twelve weeks. Hand therapy is a crucial part of the process."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown or persistent oozing",
          "Increasing pain, redness, or swelling",
          "Fever",
          "New numbness in the finger",
          "Inability to bend or straighten the finger"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound review and suture removal at 10–14 days. Hand therapy begins in the first two weeks. Surgeon review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the disease come back?",
            "a": "Dupuytren's is a progressive condition and can recur. The recurrence rate depends on factors including age, family history, and disease severity. Younger patients tend to have higher recurrence rates."
          },
          {
            "q": "Why can't the finger be made completely straight?",
            "a": "If the contracture has been present for a long time, the joint itself may have adapted and full straightening may not be achievable. The surgeon will discuss realistic expectations with you."
          },
          {
            "q": "Can needle treatment be done instead?",
            "a": "Needle fasciotomy is a less invasive alternative. It is suitable for some patients but has a higher recurrence rate than open fasciectomy."
          }
        ]
      }
    ]
  },
  "distal-radius": {
    "name": "Distal Radius Fracture Fixation",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal radius fracture fixation is an operation to realign and stabilise a broken wrist. It is one of the most common fractures treated by orthopaedic surgeons. Surgery involves using a metal plate and screws to hold the bone in the correct position while it heals.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front (palmar side) of the wrist. The fracture fragments are realigned under direct vision and fixed with a metal plate and screws (volar locking plate). In some cases, pins, an external fixator, or dorsal approach may be used. The wound is closed and a splint or plaster is applied. The operation usually takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the fracture is significantly displaced and cannot be adequately reduced (repositioned) or maintained in a plaster cast. Surgery is also considered when the fracture involves the joint surface, when the bone is unstable, or when the fracture has re-displaced after initial cast treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many wrist fractures can be treated with a plaster cast for approximately six weeks. The decision depends on fracture pattern, displacement, stability, and patient factors. Undisplaced or minimally displaced fractures usually heal well in a cast."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery may be performed as an emergency or electively within days of the injury. Standard pre-assessment and fasting are required. Inform the team about all medications and allergies."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the normal alignment and stability of the wrist, reduce pain, and allow earlier and more predictable rehabilitation. Most patients achieve good function and return to normal activities."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Wrist and finger stiffness is common after fractures. Early movement and hand therapy help.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected around the wrist for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Scar tenderness",
            "detail": "The incision may be sensitive initially.",
            "freq": "Common"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate may be palpable under the thin skin of the wrist. Removal is occasionally needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon irritation or rupture",
            "detail": "Tendons running over the plate can become irritated. Rupture of the extensor pollicis longus tendon is an uncommon but recognised risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "The median nerve may be compressed during the injury or irritated during surgery. Carpal tunnel symptoms may develop.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection, usually treated with antibiotics.",
            "freq": "Rare"
          },
          {
            "risk": "Malunion or non-union",
            "detail": "The bone may heal in an imperfect position or fail to heal.",
            "freq": "Rare"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "Chronic pain and stiffness affecting the hand and wrist.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia or regional arm block. Local anaesthesia is possible for some patients."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A splint or cast is worn for two to six weeks depending on the fixation. Finger exercises begin immediately. Wrist exercises start once the splint is removed. Hand therapy helps restore movement and strength. Most patients return to desk work within two to three weeks and to manual work at six to twelve weeks. Driving is usually possible at six weeks. Full recovery takes three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing numbness or tingling in the fingers",
          "Severe swelling or tight feeling in the hand",
          "Wound redness, discharge, or fever",
          "Inability to move the fingers",
          "Persistent severe pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check and X-ray at two weeks. Further X-rays at six weeks to confirm healing. Hand therapy as directed. The plate is not usually removed unless it causes problems."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the plate need to be removed?",
            "a": "Not routinely. Around 5–10% of patients have the plate removed if it causes tendon irritation or discomfort. This is a separate, smaller operation."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at around six weeks, once you can comfortably grip the steering wheel and operate the controls."
          },
          {
            "q": "Will my wrist be as good as before?",
            "a": "Most patients regain good function. Some mild stiffness or aching, particularly in cold weather, is not unusual. Full strength may take several months to return."
          }
        ]
      }
    ]
  },
  "trapeziectomy": {
    "name": "Trapeziectomy",
    "region": "Hand & Wrist",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A trapeziectomy is an operation to remove the trapezium bone at the base of the thumb, treating arthritis of the first carpometacarpal (CMC) joint. It is the most common surgical treatment for thumb base arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the base of the thumb on the back of the hand. The trapezium bone is carefully removed. In some cases, a piece of tendon is used to fill the space and stabilise the thumb (ligament reconstruction tendon interposition). Alternatively, a temporary wire may hold the thumb in position for a few weeks. The operation takes approximately 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for significant thumb base arthritis causing pain with pinching, gripping, and twisting movements when non-operative treatments have not provided adequate relief."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Thumb splints, pain medication, hand therapy, activity modification, and corticosteroid injections can provide effective relief for many patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Plan for the hand and thumb being in a splint or cast for several weeks. You will need help with daily activities during the initial recovery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief is achieved in the majority of patients. Pinch and grip strength improve gradually over several months. The thumb may appear slightly shorter but this rarely causes functional problems. Full recovery takes six to twelve months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Thumb weakness",
            "detail": "Pinch strength is reduced initially and takes several months to recover.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Thumb movement may be limited initially. Hand therapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "Tenderness around the incision is common for several weeks.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Sensory nerves near the incision may be damaged, causing numbness at the base of the thumb.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon injury",
            "detail": "Uncommon during the procedure.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection requiring antibiotics.",
            "freq": "Rare"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "Chronic pain and stiffness in the hand.",
            "freq": "Rare"
          },
          {
            "risk": "Subsidence",
            "detail": "The thumb metacarpal may migrate into the space left by the removed bone, potentially reducing strength.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia or regional arm block. Sometimes combined with local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A plaster cast or splint is worn for four to six weeks. After cast removal, hand therapy begins to restore movement and strength. Light activities resume at six to eight weeks. Full functional recovery takes six to twelve months. Pinch strength continues to improve for up to a year."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Severe pain not controlled by medication",
          "Fever",
          "New numbness in the thumb or fingers",
          "Cast feeling too tight or fingers becoming blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check and X-ray at two weeks. Cast removal and start of hand therapy at four to six weeks. Surgeon review at three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What fills the space where the bone was?",
            "a": "Scar tissue fills the gap naturally. If a tendon was used, it provides a cushion. The thumb functions well without the trapezium."
          },
          {
            "q": "How long until my grip strength returns?",
            "a": "Grip and pinch strength improve gradually over six to twelve months. They may not return to pre-arthritis levels but are usually sufficient for normal activities."
          },
          {
            "q": "Can I use the other hand while recovering?",
            "a": "Yes, the unaffected hand can be used normally throughout."
          }
        ]
      }
    ]
  },
  "ganglion": {
    "name": "Ganglion Excision",
    "region": "Hand & Wrist",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ganglion excision is a surgical procedure to remove a ganglion cyst — a fluid-filled swelling that commonly arises from a joint or tendon sheath in the wrist or hand.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the ganglion. The cyst is carefully dissected from the surrounding tissues, and a portion of the joint capsule or tendon sheath from which it arises is removed to reduce the risk of recurrence. The wound is closed with stitches and a dressing applied. The procedure takes approximately 20–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered when a ganglion causes persistent pain, interferes with function, compresses nearby nerves, or is cosmetically unacceptable, and has not responded to observation or aspiration (draining with a needle)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many ganglions are harmless and can be left alone. Aspiration (draining the cyst with a needle) is a simple option but has a recurrence rate of around 50%. Ganglions may also resolve spontaneously."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is a day-case procedure. Eat and drink normally. Remove watches and jewellery from the affected wrist."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Surgical excision removes the cyst and addresses the underlying connection to the joint or tendon sheath. Recurrence after surgery is approximately 10–20%, which is lower than after aspiration."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "The ganglion may return in approximately 10–20% of cases.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "The incision site may be tender for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary wrist stiffness improving with exercises.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Sensory nerves near the ganglion may be damaged, causing numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon or vessel injury",
            "detail": "Damage to nearby structures, particularly with volar (palm-side) ganglions.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Can be performed under local, regional, or general anaesthesia depending on the location and size of the ganglion."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A dressing is worn for a few days. Gentle wrist and finger movements are encouraged immediately. Stitches are removed at 10–14 days. Most patients return to normal activities within two to four weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Increasing pain",
          "New numbness in the hand",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Suture removal at 10–14 days. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can the ganglion come back?",
            "a": "Yes, there is approximately a 10–20% chance of recurrence after surgical excision."
          },
          {
            "q": "Is it dangerous to leave a ganglion alone?",
            "a": "No. Ganglions are benign and not harmful. Surgery is only necessary if the cyst causes pain or functional problems."
          }
        ]
      }
    ]
  },
  "de-quervains": {
    "name": "De Quervain's Release",
    "region": "Hand & Wrist",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "De Quervain's release is a minor surgical procedure to treat De Quervain's tenosynovitis — a painful condition affecting the tendons on the thumb side of the wrist. The operation involves opening the tight tendon sheath to relieve pressure.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (2–3 cm) is made over the thumb side of the wrist. The thickened tendon sheath (first dorsal compartment) is identified and divided to release the tendons. Care is taken to identify and protect the sensory branch of the radial nerve. The wound is closed with stitches. The procedure takes approximately 15–20 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when De Quervain's tenosynovitis causes persistent pain and swelling at the thumb side of the wrist that has not responded to splinting, activity modification, and corticosteroid injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Thumb spica splinting, anti-inflammatory medication, activity modification, and corticosteroid injection. Injection is effective in approximately 70–80% of patients and is usually tried before surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure under local anaesthetic. Normal eating and drinking. Remove jewellery from the affected hand."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve pain and restore normal thumb and wrist function. Success rates are very high, with over 90% of patients experiencing complete relief."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "Tenderness at the incision site for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Temporary weakness",
            "detail": "Thumb grip may feel weak initially.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "The superficial branch of the radial nerve is at risk. Injury can cause numbness or painful sensitivity on the back of the thumb and hand.",
            "freq": "Uncommon"
          },
          {
            "risk": "Incomplete release",
            "detail": "If a separate sub-compartment is not released, symptoms may persist.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon subluxation",
            "detail": "The tendons may slip out of the groove if too much of the sheath is released.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under local anaesthetic. Regional or general anaesthesia may be used if preferred."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Gentle thumb and wrist movements from the day of surgery. Stitches removed at 10–14 days. Most patients return to normal activities within two to four weeks. Heavy gripping takes four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "New numbness on the back of the thumb",
          "Persistent pain despite recovery"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Suture removal at 10–14 days. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why didn't the injection work?",
            "a": "Injections are effective for most patients but may not work if there is an anatomical variant (a separate sub-compartment) that the injection did not reach."
          },
          {
            "q": "Can the condition come back?",
            "a": "Recurrence after surgery is rare."
          }
        ]
      }
    ]
  },
  "tendon-repair": {
    "name": "Tendon Repair",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tendon repair in the hand is an operation to rejoin a cut or ruptured tendon, restoring the ability to bend or straighten the finger. Tendons do not heal reliably on their own and surgical repair is usually required.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the injured area (or the existing wound is extended). The cut tendon ends are identified and stitched together using strong sutures. The wound is closed and the hand is placed in a protective splint. Flexor tendon repairs are technically demanding procedures. The operation takes 45–90 minutes depending on the number and location of tendons injured."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for all significant tendon injuries in the hand, as tendons cannot heal without surgical repair. Delay in treatment may make repair more difficult."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Partial tendon injuries (less than 60% of the tendon width) may sometimes be managed with splinting alone. Complete tendon divisions always require surgical repair. In some cases where repair is not possible, tendon grafting or transfer may be considered."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Tendon repair is usually performed as an urgent or semi-urgent procedure, ideally within days of the injury. Standard pre-operative assessment and fasting are required."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore tendon function and allow the finger to move normally. With careful surgery and dedicated hand therapy, most patients achieve a good functional result. However, some stiffness and loss of range compared to normal is common, particularly with flexor tendon injuries in the finger."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Scar tissue around the repair can restrict tendon gliding. This is the most common challenge. Hand therapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Reduced range of motion",
            "detail": "Some limitation compared to the uninjured finger is common.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Hand swelling is expected and improves over weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Rupture of repair",
            "detail": "The repaired tendon may re-rupture, especially if loaded too early or too aggressively. This may require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adhesion formation",
            "detail": "Scar tissue binding the tendon to surrounding structures, limiting movement. May require further surgery (tenolysis).",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection, which may compromise the repair.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Associated nerve injuries may be present with the original injury.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia or regional arm block. Occasionally under local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A protective splint is worn for four to six weeks. Hand therapy begins within the first few days — a carefully controlled exercise programme protects the repair while maintaining tendon glide. The therapy regime is critical to the outcome. Full recovery takes three to six months. Return to heavy manual work may take longer."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of ability to bend or straighten the finger (possible tendon rupture)",
          "Wound redness, swelling, or discharge",
          "Fever",
          "Increasing numbness in the finger"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Hand therapy begins within the first week. Wound review and suture removal at 10–14 days. Surgeon review at six weeks. Ongoing hand therapy for several months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is hand therapy so important?",
            "a": "The repaired tendon needs to be moved carefully to prevent it from sticking to surrounding tissues, while also protecting the repair from rupture. This requires a carefully balanced exercise programme supervised by a specialist hand therapist."
          },
          {
            "q": "What if the repair breaks?",
            "a": "If the repair ruptures, further surgery is usually needed. This may involve a new repair, a tendon graft, or a staged reconstruction depending on the timing and circumstances."
          },
          {
            "q": "Will my finger work normally again?",
            "a": "Most patients achieve good functional recovery, particularly with dedicated hand therapy. Some degree of stiffness compared to the uninjured finger is common."
          }
        ]
      }
    ]
  },
  "total-hip": {
    "name": "Total Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A total hip replacement (total hip arthroplasty) is an operation to replace the worn ball-and-socket joint of the hip with artificial components. It is one of the most reliable and effective operations in modern medicine, performed on tens of thousands of patients in the UK each year.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgeon makes an incision over the side or front of the hip. The damaged ball (femoral head) is removed and the socket (acetabulum) is prepared. An artificial socket made of metal and a plastic or ceramic liner is fixed into the pelvis, and a new ball on a metal stem is inserted into the thighbone (femur). These components may be cemented, uncemented (press-fit), or a combination of both. The operation usually takes between one and two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip replacement is recommended when hip arthritis or a hip fracture causes significant pain, stiffness, and limitation of daily activities. It is considered when non-operative treatments have not provided sufficient relief."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and structured exercise, weight loss if appropriate, oral pain medication, walking aids, activity modification, and hip injections. These can be effective for many patients and are worth discussing fully with your clinician."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "A pre-operative assessment includes blood tests, heart tracing, and medication review. If you take blood-thinning medication, you may need to stop this before surgery. Maintaining a healthy weight, staying active, and optimising medical conditions before the operation supports a smoother recovery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve hip pain, restore mobility, and allow a return to normal daily activities. The vast majority of patients experience dramatic improvement in pain and quality of life. Modern hip replacements typically last 20 years or more."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg-length discrepancy",
            "detail": "A slight difference in leg lengths after surgery is relatively common, though usually minor.",
            "freq": "Common"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the wound in the early weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Wound infection (superficial)",
            "detail": "Occurs in a small percentage of cases, usually manageable with antibiotics.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots (DVT)",
            "detail": "Possible despite preventive measures including medication and stockings.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "The ball coming out of the socket. Occurs in roughly 1–2% of patients, more likely in the first few weeks.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep joint infection",
            "detail": "Approximately 1 in 100. May require further surgery or prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare but can cause weakness or numbness.",
            "freq": "Rare"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture of the femur during or after surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation around the joint.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pulmonary embolism",
            "detail": "A blood clot travelling to the lungs. Rare but serious.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Commonly performed under spinal anaesthesia with sedation, or under general anaesthesia. Your anaesthetist will discuss the best approach. Regional nerve blocks may assist with pain management."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients are mobilised on the day of surgery. Hospital stays are typically one to three days. Crutches or a walking stick are used for several weeks. Driving is usually possible at around six weeks. Many patients return to low-impact activities within three to six months. Full recovery may take up to a year."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling around the wound",
          "Fever or feeling systemically unwell",
          "Sudden calf pain or leg swelling",
          "Chest pain or shortness of breath",
          "A feeling that the hip has 'given way' or clunked",
          "Inability to weight-bear or significant new weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Typically reviewed at two weeks, six weeks, three months, and one year. X-rays are taken to monitor the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does a hip replacement last?",
            "a": "Modern hip replacements are expected to last 20 years or more for most patients."
          },
          {
            "q": "What movements should I avoid?",
            "a": "Your surgeon may advise specific precautions depending on the surgical approach. These are usually relaxed after six to twelve weeks."
          },
          {
            "q": "When can I return to sport?",
            "a": "Low-impact activities such as swimming, cycling, and golf are generally encouraged. High-impact sports are usually discouraged."
          },
          {
            "q": "Will I need the other hip done?",
            "a": "Not necessarily. If both hips are affected, the second replacement is usually planned after recovery from the first."
          }
        ]
      }
    ]
  },
  "hemiarthroplasty": {
    "name": "Hemiarthroplasty",
    "region": "Hip",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A hemiarthroplasty is a partial hip replacement in which the ball of the hip joint (femoral head) is replaced with a metal implant, while the natural socket is preserved. It is most commonly performed for displaced neck of femur fractures in older patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the side or back of the hip. The broken femoral head is removed and replaced with a smooth metal ball on a stem, which is inserted into the thighbone. The natural socket is left in place. The components may be cemented or uncemented. The operation usually takes approximately one hour."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hemiarthroplasty is the standard treatment for displaced intracapsular hip fractures (fractures across the neck of the femur) in older, less active patients. It allows early mobilisation and return to walking. For more active or younger patients, a total hip replacement may be preferred."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative management of displaced hip fractures is rarely appropriate as it usually leads to prolonged immobility, severe pain, and high complication rates. In very rare cases where a patient is too unwell for surgery, palliative management may be discussed."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Hip fracture surgery is usually performed within 36 hours of admission. Rapid pre-operative assessment is performed including blood tests, heart tracing, and chest X-ray. Optimisation of medical conditions is important."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve fracture pain, allow early mobilisation, and restore independence. Most patients can walk with support within a day or two of surgery. The procedure is well-established with predictable outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Reduced mobility",
            "detail": "Many patients do not return to their pre-fracture level of mobility. This reflects the overall frailty associated with hip fractures.",
            "freq": "Common"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected around the hip in the early weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Blood clots (DVT)",
            "detail": "Risk is present despite preventive measures.",
            "freq": "Common"
          },
          {
            "risk": "Delirium",
            "detail": "Confusion is common in older patients after surgery, particularly those with existing cognitive impairment.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "The hip may dislocate, particularly in the early weeks. Precautions help reduce this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "Approximately 1–2%. May require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medical complications",
            "detail": "Chest infection, heart problems, kidney injury, and other medical complications are more common in frail elderly patients.",
            "freq": "Common"
          },
          {
            "risk": "Acetabular erosion",
            "detail": "The metal ball may gradually wear the natural socket over time, potentially requiring conversion to a total hip replacement in the future.",
            "freq": "Long-term"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under spinal anaesthesia, which avoids the risks of general anaesthesia in elderly patients. General anaesthesia is used when spinal is not suitable. The anaesthetist will discuss options with you and your family."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Mobilisation with a physiotherapist begins on the day of or day after surgery. Most patients walk with a frame initially, progressing to a stick. Hospital stays vary from a few days to several weeks depending on overall health and recovery. Many patients benefit from ongoing rehabilitation, either in hospital or in a community setting."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or discharge from the wound",
          "Fever or confusion",
          "Sudden calf pain or leg swelling",
          "Chest pain or breathing difficulty",
          "A feeling that the hip has shifted or clunked",
          "Inability to stand or bear weight"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Follow-up is arranged at six weeks with an X-ray. Ongoing support from rehabilitation services as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not a total hip replacement?",
            "a": "In less active older patients, a hemiarthroplasty is quicker, simpler, and has a lower dislocation rate. For more active patients with a longer life expectancy, a total hip replacement may be recommended."
          },
          {
            "q": "How long will my parent/relative be in hospital?",
            "a": "This varies widely. Some patients go home within a few days; others need several weeks of rehabilitation. The team will keep you informed."
          },
          {
            "q": "Will they walk again?",
            "a": "Most patients who were walking before the fracture will walk again, though often with more support than before. Early mobilisation and rehabilitation are key."
          }
        ]
      }
    ]
  },
  "hip-resurfacing": {
    "name": "Hip Resurfacing",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip resurfacing is an alternative to total hip replacement in which the damaged surfaces of the hip joint are reshaped and capped with smooth metal components, rather than removing the femoral head entirely. It is most suitable for younger, active male patients with good bone quality.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the side of the hip. The damaged surface of the femoral head is trimmed and capped with a smooth metal shell. The socket is prepared and lined with a corresponding metal cup. This preserves more of the natural bone compared to a total hip replacement. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip resurfacing may be recommended for younger, active patients (typically men under 65) with severe hip arthritis and good bone quality. It preserves bone stock, potentially making future revision surgery easier, and allows a larger bearing surface which may reduce the risk of dislocation and permit higher levels of activity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "The same non-operative options as for total hip replacement: physiotherapy, weight management, pain medication, activity modification, and injections. A total hip replacement is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment. A CT scan or MRI may be required to confirm suitability. Metal ion blood tests may be arranged as part of the screening. The same general preparation as for total hip replacement applies."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent activity levels are achievable, often including impact sports. Preservation of bone stock. Large bearing diameter reduces dislocation risk. In the right patient, results can be as good as or better than conventional replacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg-length discrepancy",
            "detail": "Usually minimal with resurfacing.",
            "freq": "Common"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the hip.",
            "freq": "Expected"
          },
          {
            "risk": "Groin pain",
            "detail": "Some patients experience groin discomfort in the early months that usually settles.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Femoral neck fracture",
            "detail": "Fracture of the preserved femoral neck, requiring conversion to total hip replacement. Most common risk, approximately 1–2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Metal ion release",
            "detail": "Metal-on-metal bearings release metal ions. Blood levels are monitored. High levels may cause soft tissue reactions (ARMD).",
            "freq": "Uncommon"
          },
          {
            "risk": "Adverse reaction to metal debris (ARMD)",
            "detail": "Inflammatory reaction to metal particles causing pain and tissue damage. May require revision.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection in approximately 1% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sciatic or femoral nerve stretching is rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under spinal or general anaesthesia, similar to total hip replacement."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is similar to total hip replacement. Most patients mobilise on the day of surgery. Hospital stay is typically one to three days. Crutches for several weeks. Many patients return to high-activity pursuits including running and impact sports, which is a key advantage over conventional replacement. Full recovery takes three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden onset of groin or thigh pain (possible femoral neck fracture)",
          "Wound redness, discharge, or fever",
          "Clicking, grinding, or new hip pain after initial recovery (possible ARMD)",
          "Calf pain or swelling",
          "Chest pain or breathing difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Standard follow-up at two weeks, six weeks, three months, and one year. Blood metal ion levels are checked periodically. Long-term surveillance is important."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is resurfacing not suitable for everyone?",
            "a": "Women, older patients, those with small femoral heads, osteoporosis, or certain hip anatomy are at higher risk of complications. Total hip replacement is more appropriate for these groups."
          },
          {
            "q": "What about the metal-on-metal concern?",
            "a": "Some older metal-on-metal hip designs had high failure rates. Modern resurfacing implants with established track records (such as the Birmingham Hip Resurfacing) have excellent long-term data when used in the right patients."
          },
          {
            "q": "Can I run after a hip resurfacing?",
            "a": "Many patients return to running and impact sports. This is one of the main advantages of resurfacing over conventional replacement."
          }
        ]
      }
    ]
  },
  "dhs": {
    "name": "Dynamic Hip Screw",
    "region": "Hip",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A dynamic hip screw (DHS) is an operation to fix a broken hip (extracapsular hip fracture) using a large screw and metal plate. It is one of the most commonly performed trauma operations and allows the fracture to heal in a stable position while the patient mobilises.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the upper thigh. A large screw is inserted across the fracture into the head of the femur (thighbone), guided by X-ray. This screw slides within a metal barrel attached to a plate, which is fixed to the outer shaft of the femur with screws. The 'dynamic' design allows controlled compression of the fracture as the patient walks, promoting healing. The operation typically takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The DHS is the standard fixation for intertrochanteric (extracapsular) hip fractures — fractures that occur in the region just below the neck of the femur. These fractures are common in elderly patients following a fall."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative management of these fractures is rarely appropriate as it leads to prolonged immobility, pain, and high rates of complications including blood clots, chest infections, and pressure sores."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is usually performed within 36 hours of admission. Rapid pre-assessment is performed. Blood tests, heart tracing, and chest X-ray. Medication review and optimisation of medical conditions."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to stabilise the fracture, relieve pain, and allow early weight-bearing and mobilisation. Most patients can put full weight on the leg from the day after surgery. The fracture typically heals over six to twelve weeks."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Reduced mobility",
            "detail": "Many elderly patients experience some decline in mobility after a hip fracture. Rehabilitation aims to restore as much function as possible.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT risk despite preventive measures.",
            "freq": "Common"
          },
          {
            "risk": "Delirium",
            "detail": "Confusion is common in elderly patients post-operatively.",
            "freq": "Common"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected around the hip and thigh.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Screw cut-out",
            "detail": "The screw may cut through the femoral head, particularly in osteoporotic bone. This may require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "The fracture may not heal or may heal in a poor position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the femoral head. Less common with extracapsular fractures than intracapsular ones.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medical complications",
            "detail": "Chest infection, heart problems, kidney injury are more common in frail elderly patients.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under spinal anaesthesia, which is generally preferred in elderly patients. General anaesthesia is used when spinal is not suitable."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Mobilisation begins on the day of or day after surgery with physiotherapy support. Full weight-bearing is usually permitted immediately. Rehabilitation continues in hospital or in a community setting. Recovery time varies depending on overall health and pre-fracture mobility. The metalwork is usually left in place permanently."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing hip or thigh pain",
          "Wound redness, swelling, or discharge",
          "Fever or confusion",
          "Shortening or rotation of the leg",
          "Calf pain or swelling",
          "Chest pain or breathing difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. X-ray and clinic review at six weeks. Further follow-up as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the metalwork need to be removed?",
            "a": "Usually not. The plate and screw are left in place permanently. Removal is only considered if they cause problems."
          },
          {
            "q": "Can I walk on the leg straight away?",
            "a": "Yes, most patients are encouraged to put full weight on the leg from the day after surgery."
          },
          {
            "q": "How long does the fracture take to heal?",
            "a": "Typically six to twelve weeks. Full recovery of mobility may take longer."
          }
        ]
      }
    ]
  },
  "hip-arthroscopy": {
    "name": "Hip Arthroscopy",
    "region": "Hip",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip arthroscopy is a keyhole procedure used to diagnose and treat conditions within and around the hip joint, most commonly femoroacetabular impingement (FAI) and labral tears. It allows the surgeon to reshape bone and repair soft tissues through small incisions.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The leg is placed in traction on a special operating table to create space in the hip joint. Two or three small incisions are made around the hip. A camera (arthroscope) is inserted to view the joint. Depending on the findings, the surgeon may reshape the bone to treat impingement (osteoplasty), repair or trim a torn labrum, treat cartilage damage, or remove loose bodies. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip arthroscopy is considered for femoroacetabular impingement (FAI) causing groin pain and limited movement, labral tears, removal of loose bodies, and assessment of early cartilage damage. It is usually recommended after physiotherapy and other non-operative measures have been tried."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Structured physiotherapy, activity modification, anti-inflammatory medication, and corticosteroid or hyaluronic acid injection into the hip. Many patients with FAI symptoms improve with physiotherapy alone."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is usually a day-case or overnight procedure. Crutches will be needed for several weeks. Plan for limited mobility in the initial recovery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to reduce pain, improve movement, and allow return to sport and activity. Success rates are highest in younger patients with well-defined impingement and preserved joint cartilage. If significant arthritis is present, the results are less predictable."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Traction-related symptoms",
            "detail": "Numbness or tingling in the genital area or foot from traction during surgery. Usually temporary, resolving within days.",
            "freq": "Common"
          },
          {
            "risk": "Groin soreness",
            "detail": "Bruising and soreness around the hip and groin area.",
            "freq": "Expected"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Symptoms may not fully resolve, particularly if cartilage damage is present.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Lateral femoral cutaneous nerve irritation causing thigh numbness. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Very rare risk of damage to blood supply of the femoral head.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection in approximately 0.5% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Fracture",
            "detail": "Rare fracture of the femoral neck, more common with aggressive bone reshaping.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation. Preventive medication may be given.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Performed under general anaesthesia. Muscle relaxation is important to allow adequate traction."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches are used for two to six weeks depending on the procedure. Physiotherapy begins within the first week and continues for three to six months. Return to office work at one to two weeks. Return to sport at three to six months, depending on the procedure and individual progress. Full recovery may take six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin or hip pain",
          "Wound redness or discharge",
          "Fever",
          "Persistent numbness in the thigh, groin, or foot",
          "Significant swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks and three months. Physiotherapy is a critical component."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I be able to return to sport?",
            "a": "Most patients return to their sporting activities. The success depends on the degree of cartilage preservation and the procedure performed."
          },
          {
            "q": "Is this suitable if I have arthritis?",
            "a": "Hip arthroscopy is less successful when significant arthritis is present. In these cases, hip replacement may be a more reliable option."
          },
          {
            "q": "How long do I need crutches?",
            "a": "Typically two to six weeks, depending on the procedure performed."
          }
        ]
      }
    ]
  },
  "revision-hip": {
    "name": "Revision Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision hip replacement is an operation to replace or repair a hip replacement that has worn out, loosened, or failed. It is a more complex procedure than a primary hip replacement, requiring specialist surgical expertise.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is usually reopened. The failed or worn components are removed, which may require special instruments. Bone defects are assessed and may need bone grafting or augmentation. New implant components are inserted, often larger or specialised revision designs. The operation is longer and more complex than a primary replacement, typically taking two to three hours or more."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision may be needed for implant loosening (the most common reason), wear of the bearing surfaces, recurrent dislocation, periprosthetic fracture, infection, or adverse reaction to metal debris. Pain and deteriorating function are the usual presenting symptoms."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "If symptoms are mild, observation and monitoring with regular imaging may be appropriate. Pain management and activity modification can provide temporary relief. However, once an implant has failed, revision surgery is usually the definitive treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-operative assessment. Additional imaging (CT scan, bone scan) is usually required. If infection is suspected, blood tests and aspiration of the joint may be performed. Optimisation of health before this more complex procedure is particularly important."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore a pain-free, functioning hip. While most patients experience significant improvement, outcomes are generally less predictable than primary replacement. Revision implants may not last as long as primary implants, and recovery can be slower."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Longer recovery",
            "detail": "Recovery is slower than primary hip replacement due to the complexity of the surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Leg-length discrepancy",
            "detail": "May be more difficult to match leg lengths precisely in revision surgery.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Greater blood loss is common with revision surgery. Blood transfusion may be required.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "Higher risk than with primary replacement, approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary surgery, approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Higher risk of periprosthetic fracture during the procedure due to bone loss.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Scar tissue makes nerve identification more difficult.",
            "freq": "Uncommon"
          },
          {
            "risk": "Further revision",
            "detail": "Revision implants may not last as long as primary implants.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually general or spinal anaesthesia. The anaesthetic team will plan for the longer operation and potential blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay is typically longer than for primary surgery — three to seven days. Weight-bearing and movement restrictions may apply depending on the surgery performed. Physiotherapy is essential. Full recovery takes six to twelve months. Mobility aids may be needed for longer."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems: redness, discharge, breakdown",
          "Fever or feeling unwell",
          "A sensation that the hip has dislocated",
          "Increasing pain or inability to weight-bear",
          "Calf or leg swelling",
          "Chest pain or breathing difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Close follow-up with wound checks, X-rays, and surgeon review at two weeks, six weeks, three months, and one year. Long-term surveillance is particularly important."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is revision surgery more risky?",
            "a": "Yes. Revision surgery is more complex and carries higher risks of complications than primary hip replacement. However, it is still a well-established and generally successful procedure."
          },
          {
            "q": "How long will a revision hip last?",
            "a": "Revision implants typically last 10–15 years, though this varies. Longevity depends on bone quality, implant type, and activity level."
          },
          {
            "q": "Will recovery take longer?",
            "a": "Yes, recovery is generally slower than after a primary replacement. Patience and dedication to rehabilitation are important."
          }
        ]
      }
    ]
  },
  "total-knee": {
    "name": "Total Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A total knee replacement (also called total knee arthroplasty) is an operation to replace the worn surfaces of the knee joint with artificial components. It is one of the most commonly performed and successful orthopaedic procedures in the United Kingdom.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgeon makes an incision over the front of the knee and removes the damaged cartilage and bone surfaces from the end of the thighbone (femur), the top of the shinbone (tibia), and usually the underside of the kneecap (patella). These surfaces are replaced with precisely shaped metal and high-grade plastic components that recreate the shape and movement of a healthy knee. The components are usually fixed with bone cement. The wound is closed with stitches or clips and a dressing is applied. The operation typically takes between one and two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Total knee replacement is usually recommended for people with significant knee arthritis that causes persistent pain, stiffness, and difficulty with everyday activities such as walking, climbing stairs, or getting up from a chair. It is generally considered when non-operative treatments have been tried and are no longer providing adequate relief."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Before considering surgery, most patients will have tried some combination of weight management, physiotherapy and exercise, pain medication, walking aids, activity modification, and injections (corticosteroid or hyaluronic acid). These remain valid options, and the decision to proceed with surgery is always made jointly with your surgeon."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "You will attend a pre-assessment clinic where blood tests, heart tracing, and other investigations may be arranged. Discuss your regular medications with the surgical team. Maintaining good dental health before surgery reduces infection risk. Strengthening exercises for the leg muscles can aid your recovery. You will be asked to fast before the operation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The primary aim is to relieve pain and improve knee function. Most patients experience significant pain relief and are able to return to everyday activities including walking, gardening, and light recreational activity. The artificial joint typically lasts 15 to 25 years. The goal is a well-functioning, pain-free knee rather than a completely \"normal\" knee."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling and stiffness",
            "detail": "Normal in the early weeks and gradually improves with physiotherapy.",
            "freq": "Expected"
          },
          {
            "risk": "Wound infection (superficial)",
            "detail": "Occurs in roughly 1–2 in every 100 patients. Usually treated with antibiotics.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots (DVT)",
            "detail": "Can occur despite preventive measures such as blood-thinning medication and compression stockings.",
            "freq": "Common"
          },
          {
            "risk": "Numbness near the scar",
            "detail": "A patch of numbness on the outer edge of the knee is relatively common and usually improves over time.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Deep joint infection",
            "detail": "Occurs in roughly 1 in 100 patients. May require further surgery or prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare, but could cause weakness or altered sensation in the lower leg.",
            "freq": "Rare"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture of the bone around the implant.",
            "freq": "Rare"
          },
          {
            "risk": "Implant loosening",
            "detail": "The components can loosen over time, eventually requiring revision surgery.",
            "freq": "Long-term"
          },
          {
            "risk": "Pulmonary embolism",
            "detail": "A blood clot travelling to the lungs. Rare but potentially life-threatening.",
            "freq": "Rare"
          },
          {
            "risk": "Persistent stiffness",
            "detail": "A small number of patients require manipulation under anaesthesia.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under spinal anaesthesia combined with sedation, or under general anaesthesia. Your anaesthetist will discuss the most suitable option. A nerve block may be used for pain relief after surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients stay in hospital for one to three days. Physiotherapy begins on the day of surgery or the day after. Walking with crutches or a frame is encouraged immediately. Most people return to driving at around six weeks. Full recovery continues for up to 12 months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing redness, swelling, or discharge from the wound",
          "Fever or feeling generally unwell",
          "Sudden calf pain or swelling",
          "Chest pain or difficulty breathing",
          "Inability to move the knee or bear weight",
          "Severe pain not controlled by your medication"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Typically seen at two weeks, six weeks, three months, and one year. X-rays are taken to monitor the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long will my new knee last?",
            "a": "Modern knee replacements typically last 15 to 25 years."
          },
          {
            "q": "Will I set off airport security?",
            "a": "The metal components may trigger scanners. You can request a card from your surgeon."
          },
          {
            "q": "Can I kneel after a knee replacement?",
            "a": "Many patients find kneeling uncomfortable, though it is generally safe."
          },
          {
            "q": "When can I drive?",
            "a": "Most patients can return to driving at around six weeks."
          }
        ]
      }
    ]
  },
  "partial-knee": {
    "name": "Partial Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A partial (unicompartmental) knee replacement replaces only the damaged part of the knee joint, preserving the healthy bone, cartilage, and ligaments. It is suitable when arthritis is limited to one compartment of the knee.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A smaller incision is made than for a total knee replacement. Only the damaged compartment (usually the inner/medial side) is resurfaced with a metal and plastic implant. The healthy parts of the knee, including the cruciate ligaments, are preserved. The operation typically takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "A partial knee replacement is suitable when arthritis is confined to one compartment of the knee, the cruciate ligaments are intact, and the knee is not severely deformed. It may provide a more natural-feeling knee than a total replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Weight management, physiotherapy, pain medication, activity modification, injections, and bracing. A total knee replacement is the main surgical alternative if the arthritis progresses or involves more than one compartment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. The same preparation as for total knee replacement."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Faster recovery, more natural knee movement, and preservation of bone stock compared to total knee replacement. Many patients report the knee feels more 'normal' than after a total replacement. Typically lasts 15–20 years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling and stiffness",
            "detail": "Expected but often less than after total knee replacement.",
            "freq": "Expected"
          },
          {
            "risk": "Progression of arthritis",
            "detail": "The remaining compartments may develop arthritis over time, potentially requiring conversion to total knee replacement.",
            "freq": "Long-term"
          },
          {
            "risk": "Numbness near the scar",
            "detail": "Common and usually settles.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Bearing dislocation",
            "detail": "The plastic bearing may dislocate in some designs. May require a further procedure.",
            "freq": "Rare"
          },
          {
            "risk": "Fracture",
            "detail": "Tibial plateau fracture is a rare but recognised complication.",
            "freq": "Rare"
          },
          {
            "risk": "Conversion to total knee",
            "detail": "If the partial replacement fails, conversion to a total knee replacement is needed. This is usually straightforward.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Risk similar to total knee replacement, approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism despite preventive measures.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Spinal or general anaesthesia, as for total knee replacement."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is typically faster than total knee replacement. Hospital stay is one to two days. Many patients return to driving at three to four weeks and to desk work at similar timescales. Full recovery takes three to six months. Higher activity levels are often achievable than after total knee replacement."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "The same warning signs as total knee replacement",
          "Sudden locking or catching of the knee (possible bearing dislocation)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same schedule as total knee replacement."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not just have a total knee replacement?",
            "a": "A partial replacement preserves healthy bone and ligaments, gives a more natural feel, and allows faster recovery. However, it is only suitable if arthritis is limited to one compartment."
          },
          {
            "q": "What if the arthritis spreads?",
            "a": "If the remaining compartments develop arthritis, the partial replacement can usually be converted to a total knee replacement."
          },
          {
            "q": "Can I be more active with a partial knee?",
            "a": "Many surgeons are comfortable allowing higher activity levels with a partial replacement than with a total replacement, including gentle impact activities."
          }
        ]
      }
    ]
  },
  "acl-reconstruction": {
    "name": "ACL Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "ACL reconstruction is a surgical procedure to replace a torn anterior cruciate ligament — one of the key stabilising ligaments in the knee. It uses a graft (usually from the patient's own hamstring tendons or patellar tendon) to create a new ligament.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically (keyhole). A graft is harvested — commonly the hamstring tendons from the inner side of the knee, or the middle third of the patellar tendon. The graft is prepared and passed through tunnels drilled in the thighbone and shinbone, positioned where the original ACL was. It is secured with screws, buttons, or other fixation devices. If there is a meniscal tear, this is repaired or trimmed at the same time. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ACL reconstruction is recommended for patients with a torn ACL who experience recurrent knee instability or giving way, particularly those who wish to return to pivoting sports or have physically demanding occupations. Not everyone with an ACL tear needs surgery — the decision depends on activity level, symptoms, and the presence of associated injuries."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Intensive physiotherapy to strengthen the muscles around the knee and improve balance. Activity modification — avoiding pivoting and cutting sports. Bracing for certain activities. Many patients, particularly those with lower activity demands, manage well without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-operative physiotherapy (prehabilitation) is strongly recommended. Evidence shows that patients who optimise their knee movement and muscle strength before surgery have better outcomes. Standard pre-assessment is required. You should stop smoking if possible."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Approximately 85–90% of patients achieve a stable knee that allows return to sport and demanding activities. The new ligament aims to restore directional stability and protect the knee from further damage. However, the knee may not be exactly as it was before the injury."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee swelling",
            "detail": "Expected after surgery and may persist for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Graft site pain",
            "detail": "Pain at the hamstring or patellar tendon donor site. Usually settles over weeks to months.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of range of motion is common initially. Early physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Numbness",
            "detail": "An area of numbness on the outer aspect of the lower leg is common and usually resolves.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "The new ligament may stretch or re-rupture. Risk is approximately 5–10%, higher in younger patients returning to pivoting sports.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection in approximately 0.5–1% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare damage to structures around the knee.",
            "freq": "Rare"
          },
          {
            "risk": "Ongoing instability",
            "detail": "A small proportion of patients continue to experience some instability despite reconstruction.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness requiring MUA",
            "detail": "Arthrofibrosis — excessive scarring leading to loss of movement.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia. A nerve block may be used for post-operative pain relief. Spinal anaesthesia is an alternative."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches are used for two to four weeks. Physiotherapy begins immediately and is essential for a good outcome. Jogging typically resumes at three months. Return to competitive sport is usually at nine to twelve months, guided by functional testing rather than time alone. Evidence shows waiting until at least nine months reduces the risk of re-injury by up to 84%. Full rehabilitation takes nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Fever or wound redness/discharge",
          "Sudden giving way or instability",
          "Locking of the knee",
          "Calf pain or swelling",
          "Chest pain or breathing difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks, three months, six months, and one year. Physiotherapy is the cornerstone of recovery and continues for many months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When can I return to sport?",
            "a": "Return to competitive and pivoting sport is typically at nine to twelve months. Research shows that waiting until at least nine months and meeting performance criteria significantly reduces re-injury risk."
          },
          {
            "q": "Which graft is best?",
            "a": "Both hamstring and patellar tendon grafts have excellent track records. Your surgeon will recommend the most suitable option based on your circumstances."
          },
          {
            "q": "Will I get arthritis?",
            "a": "An ACL injury increases the long-term risk of knee arthritis regardless of whether surgery is performed. Reconstruction aims to stabilise the knee and reduce further damage."
          },
          {
            "q": "Can the ACL be reconstructed again if it fails?",
            "a": "Yes, revision ACL reconstruction is possible but more complex, with slightly less predictable results."
          }
        ]
      }
    ]
  },
  "meniscal-surgery": {
    "name": "Meniscal Surgery",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Meniscal surgery is an arthroscopic (keyhole) procedure to treat a tear in one of the two menisci — the crescent-shaped shock absorbers in the knee. The torn meniscus may be partially trimmed (partial meniscectomy) or repaired with stitches, depending on the tear pattern and location.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two small incisions are made at the front of the knee. A camera (arthroscope) is inserted to view the joint. The torn meniscus is assessed. If the tear is in an area with poor blood supply, the damaged portion is trimmed away (partial meniscectomy). If the tear is in a repairable location, it is stitched back together (meniscal repair). The operation typically takes 20–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered when a meniscal tear causes persistent pain, swelling, catching, or locking of the knee that has not responded to physiotherapy and time. In younger patients with acute tears, meniscal repair is preferred to preserve the meniscus and protect the joint long-term."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many meniscal tears, particularly degenerative tears in older patients, can be managed with physiotherapy, pain medication, and activity modification. Evidence shows that in patients over 40 with degenerative tears, physiotherapy is often as effective as surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is usually a day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "For partial meniscectomy: rapid relief of mechanical symptoms (catching, locking). For meniscal repair: preservation of the meniscus and potential long-term protection of the joint. Most patients return to normal activities within a few weeks (meniscectomy) to a few months (repair)."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee swelling",
            "detail": "Expected for one to two weeks after surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary limitation of movement improving with exercises.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Some patients continue to experience knee pain, particularly if arthritis is present.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Repair failure",
            "detail": "Meniscal repairs do not always heal. Failure may require further surgery to trim the meniscus.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection in approximately 0.5% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT is uncommon after knee arthroscopy but possible.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Rare.",
            "freq": "Rare"
          },
          {
            "risk": "Long-term arthritis",
            "detail": "Removal of meniscal tissue increases the long-term risk of osteoarthritis.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general or spinal anaesthesia. Can sometimes be done under local anaesthesia with sedation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "For partial meniscectomy: walking without crutches within days. Return to sport at four to six weeks. For meniscal repair: crutches for four to six weeks, with restricted bending. Return to sport at three to six months. Physiotherapy is important for both."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Fever or wound redness",
          "Locking or giving way of the knee",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks. Physiotherapy as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why can't the meniscus always be repaired?",
            "a": "Repairs only heal reliably when the tear is in an area of the meniscus with good blood supply (the outer third). Tears in the inner, avascular zone cannot heal and are trimmed instead."
          },
          {
            "q": "Will removing part of the meniscus cause arthritis?",
            "a": "Removing meniscal tissue increases the long-term risk of wear on the joint cartilage. This is why surgeons try to preserve as much meniscus as possible."
          },
          {
            "q": "When can I return to sport?",
            "a": "After partial meniscectomy: usually four to six weeks. After meniscal repair: three to six months, to allow the repair to heal."
          }
        ]
      }
    ]
  },
  "knee-arthroscopy": {
    "name": "Knee Arthroscopy",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee arthroscopy is a keyhole surgical procedure used to diagnose and treat a range of conditions within the knee joint. It involves inserting a small camera through tiny incisions to visualise and operate inside the knee.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two small incisions (approximately 1 cm each) are made at the front of the knee. A camera is inserted through one, and instruments through the other. The surgeon inspects the joint surfaces, menisci, and ligaments. Treatment may include removing loose bodies, smoothing damaged cartilage, washing out the joint, or taking biopsies. The procedure usually takes 15–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Knee arthroscopy may be recommended for removal of loose bodies, treatment of cartilage damage, biopsy of the synovium, washout of an infected joint, or investigation of symptoms not explained by imaging."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication, and activity modification. MRI scanning can provide useful diagnostic information without surgery. It is important to note that arthroscopy for osteoarthritis of the knee is generally not recommended unless there is a specific mechanical problem such as a loose body."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of loose bodies provides reliable relief from mechanical symptoms. Diagnostic arthroscopy can confirm or exclude suspected conditions. For general arthritic symptoms without a specific mechanical cause, the benefit of arthroscopy is limited."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee swelling",
            "detail": "Expected for several days after surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary and improves with exercises.",
            "freq": "Common"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "If the underlying condition is arthritis, symptoms may not be relieved by arthroscopy.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Joint infection in approximately 0.5% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT is uncommon after knee arthroscopy.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia with sedation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients walk without crutches within a few days. Return to work within one to two weeks for office jobs, two to four weeks for manual work. Return to sport at four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling, warmth, or pain",
          "Fever",
          "Wound redness or discharge",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Further follow-up depends on findings and procedure performed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will arthroscopy help my arthritis?",
            "a": "Current evidence does not support arthroscopy as a treatment for knee arthritis in the absence of a specific mechanical problem. Your surgeon will discuss whether arthroscopy is appropriate for your situation."
          },
          {
            "q": "How long will it take to recover?",
            "a": "Most patients recover quickly — within one to three weeks. More complex procedures take longer."
          }
        ]
      }
    ]
  },
  "revision-knee": {
    "name": "Revision Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision knee replacement is an operation to replace or repair a knee replacement that has worn out, loosened, become infected, or is causing persistent problems. It is more complex than a primary knee replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is reopened. The failed components are removed, which may require cutting bone or cement. Bone defects are assessed and reconstructed with augments, bone graft, or metal wedges. New, larger revision implants are inserted. The operation is longer and more complex, typically two to three hours or more."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision may be needed for implant loosening, wear, persistent pain, instability, infection, or periprosthetic fracture."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation, pain management, physiotherapy, and bracing may provide temporary relief. Once the implant has failed, revision surgery is usually the definitive treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment with additional imaging (CT scan). If infection is suspected, joint aspiration and blood tests are performed. Optimisation of health is particularly important."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore a stable, functional, pain-free knee. Outcomes are generally good but less predictable than primary replacement. Recovery is slower."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Longer recovery",
            "detail": "Recovery takes longer than primary knee replacement.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "More common than after primary surgery.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Greater blood loss than primary surgery. Transfusion may be required.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Higher risk than primary surgery, approximately 3–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "The revision knee may be less stable than a primary replacement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Increased risk due to bone loss.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Scar tissue increases the difficulty.",
            "freq": "Rare"
          },
          {
            "risk": "Further revision",
            "detail": "Revision implants may not last as long as primary implants.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Planning for longer surgery and potential blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of three to seven days. Restricted weight-bearing may apply. Physiotherapy essential. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems: redness, discharge, breakdown",
          "Fever",
          "Instability or giving way",
          "Increasing pain",
          "Calf or leg swelling",
          "Chest pain or breathing difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Close follow-up at two weeks, six weeks, three months, and one year. Long-term monitoring."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is revision surgery more risky?",
            "a": "Yes, it carries higher complication rates than primary surgery but remains a well-established procedure."
          },
          {
            "q": "How long will a revision knee last?",
            "a": "Typically 10–15 years, depending on bone quality and activity level."
          }
        ]
      }
    ]
  },
  "hto": {
    "name": "High Tibial Osteotomy",
    "region": "Knee",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A high tibial osteotomy (HTO) is an operation to realign the leg by cutting and repositioning the top of the shinbone (tibia). It shifts weight away from the damaged part of the knee, relieving pain and delaying the need for knee replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made below the inner side of the knee. A precise cut is made through the tibia, and the bone is gradually opened to the desired angle. A wedge of bone or bone substitute may be inserted. The new position is secured with a metal plate and screws. The operation takes approximately one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "HTO is recommended for younger, active patients with arthritis affecting only one side (usually the inner compartment) of the knee, combined with bow-legged (varus) alignment. It is particularly suitable for patients who are too young or too active for knee replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, pain medication, bracing, injections, and activity modification. Partial or total knee replacement are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-leg X-rays and sometimes CT scan are required for precise planning. Standard pre-assessment. You will need crutches for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to reduce pain by shifting load away from the arthritic compartment. This can delay the need for knee replacement by 10–15 years in many patients. Most patients report significant pain relief and improved function."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Knee stiffness is common initially and improves with physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected around the knee for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate may be palpable under the skin.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union or delayed union",
            "detail": "The bone may be slow to heal or fail to heal. Smoking significantly increases this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over- or under-correction",
            "detail": "The alignment may not be exactly as planned.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "The peroneal nerve is at risk, potentially causing foot drop. Rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Extremely rare but serious condition requiring emergency surgery.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for six to twelve weeks while the osteotomy heals. Weight-bearing is typically restricted initially. Physiotherapy begins early. Return to desk work at two to four weeks, manual work at three to six months. Return to sport at six to twelve months once the bone has fully healed. The plate is usually left in place but can be removed after healing."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Fever",
          "Foot drop — inability to lift the foot",
          "Severe calf pain or swelling",
          "Increasing knee pain during recovery"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at six weeks, three months, and six months to monitor bone healing. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I still need a knee replacement eventually?",
            "a": "Possibly. HTO is designed to delay rather than prevent the need for knee replacement. Many patients do well for 10–15 years or more before considering replacement."
          },
          {
            "q": "Why not just have a knee replacement now?",
            "a": "Knee replacements have a limited lifespan. In younger, active patients, HTO can delay replacement to a time when it is more likely to last the rest of the patient's life."
          },
          {
            "q": "Can I return to sport?",
            "a": "Yes, many patients return to running and impact sports, which is one of the key advantages of osteotomy over replacement."
          }
        ]
      }
    ]
  },
  "mpfl": {
    "name": "MPFL Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "MPFL (medial patellofemoral ligament) reconstruction is an operation to stabilise the kneecap (patella) in patients with recurrent patellar dislocation. A tendon graft is used to recreate the ligament that prevents the kneecap from sliding outwards.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Incisions are made on the inner side of the knee. A graft (usually a hamstring tendon or synthetic ligament) is passed through a tunnel in the kneecap and secured to the inner side of the thighbone (femur) at the site of the original MPFL. This recreates the restraint that prevents lateral patellar dislocation. The procedure may be combined with other procedures to address bony alignment. The operation takes approximately one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for patients with recurrent kneecap dislocations that interfere with daily activities or sport, particularly when physiotherapy has not prevented further episodes."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy to strengthen the muscles around the kneecap (particularly the vastus medialis), patellar taping, bracing, and activity modification. These are usually tried first, particularly after a first-time dislocation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. MRI scan to assess the anatomy. Pre-operative physiotherapy to strengthen the quadriceps is beneficial."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to prevent further kneecap dislocations and restore confidence in the knee. Success rates are approximately 90% or higher in preventing further dislocations."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Some loss of knee flexion is common initially. Physiotherapy restores this.",
            "freq": "Common"
          },
          {
            "risk": "Anterior knee pain",
            "detail": "Discomfort around the kneecap may persist for some time.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-dislocation",
            "detail": "Approximately 5–10% risk of further dislocation despite surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-tightening",
            "detail": "Excessive tension on the graft can cause medial tracking of the kneecap and pain.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Rare fracture of the kneecap at the graft tunnel site.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or graft infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block for pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A brace may be worn for four to six weeks, initially limiting the range of knee bending. Crutches for two to four weeks. Physiotherapy is essential and focuses on quadriceps strengthening and gradual restoration of movement. Return to sport at four to six months, guided by physiotherapy milestones."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Kneecap feeling as though it has dislocated again",
          "Increasing knee swelling or pain",
          "Wound redness or discharge",
          "Fever",
          "Inability to bend or straighten the knee"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks and three months. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can the kneecap still dislocate after surgery?",
            "a": "The risk is significantly reduced but not eliminated. Approximately 5–10% of patients may experience further instability."
          },
          {
            "q": "Will I be able to return to sport?",
            "a": "Yes, most patients return to sport at four to six months, including pivoting activities."
          },
          {
            "q": "Is this combined with other procedures?",
            "a": "In some patients, additional procedures to realign the bony anatomy (such as tibial tubercle osteotomy) may be performed at the same time."
          }
        ]
      }
    ]
  },
  "bunion": {
    "name": "Bunion Correction",
    "region": "Foot & Ankle",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Bunion correction surgery (hallux valgus correction) is an operation to realign the big toe and reduce the bony prominence at the base of the toe. It involves cutting and repositioning the bone (osteotomy) and is one of the most commonly performed foot and ankle procedures.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the inner side of the big toe. The bony prominence is removed and the first metatarsal bone is cut with a small saw, repositioned, and fixed with one or two screws. An additional osteotomy of the big toe bone (Akin osteotomy) may be performed to further straighten the toe. The exact type of osteotomy (scarf, chevron, or Lapidus) depends on the severity of the deformity. The operation takes 45–90 minutes and is usually performed as a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a bunion causes significant pain, difficulty with footwear, and functional limitation that has not responded to non-operative measures. Surgery should not be performed for cosmetic reasons alone. The decision is based on pain and functional impact rather than the appearance of the foot."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wide, comfortable footwear, bunion pads, toe spacers, orthotics from a podiatrist, pain medication, and activity modification. These measures can manage symptoms effectively in many patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-assessment may be required. Buy a pair of roomy trainers for after surgery. Arrange for help at home as mobility will be limited. Plan time off work: two to three weeks for sedentary jobs, longer for standing or manual roles."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Research shows approximately 85% of patients are satisfied with bunion surgery. The aim is to reduce pain, improve big toe alignment, and make footwear fitting easier. However, the foot may not be perfectly straight, and some stiffness of the big toe joint is expected."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "The foot will be swollen for several months after surgery. This is normal and gradually settles.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness of the big toe",
            "detail": "Some reduction in big toe movement is expected and is usually not a functional problem.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "The incision site may be sensitive for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain under the ball of the foot (second toe area) due to altered weight distribution.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "The bunion may gradually return over time. Occurs in approximately 5–10% of patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The cut bone may not heal, particularly in smokers. May require further surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness along the big toe from damage to small sensory nerves. Sometimes permanent.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection requiring antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction",
            "detail": "The big toe drifts too far in the other direction.",
            "freq": "Rare"
          },
          {
            "risk": "DVT or PE",
            "detail": "Blood clots are rare with foot surgery but remain a risk.",
            "freq": "Rare"
          },
          {
            "risk": "CRPS",
            "detail": "Complex regional pain syndrome is a rare complication causing chronic pain.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general or spinal anaesthesia with a local anaesthetic ankle block for post-operative pain relief. Can sometimes be performed entirely under local or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A special post-operative shoe or boot is worn for four to six weeks. Weight-bearing is through the heel. Swelling is significant and takes three to six months to fully settle. Driving resumes at six to eight weeks. Normal shoes (roomy trainers) at six weeks. Fashionable footwear may take three to six months. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, discharge, or bleeding",
          "Fever",
          "Severe pain not controlled by medication",
          "Toes turning blue, white, or feeling numb",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check and X-ray at two weeks. Further review at six weeks. The screws are usually left in place permanently unless they cause irritation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can the bunion come back?",
            "a": "There is a 5–10% chance of recurrence. Wearing appropriate footwear helps maintain the correction."
          },
          {
            "q": "When can I wear normal shoes?",
            "a": "Roomy trainers from about six weeks. More fashionable shoes from three to six months, though narrow or high-heeled shoes should be avoided long-term as they may contribute to recurrence."
          },
          {
            "q": "Why is the foot swollen for so long?",
            "a": "Foot swelling after surgery is normal and related to the dependent position of the foot. Elevating the foot regularly helps. Most swelling settles by three to six months."
          },
          {
            "q": "Will the screws need to be removed?",
            "a": "Not usually. Screws are only removed if they cause discomfort, which occurs in a small minority of patients."
          }
        ]
      }
    ]
  },
  "ankle-fracture": {
    "name": "Ankle Fracture Fixation",
    "region": "Foot & Ankle",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle fracture fixation is an operation to realign and stabilise broken bones in the ankle using metal plates and screws. It is one of the most common trauma operations and is needed when the fracture is displaced or the ankle joint is unstable.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Incisions are made over the broken bone(s) — the outer ankle bone (lateral malleolus), inner ankle bone (medial malleolus), or both. The fracture fragments are realigned and fixed with metal plates and screws. If the syndesmosis (the ligament between the two leg bones) is damaged, a screw or suture button is placed to hold the bones together. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the ankle fracture is displaced or unstable — meaning the bones are not in a satisfactory position for healing in a plaster cast alone. A displaced ankle fracture that heals in a poor position can lead to long-term pain and arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stable, undisplaced fractures can be treated with a plaster cast or walking boot for six weeks. Close monitoring with repeat X-rays ensures the fracture remains in a satisfactory position."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery may be performed urgently or after a few days to allow swelling to settle. Standard pre-assessment. Fasting before surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the normal anatomy of the ankle joint, allow the fracture to heal in the correct position, and enable earlier rehabilitation. Most patients achieve good functional outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Ankle swelling is expected for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of ankle movement compared to the uninjured side is common.",
            "freq": "Common"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate and screws may be felt under the thin skin of the ankle.",
            "freq": "Common"
          },
          {
            "risk": "Aching in cold weather",
            "detail": "Many patients notice discomfort in the ankle during cold or damp weather.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The skin around the ankle is thin and swelling can compromise healing. Elevation is crucial.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around the metalwork.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "The fracture may fail to heal or heal in a poor position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Small sensory nerves may be damaged, causing numbness around the ankle.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Arthritis may develop in the ankle joint over time, depending on the severity of the original injury.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia, usually with a local anaesthetic ankle block for post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A plaster cast or boot is worn for six weeks. Weight-bearing depends on the fracture and fixation — your surgeon will advise. Physiotherapy begins after cast removal to restore movement and strength. Return to driving at eight to twelve weeks. Full recovery takes three to six months or longer. Metalwork removal is only performed if it causes problems."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Severe swelling or blistering",
          "Fever",
          "Toes turning blue or numb in the cast",
          "Cast feeling too tight",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. X-ray and review at six weeks. Further appointments as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the plate need to be removed?",
            "a": "Approximately 20–30% of patients choose to have ankle metalwork removed due to prominence. This is usually done after the fracture has fully healed."
          },
          {
            "q": "Will I develop arthritis?",
            "a": "There is an increased risk of ankle arthritis after a fracture, particularly if the joint surface was involved. Good surgical realignment reduces this risk."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at eight to twelve weeks, once the cast is removed and you can safely control the pedals."
          }
        ]
      }
    ]
  },
  "achilles-repair": {
    "name": "Achilles Tendon Repair",
    "region": "Foot & Ankle",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Achilles tendon repair is an operation to stitch together a ruptured Achilles tendon — the large tendon connecting the calf muscle to the heel bone. Rupture typically occurs during sport or sudden forceful movements.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the back of the lower leg over the tendon. The torn tendon ends are identified, brought together, and stitched with strong sutures. The wound is closed and a plaster cast or boot is applied with the foot in a downward (equinus) position. The operation takes approximately 45–60 minutes. Minimally invasive techniques using smaller incisions are also available."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgical repair is often recommended for younger, active patients and those who wish to return to sport, as it is associated with a lower re-rupture rate than non-operative treatment. The decision depends on your age, activity level, and the position of the tendon ends on ultrasound."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Functional bracing in a walking boot with progressive heel raises (functional rehabilitation) is a well-established non-operative alternative. Recent evidence suggests that with a structured rehabilitation protocol, outcomes can be comparable to surgery for many patients, with a slightly higher re-rupture rate."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Plan for limited mobility for six to twelve weeks. You will not be able to drive for several weeks. Arrange help at home."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore calf strength and function and allow return to full activity. Surgical repair typically achieves a re-rupture rate of approximately 2–5%, lower than non-operative treatment. Most patients return to sport, though full recovery of calf strength can take six to twelve months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "The incision site may be sensitive and may thicken initially.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Ankle stiffness is expected initially and improves with physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Calf weakness",
            "detail": "Some residual reduction in calf strength compared to the uninjured side is common.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The skin over the Achilles tendon has relatively poor blood supply. Wound breakdown can occur, particularly in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-rupture",
            "detail": "The repaired tendon may rupture again, especially if loaded too early. Approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "The sural nerve runs close to the tendon. Injury causes numbness on the outer side of the foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection requiring antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT risk during the period of immobilisation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or regional anaesthesia. A local anaesthetic block around the ankle provides post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A cast or boot is worn for approximately six to eight weeks. Weight-bearing progresses from non-weight-bearing to partial and then full weight-bearing, guided by your surgeon. Physiotherapy begins after the cast is removed and focuses on calf strengthening and ankle mobility. Return to gentle sport at four to six months; high-level sport at six to twelve months. Full calf strength recovery may take up to a year."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Severe calf pain or swelling",
          "Fever",
          "A sudden 'snap' or pop in the calf (possible re-rupture)",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks for wound check and change of cast/boot. Further reviews at six weeks and three months. Physiotherapy is essential."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Do I definitely need surgery?",
            "a": "Not necessarily. Non-operative treatment with structured rehabilitation is a valid alternative for many patients. Your surgeon will discuss which approach is best for your situation."
          },
          {
            "q": "When can I run again?",
            "a": "Typically at four to six months, depending on recovery. Return to competitive sport may take longer."
          },
          {
            "q": "Will my calf strength return fully?",
            "a": "Most patients regain good functional strength. A small reduction in peak calf power compared to the uninjured side is common."
          }
        ]
      }
    ]
  },
  "ankle-replacement": {
    "name": "Ankle Replacement",
    "region": "Foot & Ankle",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Total ankle replacement (ankle arthroplasty) is an operation to replace the damaged surfaces of the ankle joint with metal and plastic components. It aims to relieve pain while preserving ankle movement, unlike ankle fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the ankle. The damaged surfaces of the tibia and talus are carefully removed and replaced with metal components separated by a plastic bearing. The foot is positioned in a boot or cast. The operation takes approximately one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Ankle replacement is considered for severe ankle arthritis causing significant pain and stiffness when non-operative treatments have failed. It is an alternative to ankle fusion, with the advantage of preserving movement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, ankle bracing, activity modification, and injections. Ankle fusion (arthrodesis) is the main surgical alternative and remains the gold standard for younger, heavier, or very active patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment. CT scan is usually required for planning. Smoking cessation is strongly advised. Plan for limited mobility for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief with preservation of ankle movement. Most patients can walk comfortably and perform daily activities. Modern ankle replacements have improving long-term survival, though they do not match the track record of hip or knee replacements."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Expected for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some improvement in movement but rarely a fully 'normal' range.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing issues",
            "detail": "The anterior ankle skin is thin and vulnerable.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fracture",
            "detail": "Fracture of the tibia or talus during surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Loosening or subsidence of components. May require revision or conversion to fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection may require implant removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness on the top of the foot from stretching of the superficial peroneal nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Ongoing pain",
            "detail": "Not all patients achieve complete pain relief.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block for pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A cast or boot is worn for four to six weeks, initially with restricted weight-bearing. Physiotherapy begins after cast removal. Walking comfortably is usually achieved by three months. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Fever",
          "Severe pain or instability",
          "Toes turning blue or numb",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at two weeks, six weeks, three months, and annually long-term."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Replacement or fusion — which is better?",
            "a": "Both are effective. Replacement preserves movement; fusion is more durable but eliminates ankle motion. Your surgeon will recommend the best option based on your individual circumstances."
          },
          {
            "q": "How long does an ankle replacement last?",
            "a": "Current evidence suggests 10–15 year survival rates of 80–90% for modern designs, with improving outcomes."
          }
        ]
      }
    ]
  },
  "ankle-fusion": {
    "name": "Ankle Fusion",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle fusion (ankle arthrodesis) is an operation to permanently join the bones of the ankle joint together, eliminating the painful arthritic joint. It is the gold standard surgical treatment for severe ankle arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The damaged cartilage is removed from the ankle joint surfaces. The bones (tibia and talus) are positioned in the optimal alignment and fixed together with screws, a plate, or a nail. Over the following months, the bones grow together to form a solid union. The procedure can be performed as open surgery or arthroscopically. It takes approximately one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Ankle fusion is recommended for severe ankle arthritis or significant joint damage from injury, infection, or failed previous surgery. It provides predictable, durable pain relief and is particularly suitable for younger, active, or heavier patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, ankle bracing, orthotics, rocker-bottom shoes, activity modification, and injections. Ankle replacement is a surgical alternative that preserves movement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for planning. Smoking cessation is essential — smoking dramatically increases the risk of the bones not fusing. Plan for non-weight-bearing or limited weight-bearing for six to twelve weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent pain relief in over 90% of patients. The ankle no longer moves, but the adjacent joints in the foot compensate to provide a surprisingly functional gait. Most patients walk without a limp and can manage most activities."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of ankle motion",
            "detail": "This is expected — the purpose of the operation is to eliminate the painful joint. Foot joints compensate partially.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged foot swelling is common.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Walking pattern changes slightly, particularly on uneven ground and stairs.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "The bones may fail to fuse together. Risk is approximately 5–10% and is significantly higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint arthritis",
            "detail": "Increased stress on neighbouring joints may lead to arthritis over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Malunion",
            "detail": "Fusion in a suboptimal position.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness around the ankle.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware problems",
            "detail": "Screws may cause irritation and require removal.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with an ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A cast or boot for six to twelve weeks. Initially non-weight-bearing, progressing to weight-bearing as fusion progresses. Physiotherapy focuses on foot and ankle exercises. Driving resumes at approximately three months. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Persistent pain beyond expected levels",
          "Cast too tight",
          "Toes blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays to monitor fusion. Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk normally after fusion?",
            "a": "Most patients walk well, though the gait is slightly altered. Walking on flat ground is usually very comfortable. Stairs and slopes require more adaptation."
          },
          {
            "q": "Can I still run?",
            "a": "Light jogging is possible for some patients. High-impact running is generally not recommended."
          },
          {
            "q": "What shoes will I need?",
            "a": "Rocker-bottom sole shoes can help with walking comfort after fusion."
          }
        ]
      }
    ]
  },
  "lesser-toe": {
    "name": "Lesser Toe Correction",
    "region": "Foot & Ankle",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lesser toe correction surgery treats deformities of the smaller toes (hammer toes, claw toes, or mallet toes) that cause pain, difficulty with footwear, and calluses. It may involve straightening the toe, fusing a small joint, or releasing tight tendons.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made over the affected toe joint. Depending on the deformity, the procedure may involve removal of a small piece of bone, fusion of a small toe joint with a wire or screw, tendon release, or a combination. A wire may protrude from the tip of the toe for four to six weeks. The operation takes 20–40 minutes per toe."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a toe deformity causes persistent pain, calluses, ulceration, or difficulty with footwear that has not responded to non-operative measures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wider footwear, toe padding, silicone toe sleeves, strapping, and podiatry. These measures can effectively manage many patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Plan for limited footwear options for several weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduced pain, improved toe alignment, and easier footwear fitting. Satisfaction rates are generally good, though perfect toe straightening is not always achievable."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Toe swelling may persist for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "The corrected joint is usually stiff or fused by design.",
            "freq": "Expected"
          },
          {
            "risk": "Wire irritation",
            "detail": "If a wire is used, it may catch on clothing or bedding.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence",
            "detail": "The deformity may gradually recur over time.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Pin-site infection or wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The small joint may fail to fuse.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malalignment",
            "detail": "The toe may heal in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness in the toe.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic with or without sedation, or general/spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A special post-operative shoe for four to six weeks. If a wire is used, it is removed at four to six weeks in clinic. Swelling settles over three to six months. Normal footwear at six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound or pin-site redness, discharge, or swelling",
          "Fever",
          "Toe turning blue or very pale",
          "Increasing pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wire removal at four to six weeks. Review as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the wire hurt when it's removed?",
            "a": "Wire removal is quick and usually causes only brief discomfort. Local anaesthetic is not usually needed."
          },
          {
            "q": "Can multiple toes be corrected at once?",
            "a": "Yes, multiple toes can be corrected in the same operation."
          }
        ]
      }
    ]
  },
  "ankle-arthroscopy": {
    "name": "Ankle Arthroscopy",
    "region": "Foot & Ankle",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle arthroscopy is a keyhole procedure to diagnose and treat conditions within the ankle joint, including removal of loose bodies, treatment of impingement, cartilage repair, and joint assessment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two small incisions are made at the front of the ankle. A camera is inserted to view the joint. Procedures may include removal of bony spurs (anterior impingement), removal of loose bodies, debridement of damaged cartilage, or microfracture for cartilage defects. The procedure usually takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Ankle arthroscopy is recommended for anterior ankle impingement (footballer's ankle), loose bodies, cartilage lesions (osteochondral defects), and diagnostic purposes when imaging is inconclusive."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, ankle bracing, anti-inflammatory medication, and corticosteroid injection. For impingement, footwear modification may help."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of bony spurs or loose bodies provides rapid symptom relief. Treatment of cartilage defects can reduce pain and improve function. Success depends on the underlying condition."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling and bruising",
            "detail": "Expected for one to two weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary ankle stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Sensory nerves at the front of the ankle may be damaged, causing numbness on the top of the foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Symptoms may not fully resolve, particularly if arthritis is present.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or regional anaesthesia with an ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients walk in a supportive shoe or boot within a few days. Return to desk work within one to two weeks. Return to sport at four to eight weeks. Physiotherapy helps restore movement and strength."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing ankle pain or swelling",
          "Wound redness or discharge",
          "Fever",
          "New numbness on the foot"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When can I return to football?",
            "a": "Usually at six to eight weeks for anterior impingement surgery. Cartilage procedures may take longer."
          },
          {
            "q": "Will the bony spurs come back?",
            "a": "Recurrence is possible over time but uncommon."
          }
        ]
      }
    ]
  },
  "plantar-fascia": {
    "name": "Plantar Fascia Release",
    "region": "Foot & Ankle",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Plantar fascia release is a surgical procedure to treat persistent plantar fasciitis (heel pain) by partially cutting the tight plantar fascia band on the sole of the foot to relieve tension.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made on the inner side or sole of the heel. The plantar fascia is partially released (cut) to reduce the tension causing pain. Any bone spur may be removed, though the spur itself is rarely the cause of pain. The procedure takes approximately 20–30 minutes and is usually performed as a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered when plantar fasciitis causes severe heel pain that has persisted for at least six to twelve months despite thorough non-operative treatment. Surgery is a last resort — the vast majority of patients (over 90%) improve without surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stretching exercises (calf and plantar fascia), supportive footwear, heel pads, orthotics, night splints, corticosteroid injection, shockwave therapy, and activity modification. These should all be exhausted before considering surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Plan for limited weight-bearing for two to four weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Surgery relieves heel pain in approximately 70–80% of carefully selected patients. Improvement may be gradual over weeks to months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent pain",
            "detail": "Not all patients achieve complete pain relief. Approximately 20–30% may have some residual symptoms.",
            "freq": "Common"
          },
          {
            "risk": "Heel soreness",
            "detail": "The operative site may be tender for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Arch collapse",
            "detail": "If too much fascia is released, the arch may flatten, altering foot mechanics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral column pain",
            "detail": "Pain along the outer side of the foot due to altered loading.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Damage to small nerves causing numbness in the heel.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Plantar fascia rupture",
            "detail": "Complete rupture leading to arch collapse.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A protective shoe or boot for two to four weeks. Gradual return to full weight-bearing. Stretching exercises continue. Return to normal activities at four to eight weeks. Full recovery may take three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing pain or arch collapse",
          "Fever",
          "Numbness in the heel"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why isn't surgery recommended sooner?",
            "a": "Because over 90% of patients with plantar fasciitis improve without surgery. Surgery is reserved for the small number of cases that do not respond to extensive non-operative treatment."
          },
          {
            "q": "Will the heel spur be removed?",
            "a": "The spur may be removed, but research shows it is rarely the cause of pain. Pain comes from the inflamed fascia, not the spur itself."
          }
        ]
      }
    ]
  },
  "discectomy": {
    "name": "Lumbar Discectomy",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A lumbar discectomy (microdiscectomy) is an operation to remove part of a herniated (slipped) disc in the lower back that is pressing on a nerve, causing leg pain (sciatica). It is the most common spinal operation and has a high success rate for relieving leg symptoms.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (2–3 cm) is made in the lower back. Using a microscope or magnifying loupes, the surgeon gently moves the nerve aside and removes the piece of disc that is compressing it. Only the fragment causing pressure is removed — not the entire disc. The operation typically takes 45–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a herniated disc causes persistent or severe leg pain (sciatica) that has not improved with at least six to twelve weeks of non-operative treatment, or when there is significant weakness, numbness, or bladder/bowel symptoms requiring urgent intervention."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication (including neuropathic pain medication), epidural steroid injections, activity modification, and time. The majority of disc herniations improve without surgery within six to twelve weeks. Surgery is generally offered when symptoms persist or are severe."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. MRI scan is required to confirm the diagnosis. This is usually performed as a day-case or overnight procedure. Smoking cessation is advised."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Over 90% of patients experience significant improvement in leg pain after microdiscectomy. Back pain may also improve but is less predictable. The operation is designed primarily to relieve leg symptoms caused by nerve compression."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent disc herniation",
            "detail": "The disc may herniate again at the same level in approximately 5–10% of patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Back stiffness",
            "detail": "Mild low back stiffness is common initially and usually settles.",
            "freq": "Common"
          },
          {
            "risk": "Persistent leg symptoms",
            "detail": "Some residual numbness or tingling may persist, particularly if the nerve was compressed for a long time.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve root injury",
            "detail": "Approximately 1 in 1000 risk of nerve damage causing weakness, numbness, or pain.",
            "freq": "Rare"
          },
          {
            "risk": "Dural tear (CSF leak)",
            "detail": "A tear in the membrane surrounding the nerves occurs in 1–3% of cases. Usually managed during surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or disc space infection. Approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Cauda equina syndrome",
            "detail": "Extremely rare but serious compression of the nerves controlling bladder and bowel function.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Collection of blood around the nerves. May require urgent return to surgery.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia. You are positioned face-down on a specialised operating table."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home on the day of surgery or the next day. Walking is encouraged immediately. Avoid prolonged sitting for the first two weeks. Gentle walking and stretching exercises are beneficial. Return to desk work at two to four weeks, manual work at six to twelve weeks depending on demands. Avoid heavy lifting for the first six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New numbness or loss of bladder/bowel control (attend A&E urgently)",
          "Wound redness, swelling, or discharge",
          "Fever",
          "Clear fluid leaking from the wound (possible CSF leak)",
          "Severe headache when sitting or standing"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at one to two weeks. Surgeon review at six weeks. Physiotherapy if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the disc herniate again?",
            "a": "There is approximately a 5–10% chance of recurrent herniation at the same level. If it recurs, a repeat discectomy is usually effective, though some patients may need a fusion for repeated recurrences."
          },
          {
            "q": "Will the surgery help my back pain?",
            "a": "Microdiscectomy is primarily designed to relieve leg pain. Back pain may improve but is less predictable. If your main symptom is back pain rather than leg pain, other treatments may be more appropriate."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at two to four weeks, once you can sit comfortably and perform an emergency stop."
          },
          {
            "q": "Do I need to sleep in a special position?",
            "a": "There is no strict requirement. Find a comfortable position. Sleeping on your side with a pillow between your knees is often comfortable."
          }
        ]
      }
    ]
  },
  "laminectomy": {
    "name": "Lumbar Decompression",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lumbar decompression (laminectomy) is an operation to relieve pressure on the nerves in the lower back caused by spinal stenosis — narrowing of the spinal canal due to degenerative changes. It is one of the most common procedures performed on the ageing spine.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the midline of the lower back over the affected levels. Part of the lamina (the bone forming the back wall of the spinal canal) is removed, along with thickened ligament and any other tissue compressing the nerves. This creates more space for the nerves. One or more levels may be decompressed. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when spinal stenosis causes significant leg pain, numbness, and weakness (neurogenic claudication) — typically pain that worsens with walking and standing and improves with sitting or bending forward — that has not responded to non-operative treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication, epidural injections, activity modification, and the use of a walking frame or trolley (which encourages the forward lean that relieves symptoms). Spinal stenosis is a degenerative condition that tends to worsen slowly over time."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. MRI scan confirms the diagnosis. This may be a day-case or involve an overnight stay."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to improve walking distance and reduce leg symptoms. Most patients experience significant improvement in leg pain and walking capacity. Back pain may also improve but is less predictable."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Back stiffness",
            "detail": "Some increase in back stiffness is common after surgery.",
            "freq": "Common"
          },
          {
            "risk": "Residual leg symptoms",
            "detail": "Some numbness or tingling may persist, particularly if symptoms were long-standing.",
            "freq": "Common"
          },
          {
            "risk": "Recurrent stenosis",
            "detail": "Stenosis may recur over time as the degenerative process continues.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dural tear",
            "detail": "A tear in the membrane covering the nerves. Occurs in approximately 5–10% of cases and is usually repaired during surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Rare damage to nerve roots.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection in approximately 1–2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "Removing bone may cause the spine to become less stable, potentially requiring fusion in the future.",
            "freq": "Uncommon"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection around the nerves requiring urgent drainage.",
            "freq": "Rare"
          },
          {
            "risk": "Cauda equina syndrome",
            "detail": "Extremely rare but serious compression of the nerves.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned face-down on a specialised operating table."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients stay in hospital for one to two days. Walking is encouraged from the first day. Recovery is gradual — improvement occurs over weeks to months. Return to desk work at two to six weeks. Avoid heavy lifting and bending for six weeks. Physiotherapy helps restore mobility and strength."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at one to two weeks. Surgeon review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my walking improve?",
            "a": "Most patients experience significant improvement in walking distance and leg symptoms. However, some residual symptoms may persist, particularly if the stenosis was severe or long-standing."
          },
          {
            "q": "Can the stenosis come back?",
            "a": "Yes, as the degenerative process continues, symptoms may recur over years. Further surgery is possible if needed."
          },
          {
            "q": "Is this the same as disc surgery?",
            "a": "No. A discectomy removes a herniated disc fragment. A laminectomy removes bone and ligament to widen the spinal canal. They are different operations for different conditions."
          }
        ]
      }
    ]
  },
  "spinal-fusion": {
    "name": "Spinal Fusion",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Spinal fusion is an operation to permanently join two or more vertebrae together, eliminating movement between them. It is performed for spinal instability, severe disc degeneration, spondylolisthesis, or as part of deformity correction.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the back (posterior) and sometimes also the front (anterior). Screws are inserted into the vertebrae (pedicle screws) and connected with rods. A cage filled with bone graft material is placed in the disc space to promote fusion. Bone graft (from the patient or synthetic) is packed around the instrumentation. Over the following months, the bones grow together. The operation takes two to four hours depending on the number of levels."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Fusion may be recommended for spondylolisthesis (where one vertebra has slipped forward), spinal instability, recurrent disc herniations, severe disc degeneration causing back pain, spinal fractures, or deformity. It is also sometimes combined with decompression when the spine is unstable."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and core strengthening, pain management, corticosteroid injections, bracing, and activity modification. Spinal fusion for back pain is a significant operation, and non-operative options should be fully explored."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment. CT and MRI scans for planning. Smoking cessation is critical — smoking dramatically reduces fusion rates. Optimise weight and fitness before surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to stabilise the spine, relieve pain, and protect the nerves. Most patients with instability or spondylolisthesis experience significant improvement. For degenerative back pain, results are more variable."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Reduced spinal mobility",
            "detail": "The fused segment will not move. This is usually compensated by adjacent levels.",
            "freq": "Expected"
          },
          {
            "risk": "Back stiffness",
            "detail": "Stiffness is common, particularly in the early months.",
            "freq": "Common"
          },
          {
            "risk": "Persistent pain",
            "detail": "Not all patients achieve complete pain relief.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union (pseudarthrosis)",
            "detail": "The bones may fail to fuse. Risk is approximately 5–15% and is much higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "Increased stress on levels above and below the fusion may cause new problems over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "Risk to nerve roots during screw placement.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around the metalwork. Approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware failure",
            "detail": "Screws may loosen or rods may break.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood loss",
            "detail": "More significant than simpler spinal procedures. Transfusion may be required.",
            "freq": "Common"
          },
          {
            "risk": "Dural tear",
            "detail": "Tear in the membrane covering the nerves.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Neuromonitoring may be used during surgery to monitor nerve function."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of two to five days. A brace may be worn for several weeks. Walking is encouraged early. Avoid bending, lifting, and twisting for six to twelve weeks. Return to desk work at four to eight weeks. Manual work at three to six months. Full fusion takes six to twelve months. Physiotherapy is important."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Sudden increase in back pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at six weeks, three months, six months, and one year to monitor fusion progress."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose flexibility?",
            "a": "The fused segment will be rigid, but most patients adapt well. Fusion of one or two levels causes minimal functional limitation for most daily activities."
          },
          {
            "q": "Why is smoking so important?",
            "a": "Nicotine significantly impairs bone healing. Smokers have a much higher risk of non-union (failure to fuse). Stopping smoking is one of the most important things you can do to improve outcomes."
          },
          {
            "q": "How long does fusion take?",
            "a": "Solid bony fusion typically takes six to twelve months."
          }
        ]
      }
    ]
  },
  "cervical-disc": {
    "name": "Cervical Disc Replacement",
    "region": "Spine",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cervical disc replacement is an operation to replace a damaged disc in the neck with an artificial disc, preserving movement at the treated level. It is an alternative to anterior cervical discectomy and fusion (ACDF).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the front of the neck. The damaged disc is completely removed, decompressing the nerve root or spinal cord. An artificial disc — usually made of metal with a plastic core — is inserted in its place. The wound is closed and covered with a dressing. The operation takes approximately one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Disc replacement is considered for cervical disc herniation or cervical spondylotic myelopathy at one or two levels when the patient wishes to preserve neck movement and meet specific criteria regarding bone quality and spinal alignment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication including neuropathic agents, cervical epidural injection, activity modification. Anterior cervical discectomy and fusion (ACDF) is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. CT and MRI scans for planning. You may need to fast before surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve arm pain and/or spinal cord compression while preserving neck movement at the treated level. This may reduce the risk of adjacent level degeneration compared to fusion. Results are generally comparable to or slightly better than fusion for well-selected patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Sore throat and difficulty swallowing",
            "detail": "Very common after surgery through the front of the neck. Usually settles within a few days.",
            "freq": "Expected"
          },
          {
            "risk": "Hoarseness",
            "detail": "Temporary change in voice quality due to nerve stretching during the approach. Usually resolves.",
            "freq": "Common"
          },
          {
            "risk": "Neck stiffness",
            "detail": "Expected initially and improves with exercises.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Implant subsidence or migration",
            "detail": "The artificial disc may shift or sink into the vertebra.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation around the implant that may restrict movement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Risk to nerve roots or spinal cord. Arm weakness or numbness.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrent laryngeal nerve palsy",
            "detail": "Damage to the nerve controlling the voice box, causing persistent hoarseness. Usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Oesophageal injury",
            "detail": "Very rare injury to the food pipe.",
            "freq": "Rare"
          },
          {
            "risk": "Vascular injury",
            "detail": "Very rare injury to major blood vessels in the neck.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection in the neck causing swelling and breathing difficulty. A surgical emergency.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Neuromonitoring may be used."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of one to two days. A soft collar may be worn for comfort. Gentle neck exercises begin early. Return to desk work at two to four weeks. Avoid heavy lifting and contact sports for six to twelve weeks. Most patients recover quickly."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Difficulty breathing or swallowing (attend A&E urgently)",
          "Increasing arm weakness or numbness",
          "Worsening neck pain",
          "Wound swelling, redness, or discharge",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review with X-rays at six weeks and six months. Long-term monitoring of the disc replacement."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the advantage over fusion?",
            "a": "Disc replacement preserves movement at the operated level and may reduce the risk of increased wear on adjacent discs over time."
          },
          {
            "q": "Is everyone suitable for disc replacement?",
            "a": "No. Patients with significant spinal arthritis, instability, or osteoporosis may be better suited to fusion. Your surgeon will advise."
          },
          {
            "q": "How long does an artificial disc last?",
            "a": "Long-term data is still accumulating, but current evidence suggests good durability over 10–15 years."
          }
        ]
      }
    ]
  },
  "spinal-injections": {
    "name": "Spinal Injections",
    "region": "Spine",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Spinal injections are procedures to deliver steroid and local anaesthetic medication to specific areas around the spine, aiming to reduce pain and inflammation. Common types include epidural injections, nerve root blocks, and facet joint injections.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Using X-ray or ultrasound guidance, a needle is positioned precisely at the target — the epidural space, a specific nerve root, or a facet joint. A mixture of corticosteroid and local anaesthetic is injected. The procedure takes 15–30 minutes and is usually performed as a day case. You will be awake throughout but may receive light sedation."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Spinal injections may be recommended for sciatica from a disc herniation (epidural or nerve root block), spinal stenosis symptoms, facet joint pain, or as a diagnostic test to identify the source of pain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Oral pain medication, physiotherapy, activity modification, and time. Surgery may be an alternative for persistent nerve compression."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Inform your team about any blood-thinning medication — this may need to be stopped before the procedure. You do not usually need to fast. Arrange transport home."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Injections can provide significant pain relief, often lasting weeks to months. They do not cure the underlying condition but may reduce symptoms enough to allow effective rehabilitation. The response varies — some patients experience excellent relief, others modest or no improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Temporary pain increase",
            "detail": "Symptoms may flare for a few days after the injection before improving.",
            "freq": "Common"
          },
          {
            "risk": "No improvement",
            "detail": "Not all patients respond to spinal injections.",
            "freq": "Common"
          },
          {
            "risk": "Facial flushing",
            "detail": "Some patients experience facial redness and warmth for a few days.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood sugar changes",
            "detail": "Diabetic patients may notice temporary increase in blood glucose levels.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Infection at the injection site or within the spinal canal. Very rare but serious.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve damage",
            "detail": "Very rare injury to nerve roots.",
            "freq": "Rare"
          },
          {
            "risk": "Dural puncture",
            "detail": "Accidental puncture of the dural membrane causing headache.",
            "freq": "Rare"
          },
          {
            "risk": "Bleeding",
            "detail": "Epidural haematoma. Very rare but potentially serious.",
            "freq": "Rare"
          },
          {
            "risk": "Allergic reaction",
            "detail": "Rare reaction to the injected medication.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic is used to numb the skin. Light sedation may be offered. General anaesthesia is not required."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "You may feel slightly numb or weak in the legs for a few hours after an epidural injection. Avoid driving for 24 hours. Rest on the day of the procedure. Resume normal activities the following day. The steroid typically takes effect over two to seven days."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Fever or signs of infection at the injection site",
          "Severe headache when sitting or standing",
          "New weakness or numbness in the legs",
          "Loss of bladder or bowel control (attend A&E urgently)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Follow-up depends on the response. If the injection provides significant relief, it may be repeated if symptoms recur. If it provides little relief, other treatment options will be discussed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does the relief last?",
            "a": "Response varies widely. Some patients experience weeks to months of relief; others may have minimal benefit. Injections can be repeated if effective."
          },
          {
            "q": "How many injections can I have?",
            "a": "There is no strict limit, but most clinicians recommend no more than three to four steroid injections per year to the same area, to avoid potential side effects of repeated steroid use."
          },
          {
            "q": "Is the injection painful?",
            "a": "You will feel a sting from the local anaesthetic and some pressure during the procedure. Most patients tolerate it well."
          }
        ]
      }
    ]
  },
  "fracture-fixation": {
    "name": "Fracture Fixation (Principles)",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Fracture fixation (also called open reduction and internal fixation, or ORIF) is a surgical procedure to realign broken bones and hold them in the correct position using metal implants such as plates, screws, nails, or wires. This page covers general principles applicable across different fracture types.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over or near the fracture site. The broken bone fragments are carefully realigned (reduced) and held in position with metal implants. The type of fixation depends on the fracture location and pattern: plates and screws for joint fractures, intramedullary nails for long bone shaft fractures, or wires and pins for smaller bones. The wound is closed and a splint, cast, or dressing is applied. The operation duration varies depending on the fracture complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a fracture is displaced, unstable, involves a joint surface, or cannot be managed satisfactorily with a plaster cast. The goal is to restore the bone to its normal alignment and allow earlier, safer rehabilitation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many fractures heal well with plaster casts, splints, or functional bracing. Your surgeon will advise whether surgery is necessary based on the fracture type, displacement, stability, and your individual circumstances."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Fracture fixation may be performed as an emergency or planned within days of the injury, depending on the urgency. Standard pre-operative fasting and assessment are required."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore bone alignment, promote healing, reduce pain, and allow earlier movement and rehabilitation. Most fractures heal within six to twelve weeks after fixation. The metalwork may be left permanently or removed once the fracture has healed."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Joints near the fracture may become stiff. Early movement and physiotherapy help.",
            "freq": "Common"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected around the fracture site for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "Plates and screws may be felt under the skin, particularly in areas with little soft tissue cover.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around the metalwork. Risk varies by fracture location and severity.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The fracture may fail to heal. Smoking significantly increases this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "The fracture may heal in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware failure",
            "detail": "Plates or screws may break, particularly if the bone is slow to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Structures near the fracture may be damaged during surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A rare but serious condition where pressure builds within the muscles. Requires emergency surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism, particularly with lower limb fractures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia depending on the fracture location and patient factors."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery depends on the fracture type and location. Physiotherapy is usually essential. Your surgeon will advise on weight-bearing restrictions, return to activities, and the timeline for healing."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, swelling, or redness at the wound",
          "Fever",
          "New numbness or weakness beyond the fracture",
          "Severe tightness or pressure in the limb (possible compartment syndrome — seek urgent help)",
          "Toes or fingers turning blue or numb in a cast"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays to monitor fracture healing. Timing depends on the fracture type."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the metalwork need to be removed?",
            "a": "Not always. Metalwork is only removed if it causes problems such as pain, prominence, or infection. In some locations (such as the ankle), removal is more commonly needed."
          },
          {
            "q": "How long does a fracture take to heal?",
            "a": "Most fractures heal within six to twelve weeks. Factors affecting healing include fracture severity, location, blood supply, smoking, and overall health."
          },
          {
            "q": "Why is smoking so harmful to fracture healing?",
            "a": "Nicotine reduces blood flow to bone and impairs the healing process. Smokers have significantly higher rates of non-union and delayed healing."
          }
        ]
      }
    ]
  },
  "metalwork-removal": {
    "name": "Metalwork Removal",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Metalwork removal is an operation to take out plates, screws, nails, or wires that were used to fix a fracture, once the bone has fully healed. It is usually performed because the metalwork is causing discomfort, prominence, or other problems.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the existing scar or directly over the metalwork. The plate, screws, nail, or wires are identified and removed. In most cases the procedure is straightforward, though occasionally screws may be difficult to remove if bone has grown over them. The wound is closed and a dressing applied. The operation typically takes 30–90 minutes depending on the type and location of metalwork."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Metalwork removal is considered when implants cause pain, prominence, or irritation (particularly in areas with thin soft tissue such as the ankle, elbow, or clavicle), when they restrict movement, or occasionally for specific reasons such as planned future surgery or in young patients who have completed growth."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "If the metalwork is not causing problems, it can safely be left in place permanently. Most orthopaedic implants are made of titanium or stainless steel and do not need to be routinely removed."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. This is usually a day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of prominent or painful metalwork usually provides relief from local symptoms. However, not all discomfort around a fracture site is caused by the metalwork — some pain may persist after removal."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent pain",
            "detail": "Pain may not be fully relieved, as the discomfort may not have been caused solely by the metalwork.",
            "freq": "Common"
          },
          {
            "risk": "Scar",
            "detail": "The existing scar may need to be extended or a new incision made.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary weakness",
            "detail": "The bone may be slightly weakened where screws were removed. Restrictions on activity may apply for a few weeks.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-fracture",
            "detail": "The bone may fracture through the screw holes after removal. This risk is small and can be reduced by restricting heavy activity for four to six weeks.",
            "freq": "Uncommon"
          },
          {
            "risk": "Difficult removal",
            "detail": "Screws may be stripped, broken, or overgrown with bone, making removal difficult or incomplete.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Scar tissue from the original surgery may make nerve identification more difficult.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia depending on the location of the metalwork."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is usually quick. The limb may need protection for four to six weeks while the screw holes fill in with new bone. Activity restrictions during this period reduce the risk of re-fracture. Return to normal activities at four to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Fever",
          "Sudden pain or instability at the site (possible re-fracture)",
          "New numbness near the surgical site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Does metalwork always need to be removed?",
            "a": "No. Most metalwork can be left in permanently if it is not causing problems. Removal is only recommended when there is a specific reason."
          },
          {
            "q": "Is there a risk of re-fracture?",
            "a": "A small risk exists, particularly with large plates. Activity is restricted for four to six weeks after removal to allow the bone to strengthen."
          },
          {
            "q": "Will it be a big operation?",
            "a": "Usually not. Metalwork removal is typically a shorter, simpler procedure than the original fracture fixation."
          }
        ]
      }
    ]
  },
  "clavicle-fixation": {
    "name": "Clavicle Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Clavicle (collarbone) fracture fixation is an operation to realign and stabilise a broken collarbone using a metal plate and screws. It is performed when the fracture is significantly displaced, shortened, or at high risk of non-union.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the top of the collarbone directly over the fracture. The bone fragments are realigned and held in position with a contoured metal plate and screws. In some cases, particularly for fractures near the outer end, sutures or hook plates may be used. The operation typically takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for significantly displaced or shortened clavicle fractures, fractures with skin tenting or threatened skin breakdown, fractures near the outer end (lateral third) with displacement, open fractures, and in patients who need to return to activity sooner. Evidence suggests surgical fixation reduces the risk of non-union and malunion in displaced midshaft fractures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many clavicle fractures heal well with a sling for four to six weeks. Non-operative treatment is appropriate for undisplaced fractures and many minimally displaced fractures. However, displaced fractures have a higher risk of non-union (up to 15%) and malunion with non-operative treatment compared to approximately 5% with surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-operative assessment and fasting. Surgery is usually performed within one to two weeks of the injury. Inform the team about all medications."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the normal length and alignment of the collarbone, reduce the risk of non-union, relieve pain, and allow earlier return to activity. Most patients experience good outcomes with reliable fracture healing by three months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prominent metalwork",
            "detail": "The plate sits just beneath the skin and is often palpable. Some patients find it uncomfortable, particularly with rucksack straps or seat belts.",
            "freq": "Common"
          },
          {
            "risk": "Numbness below the scar",
            "detail": "A patch of numbness below the incision is very common due to small sensory nerves being unavoidably divided.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "The scar is visible on the upper chest and shoulder area.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Metalwork irritation requiring removal",
            "detail": "Approximately 20–30% of patients choose to have the plate removed after healing, usually at 12–18 months.",
            "freq": "Common"
          },
          {
            "risk": "Non-union",
            "detail": "The fracture may fail to heal despite fixation. Risk is approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection requiring antibiotics or rarely further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Major vessels and the brachial plexus lie beneath the clavicle. Injury is rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Re-fracture",
            "detail": "After plate removal, the bone may fracture through screw holes.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Usually performed under general anaesthesia. A nerve block may be used for post-operative pain relief. You are positioned in a beach-chair or supine position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling is worn for comfort for approximately two weeks. Gentle shoulder exercises begin immediately. Most patients return to desk work within one to two weeks. Driving resumes at two to four weeks once comfortable. Heavy lifting and contact sport are restricted for six to twelve weeks until the fracture has healed. The plate may be removed after twelve months if it causes irritation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Wound discharge or bleeding",
          "Metalwork feeling loose or prominent through the skin"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. X-ray and review at six weeks and three months to confirm healing."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the plate need to be removed?",
            "a": "Not always, but approximately 20–30% of patients choose removal because of irritation from straps, clothing, or cosmetic preference. This is done after the fracture has fully healed."
          },
          {
            "q": "Will I have a visible scar?",
            "a": "Yes, the scar runs along the top of the collarbone and is usually 8–12 cm long. It tends to heal well but is visible in low-cut clothing."
          },
          {
            "q": "When can I return to sport?",
            "a": "Non-contact sport at six to eight weeks. Contact sport at twelve weeks once the fracture has healed on X-ray."
          }
        ]
      }
    ]
  },
  "tibial-nailing": {
    "name": "Tibial Intramedullary Nailing",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tibial intramedullary nailing is an operation to stabilise a fracture of the shinbone (tibia) by inserting a metal rod down the centre of the bone. It is the standard treatment for most displaced tibial shaft fractures.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made just below the knee. Under X-ray guidance, a metal rod (nail) is inserted into the hollow centre of the tibia and passed across the fracture to hold the bone in alignment. The nail is secured at the top and bottom with locking screws. The fracture does not need to be opened directly. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Intramedullary nailing is the standard treatment for displaced tibial shaft fractures. It provides strong fixation, allows early weight-bearing, and has high healing rates. It is also used for open fractures after initial wound management."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Some tibial fractures can be managed with a plaster cast or functional brace, but this requires prolonged immobilisation, close monitoring, and carries higher rates of malunion. Non-operative treatment may be appropriate for undisplaced or minimally displaced fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery may be performed urgently or within days of the injury. Standard pre-assessment and fasting are required."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore alignment, promote healing, and allow early mobilisation. Union rates with tibial nailing are approximately 95%. Most patients can begin weight-bearing within days of surgery, depending on the fracture pattern."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Anterior knee pain",
            "detail": "Pain at the front of the knee near the nail entry point is the most common long-term complaint, affecting 30–50% of patients.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected around the leg for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Delayed union",
            "detail": "Tibial fractures can be slow to heal, particularly in the lower third.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to heal requiring further surgery such as bone grafting or exchange nailing. Approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Healing in a rotated or angulated position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A serious emergency where pressure builds in the leg muscles. Requires urgent surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Particularly with open fractures. Deep infection may require nail removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. The patient is positioned supine on a specialised fracture table."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing status depends on the fracture pattern — many patients can weight-bear immediately. Physiotherapy focuses on knee movement, ankle exercises, and progressive loading. Return to desk work at two to four weeks, manual work at three to six months. The nail is usually left in permanently but can be removed if it causes symptoms, typically after 18–24 months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Chest pain or breathing difficulty",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Severe tightness or pressure in the calf (possible compartment syndrome — seek urgent help)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months to monitor healing. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the rod need to be removed?",
            "a": "Not routinely. Removal is considered if the nail causes anterior knee pain or other symptoms after the fracture has healed."
          },
          {
            "q": "When can I walk?",
            "a": "Many patients begin weight-bearing within days of surgery, but this depends on the fracture pattern. Your surgeon will advise."
          },
          {
            "q": "Why is the tibial shaft slow to heal?",
            "a": "The tibia has a relatively limited blood supply compared to other bones, particularly in the lower third. This can lead to delayed healing."
          }
        ]
      }
    ]
  },
  "femoral-nailing": {
    "name": "Femoral Intramedullary Nailing",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Femoral intramedullary nailing is an operation to stabilise a fracture of the thighbone (femur) by inserting a metal rod into the centre of the bone. It is the standard treatment for femoral shaft fractures.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made near the hip or the top of the thighbone. Under X-ray guidance, a long metal rod is inserted down the hollow canal of the femur, crossing the fracture. Locking screws are placed at each end to prevent rotation. The fracture site itself is usually not opened. The operation typically takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Femoral shaft fractures in adults are almost always treated with intramedullary nailing. The femur is the strongest bone in the body and requires robust fixation to maintain alignment and allow healing. Nailing provides excellent stability and allows early mobilisation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative treatment (traction) is rarely used in adults due to the prolonged immobilisation required and inferior outcomes. It may be considered in exceptional circumstances where surgery is not possible."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Femoral shaft fractures are typically treated as an urgent or emergency procedure within 24–48 hours. Blood loss from the fracture may require transfusion. Standard pre-assessment is performed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "High union rates exceeding 95%. Most patients can begin partial weight-bearing within days and progress to full weight-bearing over six to twelve weeks. The nail provides strong, reliable fixation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Thigh pain",
            "detail": "Discomfort in the thigh, particularly at the proximal locking screw site, is common.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Femoral fractures and their fixation involve more blood loss than smaller bone fractures. Transfusion may be needed.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Significant thigh swelling is expected.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to heal requiring further surgery. Approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malrotation",
            "detail": "Rotational malalignment can occur and may affect gait.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fat embolism syndrome",
            "detail": "Release of fat particles into the bloodstream during nailing. Rare but potentially serious.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection requiring further surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Pudendal nerve injury from the traction post during surgery, causing numbness in the genital area. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. The patient is positioned on a fracture table with traction applied to align the bone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on the fracture pattern — most patients begin partial weight-bearing within a few days. Crutches or a frame are used for four to eight weeks. Physiotherapy focuses on hip, knee, and thigh muscle rehabilitation. Return to desk work at four to six weeks, manual work at three to six months. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Chest pain or breathing difficulty",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Severe thigh pain or swelling",
          "Shortness of breath, confusion, or a rash on the chest (possible fat embolism)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months. The nail is usually left in permanently."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why was this done as an emergency?",
            "a": "Femoral shaft fractures cause significant blood loss and pain. Early fixation reduces complications and allows faster recovery."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at eight to twelve weeks, once you can comfortably control the pedals and perform an emergency stop."
          },
          {
            "q": "Will the nail need to be removed?",
            "a": "Not usually. Removal is only considered if the nail causes symptoms after the fracture has healed."
          }
        ]
      }
    ]
  },
  "pelvic-fracture": {
    "name": "Pelvic Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pelvic fracture fixation is an operation to stabilise broken bones in the pelvis using plates, screws, or an external fixator. It is performed for unstable pelvic fractures that cannot be managed safely without surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach depends on the fracture pattern. Anterior fractures are approached through an incision in the lower abdomen or groin. Posterior fractures may be fixed with screws placed under X-ray guidance through small incisions (percutaneous fixation) or through a larger incision. External fixation involves pins placed through the skin into the pelvic bones, connected by an external frame. Surgery may take two to four hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for unstable pelvic ring injuries where the pelvis has been disrupted in two or more places, acetabular (hip socket) fractures with displacement, and pelvic fractures with associated injuries to blood vessels, nerves, or internal organs."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stable pelvic fractures (such as isolated pubic rami fractures in elderly patients) are managed with pain relief and mobilisation. These fractures heal without surgery. Unstable fractures require surgical stabilisation to prevent ongoing pain, deformity, and difficulty walking."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pelvic fractures are often high-energy injuries with associated injuries. Resuscitation and stabilisation take priority. Surgery may be performed urgently or planned within days. CT scanning is essential for surgical planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore pelvic stability, relieve pain, and allow mobilisation. Successful fixation enables most patients to return to walking, though recovery is prolonged. Outcomes depend heavily on the severity of the initial injury and associated injuries."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Pelvic fractures are major injuries. Full recovery typically takes six to twelve months or longer.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Hip and lower back stiffness are common.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "High risk with pelvic injuries despite preventive measures.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "The sciatic nerve and lumbosacral plexus are at risk, particularly with posterior fractures. Damage can cause leg weakness or numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "The pelvis may heal in a slightly asymmetric position, potentially causing leg-length discrepancy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Particularly with open fractures or external fixation pin sites.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bladder or bowel injury",
            "detail": "Pelvic fractures may be associated with injuries to pelvic organs.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation around the hip that may limit movement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sexual or reproductive dysfunction",
            "detail": "Nerve and vascular injuries associated with pelvic fractures can affect these functions.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Significant blood loss may occur, and transfusion facilities must be available."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions typically apply for six to twelve weeks. Physiotherapy is essential and begins in hospital. Many patients need a walking frame or crutches for several months. Return to work depends on the severity of injury and type of employment. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Chest pain or breathing difficulty",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Difficulty passing urine",
          "Pins becoming loose or infected (if external fixation)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at six weeks, three months, and six months. Physiotherapy throughout. Long-term follow-up may be needed for complex injuries."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk normally again?",
            "a": "Most patients with successfully treated pelvic fractures return to walking. Some may have a limp or ongoing discomfort, depending on the severity of the original injury."
          },
          {
            "q": "When can I drive?",
            "a": "Usually at three to six months, depending on the fracture and recovery. Your surgeon will advise."
          },
          {
            "q": "Will the metalwork be removed?",
            "a": "Usually not. Removal is only considered if the metalwork causes specific problems."
          }
        ]
      }
    ]
  },
  "tibial-plateau": {
    "name": "Tibial Plateau Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tibial plateau fracture fixation is an operation to repair a break in the top of the shinbone where it forms the knee joint. These fractures involve the joint surface and require precise reconstruction to preserve knee function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the side of the knee over the fracture. The depressed or displaced joint surface is elevated back to its normal position, often with bone graft to fill any voids. The fracture is then held in place with plates and screws. Arthroscopy (keyhole camera) may be used to check the joint surface alignment. The operation takes one and a half to three hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the tibial plateau fracture is displaced, depressed, or unstable. These fractures involve the weight-bearing surface of the knee, and precise alignment is essential to prevent early arthritis and instability."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced or minimally displaced fractures may be treated with a hinged knee brace, restricted weight-bearing, and physiotherapy. Close monitoring with repeat X-rays is needed to ensure the fracture does not displace."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scanning is essential for surgical planning. Surgery may be delayed for several days to allow swelling to settle — operating through very swollen tissue increases the risk of wound problems."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Accurate restoration of the joint surface gives the best chance of a good functional outcome and delays the onset of post-traumatic arthritis. Most patients achieve a functional range of knee movement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Very common after tibial plateau fractures. Early physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Arthritis may develop over time regardless of treatment, depending on the severity of cartilage damage.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The skin around the proximal tibia is vulnerable, particularly if surgery is performed through swollen tissues.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around metalwork. Risk increases with open fractures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A surgical emergency requiring fasciotomy. Uncommon but must be watched for.",
            "freq": "Rare"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "The fracture may fail to heal or heal in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Meniscal or ligament injury",
            "detail": "Associated injuries within the knee may need treatment at the same time or later.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. The patient is positioned supine."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing is typically restricted for six to twelve weeks to protect the joint surface while it heals. A hinged knee brace may be used. Physiotherapy begins immediately to maintain knee movement. Range of motion exercises are critical. Full recovery takes six to twelve months. Some patients eventually require knee replacement if significant arthritis develops."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Chest pain or breathing difficulty",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Severe tightness in the calf or shin (possible compartment syndrome — seek urgent help)",
          "Increasing knee swelling or inability to bend the knee"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at two weeks, six weeks, three months, and six months. Physiotherapy is critical."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I get arthritis?",
            "a": "There is an increased risk of post-traumatic arthritis after tibial plateau fractures, even with excellent surgical reconstruction. The risk depends on the severity of the original cartilage damage."
          },
          {
            "q": "When can I put weight on the leg?",
            "a": "Usually six to twelve weeks, depending on the fracture pattern and healing. Your surgeon will guide this."
          },
          {
            "q": "Will I need a knee replacement later?",
            "a": "Some patients develop significant arthritis years later and may eventually benefit from knee replacement, but many do well long-term."
          }
        ]
      }
    ]
  },
  "calcaneal-fracture": {
    "name": "Calcaneal (Heel) Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Calcaneal fracture fixation is an operation to reconstruct a broken heel bone (calcaneus). These fractures often involve the subtalar joint surface and require surgery to restore foot shape and function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the heel. The fracture fragments are carefully elevated and realigned, restoring the joint surface and the height and width of the heel bone. The repair is held with a plate and screws. In some cases, bone graft is used. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced calcaneal fractures involving the subtalar joint surface. Without surgery, the heel may heal flattened and widened, causing chronic pain, difficulty with footwear, and early arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative management with elevation, ice, and early range-of-motion exercises. This may be appropriate for undisplaced fractures, fractures in patients with poor blood supply (such as heavy smokers or diabetics), or in patients who are not fit for surgery. Results are less predictable than surgical treatment for displaced fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is typically delayed for one to two weeks to allow swelling to settle. The 'wrinkle test' is used — surgery proceeds when skin wrinkles return, indicating reduced swelling. CT scanning is essential for planning. Smoking cessation is critical."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the shape of the heel, the subtalar joint surface, and foot function. Most patients can return to walking in shoes, though the heel may remain somewhat wider than before. Some patients require subtalar fusion later if arthritis develops."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The most significant risk. The lateral heel skin is vulnerable. Wound complications occur in 10–25% of patients.",
            "freq": "Common"
          },
          {
            "risk": "Subtalar stiffness",
            "detail": "Loss of side-to-side foot movement is expected.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Heel and foot swelling persists for many months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound infection",
            "detail": "Superficial or deep infection. May require further surgery. Risk is higher in smokers and diabetics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "Numbness on the outer side of the foot. Common minor complication.",
            "freq": "Uncommon"
          },
          {
            "risk": "Subtalar arthritis",
            "detail": "May develop despite good surgical reconstruction and may require fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "Peroneal tendon injury",
            "detail": "Tendons running behind the outer ankle may be irritated.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome of the foot",
            "detail": "Rare but requires urgent treatment.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block for post-operative pain relief. The patient is positioned on their side."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to twelve weeks. Elevation is critical in the first two weeks to protect the wound. Gentle ankle and subtalar exercises begin once the wound is healed. Gradual return to weight-bearing in a supportive boot. Full recovery takes six to twelve months or longer. A wider heel may require modified footwear."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown, redness, or discharge",
          "Fever",
          "Severe pain or swelling",
          "Toes turning blue or numb",
          "Blistering around the wound"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks (critical). X-rays at six weeks and three months. Physiotherapy for ankle and foot rehabilitation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why did surgery have to wait?",
            "a": "Operating through very swollen tissue dramatically increases the risk of wound problems. Waiting for swelling to settle is essential for a safe outcome."
          },
          {
            "q": "Will I walk normally?",
            "a": "Most patients return to walking comfortably, though side-to-side foot movement is usually reduced. Some adaptation to uneven ground is needed."
          },
          {
            "q": "Why is smoking so harmful?",
            "a": "Smoking severely impairs wound healing and bone healing. The lateral heel skin has a tenuous blood supply, and smoking increases wound complication rates significantly."
          }
        ]
      }
    ]
  },
  "pilon-fracture": {
    "name": "Pilon (Distal Tibial) Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pilon fracture fixation is an operation to reconstruct a fracture of the lower end of the tibia (shinbone) where it forms the ankle joint. These are complex, high-energy fractures that involve the weight-bearing surface of the ankle.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Surgery often occurs in two stages. First, an external fixator (a frame with pins outside the skin) is applied to restore length and alignment while swelling settles. After one to two weeks, definitive fixation is performed through incisions over the tibia, using plates and screws to reconstruct the joint surface. Bone graft may be used. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced pilon fractures to restore the ankle joint surface. Without accurate reconstruction, severe ankle arthritis develops early."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative treatment may be considered for undisplaced fractures or in patients who are not suitable for surgery. Results are generally less predictable than surgical reconstruction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scanning is essential. Surgery is typically staged — initial external fixation followed by definitive surgery once swelling settles. This approach significantly reduces wound complications."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore the ankle joint surface as accurately as possible. Even with excellent reconstruction, the ankle rarely returns to normal due to the severity of the cartilage injury. Most patients achieve a functional ankle, though some stiffness and discomfort are common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ankle stiffness",
            "detail": "Very common. The ankle rarely regains full movement after a pilon fracture.",
            "freq": "Expected"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Develops in a significant proportion of patients regardless of treatment quality.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged ankle and foot swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "A major concern with pilon fractures. Staged surgery reduces but does not eliminate this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "May require metalwork removal and prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "The fracture may fail to heal or heal in a poor position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Rare but requires emergency fasciotomy.",
            "freq": "Rare"
          },
          {
            "risk": "Ankle fusion requirement",
            "detail": "If severe arthritis develops, ankle fusion may be needed in the future.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia for both stages."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for eight to twelve weeks. Ankle exercises begin once the wound is healed. Progressive weight-bearing in a boot. Full recovery takes nine to eighteen months. Many patients have some long-term ankle stiffness and discomfort."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown or discharge",
          "Fever",
          "Severe swelling or blistering",
          "Toes turning blue or numb",
          "External fixator pin loosening or discharge"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Close follow-up with wound checks and X-rays throughout. Long-term monitoring for ankle arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is surgery done in two stages?",
            "a": "Operating through very swollen soft tissues causes wound problems. Temporary external fixation allows swelling to settle before definitive reconstruction, dramatically reducing complications."
          },
          {
            "q": "Will I need an ankle fusion?",
            "a": "Possibly, if significant post-traumatic arthritis develops. This depends on the severity of the original cartilage damage."
          }
        ]
      }
    ]
  },
  "acdf": {
    "name": "Anterior Cervical Discectomy and Fusion (ACDF)",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "ACDF is an operation to remove a damaged disc in the neck and fuse the vertebrae above and below it together. It is performed through the front of the neck to relieve pressure on the spinal cord or nerve roots, treating arm pain, numbness, weakness, and balance problems.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the front of the neck, typically in a skin crease. The neck muscles, trachea, and oesophagus are gently moved aside to access the spine. The damaged disc is removed, relieving pressure on the nerves or spinal cord. A cage filled with bone graft material is placed in the disc space, and a small plate and screws are fixed to the front of the vertebrae to hold everything in place while fusion occurs. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ACDF is recommended for cervical disc herniation causing arm pain (radiculopathy) that has not responded to non-operative treatment, cervical spinal stenosis causing spinal cord compression (myelopathy) with symptoms such as balance problems, hand clumsiness, or leg stiffness, and certain cervical spine fractures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication including neuropathic agents, cervical epidural injection, activity modification, and time. Many disc herniations improve without surgery. Cervical disc replacement is a surgical alternative that preserves movement at the treated level."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. CT and MRI scans for planning. Smoking cessation is critical — fusion failure rates are five times higher in smokers."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Up to 90% of patients experience significant improvement in arm pain. Symptoms of spinal cord compression may stabilise or improve, though recovery of established neurological damage is less predictable. The fused segment provides permanent stability."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Difficulty swallowing (dysphagia)",
            "detail": "Very common in the first few days after surgery due to oesophageal retraction. Usually resolves within one to two weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Hoarseness",
            "detail": "Temporary voice changes from recurrent laryngeal nerve stretching. Usually resolves.",
            "freq": "Common"
          },
          {
            "risk": "Neck stiffness",
            "detail": "Some loss of neck rotation at the fused level. Usually well compensated by adjacent levels.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-fusion (pseudarthrosis)",
            "detail": "The bones may fail to fuse. Risk approximately 5–8% for single-level, higher for multi-level. Much higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "Increased stress on levels above and below the fusion may cause new problems over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Recurrent laryngeal nerve palsy",
            "detail": "Persistent hoarseness from nerve damage. Permanent in less than 1 in 250 patients.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve root or spinal cord injury",
            "detail": "Risk approximately 1%. Could cause arm weakness, numbness, or in very rare cases, paralysis.",
            "freq": "Rare"
          },
          {
            "risk": "CSF leak",
            "detail": "Tear in the dural membrane. Occurs in approximately 3% and usually heals.",
            "freq": "Uncommon"
          },
          {
            "risk": "Oesophageal injury",
            "detail": "Very rare injury to the food pipe.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection causing airway compromise. A surgical emergency requiring urgent drainage.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Neuromonitoring may be used to monitor nerve function during surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of one to two days. A soft collar may be worn for comfort. Walking is encouraged immediately. Gentle neck exercises begin at two to four weeks. Return to desk work at two to four weeks. Driving when you can turn your head safely, usually at two to four weeks. Avoid heavy lifting for six to twelve weeks. Full fusion takes three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Difficulty breathing or increasing swelling in the neck (attend A&E urgently)",
          "Difficulty swallowing that worsens rather than improves",
          "Increasing arm weakness or numbness",
          "Worsening neck pain",
          "Wound redness, swelling, or discharge",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Surgeon review with X-rays at six weeks and three to six months to assess fusion. Long-term monitoring for adjacent segment disease."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose neck movement?",
            "a": "A single-level fusion causes minimal noticeable loss of movement. Multi-level fusions may be more noticeable, but most patients adapt well."
          },
          {
            "q": "Why is smoking so important?",
            "a": "Nicotine prevents bone growth and dramatically increases the risk of non-fusion. Stopping smoking is the single most important thing you can do to improve your outcome."
          },
          {
            "q": "Is disc replacement an alternative?",
            "a": "For suitable patients, cervical disc replacement preserves movement and may reduce adjacent segment disease. Not everyone is a candidate — your surgeon will advise."
          }
        ]
      }
    ]
  },
  "cervical-laminectomy": {
    "name": "Cervical Laminectomy",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cervical laminectomy is an operation to relieve pressure on the spinal cord in the neck by removing the lamina — the bony arch at the back of the vertebrae. It is performed for cervical spinal stenosis causing spinal cord compression (myelopathy).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the midline at the back of the neck. The muscles are moved aside to expose the vertebrae. The lamina and any thickened ligament are removed to create more space for the spinal cord. Multiple levels are usually decompressed. The procedure may be combined with fusion using screws and rods to prevent the spine from becoming unstable or developing a kyphotic (forward) curve. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Cervical laminectomy is recommended for multi-level cervical spinal stenosis causing myelopathy — symptoms include difficulty with balance, leg stiffness, hand clumsiness, and bladder problems. It is typically chosen over ACDF when three or more levels need decompression."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Mild myelopathy may be monitored with regular MRI. Physiotherapy can help with balance and function. However, spinal cord compression that is causing progressive neurological symptoms generally requires surgery to prevent further deterioration."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment. MRI and CT scans for planning. This is a more significant procedure than anterior surgery, with a longer recovery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The primary aim is to prevent further deterioration of spinal cord function. Many patients experience stabilisation of symptoms, and some improve. Recovery of established spinal cord damage is variable and may be incomplete."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Neck stiffness and pain",
            "detail": "Expected, particularly if fusion is performed.",
            "freq": "Common"
          },
          {
            "risk": "Axial neck pain",
            "detail": "Post-operative neck and shoulder pain from muscle dissection. Usually improves over months.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "More blood loss than anterior procedures. Transfusion may be needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "Risk approximately 1%. Could cause worsening weakness or, very rarely, paralysis.",
            "freq": "Rare"
          },
          {
            "risk": "C5 palsy",
            "detail": "Weakness of the deltoid muscle after decompression. Occurs in approximately 5% and usually recovers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection. Risk approximately 2–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear with spinal fluid leakage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "If laminectomy is performed without fusion, the spine may develop a kyphotic deformity over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Hardware failure",
            "detail": "If fusion is performed, screws may loosen.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring. Positioned prone (face down) or sitting."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of two to five days. A collar may be worn for several weeks. Walking is encouraged early. Physiotherapy for balance and neck rehabilitation. Return to desk work at four to eight weeks. Avoid heavy lifting for three months. Full recovery takes three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Worsening hand clumsiness or difficulty walking",
          "Increasing arm weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at six weeks, three months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my balance improve?",
            "a": "Many patients notice improvement in balance, though recovery of established spinal cord damage is variable. The primary aim is to prevent further deterioration."
          },
          {
            "q": "Why is fusion sometimes added?",
            "a": "Removing the lamina can make the spine less stable. Adding screws and rods (fusion) prevents the spine from developing an abnormal forward curve."
          }
        ]
      }
    ]
  },
  "vertebroplasty": {
    "name": "Vertebroplasty and Kyphoplasty",
    "region": "Spine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Vertebroplasty and kyphoplasty are minimally invasive procedures to treat painful vertebral compression fractures by injecting bone cement into the collapsed vertebra. These fractures are most commonly caused by osteoporosis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, a needle is inserted through the skin of the back into the fractured vertebra. In vertebroplasty, bone cement is injected directly. In kyphoplasty, a balloon is first inflated inside the vertebra to restore height before cement is injected. The cement hardens within minutes, stabilising the fracture. The procedure takes 30–60 minutes per level and is performed through one or two small puncture wounds."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "These procedures are considered for painful osteoporotic vertebral compression fractures that have not responded to four to six weeks of pain management, bracing, and activity modification. They are also used for certain pathological fractures from tumours."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, bracing, physiotherapy, and time. Many vertebral compression fractures improve with conservative management over six to twelve weeks. Osteoporosis treatment should be optimised regardless of whether the fracture is treated surgically."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI scan to confirm the fracture is recent and likely to be the source of pain. Blood tests including clotting studies. This is usually a day-case or overnight procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Rapid pain relief is the primary benefit. Most patients experience significant improvement within 24–48 hours. Kyphoplasty may also partially restore vertebral height and reduce spinal deformity."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Soreness at needle site",
            "detail": "Temporary local pain where the needle was inserted.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete pain relief",
            "detail": "Not all patients achieve full pain relief.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Cement leakage",
            "detail": "Cement may leak outside the vertebra. Usually asymptomatic but can rarely cause nerve compression.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent vertebral fracture",
            "detail": "Stiffening one vertebra may increase stress on adjacent levels, leading to new fractures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or spinal cord compression",
            "detail": "From leaked cement. May require urgent decompression surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Pulmonary cement embolism",
            "detail": "Cement entering the venous system and travelling to the lungs. Very rare but potentially serious.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Can be performed under local anaesthesia with sedation, or under general anaesthesia. The patient is positioned face down."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients mobilise within hours and go home the same day or the next day. Walking is encouraged immediately. Pain relief is often rapid. Osteoporosis treatment should be started or optimised. Physiotherapy for back strengthening and balance."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden increase in back pain",
          "New leg weakness or numbness",
          "Difficulty passing urine",
          "Fever",
          "Shortness of breath"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two to four weeks. Osteoporosis management is essential to prevent further fractures."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How quickly will the pain improve?",
            "a": "Many patients notice significant improvement within 24–48 hours. Some improve immediately."
          },
          {
            "q": "Is the cement permanent?",
            "a": "Yes, the cement is permanent and maintains its strength indefinitely."
          },
          {
            "q": "Do I need osteoporosis treatment?",
            "a": "Yes. Vertebroplasty treats the fracture but not the underlying osteoporosis. Medication to strengthen bones and prevent further fractures is essential."
          }
        ]
      }
    ]
  },
  "scoliosis-correction": {
    "name": "Scoliosis Correction Surgery",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Scoliosis correction surgery is a major operation to straighten and stabilise a curved spine using metal rods, screws, and bone grafting. It is performed for progressive spinal deformities that have not responded to bracing or observation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the midline of the back over the curved segment. Screws are placed into the vertebrae throughout the curve. Rods are then connected to the screws and used to correct the curvature. Bone graft is placed along the spine to promote fusion of the vertebrae into their corrected position. The operation typically takes four to eight hours depending on the complexity and length of the fusion."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for progressive scoliosis curves exceeding 40–50 degrees, curves that are causing pain or respiratory compromise, and curves that are likely to progress. It is most commonly performed in adolescents with idiopathic scoliosis but is also performed in adults for degenerative scoliosis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bracing (for growing adolescents with curves of 25–40 degrees), physiotherapy and exercise (Schroth method), pain management, and observation. Bracing can prevent progression but does not correct an established curve."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough pre-assessment including pulmonary function tests and cardiac assessment. Full-length spine X-rays and MRI. Blood should be available for transfusion. This is a major operation requiring careful planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to correct the spinal curvature, prevent further progression, improve spinal balance, and in some cases improve appearance and respiratory function. Typical correction is 50–70% of the curve. The corrected position is maintained by the fusion."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of spinal flexibility",
            "detail": "The fused segment will be rigid. This is expected and usually well compensated.",
            "freq": "Expected"
          },
          {
            "risk": "Post-operative pain",
            "detail": "Significant pain is expected in the first few weeks and is managed with strong pain relief.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant blood loss is common. Blood transfusion may be needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Neurological injury",
            "detail": "Risk to spinal cord or nerve roots. Neuromonitoring is used to reduce this risk. Occurs in approximately 1% of cases.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Deep wound infection in approximately 2–3%. May require further surgery and prolonged antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pseudarthrosis",
            "detail": "Failure of fusion. May require revision surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Screws may loosen or rods may break, particularly if fusion does not occur.",
            "freq": "Uncommon"
          },
          {
            "risk": "Flat back syndrome",
            "detail": "Loss of normal lumbar lordosis causing difficulty standing upright.",
            "freq": "Uncommon"
          },
          {
            "risk": "Proximal junctional kyphosis",
            "detail": "The spine may develop a new curve above the fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pulmonary complications",
            "detail": "Including pneumonia, particularly in patients with pre-existing respiratory compromise.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with full neuromonitoring (motor and sensory evoked potentials) throughout surgery. Positioned prone on a specialised frame."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay of five to seven days. Walking begins within a day or two of surgery. A brace may be worn for several months. Return to school or desk work at four to eight weeks. Sports at six to twelve months, with some high-impact activities restricted. Full recovery takes six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain despite medication",
          "Wound redness, swelling, or discharge",
          "Fever",
          "New weakness or numbness in the legs",
          "Difficulty breathing",
          "Changes in bladder or bowel function"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays at six weeks, three months, six months, one year, and annually for several years. Long-term monitoring for adjacent segment problems."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the spine be completely straight?",
            "a": "Surgery typically corrects 50–70% of the curve. Complete correction is not the goal — the aim is a balanced, stable spine."
          },
          {
            "q": "What activities will be restricted?",
            "a": "Most daily activities and many sports are possible. High-impact activities and contact sports may be restricted depending on the extent of fusion. Swimming, cycling, and walking are encouraged."
          },
          {
            "q": "How long does the surgery take?",
            "a": "Typically four to eight hours, depending on the number of levels fused and the complexity of the curve."
          }
        ]
      }
    ]
  },
  "cartilage-repair": {
    "name": "Cartilage Repair (Microfracture / MACI)",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cartilage repair procedures aim to restore damaged joint surface cartilage in the knee. Techniques include microfracture (stimulating the bone to grow new cartilage) and MACI (matrix-assisted autologous chondrocyte implantation, where laboratory-grown cartilage cells are implanted).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For microfracture: performed arthroscopically. Small holes are drilled into the bone beneath the cartilage defect, releasing stem cells that form a repair tissue (fibrocartilage). For MACI: a two-stage procedure. First, a small sample of cartilage is taken arthroscopically and sent to a laboratory where the cells are grown on a scaffold for several weeks. In the second operation, the scaffold with cells is implanted into the defect through a small incision or arthroscopically."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Cartilage repair is considered for patients with localised, full-thickness cartilage defects in the knee causing pain and swelling, typically in younger, active patients. It is not suitable for widespread arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, activity modification, anti-inflammatory medication, and intra-articular injections (corticosteroid, hyaluronic acid, or PRP). Osteotomy may be considered if alignment contributes to the problem."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI scan to assess the defect. For MACI, the first stage (cartilage biopsy) is a minor arthroscopic procedure. The second stage is planned four to six weeks later."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to reduce pain, improve function, and potentially delay or prevent the need for joint replacement. Microfracture produces fibrocartilage (less durable than normal cartilage). MACI produces hyaline-like cartilage with potentially better long-term durability."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Cartilage repair requires extended rehabilitation with restricted weight-bearing.",
            "freq": "Expected"
          },
          {
            "risk": "Knee swelling",
            "detail": "Common during the healing phase.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of movement requiring physiotherapy.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "The repair tissue may not fully develop or may break down over time.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT with prolonged restricted weight-bearing.",
            "freq": "Uncommon"
          },
          {
            "risk": "Continued symptoms",
            "detail": "Pain may not be fully relieved, particularly if there are associated problems like misalignment.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for six to eight weeks. Continuous passive motion (CPM) machines may be used. Physiotherapy is essential and continues for six to twelve months. Return to impact sport at nine to twelve months. Full maturation of the repair tissue takes twelve to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Fever",
          "Wound redness or discharge",
          "Locking or giving way of the knee"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews at two weeks, six weeks, three months, six months, and one year. MRI may be used to assess repair tissue maturation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the difference between microfracture and MACI?",
            "a": "Microfracture is simpler but produces fibrocartilage, which is less durable. MACI uses your own laboratory-grown cartilage cells and may produce more durable hyaline-like cartilage. MACI is typically recommended for larger defects."
          },
          {
            "q": "Will this prevent arthritis?",
            "a": "Cartilage repair aims to restore the joint surface and may delay the onset of arthritis, but it cannot guarantee prevention, particularly if the cartilage was significantly damaged."
          },
          {
            "q": "Why is recovery so long?",
            "a": "The repair tissue takes many months to mature and strengthen. Premature loading can damage the new cartilage."
          }
        ]
      }
    ]
  },
  "pcl-reconstruction": {
    "name": "PCL Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "PCL (posterior cruciate ligament) reconstruction is a surgical procedure to replace a torn PCL — the ligament that prevents the shinbone from sliding backwards beneath the thighbone. It is less common than ACL reconstruction and is performed when instability is significant.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically. A graft (usually from a donor tendon — allograft — or from the patient's own tendons) is used to reconstruct the ligament. Tunnels are drilled in the thighbone and shinbone, and the graft is passed through and fixed in position. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "PCL reconstruction is recommended for patients with symptomatic posterior knee instability that interferes with daily activities or sport, particularly when combined with other ligament injuries (multi-ligament knee injury). Isolated PCL tears are often managed non-operatively."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many isolated PCL tears can be managed with intensive quadriceps rehabilitation and bracing. The PCL has some capacity for healing, unlike the ACL. Surgery is reserved for persistent instability despite rehabilitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and sometimes stress X-rays to confirm the diagnosis and assess associated injuries. Pre-operative physiotherapy to optimise quadriceps strength."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore posterior stability of the knee and reduce symptoms of instability. Most patients achieve improved stability and function, though results are somewhat less predictable than ACL reconstruction."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Loss of knee flexion is the most common complication. Aggressive physiotherapy is important.",
            "freq": "Common"
          },
          {
            "risk": "Graft site pain",
            "detail": "Discomfort at the graft harvest or fixation sites.",
            "freq": "Common"
          },
          {
            "risk": "Residual laxity",
            "detail": "Some degree of posterior laxity may persist despite reconstruction.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "The reconstructed ligament may stretch or rupture.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neurovascular injury",
            "detail": "The popliteal artery and nerve run close to the PCL and are at risk during surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A brace locked in extension is worn for four to six weeks. Crutches for six weeks. Physiotherapy begins immediately with a focus on quadriceps strengthening. Jogging at four to six months. Return to sport at nine to twelve months. Full recovery takes twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Wound redness or discharge",
          "Fever",
          "Calf pain or swelling",
          "Sudden instability or giving way"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews at two weeks, six weeks, three months, six months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is non-operative treatment often tried first?",
            "a": "The PCL has better healing potential than the ACL, and many patients function well with a PCL-deficient knee after quadriceps strengthening."
          },
          {
            "q": "Is PCL reconstruction more complex than ACL?",
            "a": "Yes, the PCL is deeper and closer to major blood vessels and nerves, making reconstruction technically more demanding."
          }
        ]
      }
    ]
  },
  "patellar-tendon-repair": {
    "name": "Patellar Tendon Repair",
    "region": "Knee",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Patellar tendon repair is an operation to reattach the ruptured patellar tendon — the strong tendon connecting the kneecap to the shinbone. Rupture prevents the ability to straighten the knee against gravity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the knee. The torn tendon ends are identified and stitched together using strong sutures. Suture anchors or tunnels through the kneecap may be used to reinforce the repair. A protective wire or suture may be placed around the kneecap to protect the repair during healing. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is essential for complete patellar tendon ruptures, as the tendon cannot heal on its own and the patient cannot straighten the knee against gravity without it."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Partial tears may be managed with bracing and physiotherapy. Complete ruptures require surgical repair."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is ideally performed within two weeks of the injury, before the tendon retracts and scarring makes repair more difficult."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the ability to straighten the knee and return to normal function. Most patients achieve good functional outcomes with dedicated rehabilitation, though some loss of knee flexion is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Loss of knee flexion is common and requires dedicated physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Quadriceps weakness",
            "detail": "Some residual weakness compared to the uninjured side.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail, particularly with premature loading. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Patella baja",
            "detail": "The kneecap may sit lower than normal after healing, affecting knee mechanics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A hinged brace is worn for six to twelve weeks with gradually increasing flexion. Weight-bearing begins immediately in the brace with the knee locked in extension. Physiotherapy is essential. Jogging at four to six months. Return to sport at six to nine months. Full recovery takes nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of ability to straighten the knee (possible re-rupture)",
          "Increasing knee swelling or pain",
          "Wound redness or discharge",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does this happen?",
            "a": "Patellar tendon ruptures typically occur during forceful knee bending, such as landing from a jump. They are more common in patients with pre-existing tendon disease (tendinopathy) and in those who have had corticosteroid injections into the tendon."
          },
          {
            "q": "Will I return to sport?",
            "a": "Most patients return to sport, though it takes nine to twelve months of dedicated rehabilitation."
          }
        ]
      }
    ]
  },
  "mortons-neuroma": {
    "name": "Morton's Neuroma Excision",
    "region": "Foot & Ankle",
    "tag": "Nerve",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Morton's neuroma excision is an operation to remove a thickened, irritated nerve between the toes (most commonly between the third and fourth toes) that causes pain, burning, and numbness in the ball of the foot.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the top of the foot (dorsal approach) between the affected toes. The thickened nerve (neuroma) is identified and carefully removed. The wound is closed with stitches. The procedure takes approximately 30 minutes and is usually performed as a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a Morton's neuroma causes persistent forefoot pain, burning, or numbness that has not responded to footwear modification, orthotics, and corticosteroid injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wider footwear with a metatarsal pad, custom orthotics, corticosteroid injection, and activity modification. These measures are effective for many patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Ultrasound or MRI may have been used to confirm the diagnosis."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of the burning pain and shooting sensations in approximately 80% of patients. An area of numbness between the affected toes is expected and permanent, as the nerve has been removed."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Permanent numbness",
            "detail": "Numbness between the affected toes is expected because the nerve has been removed. Most patients find this preferable to the pain.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Forefoot swelling for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Scar discomfort",
            "detail": "Tenderness at the incision site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence (stump neuroma)",
            "detail": "The cut nerve end may form a painful stump neuroma in approximately 5–10% of cases.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "Chronic pain and swelling.",
            "freq": "Rare"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Symptoms may persist if the diagnosis was incorrect or if there are multiple neuromas.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic, regional ankle block, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A post-operative shoe is worn for two to three weeks. Stitches are removed at two weeks. Most patients return to comfortable footwear at three to four weeks. Full recovery takes six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing pain",
          "Fever",
          "Toes turning blue or numb beyond the expected area"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose feeling in my toes?",
            "a": "Yes, there will be permanent numbness between the two affected toes. Most patients consider this a worthwhile trade-off for relief of the burning pain."
          },
          {
            "q": "Can the neuroma come back?",
            "a": "The same neuroma cannot return as it has been removed, but a painful stump neuroma may develop at the cut nerve end in a small percentage of patients."
          }
        ]
      }
    ]
  },
  "flatfoot-reconstruction": {
    "name": "Flatfoot Reconstruction",
    "region": "Foot & Ankle",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Flatfoot reconstruction is a combination of procedures to restore the arch of the foot and correct the deformity caused by posterior tibial tendon dysfunction (adult acquired flatfoot). It typically involves tendon transfer, osteotomy, and sometimes fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Multiple incisions are made on the inner and outer sides of the foot. The procedure typically involves transferring a nearby tendon (flexor digitorum longus) to replace the failed posterior tibial tendon, performing a calcaneal osteotomy (cutting and shifting the heel bone to improve alignment), and sometimes a lateral column lengthening or medial column fusion. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for progressive flatfoot deformity causing pain, difficulty walking, and failure to respond to non-operative management with orthotics and physiotherapy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Supportive footwear, custom orthotics (medial arch support), ankle-foot orthosis (AFO), physiotherapy for tibialis posterior strengthening, and activity modification. Non-operative management is effective for many patients, particularly in early-stage disease."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and sometimes CT or MRI. This is a significant procedure requiring planning for six to twelve weeks of restricted weight-bearing."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the foot arch, improved alignment, reduced pain, and improved walking ability. Most patients experience significant improvement, though the foot may not be perfectly 'normal'."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged swelling",
            "detail": "Foot swelling persists for many months.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of subtalar and midfoot movement.",
            "freq": "Common"
          },
          {
            "risk": "Scar discomfort",
            "detail": "Multiple incisions may cause scar-related issues.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Osteotomy or fusion sites may fail to heal. Risk is higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing problems",
            "detail": "Multiple incisions increase risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sural or medial plantar nerve irritation causing numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction",
            "detail": "The foot may be corrected into a cavus (high-arched) position.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT during the period of restricted weight-bearing.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block for post-operative pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing in a cast for six to eight weeks. Transition to weight-bearing in a boot for a further four to six weeks. Physiotherapy for ankle and foot rehabilitation. Custom orthotics may be needed long-term. Full recovery takes nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Fever",
          "Cast feeling too tight",
          "Toes turning blue or numb",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up at two weeks, six weeks, three months, and six months with X-rays."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I need to wear orthotics afterwards?",
            "a": "Many patients benefit from supportive insoles or orthotics long-term, even after successful surgery."
          },
          {
            "q": "Why are multiple procedures needed?",
            "a": "Flatfoot deformity involves multiple structures — the tendon, the heel bone alignment, and sometimes the midfoot joints. Addressing all components gives the best result."
          }
        ]
      }
    ]
  },
  "subtalar-fusion": {
    "name": "Subtalar Fusion",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Subtalar fusion (arthrodesis) is an operation to permanently join the talus and calcaneus bones beneath the ankle, eliminating the painful subtalar joint. It is performed for severe subtalar arthritis, commonly following a calcaneal fracture or inflammatory arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the hindfoot. The remaining cartilage is removed from the subtalar joint surfaces. The bones are positioned in the optimal alignment and fixed with screws. Bone graft may be used. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Subtalar fusion is recommended for severe subtalar arthritis causing pain with walking on uneven ground, post-traumatic arthritis (particularly after calcaneal fractures), inflammatory arthritis, and certain congenital or acquired foot deformities."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Supportive footwear, orthotics, ankle-foot orthosis, corticosteroid injection into the subtalar joint, pain medication, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for planning. Smoking cessation is critical for bone healing."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief in over 85% of patients. The subtalar joint no longer moves, but the ankle joint and midfoot joints compensate partially. Walking on flat ground is usually comfortable; walking on uneven terrain requires more adaptation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of subtalar motion",
            "detail": "Expected — this is the purpose of the operation. Foot adaptability on uneven ground is reduced.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged foot swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Subtle changes in walking pattern.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to fuse. Risk approximately 5–10%. Significantly higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "Numbness on the outer side of the foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint arthritis",
            "detail": "Increased stress on the ankle and midfoot joints over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing problems",
            "detail": "Particularly in patients with prior surgery or poor blood supply.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing in a cast for six to eight weeks. Weight-bearing in a boot for a further four to six weeks. Physiotherapy for ankle strengthening. Full recovery takes six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Fever",
          "Cast too tight",
          "Toes blue or numb",
          "Increasing pain beyond expected levels"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks and three months to monitor fusion progress."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk normally?",
            "a": "Most patients walk comfortably on flat ground. Walking on uneven surfaces, hills, and slopes requires more adaptation."
          },
          {
            "q": "Can I still run?",
            "a": "Low-impact jogging may be possible for some patients. High-impact running is generally not recommended."
          }
        ]
      }
    ]
  },
  "midfoot-fusion": {
    "name": "Midfoot (Lisfranc) Fusion",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Midfoot fusion is an operation to permanently join the bones in the middle of the foot (tarsometatarsal joints). It is performed for midfoot arthritis, Lisfranc injuries, or deformity causing pain with walking.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the top of the midfoot. The damaged cartilage is removed from the affected tarsometatarsal joints. The bones are positioned in the correct alignment and fixed with screws or plates. Bone graft may be used. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for painful midfoot arthritis from previous Lisfranc injury, degenerative arthritis of the tarsometatarsal joints, or midfoot deformity causing pain and difficulty with footwear."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stiff-soled footwear, carbon fibre insoles, orthotics, corticosteroid injection, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT scan. Plan for six to twelve weeks of restricted weight-bearing."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief and improved foot alignment in approximately 85% of patients. The midfoot joints contribute relatively little to normal walking, so fusion causes minimal functional limitation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Prolonged foot swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "Screws may be palpable on the top of the foot.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Expected at the fused joints but functionally well tolerated.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to fuse at one or more joints. Risk approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness on the top of the foot from cutaneous nerve damage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Metalwork irritation",
            "detail": "Screws may need removal after fusion has occurred.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing problems",
            "detail": "Particularly in smokers and diabetics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain under adjacent metatarsal heads due to altered mechanics.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks in a cast. Weight-bearing in a boot for four to six weeks. Roomy footwear at three to four months. Full recovery takes six to twelve months. Stiff-soled shoes or carbon fibre insoles may improve comfort."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Fever",
          "Cast feeling too tight",
          "Toes blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks and three months. Metalwork removal may be planned at six to twelve months if symptomatic."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I notice the fusion?",
            "a": "The midfoot joints contribute very little to normal gait. Most patients do not notice significant functional limitation from midfoot fusion."
          },
          {
            "q": "Will the screws need to be removed?",
            "a": "Approximately 30–40% of patients choose screw removal because of prominence on the top of the foot. This is done after fusion is confirmed."
          }
        ]
      }
    ]
  },
  "scaphoid-fixation": {
    "name": "Scaphoid Fracture Fixation",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Scaphoid fracture fixation is an operation to stabilise a broken scaphoid bone in the wrist using a small headless screw. The scaphoid has a vulnerable blood supply, and surgical fixation may be recommended to promote healing and allow earlier return to activity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made on the front or back of the wrist. Under X-ray guidance, a headless compression screw is inserted across the fracture to hold the bone fragments together and promote healing. The operation takes 30–60 minutes and is usually performed as a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced scaphoid fractures, fractures of the proximal pole (which has the poorest blood supply), fractures that have failed to heal with cast treatment (non-union), and in active patients who wish to return to sport or manual work more quickly."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced waist fractures may be treated with a plaster cast (including the thumb) for eight to twelve weeks. Cast treatment has high healing rates for undisplaced fractures but requires prolonged immobilisation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to assess displacement. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "High healing rates (over 95% for acute fixation). Earlier return to function compared to cast treatment. The screw is buried within the bone and does not need removal."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "Small but may be sensitive.",
            "freq": "Common"
          },
          {
            "risk": "Wrist stiffness",
            "detail": "Temporary loss of movement improving with exercises.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "The scaphoid may still fail to heal despite fixation, particularly with proximal pole fractures. May require bone grafting.",
            "freq": "Uncommon"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to part of the scaphoid, causing bone collapse.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw prominence",
            "detail": "The screw may protrude slightly and irritate tendons.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Small sensory nerve branches may be damaged.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, regional, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A splint or cast may be worn for two to six weeks depending on the fracture and fixation. Hand therapy to restore movement and grip strength. Return to desk work within days. Return to sport at six to eight weeks for non-contact activities. Full healing at eight to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent wrist pain",
          "Wound redness or discharge",
          "New weakness or numbness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray and review at six weeks and three months to confirm healing. CT scan may be used to assess union."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is the scaphoid slow to heal?",
            "a": "The scaphoid has a retrograde blood supply — blood enters from one end and travels backwards. This means fractures at the proximal pole have a higher risk of non-union and avascular necrosis."
          },
          {
            "q": "Can the screw be left in permanently?",
            "a": "Yes. The headless screw is buried within the bone and does not normally cause problems. It does not need to be removed."
          }
        ]
      }
    ]
  },
  "wrist-arthroscopy": {
    "name": "Wrist Arthroscopy",
    "region": "Hand & Wrist",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Wrist arthroscopy is a keyhole procedure to diagnose and treat conditions within the wrist joint, including ligament injuries, cartilage damage, and removal of loose bodies.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small incisions (portals) are made on the back of the wrist. A tiny camera is inserted to view the joint surfaces, ligaments, and cartilage. Depending on findings, the surgeon may repair or debride ligament tears (such as the TFCC — triangular fibrocartilage complex), remove loose bodies, treat cartilage damage, or excise inflamed tissue. The procedure typically takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Wrist arthroscopy is considered for persistent wrist pain not explained by imaging, TFCC tears causing clicking or pain on the ulnar (little finger) side of the wrist, scapholunate ligament injuries, ganglion removal, or assessment of articular cartilage damage."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wrist splinting, physiotherapy, anti-inflammatory medication, and corticosteroid injection. Many wrist conditions improve with non-operative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or MR arthrogram may have been performed. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Diagnostic arthroscopy provides definitive assessment of intra-articular pathology. Therapeutic procedures such as TFCC repair or debridement can provide good symptom relief."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling and stiffness",
            "detail": "Expected for one to two weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Portal site tenderness",
            "detail": "Tenderness at the small incision sites.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Sensory nerve branches on the back of the wrist may be damaged, causing numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon injury",
            "detail": "Rare damage to extensor tendons near the portals.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Ongoing symptoms",
            "detail": "Arthroscopy may not resolve all wrist symptoms.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, regional, or local anaesthesia. A traction tower is used to open the joint space."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A splint or bandage for a few days. Gentle wrist exercises begin within the first week. If a TFCC repair was performed, a cast may be needed for four to six weeks. Return to desk work within one to two weeks. Full recovery depends on the procedure performed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing wrist pain",
          "New weakness or numbness",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Follow-up depends on the procedure performed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is a TFCC tear?",
            "a": "The triangular fibrocartilage complex is a cushion and stabiliser on the ulnar side of the wrist. Tears cause pain with gripping, twisting, and pushing movements."
          },
          {
            "q": "Will arthroscopy tell me what is wrong?",
            "a": "Wrist arthroscopy is the most accurate way to assess the inside of the wrist joint and often identifies problems not visible on MRI."
          }
        ]
      }
    ]
  },
  "finger-joint-replacement": {
    "name": "Finger Joint Replacement",
    "region": "Hand & Wrist",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Finger joint replacement (arthroplasty) is an operation to replace a damaged finger joint with an artificial implant, most commonly a silicone spacer. It is performed for painful, stiff finger joints affected by rheumatoid or osteoarthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the affected joint (most commonly the metacarpophalangeal or proximal interphalangeal joint). The damaged joint surfaces are removed and a silicone or pyrocarbon implant is inserted. The ligaments and tendons are repaired around the implant. The operation takes 30–60 minutes per joint."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for painful, deformed, or stiff finger joints that significantly limit hand function and have not responded to medical management. It is most commonly performed for rheumatoid arthritis of the MCP joints."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Disease-modifying medication for rheumatoid arthritis, hand therapy, splinting, corticosteroid injection, and adaptive equipment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Hand therapy assessment. Rheumatoid medication may need adjustment. Multiple joints can be replaced in one operation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to relieve pain, improve finger alignment, and restore functional grip. The replacement provides a stable, pain-free arc of movement rather than a fully normal joint. Patient satisfaction is generally high for pain relief and improved appearance."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited range of motion",
            "detail": "The replaced joint has a functional arc but not full normal movement.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Hand swelling for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrent deviation",
            "detail": "The fingers may drift again over time, particularly in rheumatoid arthritis.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Implant fracture",
            "detail": "Silicone implants can fracture over time. This may or may not cause symptoms and may require revision.",
            "freq": "Long-term"
          },
          {
            "risk": "Implant subsidence or dislocation",
            "detail": "The implant may shift position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection requiring implant removal.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon rupture",
            "detail": "Weakened tendons in rheumatoid disease may rupture.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Regional arm block, general, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hand therapy is essential and begins within the first week. A dynamic splint may be worn for several weeks to guide the fingers into proper alignment. Light use of the hand at four to six weeks. Full recovery takes three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Increasing pain",
          "New inability to straighten or bend the finger",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews with hand therapy. Surgeon review at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does a finger joint replacement last?",
            "a": "Silicone implants typically last 10–15 years. Some fracture earlier but may remain asymptomatic. Pyrocarbon implants may last longer."
          },
          {
            "q": "Can multiple joints be replaced at once?",
            "a": "Yes, multiple MCP joints are commonly replaced in a single operation."
          }
        ]
      }
    ]
  },
  "nail-bed-repair": {
    "name": "Nail Bed Repair",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Nail bed repair is an operation to reconstruct the tissue beneath the fingernail following a crush injury or laceration. It aims to restore normal nail growth and finger appearance.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The damaged fingernail is carefully removed (or lifted if still partially attached). The lacerated nail bed is repaired with fine absorbable stitches under magnification. Any fracture of the underlying bone (distal phalanx) is assessed and managed. The nail (or a substitute) is replaced to act as a splint for the repair and protect the nail fold. The procedure takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Nail bed repair is recommended for significant lacerations of the nail bed, subungual haematomas involving more than 50% of the nail, and displaced fractures of the distal phalanx with nail bed injury. Early repair gives the best chance of normal nail regrowth."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Small, undisplaced injuries with an intact nail may be managed conservatively. Subungual haematomas can sometimes be drained (trephined) without removing the nail."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is usually performed as an urgent day-case procedure. X-ray to assess for an underlying fracture."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The aim is to restore normal nail growth. Meticulous repair gives the best chance, but some nail irregularity is common, particularly with severe injuries. The nail takes four to six months to grow back fully."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Nail irregularity",
            "detail": "Some degree of nail ridging, splitting, or deformity is common despite repair.",
            "freq": "Common"
          },
          {
            "risk": "Sensitivity",
            "detail": "The fingertip may be sensitive for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Fingertip swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-adherence of nail",
            "detail": "The new nail may not fully adhere to the nail bed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or bone infection, particularly with open fractures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nail loss",
            "detail": "In severe injuries, the nail may not regrow.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hook nail",
            "detail": "The nail may curve over the shortened fingertip if bone was lost.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Digital nerve block (ring block) or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A protective dressing and splint for the first two weeks. The replaced nail typically falls off after four to eight weeks as the new nail grows beneath it. Gentle finger movement is encouraged early. Full nail regrowth takes four to six months. The final nail appearance may take up to twelve months to become apparent."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Increasing throbbing pain",
          "Fever",
          "Foul smell from the dressing"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at one to two weeks. Further review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my nail look normal?",
            "a": "Many patients achieve a cosmetically acceptable nail, but some irregularity is common. The final result depends on the severity of the original injury."
          },
          {
            "q": "How long does the nail take to grow back?",
            "a": "Fingernails grow approximately 1 mm per week. Full regrowth takes four to six months."
          }
        ]
      }
    ]
  },
  "distal-biceps-repair": {
    "name": "Distal Biceps Tendon Repair",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal biceps tendon repair is an operation to reattach the biceps tendon to the radius bone at the elbow. Rupture typically occurs during a sudden lifting or pulling injury and results in loss of elbow flexion and forearm rotation strength.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the elbow. The ruptured tendon end is retrieved and prepared. A fixation device (such as a button, anchor, or interference screw) is used to reattach the tendon to the radius bone. The operation takes approximately one hour."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for active patients who wish to restore full elbow and forearm strength. Without repair, there is approximately 30–40% loss of forearm supination strength (turning the palm upward) and approximately 30% loss of elbow flexion strength."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative management is an option for less active patients or those with significant medical risks. The arm remains functional but with reduced strength for heavy lifting and rotation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is ideally performed within two to three weeks of injury, before the tendon retracts and scarring makes repair more difficult. MRI or ultrasound confirms the diagnosis."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of elbow flexion and forearm rotation strength to near-normal levels. Most patients return to full activity including manual work and sport."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar",
            "detail": "Visible scar on the front of the elbow.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary numbness",
            "detail": "Lateral cutaneous nerve of the forearm may be stretched, causing temporary forearm numbness.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of full elbow extension.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation in the soft tissues around the elbow, potentially limiting rotation. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail, particularly if loaded too early. Risk approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Posterior interosseous nerve injury",
            "detail": "Temporary weakness of finger extension. Usually recovers.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Synostosis",
            "detail": "Very rare fusion of the radius and ulna bones, severely limiting rotation.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional arm block anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A hinged elbow brace is worn for six weeks. Gentle movement begins immediately within protected limits. Strengthening starts at three months. Return to manual work at three to four months. Return to sport at four to six months. Full recovery at six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of elbow flexion strength (possible re-rupture)",
          "Wound redness or discharge",
          "New weakness in finger extension",
          "Increasing elbow stiffness",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What happens if I don't have surgery?",
            "a": "The arm remains functional but with approximately 30–40% loss of forearm rotation strength and 30% loss of elbow flexion strength. This is noticeable with heavy lifting and manual work."
          },
          {
            "q": "How did this happen?",
            "a": "Distal biceps ruptures typically occur when a heavy load is lifted with the elbow bent, creating a sudden force on the tendon. They are more common in men aged 30–60."
          }
        ]
      }
    ]
  },
  "slap-repair": {
    "name": "Shoulder SLAP Repair",
    "region": "Sports Medicine",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "SLAP (Superior Labrum Anterior to Posterior) repair is an arthroscopic operation to reattach the torn superior labrum in the shoulder, where the biceps tendon attaches. It is performed for shoulder pain and instability caused by a SLAP tear.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically through small incisions around the shoulder. The torn labrum is identified and reattached to the bone using small suture anchors. In some patients, particularly those over 35, a biceps tenodesis (reattaching the biceps tendon to the humerus instead of repairing the labrum) may be a better option. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "SLAP repair is considered for active patients with symptomatic SLAP tears causing deep shoulder pain, catching, or popping, particularly overhead athletes (throwers, swimmers). The diagnosis should be confirmed with MR arthrogram and clinical examination."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy focusing on rotator cuff and scapular stabiliser strengthening, activity modification, and anti-inflammatory medication. Many SLAP tears are incidental findings on MRI and do not require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MR arthrogram for diagnosis. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of pain and mechanical symptoms. Return to overhead sport is achievable in approximately 70–80% of athletes, though return to pre-injury level is not guaranteed, particularly in throwing athletes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Shoulder stiffness, particularly loss of external rotation, is common after SLAP repair.",
            "freq": "Common"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Not all patients achieve complete relief, particularly overhead athletes.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pain",
            "detail": "Post-operative discomfort is expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Failure of repair",
            "detail": "The labrum may re-tear.",
            "freq": "Uncommon"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Painful stiffness that can develop after surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a nerve block for pain relief."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises begin within the first week. Active movement from six weeks. Strengthening at three months. Return to non-overhead sport at four to six months. Return to overhead sport at six to nine months. Full recovery takes nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Wound discharge or bleeding",
          "Sudden increase in pain",
          "Sensation that the shoulder has shifted"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Should I have a SLAP repair or biceps tenodesis?",
            "a": "In patients over 35 or those with significant biceps tendon wear, tenodesis often provides more reliable results with faster recovery. Your surgeon will recommend the best option for you."
          },
          {
            "q": "Can I return to throwing?",
            "a": "Return to throwing is possible but not guaranteed. Approximately 70–80% of overhead athletes return to sport, though not all return to their pre-injury level."
          }
        ]
      }
    ]
  },
  "hamstring-repair": {
    "name": "Proximal Hamstring Repair",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Proximal hamstring repair is an operation to reattach the hamstring tendons to the sitting bone (ischial tuberosity) after a complete or near-complete avulsion injury. These injuries typically occur during sprinting, lunging, or water skiing.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the crease of the buttock. The retracted hamstring tendons are identified, mobilised, and reattached to the ischial tuberosity using suture anchors. The sciatic nerve is carefully identified and protected throughout. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for complete avulsion of two or more hamstring tendons from the bone, or for significant retraction of the tendons. Without repair, patients experience chronic posterior thigh weakness, pain with sitting, and difficulty running."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Partial tears and single-tendon avulsions may be managed with rest, physiotherapy, and gradual rehabilitation. Complete avulsions managed non-operatively result in significant weakness."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirms the diagnosis and extent of tendon retraction. Surgery is ideally performed within four weeks of injury. Delayed repair is more difficult."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of hamstring strength and function. Most patients return to sporting activity, though full strength recovery may take six to twelve months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Posterior thigh numbness",
            "detail": "Cutaneous nerve branches may be divided, causing numbness on the back of the thigh.",
            "freq": "Common"
          },
          {
            "risk": "Sitting discomfort",
            "detail": "Tenderness over the sitting bone may persist for several months.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Hamstring tightness requiring stretching.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Sciatic nerve injury",
            "detail": "The sciatic nerve is close to the surgical field. Injury can cause leg weakness or numbness. Careful identification reduces this risk.",
            "freq": "Rare"
          },
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail, particularly with premature loading.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Persistent weakness",
            "detail": "Some degree of strength deficit compared to the uninjured side may persist.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. The patient is positioned prone (face down)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for six weeks with restricted hip flexion. A brace may limit range of motion initially. Gentle stretching begins at six weeks. Running at three to four months. Return to sport at six to nine months. Full recovery at nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "New leg weakness or numbness (possible sciatic nerve issue)",
          "Wound redness, swelling, or discharge",
          "Severe posterior thigh pain",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does this injury happen?",
            "a": "Proximal hamstring avulsions typically occur during rapid hip flexion with the knee extended, such as during sprinting, water skiing, or a splits-type movement."
          },
          {
            "q": "Why is early surgery important?",
            "a": "The tendons retract after rupture. Early repair (within four weeks) is technically easier and produces better outcomes than delayed repair."
          }
        ]
      }
    ]
  },
  "quad-tendon-repair": {
    "name": "Quadriceps Tendon Repair",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Quadriceps tendon repair is an operation to reattach the ruptured quadriceps tendon to the top of the kneecap (patella). Rupture prevents the ability to straighten the knee against gravity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the knee above the kneecap. The torn tendon ends are identified and stitched together using strong sutures passed through drill holes in the patella or via suture anchors. The repair may be reinforced with a protective suture or wire. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is essential for complete quadriceps tendon ruptures as the tendon cannot heal on its own and the patient cannot straighten the knee or walk normally without it."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Partial tears may be managed with bracing and physiotherapy. Complete ruptures always require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Surgery is ideally performed within two weeks of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the ability to straighten the knee, walk, and return to activities. Most patients achieve good functional outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Loss of knee flexion is common initially.",
            "freq": "Common"
          },
          {
            "risk": "Quadriceps weakness",
            "detail": "Some residual weakness compared to the other side.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Patella alta",
            "detail": "The kneecap may sit higher than normal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A hinged brace for six to twelve weeks with gradually increasing flexion. Weight-bearing in the brace with the knee locked straight. Physiotherapy essential. Running at four to six months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of ability to straighten the knee",
          "Increasing knee swelling",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this different from a patellar tendon rupture?",
            "a": "Yes. The quadriceps tendon is above the kneecap; the patellar tendon is below it. Quadriceps ruptures are more common in patients over 40."
          },
          {
            "q": "Will I return to full function?",
            "a": "Most patients regain good function with dedicated rehabilitation, though some strength deficit may persist."
          }
        ]
      }
    ]
  },
  "biceps-tenodesis": {
    "name": "Proximal Biceps Tenodesis",
    "region": "Sports Medicine",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Proximal biceps tenodesis is an operation to detach the long head of the biceps tendon from inside the shoulder joint and reattach it to the upper arm bone (humerus). It is performed for painful biceps tendon conditions and as an alternative to SLAP repair in some patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure can be performed arthroscopically, through a small open incision, or as a combination. The long head of the biceps tendon is released from its attachment inside the shoulder joint and fixed to the humerus using a screw, button, or suture anchor in the bicipital groove. The operation takes 30–60 minutes and is often combined with other shoulder procedures."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Biceps tenodesis is recommended for painful SLAP tears (particularly in patients over 35), biceps tendinitis or tendinopathy that has not responded to non-operative treatment, partial biceps tendon tears, and as part of rotator cuff repair when the biceps is damaged."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, corticosteroid injection, activity modification, and anti-inflammatory medication. SLAP repair is an alternative for younger patients with SLAP tears."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or MR arthrogram for assessment. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief and preservation of biceps muscle strength and appearance. Recovery is generally faster and more predictable than SLAP repair, particularly in patients over 35."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Anterior shoulder pain",
            "detail": "Tenderness at the tenodesis site may persist for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary shoulder stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Failure of fixation",
            "detail": "The tenodesis may pull out, causing a 'Popeye' deformity of the biceps muscle. Functionally this is rarely significant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Very rare fracture of the humerus at the fixation site.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Musculocutaneous nerve injury is very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for two to four weeks. Gentle exercises begin immediately. Active biceps loading restricted for six weeks. Return to sport at three to four months. Full recovery at four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Fever or feeling systemically unwell",
          "New numbness or weakness",
          "Wound discharge or bleeding"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks and six weeks. Physiotherapy as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my biceps look different?",
            "a": "In most cases, the biceps muscle appearance is preserved. Occasionally, if the tenodesis fails, the muscle may bunch slightly ('Popeye sign'), but this is usually cosmetic only."
          },
          {
            "q": "Why tenodesis instead of SLAP repair?",
            "a": "In patients over 35, tenodesis provides more reliable pain relief with faster recovery. The labrum in older patients heals less predictably, making tenodesis a better option."
          }
        ]
      }
    ]
  },
  "bone-biopsy": {
    "name": "Bone Biopsy",
    "region": "Tumour & Rare",
    "tag": "Diagnostic",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A bone biopsy is a procedure to take a sample of bone tissue for examination under a microscope. It is performed to diagnose bone lesions, tumours, infections, or other conditions that cannot be conclusively identified through imaging alone.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A biopsy can be performed as a needle biopsy (using a special needle inserted through the skin under X-ray or CT guidance) or as an open biopsy (through a small surgical incision). The sample is sent to the laboratory for analysis. Needle biopsy takes 30–60 minutes; open biopsy takes approximately one hour."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Biopsy is essential for diagnosing bone tumours (benign or malignant), suspected bone infection (osteomyelitis), unexplained bone lesions seen on imaging, and metabolic bone diseases when the diagnosis is uncertain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "In some cases, imaging (MRI, CT, bone scan, PET-CT) may be sufficient for diagnosis. However, definitive tissue diagnosis often requires a biopsy, particularly when malignancy is a possibility."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Blood tests including clotting studies. The biopsy site and approach are carefully planned to avoid contaminating uninvolved tissue compartments, as this is critical if further surgery is needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive tissue diagnosis that guides treatment. This information is essential for planning surgery, chemotherapy, radiotherapy, or antibiotic treatment."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain at biopsy site",
            "detail": "Soreness at the biopsy site for several days.",
            "freq": "Expected"
          },
          {
            "risk": "Bruising",
            "detail": "Local bruising.",
            "freq": "Common"
          },
          {
            "risk": "Inconclusive result",
            "detail": "The biopsy may not provide enough tissue for a definitive diagnosis, requiring a repeat procedure.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Risk of introducing infection, particularly into bone.",
            "freq": "Rare"
          },
          {
            "risk": "Fracture",
            "detail": "Weakening of the bone at the biopsy site, potentially causing a pathological fracture.",
            "freq": "Rare"
          },
          {
            "risk": "Bleeding",
            "detail": "Significant bleeding from the biopsy site.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Damage to structures near the biopsy site.",
            "freq": "Rare"
          },
          {
            "risk": "Tumour seeding",
            "detail": "Very rare spread of tumour cells along the biopsy tract. Careful technique minimises this risk.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Needle biopsy: usually local anaesthesia with sedation. Open biopsy: general or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "For needle biopsy: a dressing over the puncture site, rest for 24 hours, and avoid heavy loading of the area for a few days. For open biopsy: a wound dressing, stitches removed at 10–14 days, and activity restrictions depending on the location and findings."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain or swelling at the biopsy site",
          "Fever",
          "Wound discharge",
          "Sudden pain suggesting fracture"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Results are typically available within one to two weeks. A follow-up appointment to discuss results and plan treatment is arranged."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is biopsy placement so important?",
            "a": "The biopsy tract must be placed so that it can be removed during any subsequent surgery. Poorly placed biopsies can complicate definitive treatment. This is why biopsies of suspected tumours should be performed at or in consultation with a specialist tumour centre."
          },
          {
            "q": "How long do results take?",
            "a": "Preliminary results may be available within a few days. Definitive diagnosis, including special stains and molecular testing, may take one to two weeks."
          }
        ]
      }
    ]
  },
  "soft-tissue-excision": {
    "name": "Soft Tissue Tumour Excision",
    "region": "Tumour & Rare",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Soft tissue tumour excision is an operation to remove a lump or mass from the soft tissues (muscle, fat, or connective tissue). Most soft tissue lumps are benign (such as lipomas), but excision may be recommended for diagnosis, symptom relief, or if malignancy is suspected.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the lump. The tumour is carefully dissected from the surrounding tissues and removed, ideally with a margin of normal tissue if malignancy is suspected. The specimen is sent for pathological examination. The wound is closed with stitches. The operation takes 30 minutes to two hours depending on size and location."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Excision is recommended for enlarging lumps, lumps causing pain or functional limitation, lumps where the diagnosis is uncertain, and confirmed or suspected sarcomas (malignant tumours). Any lump that is deep to the fascia, larger than 5 cm, or increasing in size should be investigated."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation may be appropriate for small, superficial, asymptomatic lumps that are clinically consistent with a lipoma. Imaging (ultrasound, MRI) can help characterise the lesion. Biopsy may be performed first if the diagnosis is uncertain."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and/or ultrasound to characterise the lesion. If malignancy is suspected, the case should be discussed at a specialist multidisciplinary team meeting. The surgical approach is carefully planned."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete removal of the lump with definitive histological diagnosis. For benign lesions, excision is usually curative. For malignant lesions (sarcomas), surgery is the primary treatment and may be combined with radiotherapy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar",
            "detail": "A scar proportional to the size of the lump.",
            "freq": "Expected"
          },
          {
            "risk": "Bruising and swelling",
            "detail": "Expected around the surgical site.",
            "freq": "Expected"
          },
          {
            "risk": "Seroma",
            "detail": "A collection of fluid may accumulate after removal of a large lump.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Nerves near the tumour may be damaged during excision, causing numbness or weakness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Benign lesions may occasionally recur. Sarcomas have a risk of local recurrence depending on margins achieved.",
            "freq": "Uncommon"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection requiring drainage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Functional deficit",
            "detail": "If the tumour is within or adjacent to a muscle, some weakness may result.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia depending on the size and location."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery depends on size and location. Small superficial excisions heal within two weeks. Larger or deeper excisions may require several weeks of rehabilitation. Physiotherapy may be needed if the excision involved muscle tissue."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Increasing pain",
          "Fever",
          "Fluid leaking from the wound"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Histology results at two weeks. Further follow-up depends on the diagnosis. Malignant lesions require long-term surveillance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do I know if a lump is serious?",
            "a": "Warning features include a lump that is deep to the fascia, larger than 5 cm, increasing in size, painful, or fixed to surrounding structures. Any lump with these features should be assessed by a specialist."
          },
          {
            "q": "What if it turns out to be cancer?",
            "a": "Soft tissue sarcomas are rare. If diagnosed, treatment is planned by a specialist multidisciplinary team and typically involves surgery with or without radiotherapy."
          }
        ]
      }
    ]
  },
  "joint-aspiration": {
    "name": "Joint Aspiration",
    "region": "Tumour & Rare",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Joint aspiration (arthrocentesis) is a procedure to remove fluid from a joint using a needle and syringe. It is performed for diagnostic purposes (to analyse the fluid) or for therapeutic relief of a swollen, painful joint.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The skin over the joint is cleaned with antiseptic. Local anaesthetic is injected to numb the area. A needle is inserted into the joint space and fluid is withdrawn. The fluid may be sent for analysis (microscopy, culture, crystal analysis). A corticosteroid injection may be given into the joint at the same time. The procedure takes 10–15 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Joint aspiration is recommended for diagnosis of joint infection (septic arthritis — a surgical emergency), crystal arthropathy (gout, pseudogout), inflammatory arthritis flare, and unexplained joint effusion. It is also used therapeutically to drain large, uncomfortable joint effusions."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Blood tests and imaging can provide useful information but cannot definitively diagnose joint infection or crystal arthropathy. When infection is suspected, joint aspiration is essential and urgent."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No fasting required. Inform the team about blood-thinning medications. The procedure can usually be performed in clinic or at the bedside."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive diagnosis of the cause of joint swelling. Therapeutic relief from draining a tense, painful effusion. If corticosteroid is injected, additional pain relief over the following days."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Discomfort",
            "detail": "Brief pain during needle insertion. Local anaesthetic minimises this.",
            "freq": "Expected"
          },
          {
            "risk": "Bruising",
            "detail": "Minor bruising at the needle site.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence of effusion",
            "detail": "The fluid may reaccumulate if the underlying cause is not treated.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Introduction of infection into the joint. Risk approximately 1 in 10,000 to 1 in 50,000 with proper sterile technique.",
            "freq": "Rare"
          },
          {
            "risk": "Bleeding",
            "detail": "Significant bleeding into the joint (haemarthrosis). Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon or cartilage damage",
            "detail": "Very rare with proper needle placement.",
            "freq": "Rare"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary increase in pain for 24–48 hours after corticosteroid injection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic only. No sedation or general anaesthesia required."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "No significant recovery period. The joint may feel more comfortable immediately after fluid removal. Rest the joint for 24 hours after the procedure. If a corticosteroid was injected, avoid heavy loading for 48 hours."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing joint pain, warmth, or swelling after the procedure (possible infection)",
          "Fever or feeling unwell",
          "Redness spreading from the needle site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Fluid analysis results are usually available within 24–48 hours (urgent microscopy and culture) to one week (crystal analysis). Follow-up depends on the results."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is the procedure painful?",
            "a": "There is brief discomfort from the local anaesthetic injection and needle insertion. Most patients tolerate it well."
          },
          {
            "q": "How quickly will I get results?",
            "a": "If joint infection is suspected, initial microscopy results are available within hours. Culture results take 24–48 hours. Crystal analysis is usually available within 24 hours."
          }
        ]
      }
    ]
  },
  "bone-cyst-curettage": {
    "name": "Bone Cyst Curettage and Grafting",
    "region": "Tumour & Rare",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Bone cyst curettage and grafting is an operation to scrape out a benign bone cyst or tumour and fill the cavity with bone graft. It is performed for symptomatic benign bone lesions such as unicameral bone cysts, aneurysmal bone cysts, and giant cell tumours.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the affected bone. A window is created in the bone cortex. The cyst lining is thoroughly scraped out (curettage) using special curettes. The cavity may be treated with phenol, hydrogen peroxide, or liquid nitrogen to reduce recurrence. The cavity is then filled with bone graft (autograft, allograft, or synthetic substitute). The bone window is closed or covered with a plate. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a bone cyst causes pain, fracture risk, or has already caused a pathological fracture. It is also performed when the diagnosis needs to be confirmed with tissue analysis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Small, asymptomatic cysts may be observed with periodic imaging. Corticosteroid injection into some bone cysts (particularly unicameral bone cysts in children) may promote healing. Pathological fractures through bone cysts sometimes heal and allow the cyst to resolve."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for characterisation and planning. Biopsy may have been performed first."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Resolution of the cyst, reduction of fracture risk, and pain relief. Healing rates depend on the type of lesion and completeness of curettage."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "Benign bone tumours may recur despite thorough curettage. Recurrence rates vary: 10–30% for aneurysmal bone cysts, 15–25% for giant cell tumours.",
            "freq": "Common"
          },
          {
            "risk": "Pain and swelling",
            "detail": "Expected at the surgical site.",
            "freq": "Expected"
          },
          {
            "risk": "Graft site pain",
            "detail": "If autograft bone was harvested (usually from the pelvis), the donor site may be sore.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fracture",
            "detail": "The bone may be weakened during or after surgery. Weight-bearing restrictions reduce this risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or bone infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Depending on the location of the cyst.",
            "freq": "Rare"
          },
          {
            "risk": "Joint damage",
            "detail": "If the cyst is near a joint surface.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions may apply for four to eight weeks depending on the bone involved and the size of the defect. Physiotherapy to restore movement and strength. Return to activity is guided by X-ray evidence of graft incorporation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain or swelling",
          "Fever",
          "Wound redness or discharge",
          "Sudden pain suggesting fracture"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Histology results at two weeks. Regular X-rays to monitor graft incorporation and check for recurrence. Long-term follow-up for two to five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the cyst come back?",
            "a": "There is a risk of recurrence depending on the type of lesion. Regular follow-up imaging is performed to detect recurrence early."
          },
          {
            "q": "What fills the hole in the bone?",
            "a": "Bone graft (from the patient, a donor, or synthetic material) fills the cavity. Over time, the graft incorporates and is replaced by normal bone."
          }
        ]
      }
    ]
  },
  "synovectomy": {
    "name": "Synovectomy",
    "region": "Tumour & Rare",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Synovectomy is an operation to remove the inflamed or diseased synovial lining of a joint. It is performed for conditions such as pigmented villonodular synovitis (PVNS), synovial chondromatosis, or inflammatory arthritis that has not responded to medical treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure may be performed arthroscopically (keyhole) or as an open operation, depending on the extent of disease and the joint involved. The diseased synovial tissue is identified and carefully removed using shavers, curettes, or surgical instruments. In PVNS, the goal is to remove as much abnormal tissue as possible. The operation takes one to three hours depending on the extent of disease."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Synovectomy is recommended for PVNS (a benign but locally aggressive condition causing recurrent bloody joint effusions), synovial chondromatosis (formation of cartilage nodules within the synovium), and occasionally for rheumatoid arthritis not responding to modern disease-modifying medications."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For PVNS: observation is sometimes appropriate for diffuse disease that is not causing significant symptoms. For rheumatoid arthritis: optimisation of disease-modifying medication is the primary treatment. Radiotherapy or radiosynovectomy (injection of a radioactive substance) may be used as adjuncts."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess the extent of synovial disease. Blood tests. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduction of joint swelling, pain, and recurrent effusions. For PVNS, synovectomy reduces disease burden and may prevent joint damage, though recurrence is common with diffuse disease."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "PVNS has a high recurrence rate (20–50% for diffuse disease) despite thorough synovectomy.",
            "freq": "Common"
          },
          {
            "risk": "Joint stiffness",
            "detail": "Common after extensive synovectomy. Aggressive physiotherapy is important.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged joint swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve or vessel injury",
            "detail": "Extensive synovectomy may risk nearby neurovascular structures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Haemarthrosis",
            "detail": "Bleeding into the joint after surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Joint damage",
            "detail": "Aggressive removal may damage cartilage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive physiotherapy begins immediately to prevent stiffness. Weight-bearing as tolerated. Recovery takes four to twelve weeks depending on the joint and extent of surgery. Long-term follow-up is essential, particularly for PVNS."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing joint swelling or pain",
          "Fever",
          "Wound problems",
          "Recurrent bloody joint effusions"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with MRI to monitor for recurrence. For PVNS, follow-up for at least five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is PVNS?",
            "a": "Pigmented villonodular synovitis is a benign but locally aggressive condition where the synovial lining grows abnormally, causing recurrent bloody joint swelling, pain, and eventually joint damage. It can be localised (nodular) or diffuse."
          },
          {
            "q": "Will the disease come back?",
            "a": "Localised PVNS has a low recurrence rate after complete excision. Diffuse PVNS has a high recurrence rate (up to 50%) and may require repeat surgery, radiotherapy, or emerging targeted medications."
          }
        ]
      }
    ]
  },
  "humeral-shaft-fixation": {
    "name": "Humeral Shaft Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Humeral shaft fracture fixation is an operation to realign and stabilise a fracture of the upper arm bone (humerus) using a plate and screws or an intramedullary nail. Surgery is considered when the fracture is significantly displaced, has associated nerve injury, or cannot be adequately managed with a brace.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For plating: an incision is made along the upper arm. The fracture is exposed, realigned, and fixed with a metal plate and screws. For nailing: a rod is inserted through the shoulder into the canal of the humerus under X-ray guidance. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced fractures that cannot be maintained in alignment with a brace, fractures with associated radial nerve palsy, open fractures, fractures that extend into the shoulder or elbow joint, and bilateral fractures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "A functional brace (Sarmiento brace) is effective for many humeral shaft fractures, with union rates exceeding 90%. The brace allows gravity to align the fracture while the arm heals over six to twelve weeks."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Surgery may be performed urgently or planned within days."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of arm alignment and length, allowing earlier rehabilitation. Union rates with fixation exceed 95%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder or elbow stiffness",
            "detail": "Common, particularly with nailing (shoulder) or plating (elbow approach).",
            "freq": "Common"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate may be palpable under the skin.",
            "freq": "Common"
          },
          {
            "risk": "Radial nerve palsy",
            "detail": "The radial nerve wraps around the humerus and is at risk during plating. New palsy occurs in approximately 2-5% and usually recovers.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Radial nerve injury (permanent)",
            "detail": "Permanent damage is rare but can cause wrist and finger drop.",
            "freq": "Rare"
          },
          {
            "risk": "Non-union",
            "detail": "Failure to heal requiring further surgery. Approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection around metalwork.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned supine (plating) or beach-chair/lateral (nailing)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A sling for comfort for two to four weeks. Gentle shoulder and elbow exercises begin early. Return to desk work at two to four weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Wrist drop or inability to extend fingers (radial nerve palsy)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the radial nerve recover?",
            "a": "Most radial nerve palsies from humeral fractures recover over three to six months. If there is no recovery, nerve studies and possible exploration may be needed."
          },
          {
            "q": "Can I use a brace instead?",
            "a": "Many humeral shaft fractures heal well with a functional brace. Your surgeon will discuss whether surgery or bracing is best for your specific fracture."
          }
        ]
      }
    ]
  },
  "distal-humerus-fixation": {
    "name": "Distal Humerus Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal humerus fracture fixation is an operation to repair a fracture of the lower end of the upper arm bone where it forms the elbow joint. These fractures often involve the joint surface and require precise reconstruction.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made at the back of the elbow. The ulnar nerve is identified and protected. If needed, the olecranon (elbow tip) is cut to allow access to the joint surface (olecranon osteotomy). The fracture fragments are anatomically reconstructed and fixed with plates and screws — usually two plates at right angles. The olecranon is repaired. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Almost all displaced distal humerus fractures in adults require surgery because the joint surface must be accurately restored. Without surgery, the elbow heals stiff and painful."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative treatment with a cast or splint may be considered in elderly patients with significant medical comorbidities, accepting limited function. Total elbow replacement may be an alternative in elderly patients with severely comminuted fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for planning. Surgery within days of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the elbow joint surface to allow a functional range of motion. Most patients achieve a useful arc of movement, though some loss of full extension is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Elbow stiffness",
            "detail": "Very common. Some loss of full extension is expected. Physiotherapy is critical.",
            "freq": "Expected"
          },
          {
            "risk": "Ulnar nerve symptoms",
            "detail": "Numbness or tingling in the ring and little fingers, usually temporary.",
            "freq": "Common"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "Plates may be palpable and may require removal.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation limiting movement. Preventive medication may be given.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Failure to heal. May require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Ulnar nerve injury",
            "detail": "Permanent nerve damage requiring transposition.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around metalwork.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Arthritis may develop over time.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with regional arm block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early movement is critical. Physiotherapy begins within the first few days. Splinting between exercise sessions for protection. Return to desk work at four to six weeks. Full recovery six to twelve months. Some permanent loss of extension is common."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing elbow stiffness despite exercises",
          "New numbness in ring and little fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I regain full movement?",
            "a": "Most patients achieve a functional range (approximately 30-130 degrees). Some loss of full extension is common but rarely causes functional problems."
          },
          {
            "q": "Why is early movement so important?",
            "a": "The elbow is very prone to stiffness after injury and surgery. Early, supervised movement prevents scar tissue from forming and locking the joint."
          }
        ]
      }
    ]
  },
  "forearm-fixation": {
    "name": "Forearm Fracture Fixation (Both Bones)",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Forearm fracture fixation is an operation to realign and stabilise fractures of both the radius and ulna bones in the forearm using plates and screws. Both bones must be accurately restored to allow normal forearm rotation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Separate incisions are made over the radius (front of forearm) and ulna (back of forearm). Each fracture is reduced and fixed with a contoured plate and screws. Restoring the exact curvature of the radius is critical for rotation. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Almost all displaced forearm fractures in adults require surgery. The radius and ulna must rotate around each other for normal forearm function, and any malalignment significantly impairs rotation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced fractures may be managed in a cast. In children, many forearm fractures remodel and can be treated non-operatively. In adults, displaced fractures almost always require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Surgery usually within days."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of forearm alignment and rotation. Union rates exceed 95% with plate fixation. Most patients regain good forearm rotation and grip strength."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Forearm stiffness",
            "detail": "Some loss of full pronation or supination is common.",
            "freq": "Common"
          },
          {
            "risk": "Scar",
            "detail": "Two incisions produce visible scars.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Synostosis",
            "detail": "Rare formation of a bony bridge between the radius and ulna, blocking rotation. Risk approximately 2-3%.",
            "freq": "Rare"
          },
          {
            "risk": "Non-union",
            "detail": "Failure of one or both fractures to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Posterior interosseous nerve (radius) or sensory nerves at risk.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A surgical emergency. More common in high-energy injuries.",
            "freq": "Rare"
          },
          {
            "risk": "Re-fracture after plate removal",
            "detail": "If plates are removed after healing.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A splint for comfort for one to two weeks. Active forearm rotation begins early. Return to desk work at two to four weeks. Manual work at eight to twelve weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Severe forearm tightness or swelling (possible compartment syndrome — seek urgent help)",
          "Loss of finger movement"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I regain full rotation?",
            "a": "Most patients regain 80-90% of normal rotation. Some loss is common but rarely causes functional problems for daily activities."
          },
          {
            "q": "Should the plates be removed?",
            "a": "Not routinely. Forearm plates are only removed if they cause problems. However, in young active patients, removal may be discussed after confirmed healing."
          }
        ]
      }
    ]
  },
  "patella-fixation": {
    "name": "Patella (Kneecap) Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Patella fracture fixation is an operation to repair a broken kneecap using wires, screws, or plates. The kneecap is an essential part of the knee's extensor mechanism and must be accurately restored to allow straightening of the leg.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the knee. The fracture fragments are realigned and fixed — typically with tension band wiring (two wires and a figure-of-eight wire), screws, or occasionally a plate. If the kneecap is shattered beyond repair (comminuted), partial or total patellectomy (removal) may be necessary. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced patella fractures that disrupt the extensor mechanism, preventing the patient from actively straightening the knee."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced fractures with an intact extensor mechanism can be managed in a cylinder cast or knee brace for four to six weeks."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Surgery within days of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the extensor mechanism allowing active knee extension. Most patients achieve a functional knee, though some loss of full flexion is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prominent metalwork",
            "detail": "Wires and plates sit just beneath thin skin over the kneecap. Irritation is very common.",
            "freq": "Common"
          },
          {
            "risk": "Knee stiffness",
            "detail": "Some loss of full flexion is expected.",
            "freq": "Common"
          },
          {
            "risk": "Anterior knee pain",
            "detail": "Discomfort at the front of the knee with kneeling.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wire migration",
            "detail": "Wires can break or migrate. Metalwork removal is common.",
            "freq": "Common"
          },
          {
            "risk": "Non-union",
            "detail": "Failure to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Arthritis of the patellofemoral joint may develop.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Loss of fixation",
            "detail": "The repair may fail if loaded too early.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing as tolerated in a brace. Range of motion exercises begin early under physiotherapy guidance. Brace removed at six weeks. Metalwork removal is frequently required after healing. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Wire protruding through skin",
          "Inability to straighten the knee"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the wires need to be removed?",
            "a": "Approximately 50-60% of patients require metalwork removal due to wire prominence or irritation. This is done after the fracture has healed."
          },
          {
            "q": "Can I kneel after a patella fracture?",
            "a": "Kneeling may remain uncomfortable long-term due to the scar and metalwork. This improves after metalwork removal."
          }
        ]
      }
    ]
  },
  "distal-femur-fixation": {
    "name": "Distal Femur Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal femur fracture fixation is an operation to repair a fracture of the lower end of the thighbone near the knee joint using plates and screws or an intramedullary nail. These fractures often involve the knee joint surface.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the knee and lower thigh. The joint surface is reconstructed anatomically and fixed with screws. A locking plate or retrograde intramedullary nail is then applied to stabilise the shaft component. The operation takes one and a half to three hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is required for almost all displaced distal femur fractures to restore the joint surface and allow rehabilitation. These fractures are common in elderly patients with osteoporosis and in high-energy injuries in younger patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Rarely appropriate for displaced fractures. Undisplaced fractures may be managed in a hinged knee brace with restricted weight-bearing."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for joint surface planning. Surgery within days of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the knee joint surface and femoral alignment. Most patients achieve a functional knee, though recovery is prolonged."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Very common. Aggressive physiotherapy is essential.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Significant thigh and knee swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant blood loss. Transfusion may be needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union or delayed union",
            "detail": "Distal femur fractures can be slow to heal. May require bone grafting.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Healing in an imperfect position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "If the joint surface was involved.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around metalwork.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "In patients with existing knee replacements.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on fracture pattern and fixation — often restricted for six to twelve weeks. Knee range of motion exercises begin within the first few days. Physiotherapy is critical. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Increasing knee swelling or inability to bend the knee"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When can I put weight on the leg?",
            "a": "This depends on the fracture pattern and quality of fixation. Your surgeon will guide weight-bearing progression."
          },
          {
            "q": "Will I need a knee replacement?",
            "a": "If significant post-traumatic arthritis develops years later, knee replacement may eventually be needed."
          }
        ]
      }
    ]
  },
  "acetabular-fixation": {
    "name": "Acetabular (Hip Socket) Fracture Fixation",
    "region": "Pelvis & Acetabulum",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Acetabular fracture fixation is a complex operation to reconstruct a fracture of the hip socket (acetabulum). Accurate restoration of the joint surface is essential to prevent early hip arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical approach depends on the fracture pattern and may involve an incision at the front of the hip (ilioinguinal approach), back of the hip (Kocher-Langenbeck), or both. The fracture fragments are anatomically realigned under direct vision and fixed with plates and screws. The operation is technically demanding and takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced acetabular fractures to restore the hip joint surface. Without accurate reconstruction, the incongruent joint surface leads to rapid arthritis and the need for early hip replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced fractures with a congruent hip joint may be managed with restricted weight-bearing for six to twelve weeks. In elderly patients with comminuted fractures, acute total hip replacement may be a better option than attempted fixation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with 3D reconstruction for planning. Surgery ideally within five to ten days, after swelling settles. These operations are performed at specialist centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Accurate restoration of the hip joint surface giving the best chance of a good long-term outcome. Approximately 70-80% of patients with anatomic reduction achieve a satisfactory result."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Hip stiffness",
            "detail": "Common after acetabular surgery.",
            "freq": "Common"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation around the hip. Preventive medication or radiotherapy may be used.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant. Transfusion usually required.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "These are major injuries with six to twelve month recovery.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Sciatic nerve injury",
            "detail": "The sciatic nerve is at risk, particularly with posterior approaches. Occurs in approximately 5% and usually recovers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Despite good reduction, arthritis may develop. Up to 20% of patients eventually require hip replacement.",
            "freq": "Long-term"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the femoral head.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep vein thrombosis",
            "detail": "High risk with pelvic surgery.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malreduction",
            "detail": "The fracture may not be perfectly reduced despite best efforts.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Significant blood loss requires transfusion capability. Cell salvage may be used."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for six to twelve weeks. DVT prophylaxis for several weeks. Physiotherapy for hip range of motion and strengthening. Return to desk work at six to eight weeks. Full recovery six to twelve months. Long-term monitoring for arthritis."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Hip feeling unstable or clunking",
          "Increasing difficulty walking after initial improvement"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, six months, and one year. Long-term surveillance for arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I need a hip replacement?",
            "a": "Approximately 20% of patients with acetabular fractures eventually require hip replacement, even after good surgical reduction. The risk depends on the original cartilage damage."
          },
          {
            "q": "Why is this done at a specialist centre?",
            "a": "Acetabular surgery is technically demanding and requires specialist training and equipment. Outcomes are better at high-volume centres."
          }
        ]
      }
    ]
  },
  "si-joint-fixation": {
    "name": "Sacroiliac Joint Fixation",
    "region": "Pelvis & Acetabulum",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Sacroiliac (SI) joint fixation is a minimally invasive procedure to stabilise the sacroiliac joint using screws placed under X-ray guidance. It is performed for traumatic SI joint disruption or sacral fractures as part of pelvic ring injuries.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray or CT guidance, one or two large screws are inserted percutaneously (through small skin incisions) across the sacroiliac joint into the sacrum. This stabilises the posterior pelvic ring. The procedure takes approximately one hour."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "SI joint fixation is part of the treatment for unstable pelvic ring injuries where the posterior ring is disrupted. The posterior pelvic ring carries 60% of the body's weight through the pelvis, so stabilisation is essential for weight-bearing."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stable SI joint injuries may be managed with restricted weight-bearing. Unstable injuries require fixation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for screw trajectory planning. May be performed urgently."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Stabilisation of the posterior pelvic ring allowing progressive weight-bearing and rehabilitation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Screw prominence",
            "detail": "The screw heads may be palpable in the buttock.",
            "freq": "Common"
          },
          {
            "risk": "Buttock pain",
            "detail": "Discomfort around the screw site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve root injury",
            "detail": "L5 and S1 nerve roots are at risk during screw placement. Injury can cause leg weakness or numbness. Risk approximately 2-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw malposition",
            "detail": "The screw may be placed outside the ideal corridor, requiring repositioning.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Failure of the SI joint to stabilise.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Pin-site or deep infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone or supine."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions for six to twelve weeks depending on the pelvic ring injury pattern. Crutches or frame for mobilisation. Physiotherapy for hip and core strengthening."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "New leg weakness or numbness",
          "Wound redness or discharge around screw sites",
          "Fever",
          "Difficulty with bladder or bowel function"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this a big operation?",
            "a": "No, SI joint fixation is minimally invasive — performed through small incisions under X-ray guidance. However, the underlying pelvic injury is significant."
          }
        ]
      }
    ]
  },
  "latarjet": {
    "name": "Latarjet Procedure",
    "region": "Shoulder",
    "tag": "Instability",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "The Latarjet procedure is an open operation to treat recurrent shoulder dislocations by transferring a piece of bone (coracoid process) with its attached muscles to the front of the shoulder socket. It is used when there is significant bone loss from the socket or when arthroscopic Bankart repair has failed.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the shoulder. The coracoid process (a small bony projection) with the attached conjoint tendon is cut and transferred to the front of the glenoid (shoulder socket), where it is fixed with two screws. This creates a bony block that prevents the humeral head from dislocating and the transferred muscles provide a dynamic sling effect. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Latarjet is recommended for recurrent shoulder instability with significant glenoid bone loss (typically more than 15-20%), failed previous Bankart repair, instability in collision athletes or military personnel, and engaging Hill-Sachs lesions."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy for muscle strengthening and proprioception, activity modification, and bracing. Arthroscopic Bankart repair is the main surgical alternative when bone loss is minimal."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to quantify glenoid bone loss. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The Latarjet has a recurrence rate of approximately 2-5%, which is lower than arthroscopic Bankart repair. It is particularly effective in patients with bone loss and contact athletes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of external rotation",
            "detail": "Some reduction in external rotation is expected. Usually 10-15 degrees and rarely functionally significant.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary shoulder stiffness improving with physiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Scar",
            "detail": "Visible scar over the front of the shoulder.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union of coracoid",
            "detail": "The transferred bone may fail to heal in its new position. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Musculocutaneous and axillary nerves are at risk. Usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Screw prominence or loosening",
            "detail": "May require removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft fracture",
            "detail": "The coracoid may fracture during transfer.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrent instability",
            "detail": "Despite surgery, approximately 2-5% risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Arthritis",
            "detail": "Long-term risk if screws protrude into the joint or the graft is over-medialised.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from the first week. Active movement from six weeks. Strengthening from three months. Return to non-contact sport at three to four months. Contact sport at six months. Full recovery six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sensation that the shoulder has dislocated",
          "Clicking or grinding in the shoulder"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews with X-rays at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why Latarjet instead of Bankart repair?",
            "a": "The Latarjet is chosen when there is significant bone loss from the socket, as a Bankart repair alone has a higher failure rate in this situation. The bone block restores the socket anatomy."
          },
          {
            "q": "Can I return to rugby/football?",
            "a": "Yes, the Latarjet is particularly effective for contact athletes. Return to contact sport is typically at six months."
          }
        ]
      }
    ]
  },
  "subscapularis-repair": {
    "name": "Subscapularis Repair",
    "region": "Shoulder",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Subscapularis repair is an operation to reattach the subscapularis tendon — the largest and strongest rotator cuff tendon — to the front of the humerus. It is performed for tears caused by injury or degeneration.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure may be performed arthroscopically or through an open incision at the front of the shoulder. The torn subscapularis tendon is identified, mobilised, and reattached to its footprint on the lesser tuberosity using suture anchors. The biceps tendon, which is commonly damaged with subscapularis tears, is addressed at the same time (tenodesis or tenotomy). The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for symptomatic subscapularis tears causing anterior shoulder pain, weakness of internal rotation, and difficulty lifting the hand behind the back. It may also be repaired as part of a larger rotator cuff reconstruction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy focusing on remaining rotator cuff muscles, activity modification, pain medication, and injections."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess tear size and retraction. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of internal rotation strength and reduction of anterior shoulder pain. Success rates for repair are approximately 80-85%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Loss of external rotation is common after subscapularis repair.",
            "freq": "Common"
          },
          {
            "risk": "Pain",
            "detail": "Post-operative discomfort for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-tear",
            "detail": "The repaired tendon may fail to heal, particularly with large or chronic tears.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Musculocutaneous or axillary nerve injury.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder infection.",
            "freq": "Rare"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Stiffness may develop.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for six weeks. Internal rotation is restricted during healing. Gentle exercises begin under physiotherapy guidance. Active movement from six weeks. Strengthening from three months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is the subscapularis important?",
            "a": "The subscapularis is the largest rotator cuff muscle and is critical for internal rotation and anterior stability of the shoulder. Tears cause significant weakness."
          }
        ]
      }
    ]
  },
  "shoulder-capsular-release": {
    "name": "Arthroscopic Capsular Release (Frozen Shoulder)",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Arthroscopic capsular release is a keyhole operation to divide the thickened, contracted joint capsule in a frozen shoulder, restoring range of motion. It is often combined with manipulation under anaesthesia.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small incisions are made around the shoulder. An arthroscope is inserted and the thickened, inflamed joint capsule is systematically divided using a radiofrequency device or scissors, starting from the rotator interval and proceeding around the joint. This releases the contracted tissue and immediately improves range of motion. The operation takes 30-45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopic release is recommended for frozen shoulder that has not responded to prolonged physiotherapy, corticosteroid injection, or hydrodilatation, and is causing severe limitation of daily activities."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Frozen shoulder is self-limiting and resolves over 12-30 months in most patients. Treatment options include physiotherapy, corticosteroid injection (oral or intra-articular), hydrodilatation, and manipulation under anaesthesia alone. Many patients improve without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate improvement in range of motion. Combined with intensive physiotherapy, most patients maintain the gains. Results are generally better than manipulation alone, with a lower risk of fracture."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-operative pain",
            "detail": "The shoulder is sore for several days after release.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence of stiffness",
            "detail": "Some patients experience partial recurrence if physiotherapy is not maintained.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Axillary nerve is at risk during inferior capsular release. Rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Chondral damage",
            "detail": "Cartilage may be inadvertently damaged during the release.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a nerve block. The block allows pain-free exercises immediately after surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive physiotherapy begins on the day of surgery, ideally while the nerve block is active. Home exercises several times daily for at least six weeks. Night splinting may be used. Most patients see significant sustained improvement within four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain not controlled by medication",
          "Loss of movement that was initially gained",
          "Wound redness or discharge",
          "Fever",
          "Excessive arm swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Physiotherapy from day one. Surgeon review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is release better than manipulation alone?",
            "a": "Arthroscopic release provides a more controlled and complete release with lower risk of fracture compared to manipulation alone. It is particularly advantageous in patients with diabetes, where frozen shoulder tends to be more resistant."
          },
          {
            "q": "Will the frozen shoulder come back?",
            "a": "Recurrence after capsular release is uncommon if physiotherapy is maintained. Some patients with diabetes may have a slower or less complete recovery."
          }
        ]
      }
    ]
  },
  "fai-surgery": {
    "name": "Femoroacetabular Impingement (FAI) Surgery",
    "region": "Hip",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "FAI surgery is an arthroscopic procedure to reshape the bones of the hip joint that are causing impingement — where the ball and socket don't fit together smoothly, causing pain and damage to the labrum and cartilage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically with the leg in traction. Cam impingement is treated by shaving the bony bump on the femoral head-neck junction (osteochondroplasty). Pincer impingement is treated by trimming the overcovering rim of the socket. The labrum is usually repaired with suture anchors. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for symptomatic FAI with groin pain, limited hip movement, and MRI evidence of labral damage, when physiotherapy has not provided adequate relief."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (particularly hip-specific rehabilitation), activity modification, anti-inflammatory medication, and intra-articular injection."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI arthrogram and specialised hip X-rays. Pre-operative physiotherapy (prehabilitation) improves outcomes."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduction of groin pain and improvement in hip movement. Success rates are highest in patients with preserved joint cartilage. Approximately 85-90% of well-selected patients report good outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Traction-related symptoms",
            "detail": "Temporary numbness in the groin or foot from traction. Resolves within days.",
            "freq": "Common"
          },
          {
            "risk": "Groin soreness",
            "detail": "Bruising and soreness around the hip.",
            "freq": "Expected"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Some patients continue to have symptoms, particularly if cartilage damage was present.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Thigh numbness. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "Femoral neck fracture",
            "detail": "Rare fracture from excessive bone reshaping. Risk reduced with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Very rare damage to blood supply.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection approximately 0.5%.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adhesions",
            "detail": "Scar tissue within the joint.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with muscle relaxation for traction."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for two to six weeks depending on the procedure. Physiotherapy begins within the first week and continues for three to six months. Return to office work at one to two weeks. Return to sport at three to six months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin or hip pain",
          "Wound redness or discharge",
          "Fever",
          "Persistent numbness in the thigh or foot",
          "Sudden onset of severe groin pain (possible fracture)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this suitable if I have arthritis?",
            "a": "FAI surgery is less successful in hips with significant arthritis. In these cases, hip replacement may be a more reliable option."
          },
          {
            "q": "Can both hips be done?",
            "a": "Yes, but usually at separate operations with recovery between."
          }
        ]
      }
    ]
  },
  "hip-labral-repair": {
    "name": "Hip Labral Repair",
    "region": "Hip",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip labral repair is an arthroscopic procedure to reattach a torn labrum — the ring of cartilage that lines the rim of the hip socket, providing stability, suction seal, and shock absorption.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically with the leg in traction. The torn labrum is identified, the bone at the rim is prepared, and the labrum is reattached using small suture anchors. This is usually performed in combination with bony reshaping for FAI. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Labral repair is recommended when MRI shows a labral tear causing mechanical symptoms (catching, clicking) or deep groin pain, particularly in the context of FAI. Labral repair preserves the seal and stability function of the labrum."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, anti-inflammatory medication, and corticosteroid injection."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI arthrogram confirms the tear. Pre-operative physiotherapy recommended."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the labral seal and reduction of hip pain. Labral repair has better outcomes than debridement (trimming) for most tear patterns, particularly in younger patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Traction symptoms",
            "detail": "Temporary numbness from traction.",
            "freq": "Common"
          },
          {
            "risk": "Hip stiffness",
            "detail": "Temporary limitation of movement.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Repair failure",
            "detail": "The labrum may not heal despite repair.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Lateral femoral cutaneous nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with muscle relaxation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for four to six weeks with restricted hip flexion. Physiotherapy for three to six months. Return to sport at four to six months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing hip or groin pain",
          "Clicking or locking of the hip",
          "Wound discharge",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the labrum?",
            "a": "The labrum is a ring of fibrocartilage around the rim of the hip socket. It deepens the socket, creates a suction seal, and distributes forces evenly across the joint."
          }
        ]
      }
    ]
  },
  "hip-core-decompression": {
    "name": "Hip Core Decompression (for AVN)",
    "region": "Hip",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Core decompression is a minimally invasive operation for early-stage avascular necrosis (AVN) of the femoral head. It involves drilling into the femoral head to reduce pressure, improve blood flow, and delay or prevent the need for hip replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, a drill or trocar is passed through the outer thigh into the femoral head, creating one or more channels. This releases the elevated pressure within the bone and allows new blood vessels to grow. Bone graft, bone marrow aspirate, or synthetic bone substitutes may be packed into the channels. The procedure takes 30-60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Core decompression is most effective for early-stage AVN (before the femoral head has collapsed). Once collapse occurs, hip replacement is usually more appropriate."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Weight-bearing restriction, bisphosphonate medication, and observation. However, untreated AVN usually progresses to femoral head collapse."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to stage the AVN. Blood tests to investigate underlying causes. Day-case or overnight procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "For early-stage disease, core decompression can delay or prevent femoral head collapse in approximately 60-70% of patients at five years. It is a joint-preserving procedure that may defer or avoid hip replacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Thigh pain",
            "detail": "Discomfort in the lateral thigh at the drill site for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Limited weight-bearing",
            "detail": "Crutches needed for six weeks to protect the femoral head.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Femoral neck fracture",
            "detail": "Rare fracture through the drill hole. Risk is minimised by using smaller diameter channels.",
            "freq": "Rare"
          },
          {
            "risk": "Disease progression",
            "detail": "AVN may progress despite treatment, eventually requiring hip replacement.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Bleeding at the drill site.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for six weeks. Physiotherapy for hip range of motion. MRI follow-up to monitor disease progression. Return to full activities at three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden increase in groin or hip pain (possible fracture or collapse)",
          "Fever",
          "Wound discharge",
          "Increasing difficulty walking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "MRI at three months and six months to monitor AVN progression. Regular long-term follow-up."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes AVN?",
            "a": "AVN occurs when blood supply to the femoral head is disrupted. Common causes include corticosteroid use, alcohol excess, sickle cell disease, hip fracture, and sometimes no identifiable cause (idiopathic)."
          },
          {
            "q": "Will I still need a hip replacement?",
            "a": "Possibly. Core decompression works best in early disease and may delay but not always prevent the need for replacement. If the femoral head collapses, hip replacement is usually recommended."
          }
        ]
      }
    ]
  },
  "pao": {
    "name": "Periacetabular Osteotomy (PAO)",
    "region": "Hip",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Periacetabular osteotomy (PAO) is a major joint-preserving operation to reposition the hip socket to provide better coverage of the femoral head. It is performed for hip dysplasia — a condition where the socket is too shallow, causing pain and predisposing to early arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made at the front of the hip. The acetabulum (hip socket) is cut free from the surrounding pelvis using controlled osteotomies (bone cuts), rotated into a better position to cover the femoral head, and fixed with screws. The operation is technically demanding and takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "PAO is recommended for symptomatic hip dysplasia in young adults (typically 15-40 years) with preserved joint cartilage. It aims to improve hip mechanics and prevent or delay arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, pain management, and observation. However, symptomatic dysplasia tends to progress to arthritis without correction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialised hip X-rays and CT scan for planning. This is a major operation performed at specialist centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved hip coverage, reduced pain, and delayed or prevented arthritis progression. Long-term studies show approximately 75-85% of patients have a well-functioning hip at 10-20 years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "This is a major bone operation. Full recovery takes six to twelve months.",
            "freq": "Expected"
          },
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Numbness on the outer thigh occurs in approximately 20-30% of patients. Usually improves.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant. Transfusion may be needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal. Risk approximately 2-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction or under-correction",
            "detail": "The acetabulum may be positioned suboptimally.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sciatic nerve injury",
            "detail": "Rare but potentially serious.",
            "freq": "Rare"
          },
          {
            "risk": "Deep infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Progression to arthritis",
            "detail": "Despite correction, some patients still develop arthritis.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Epidural may be used for post-operative pain management."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for six to eight weeks. Crutches for eight to twelve weeks. Physiotherapy throughout for hip range of motion and strengthening. Return to desk work at six to eight weeks. Return to sport at six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Sudden increase in hip pain",
          "Numbness extending beyond the outer thigh"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, six months, and one year. Long-term follow-up to monitor hip joint."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Am I too old for this operation?",
            "a": "PAO is most beneficial for patients under 40 with preserved cartilage. Older patients or those with significant arthritis may be better served by hip replacement."
          },
          {
            "q": "Is this done at all hospitals?",
            "a": "No. PAO is a highly specialised operation performed at a limited number of centres with expertise in young adult hip preservation."
          }
        ]
      }
    ]
  },
  "tibial-tubercle-osteotomy": {
    "name": "Tibial Tubercle Osteotomy",
    "region": "Knee",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tibial tubercle osteotomy (TTO) is an operation to move the bony attachment point of the patellar tendon on the shinbone. It is performed to improve kneecap tracking, treat patellar instability, or offload a damaged area of cartilage behind the kneecap.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the upper shin. The tibial tubercle (the bony bump where the patellar tendon attaches) is carefully cut and moved — typically inward (medialisation) to correct tracking, forward (anteriorisation, Maquet) to offload the patellofemoral joint, or a combination (Fulkerson). The repositioned bone is fixed with screws. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "TTO is recommended for recurrent patellar dislocation with an abnormally positioned tibial tubercle, patellofemoral pain or arthritis, and as part of cartilage repair procedures behind the kneecap."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy for quadriceps strengthening and patellar tracking, patellar taping, bracing, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT or MRI to measure the TT-TG distance and assess cartilage. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved kneecap tracking and stability. Reduction in anterior knee pain. Most patients achieve good outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Temporary loss of flexion.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged anterior knee swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent screws",
            "detail": "The screws may be palpable under thin skin.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal. Risk approximately 2-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "The tibial tubercle may fracture during or after surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Over-correction",
            "detail": "Excessive medialisation may cause new tracking problems.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing as tolerated in a brace. Range of motion exercises begin immediately. Brace for six weeks. Physiotherapy for quadriceps rehabilitation. Return to sport at four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Inability to straighten the knee",
          "Kneecap feeling unstable"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months. Screw removal at six to twelve months if symptomatic."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the screws need removing?",
            "a": "Approximately 30-40% of patients choose screw removal because of prominence. This is a minor procedure after the osteotomy has healed."
          }
        ]
      }
    ]
  },
  "patellofemoral-replacement": {
    "name": "Patellofemoral Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Patellofemoral replacement is an operation to replace only the joint surface between the kneecap and the thighbone, preserving the rest of the knee. It is performed for isolated patellofemoral arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the knee. The damaged surfaces of the trochlear groove (on the femur) and the underside of the patella are replaced with metal and plastic components. The rest of the knee joint is left intact. The operation takes approximately one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Patellofemoral replacement is suitable for patients with isolated arthritis of the patellofemoral compartment who have preserved cartilage in the medial and lateral compartments. It is an alternative to total knee replacement with the advantage of preserving more normal knee mechanics."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, activity modification, and injections. Total knee replacement is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. X-rays and MRI to confirm isolated patellofemoral disease."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief with preservation of more normal knee movement and proprioception compared to total knee replacement. Most patients report the knee feels more 'natural' than after TKR."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Anterior knee pain",
            "detail": "Some patients continue to have anterior knee discomfort.",
            "freq": "Common"
          },
          {
            "risk": "Swelling and stiffness",
            "detail": "Expected initially.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Progression of arthritis",
            "detail": "The remaining compartments may develop arthritis, requiring conversion to TKR.",
            "freq": "Long-term"
          },
          {
            "risk": "Implant loosening",
            "detail": "Component loosening over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Catching or clunking",
            "detail": "Patellar maltracking with the new components.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two days. Early mobilisation. Physiotherapy for quadriceps strengthening. Driving at four to six weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not just have a total knee replacement?",
            "a": "If arthritis is isolated to the patellofemoral joint, a partial replacement preserves more of the knee and typically provides a more natural-feeling result with faster recovery."
          },
          {
            "q": "What if arthritis develops elsewhere?",
            "a": "If the remaining compartments develop arthritis, the patellofemoral replacement can usually be converted to a total knee replacement."
          }
        ]
      }
    ]
  },
  "lumbar-lateral-fusion": {
    "name": "Lateral Lumbar Interbody Fusion (XLIF/LLIF)",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lateral lumbar interbody fusion is a minimally invasive spinal fusion performed through the side of the body, avoiding the back muscles and major blood vessels. A large cage is placed in the disc space to restore disc height and promote fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the side of the abdomen. Using specialised dilators, a corridor is created through the psoas muscle to reach the spine. The disc is removed and a large cage filled with bone graft is inserted. The procedure may be supplemented with posterior screws placed percutaneously. The operation takes one and a half to two hours per level."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "XLIF/LLIF is recommended for degenerative disc disease, spondylolisthesis, degenerative scoliosis, and adjacent segment disease. The lateral approach allows a large cage to be placed, providing excellent support and indirect decompression of the nerves."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain management, epidural injections, and activity modification. Posterior or anterior fusion approaches are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT and MRI for planning. Vascular imaging may be needed to assess vessel position. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Effective fusion with indirect nerve decompression, less back muscle damage than posterior approaches, and shorter hospital stay. Fusion rates exceed 90%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Hip flexor weakness",
            "detail": "Psoas muscle irritation causing temporary hip flexion weakness. Very common (up to 30%) and usually resolves within weeks.",
            "freq": "Common"
          },
          {
            "risk": "Thigh numbness",
            "detail": "Lateral femoral cutaneous nerve irritation. Usually temporary.",
            "freq": "Common"
          },
          {
            "risk": "Ileus",
            "detail": "Temporary slowing of bowel function due to abdominal approach.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Lumbar plexus injury",
            "detail": "Nerve damage causing leg weakness. Risk approximately 1-3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vascular injury",
            "detail": "Damage to segmental vessels. Rare but potentially serious.",
            "freq": "Rare"
          },
          {
            "risk": "Cage subsidence",
            "detail": "The cage may sink into the vertebral body, particularly in osteoporotic bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-fusion",
            "detail": "Failure to fuse despite cage placement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned on the side (lateral decubitus). Neuromonitoring is used."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to three days. Walking on the day of surgery. Hip flexor exercises begin immediately. Return to desk work at two to four weeks. Avoid heavy lifting for three months. Full fusion at six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Hip flexor weakness not improving after two weeks",
          "Abdominal distension or inability to eat"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. CT scan to confirm fusion if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why through the side?",
            "a": "The lateral approach avoids the back muscles (reducing post-operative pain) and the major blood vessels in front of the spine, while allowing placement of a larger cage than posterior techniques."
          },
          {
            "q": "Will the hip flexor weakness resolve?",
            "a": "Yes, in the vast majority of cases. The psoas muscle recovers within two to six weeks."
          }
        ]
      }
    ]
  },
  "cervical-foraminotomy": {
    "name": "Cervical Foraminotomy",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cervical foraminotomy is a minimally invasive operation to enlarge the nerve exit hole (foramen) in the neck, relieving pressure on a pinched nerve root without the need for fusion or disc replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made at the back of the neck. Using a microscope or tubular retractor, the surgeon removes a small amount of bone and ligament from the foramen to free the compressed nerve root. The disc is not removed and no fusion or implant is needed. The operation takes 45-90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Foraminotomy is suitable for foraminal stenosis or lateral disc herniation causing arm pain (radiculopathy) from a single nerve root. It is an alternative to ACDF that avoids fusion and preserves all neck movement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication, cervical epidural injection, and time. ACDF or disc replacement are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT to confirm foraminal stenosis. Day-case or overnight procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of arm pain in approximately 90% of patients. Preservation of neck movement at the treated level. No fusion-related complications."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Neck stiffness",
            "detail": "Temporary posterior neck soreness from muscle retraction.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Some patients have persistent numbness that improves slowly.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve root injury",
            "detail": "Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Spinal cord injury",
            "detail": "Very rare with posterior approach.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "The nerve may become compressed again over time.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "Excessive bone removal could theoretically cause instability. Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone or sitting."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home the same day or next day. Return to desk work within one to two weeks. Driving at one to two weeks. No brace required. Full recovery four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening arm pain or new weakness",
          "Difficulty with balance or walking",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not ACDF?",
            "a": "Foraminotomy avoids fusion, preserves movement, and has no risk of adjacent segment disease. It is ideal for lateral pathology but not suitable for central disc herniations or spinal cord compression."
          }
        ]
      }
    ]
  },
  "cervical-laminoplasty": {
    "name": "Cervical Laminoplasty",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cervical laminoplasty is an operation to expand the spinal canal in the neck by hinging open the lamina like a door, rather than removing it entirely. It decompresses the spinal cord while preserving more stability than laminectomy.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made at the back of the neck. One side of the lamina is cut through completely (the 'open' side) and the other side is partially cut to create a hinge. The lamina is swung open like a door and held in its new position with small plates or sutures. This expands the spinal canal without removing the bone. Multiple levels are usually treated. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Laminoplasty is recommended for multi-level cervical spinal stenosis causing myelopathy, particularly when the spine maintains its normal lordotic curve. It is an alternative to laminectomy and fusion that preserves more neck movement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation for mild myelopathy, physiotherapy, and cervical collar. Progressive myelopathy generally requires surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for planning. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Effective spinal cord decompression with preservation of neck movement. Most patients stabilise or improve neurologically."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Axial neck pain",
            "detail": "Posterior neck and shoulder pain is common after laminoplasty and may persist for months.",
            "freq": "Common"
          },
          {
            "risk": "Reduced neck extension",
            "detail": "Some loss of neck extension range.",
            "freq": "Common"
          },
          {
            "risk": "C5 palsy",
            "detail": "Weakness of deltoid muscle. Occurs in approximately 5% and usually recovers.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Hinge closure",
            "detail": "The opened lamina may close down over time, reducing the canal expansion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay two to four days. Collar for comfort for two to four weeks. Return to desk work at four to six weeks. Physiotherapy for neck rehabilitation. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Worsening hand clumsiness",
          "Increasing arm weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at six weeks, three months, and one year with X-rays."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why laminoplasty instead of laminectomy?",
            "a": "Laminoplasty preserves the posterior bony structure and may reduce the risk of post-operative kyphosis and instability, particularly when fusion is not performed."
          }
        ]
      }
    ]
  },
  "thoracic-discectomy": {
    "name": "Thoracic Discectomy",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Thoracic discectomy is an operation to remove a herniated disc in the thoracic (mid-back) spine that is compressing the spinal cord. Thoracic disc herniations are uncommon but can cause serious spinal cord compression.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach depends on the location and size of the herniation. Options include a costotransversectomy (through the back, removing part of a rib and transverse process), a transthoracic approach (through the chest), or a thoracoscopic approach (keyhole through the chest). The disc is removed from in front of the spinal cord to avoid manipulating the cord. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for symptomatic thoracic disc herniations causing myelopathy (spinal cord compression), progressive neurological deficit, or severe radiculopathy not responding to non-operative treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many thoracic disc herniations are asymptomatic and found incidentally on MRI. If symptoms are mild and stable, observation with regular monitoring may be appropriate. Pain management and physiotherapy for mild radiculopathy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for planning. Pulmonary function tests if transthoracic approach. This is a specialised procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of progressive spinal cord damage. Neurological improvement is possible but depends on the duration and severity of cord compression."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-operative pain",
            "detail": "Chest wall or back pain from the surgical approach.",
            "freq": "Expected"
          },
          {
            "risk": "Intercostal neuralgia",
            "detail": "Rib or chest wall pain from nerve irritation during the approach.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "The thoracic spinal cord is vulnerable and has limited space. Risk of worsening neurological function.",
            "freq": "Rare"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear. More common than in lumbar surgery due to limited space.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pneumothorax",
            "detail": "Air leak around the lung with transthoracic approaches. Usually managed with a chest drain.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or spinal infection.",
            "freq": "Rare"
          },
          {
            "risk": "Intercostal neuralgia (persistent)",
            "detail": "Chronic chest wall pain from nerve damage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. One-lung ventilation may be needed for transthoracic approaches. Neuromonitoring is essential."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay two to five days. If a chest drain is needed, it is usually removed within one to two days. Walking encouraged early. Return to desk work at four to six weeks. Avoid heavy lifting for three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg weakness or numbness",
          "New bladder or bowel symptoms",
          "Increasing chest pain or shortness of breath",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months with imaging."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this more complex than lumbar disc surgery?",
            "a": "The thoracic spinal cord fills more of the spinal canal than in the lumbar spine, leaving less room for surgical manoeuvre. The disc must be removed from in front of the cord, requiring specialised approaches."
          }
        ]
      }
    ]
  },
  "spinal-cord-stimulator": {
    "name": "Spinal Cord Stimulator Insertion",
    "region": "Spine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A spinal cord stimulator is an implantable device that delivers mild electrical impulses to the spinal cord to interrupt pain signals. It is used for chronic pain conditions that have not responded to other treatments.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure typically occurs in two stages. First, a trial: thin electrode leads are placed in the epidural space under X-ray guidance through a needle in the back. These are connected to an external battery for a trial period of one to two weeks. If the trial provides at least 50% pain relief, the permanent system is implanted: the leads are connected to a small battery pack (pulse generator) implanted under the skin, usually in the buttock or lower abdomen. The trial takes one hour; permanent implantation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Spinal cord stimulation is considered for failed back surgery syndrome, complex regional pain syndrome, neuropathic pain in the limbs, and certain types of chronic pain that have not responded to medication, injections, physiotherapy, and other interventions."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain medication, physiotherapy, psychological pain management programmes, nerve blocks, radiofrequency denervation, and other neuromodulation techniques."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Psychological assessment is usually required. A multidisciplinary pain team assessment. The trial period is essential before permanent implantation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Approximately 50-70% of carefully selected patients achieve at least 50% pain reduction. The stimulator can be adjusted and reprogrammed over time. It is reversible — the device can be removed."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lead migration",
            "detail": "The electrode leads may move from their optimal position, requiring repositioning. Occurs in approximately 10-15% of patients.",
            "freq": "Common"
          },
          {
            "risk": "Pain at battery site",
            "detail": "Discomfort at the pulse generator implant site.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Not all patients achieve adequate pain relief.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Infection of the leads or pulse generator. Risk approximately 3-5%. May require device removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Epidural haematoma",
            "detail": "Blood collection around the leads. Rare but potentially serious.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "During lead placement. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "CSF leak",
            "detail": "From dural puncture during lead placement.",
            "freq": "Rare"
          },
          {
            "risk": "Hardware failure",
            "detail": "Lead fracture or battery failure.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthesia with sedation for the trial. General or local anaesthesia for permanent implantation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "After the trial, normal activities with care to avoid lead displacement. After permanent implantation, avoid heavy lifting, bending, and twisting for six to eight weeks while the leads stabilise. The stimulator is programmed and adjusted over subsequent visits."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge at any incision site",
          "Fever",
          "Sudden increase in pain",
          "New weakness or numbness",
          "Headache (possible CSF leak)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Programming sessions at two weeks, six weeks, and regular intervals. Battery replacement every five to ten years depending on usage."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I feel the stimulation?",
            "a": "Modern devices offer various stimulation patterns. Some produce a gentle tingling sensation; others provide sub-perception therapy that you cannot feel."
          },
          {
            "q": "Can I have an MRI with a stimulator?",
            "a": "Some modern stimulators are MRI-conditional, meaning MRI can be performed under specific conditions. This should be discussed before implantation."
          },
          {
            "q": "Is it permanent?",
            "a": "The device can be removed if it is not effective or no longer needed. It is a reversible treatment."
          }
        ]
      }
    ]
  },
  "revision-lumbar": {
    "name": "Revision Lumbar Spine Surgery",
    "region": "Spine",
    "tag": "Revision",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision lumbar spine surgery is an operation to address persistent or recurrent symptoms after previous lumbar spine surgery. It is more complex than primary surgery and includes re-exploration for recurrent disc herniation, decompression for restenosis, revision of failed fusion, and treatment of adjacent segment disease.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is reopened. Scar tissue is carefully dissected to identify the neural structures. Depending on the indication, the surgeon may remove a recurrent disc herniation, decompress new stenosis, revise or extend a fusion, or remove and replace failed hardware. The operation takes one and a half to four hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision surgery is considered for recurrent disc herniation, restenosis causing new symptoms, pseudarthrosis (failed fusion), adjacent segment disease, hardware failure, or persistent symptoms with an identifiable surgical cause."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pain management, physiotherapy, epidural injections, and activity modification. The decision to reoperate requires careful patient selection — the cause of ongoing symptoms must be clearly identified."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Updated MRI and CT scans. Diagnostic injections may help identify the pain source. Thorough discussion of expectations."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Success rates for revision surgery are generally lower than primary surgery. Carefully selected patients — those with a clear structural cause identified on imaging — have the best outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Dural tear",
            "detail": "Higher risk in revision surgery due to scar tissue. Approximately 5-15%.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "More bleeding from scar tissue.",
            "freq": "Common"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Outcomes are less predictable than primary surgery.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Increased risk due to scar tissue around nerves.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary surgery, approximately 3-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "Further bone removal may cause instability requiring fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Epidural fibrosis",
            "detail": "Further scar formation around the nerves.",
            "freq": "Common"
          },
          {
            "risk": "Cauda equina syndrome",
            "detail": "Rare but serious.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Longer operating time than primary surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is generally slower than after primary surgery. Hospital stay one to three days. Walking encouraged immediately. Return to desk work at four to eight weeks. Full recovery three to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why are results less predictable?",
            "a": "Scar tissue, altered anatomy, and the underlying degenerative process make revision surgery more challenging. Patient selection is critical — clear identification of the pain source improves outcomes."
          },
          {
            "q": "How many revision surgeries can be done?",
            "a": "Each revision becomes progressively more complex. The decision to reoperate must be carefully considered each time, with clear evidence of a correctable structural problem."
          }
        ]
      }
    ]
  },
  "intrathecal-pump": {
    "name": "Intrathecal Drug Delivery Pump",
    "region": "Spine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "An intrathecal drug delivery pump is an implantable device that delivers pain medication directly to the spinal fluid, providing effective pain relief at much lower doses than oral medication.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A thin catheter is inserted into the intrathecal space (around the spinal cord) through a needle in the back, and tunnelled under the skin to a programmable pump implanted in the abdomen. The pump delivers precise doses of medication (usually morphine or baclofen) directly to the spinal fluid. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Intrathecal pumps are considered for severe chronic pain not adequately controlled by oral medications, cancer pain, severe spasticity (baclofen pump), and failed back surgery syndrome."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Oral or transdermal pain medication, nerve blocks, spinal cord stimulation, physiotherapy, and psychological pain management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "A trial injection of intrathecal medication is performed first to assess effectiveness. Psychological assessment. Multidisciplinary pain team review."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Effective pain relief at lower doses, reducing systemic side effects of oral medication. The pump can be adjusted and refilled without further surgery."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pump site discomfort",
            "detail": "Discomfort over the abdominal pump.",
            "freq": "Common"
          },
          {
            "risk": "Headache",
            "detail": "Post-dural puncture headache after catheter insertion.",
            "freq": "Common"
          },
          {
            "risk": "Medication side effects",
            "detail": "Even at low doses, opioids can cause nausea, drowsiness, and constipation.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Around the pump or catheter. Risk approximately 3-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Catheter problems",
            "detail": "Kinking, migration, or disconnection of the catheter.",
            "freq": "Uncommon"
          },
          {
            "risk": "CSF leak",
            "detail": "Spinal fluid leak causing headache.",
            "freq": "Uncommon"
          },
          {
            "risk": "Granuloma",
            "detail": "Inflammatory mass at the catheter tip. Can cause neurological symptoms.",
            "freq": "Rare"
          },
          {
            "risk": "Overdose",
            "detail": "Pump malfunction or programming error. Safety features reduce this risk.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or local anaesthesia with sedation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to three days. Avoid heavy lifting for six to eight weeks. The pump is refilled every one to six months depending on medication use, via a simple needle injection through the skin."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe headache when upright",
          "Wound redness or discharge",
          "Fever",
          "New weakness or numbness in the legs",
          "Signs of medication overdose: excessive drowsiness, slow breathing"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Pump programming and refill at regular intervals. Annual review of medication needs."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How often does the pump need refilling?",
            "a": "Every one to six months depending on the medication dose. Refilling is done in clinic with a needle through the skin — no surgery needed."
          },
          {
            "q": "How long does the pump battery last?",
            "a": "Five to seven years. Battery replacement requires a minor surgical procedure to exchange the pump."
          }
        ]
      }
    ]
  },
  "elbow-arthrolysis": {
    "name": "Elbow Arthrolysis (Stiffness Release)",
    "region": "Elbow",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Elbow arthrolysis is an operation to release a stiff elbow by removing scar tissue, bone spurs, and contractured capsule. It may be performed open or arthroscopically to restore a functional range of motion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic arthrolysis: the joint is accessed through small incisions. Scar tissue, thickened capsule, and bone spurs are removed under camera guidance. Open arthrolysis: a larger incision allows direct access for more severe contractures. Heterotopic bone may be excised. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthrolysis is recommended when elbow stiffness significantly limits function — typically when the arc of motion is less than 100 degrees (less than 30-130 degrees) — and has not improved with physiotherapy and splinting."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, serial splinting (static progressive or dynamic), and time. Many post-traumatic stiff elbows improve with dedicated rehabilitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to assess bony anatomy and heterotopic ossification. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improvement in range of motion, typically gaining 30-40 degrees of additional motion. Maintaining the gains requires dedicated post-operative physiotherapy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence of stiffness",
            "detail": "Scar tissue may reform. Aggressive physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected after surgery.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Ulnar nerve and other nerves are at increased risk due to scarring. Occurs in approximately 2-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "New unwanted bone may form. Preventive measures may be used.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Fracture",
            "detail": "Weakened bone may fracture during manipulation.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with a regional nerve block for early pain-free exercises."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive physiotherapy begins on the day of surgery. Continuous passive motion (CPM) machines may be used. Splinting between exercise sessions. NSAIDs or radiotherapy may be used to prevent heterotopic ossification. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing stiffness despite exercises",
          "New numbness in the hand"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent early reviews to monitor range of motion progress."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is early physiotherapy so critical?",
            "a": "The elbow forms scar tissue rapidly. The gains from surgery must be maintained with immediate, intensive movement. Delay allows new scar tissue to form."
          }
        ]
      }
    ]
  },
  "elbow-lcl-reconstruction": {
    "name": "Elbow Collateral Ligament Reconstruction",
    "region": "Elbow",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Elbow collateral ligament reconstruction is an operation to repair or reconstruct a torn ligament of the elbow. UCL reconstruction (Tommy John surgery) is performed for medial instability in throwing athletes. LCL reconstruction is performed for posterolateral rotatory instability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the inner (UCL) or outer (LCL) side of the elbow. For UCL reconstruction: a tendon graft (usually palmaris longus from the forearm) is passed through tunnels drilled in the humerus and ulna to recreate the ligament. For LCL repair: the torn ligament is reattached to bone using suture anchors. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "UCL reconstruction is recommended for throwing athletes with symptomatic medial elbow instability. LCL reconstruction is recommended for posterolateral rotatory instability causing recurrent elbow subluxation or dislocation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, and bracing. For UCL injuries, many non-throwing athletes manage well without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and stress X-rays. For UCL reconstruction, a detailed throwing history and assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "UCL reconstruction allows approximately 80-85% of throwing athletes to return to their previous level of competition. LCL reconstruction reliably restores elbow stability."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Elbow stiffness",
            "detail": "Some loss of full extension is common.",
            "freq": "Common"
          },
          {
            "risk": "Graft site discomfort",
            "detail": "Pain at the tendon donor site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve symptoms",
            "detail": "The ulnar nerve may be irritated. May require transposition.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft failure",
            "detail": "The reconstructed ligament may stretch or fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrent instability",
            "detail": "Despite reconstruction.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "UCL: Brace for six weeks. Throwing programme begins at four months. Return to competitive throwing at nine to twelve months. LCL: Brace for six weeks restricting varus stress. Return to full activity at three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Elbow giving way or clunking",
          "Increasing numbness in ring and little fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is Tommy John surgery?",
            "a": "UCL reconstruction is commonly called Tommy John surgery after the first baseball pitcher to undergo the procedure in 1974. It has become a well-established operation for throwing athletes."
          }
        ]
      }
    ]
  },
  "ankle-ligament-reconstruction": {
    "name": "Ankle Ligament Reconstruction (Broström)",
    "region": "Foot & Ankle",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle ligament reconstruction is an operation to repair or reconstruct the lateral ankle ligaments that have been damaged by recurrent ankle sprains, restoring ankle stability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the outer ankle. In a Broström repair, the stretched or torn anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are shortened and reattached to the fibula using suture anchors. The inferior extensor retinaculum may be used to reinforce the repair (Broström-Gould modification). The operation takes approximately one hour."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for chronic ankle instability with recurrent sprains and giving way that has not responded to physiotherapy and bracing. Most patients have had multiple ankle sprains over months to years."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy focusing on proprioception and peroneal strengthening, ankle bracing, activity modification. These are effective for most patients with ankle instability."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess ligament and cartilage damage. Stress X-rays may be performed. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of ankle stability in approximately 85-95% of patients. Most patients return to sport."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ankle stiffness",
            "detail": "Temporary loss of full dorsiflexion.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Expected for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent instability",
            "detail": "The repair may stretch over time. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "Numbness on the outer side of the foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Superficial peroneal nerve injury",
            "detail": "Numbness on top of the foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast or boot for two to six weeks. Weight-bearing as tolerated after two weeks. Physiotherapy for proprioception and strength. Return to running at three months. Return to sport at four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Ankle giving way",
          "Wound problems",
          "Fever",
          "Persistent numbness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the ankle sprain again?",
            "a": "The Broström repair has excellent long-term results with approximately 85-95% stability. However, no surgery can make the ankle immune to future injury."
          }
        ]
      }
    ]
  },
  "achilles-debridement": {
    "name": "Achilles Tendon Debridement",
    "region": "Foot & Ankle",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Achilles tendon debridement is an operation to remove damaged, degenerate tissue from the Achilles tendon (insertional or midsubstance tendinopathy) that has not responded to non-operative treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the tendon. The degenerate, thickened portion of the tendon is identified and carefully excised. If more than 50% of the tendon width is removed, the repair may be augmented with a tendon transfer (typically the flexor hallucis longus). For insertional disease, a prominent bone spur (Haglund's deformity) may be removed at the same time. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for chronic Achilles tendinopathy causing persistent pain that has not improved after at least six months of physiotherapy (eccentric exercises), shockwave therapy, and other non-operative treatments."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Eccentric exercise programme (Alfredson protocol), shockwave therapy, activity modification, heel raises, appropriate footwear, and PRP injection. Most patients improve without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or ultrasound to assess the tendon. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved function in approximately 75-85% of patients. Recovery is gradual."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Full recovery takes six to twelve months.",
            "freq": "Expected"
          },
          {
            "risk": "Wound healing",
            "detail": "The Achilles area has relatively poor blood supply.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Not all patients achieve complete pain relief.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon rupture",
            "detail": "If significant tendon is removed, the weakened tendon may rupture.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "Numbness on the outer foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound breakdown",
            "detail": "Particularly in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking boot for four to six weeks. Progressive weight-bearing. Physiotherapy for calf strengthening from six weeks. Running at three to four months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or breakdown",
          "Sudden calf pain (possible rupture)",
          "Fever",
          "Persistent swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is recovery so long?",
            "a": "Tendon tissue heals slowly due to its limited blood supply. Gradual loading is essential to allow the tendon to remodel."
          }
        ]
      }
    ]
  },
  "haglunds-excision": {
    "name": "Haglund's Deformity Excision",
    "region": "Foot & Ankle",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Haglund's deformity excision is an operation to remove a prominent bony bump at the back of the heel that causes irritation of the Achilles tendon and bursa, producing pain known as 'pump bump'.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made alongside the Achilles tendon. The prominent bone at the posterosuperior corner of the calcaneus is resected. The inflamed retrocalcaneal bursa is removed. If the Achilles tendon is detached during the procedure, it is reattached with suture anchors. The operation takes 45-90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when conservative measures including footwear modification, heel raises, padding, anti-inflammatory medication, and physiotherapy have failed to relieve symptoms."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Open-backed shoes, heel raises, Achilles stretching, anti-inflammatory gel, corticosteroid injection (into the bursa, not the tendon), and ice."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-ray and MRI to assess the deformity and tendon. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of posterior heel pain in approximately 80-85% of patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing",
            "detail": "The posterior heel skin heals slowly.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Heel swelling for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Residual discomfort",
            "detail": "Some patients have persistent symptoms.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Achilles tendon detachment",
            "detail": "If the tendon attachment is disrupted, prolonged rehabilitation is needed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sural nerve injury",
            "detail": "Numbness on the outer foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Achilles rupture",
            "detail": "If excessive bone is removed weakening the tendon insertion.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking boot for two to six weeks (longer if tendon was detached and repaired). Gradual return to normal footwear. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown",
          "Sudden heel pain (possible tendon issue)",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes Haglund's deformity?",
            "a": "It is partly inherited bone shape and partly related to footwear. Rigid-backed shoes (hence 'pump bump') press on the bony prominence, inflaming the bursa between the bone and the Achilles tendon."
          }
        ]
      }
    ]
  },
  "weil-osteotomy": {
    "name": "Metatarsal (Weil) Osteotomy",
    "region": "Foot & Ankle",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A Weil osteotomy is an operation to shorten and reposition a lesser metatarsal bone to relieve pain under the ball of the foot (metatarsalgia) or correct a dislocated toe joint.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the top of the foot. The metatarsal head is cut at an oblique angle and slid back (shortened) by a few millimetres. It is fixed with a small screw. This reduces the pressure on the ball of the foot. Multiple metatarsals may be treated. The operation takes 30-60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "A Weil osteotomy is recommended for persistent metatarsalgia, MTP joint dislocation, or crossover toes that have not responded to orthotics, padding, and footwear modification."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Metatarsal dome pads, custom orthotics, appropriate footwear, and corticosteroid injection."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of forefoot pain and correction of toe position in approximately 80-85% of patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Floating toe",
            "detail": "The toe may not sit flat on the ground after surgery. This is the most common complication.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Forefoot swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain may shift to an adjacent metatarsal.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "Symptoms may return.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Numbness in the toe.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "MTP joint stiffness.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Post-operative shoe for four to six weeks. Weight-bearing through the heel. Toe exercises begin immediately. Normal footwear at six to eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing pain",
          "Toe turning blue",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks and six weeks with X-rays."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is a floating toe?",
            "a": "After a Weil osteotomy, the toe may sit slightly elevated and not touch the ground. This is usually painless and functionally acceptable, but some patients find it bothersome."
          }
        ]
      }
    ]
  },
  "triple-arthrodesis": {
    "name": "Triple Arthrodesis",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Triple arthrodesis is a major foot operation to fuse three joints in the hindfoot — the subtalar, talonavicular, and calcaneocuboid joints. It provides powerful correction of foot deformity and is performed for severe hindfoot arthritis, deformity, or instability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Incisions are made on the outer and sometimes inner side of the foot. The cartilage is removed from all three hindfoot joints. The bones are repositioned into optimal alignment and fixed with screws. Bone graft may be needed. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Triple arthrodesis is recommended for severe hindfoot arthritis, rigid flatfoot or cavus foot deformity, posterior tibial tendon dysfunction (advanced stage), neuromuscular conditions causing foot deformity, and failed previous hindfoot surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Orthotics, ankle-foot orthosis, footwear modification, and pain management. These may manage symptoms but cannot correct a fixed deformity."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT scan. Smoking cessation is essential. Plan for prolonged non-weight-bearing."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent pain relief and deformity correction. The foot is stable and plantigrade (flat on the ground). Most patients walk comfortably in supportive shoes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of hindfoot motion",
            "detail": "Expected — this is the purpose of the surgery. The foot is less adaptable on uneven ground.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged swelling",
            "detail": "Foot swelling for many months.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Walking pattern changes, particularly on uneven terrain and stairs.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "One or more joints may fail to fuse. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint arthritis",
            "detail": "Increased stress on ankle and midfoot joints.",
            "freq": "Long-term"
          },
          {
            "risk": "Wound problems",
            "detail": "Multiple incisions increase risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sural, superficial peroneal, or deep peroneal nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malposition",
            "detail": "The foot may heal in a suboptimal position.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast for eight to twelve weeks. Weight-bearing in a boot for a further four to six weeks. Physiotherapy. Full recovery nine to twelve months. Supportive footwear long-term."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Cast too tight",
          "Toes blue or numb",
          "Increasing pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why fuse three joints?",
            "a": "These three joints work together as a unit. Fusing all three provides the most reliable correction and stability. Fusing one in isolation may overload the others."
          },
          {
            "q": "Will I walk normally?",
            "a": "Most patients walk well on flat ground. Walking on uneven terrain, hills, and slopes requires more adaptation. Running is generally not recommended."
          }
        ]
      }
    ]
  },
  "lisfranc-fixation": {
    "name": "Lisfranc Injury Fixation",
    "region": "Foot & Ankle",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lisfranc injury fixation is an operation to stabilise a disruption of the tarsometatarsal (Lisfranc) joint complex — the junction between the midfoot and forefoot. These injuries range from subtle ligament sprains to complete fracture-dislocations.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the top of the foot. The displaced joints and fractures are anatomically reduced and fixed with screws or plates. Bridge plating may be used across the joints. In chronic or severely damaged cases, primary fusion of the involved joints may be preferred. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is required for unstable Lisfranc injuries — any displacement of the tarsometatarsal joints needs fixation. Missed or poorly treated Lisfranc injuries lead to chronic midfoot pain and deformity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Truly stable, undisplaced Lisfranc injuries can be managed in a cast or boot with non-weight-bearing for six weeks. However, most displaced injuries require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT scan. The injury is often initially missed — a high index of suspicion is needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Anatomic reduction of the Lisfranc joint gives the best chance of a good long-term outcome. However, even with good surgery, some patients develop post-traumatic midfoot arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Midfoot stiffness",
            "detail": "Some loss of midfoot flexibility.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged foot swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Metalwork removal",
            "detail": "Screws usually need removal at three to four months to allow joint mobility.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-traumatic arthritis",
            "detail": "May develop despite good reduction. May require later fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "Compartment syndrome of the foot",
            "detail": "Rare but serious.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal cutaneous nerves.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound problems",
            "detail": "Swollen feet heal slowly.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malreduction",
            "detail": "The joints may not be perfectly reduced.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. Screw removal at three to four months. Gradual return to full weight-bearing. Supportive footwear and orthotics. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe foot pain or swelling",
          "Wound problems",
          "Fever",
          "Toes blue or numb",
          "Compartment tightness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months. Screw removal planned at three to four months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why remove the screws?",
            "a": "Bridge screws across joints restrict normal motion. Removing them after the ligaments have healed allows the joints to regain some flexibility."
          },
          {
            "q": "Why is this injury often missed?",
            "a": "Subtle Lisfranc injuries may look nearly normal on initial X-rays. Weight-bearing X-rays and high clinical suspicion are needed. A missed Lisfranc injury leads to chronic pain and deformity."
          }
        ]
      }
    ]
  },
  "calcaneal-osteotomy": {
    "name": "Calcaneal Osteotomy (Dwyer/Sliding)",
    "region": "Foot & Ankle",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A calcaneal osteotomy is an operation to cut and reposition the heel bone to correct hindfoot alignment. It is used to treat valgus (flat) or varus (high-arched) heel deformities.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the heel. The calcaneus (heel bone) is cut and shifted — medially (inward) for valgus correction or laterally (outward) for varus correction. The bone is fixed in its new position with screws. For varus correction, a wedge of bone may be removed (closing wedge — Dwyer). The operation takes 45-90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Calcaneal osteotomy is commonly performed as part of flatfoot reconstruction (medial displacement osteotomy), cavovarus foot correction, or to improve hindfoot alignment in ankle arthritis or instability."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Orthotics, supportive footwear, physiotherapy, and bracing. These manage symptoms but cannot correct a structural deformity."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. Often combined with other procedures."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Correction of heel alignment improves foot mechanics, reduces pain, and protects adjacent joints. Union rates exceed 95%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Heel soreness",
            "detail": "Discomfort at the osteotomy site for several months.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Heel swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Sural nerve irritation",
            "detail": "Numbness on the outer heel.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to heal. Uncommon in the calcaneus.",
            "freq": "Rare"
          },
          {
            "risk": "Over-correction",
            "detail": "Excessive shift.",
            "freq": "Rare"
          },
          {
            "risk": "Wound problems",
            "detail": "Lateral heel skin is vulnerable.",
            "freq": "Uncommon"
          },
          {
            "risk": "Peroneal tendon irritation",
            "detail": "Tendons may be irritated by the shifted bone.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six weeks, then progressive weight-bearing in a boot. Physiotherapy. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Severe heel pain",
          "Toes numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this done alone or with other procedures?",
            "a": "Calcaneal osteotomy is most commonly performed in combination with other procedures such as tendon transfer or spring ligament repair for flatfoot correction."
          }
        ]
      }
    ]
  },
  "dupuytrens-needle": {
    "name": "Dupuytren's Needle Fasciotomy",
    "region": "Hand & Wrist",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Needle fasciotomy (needle aponeurotomy) is a minimally invasive procedure to release Dupuytren's contracture by dividing the cord with a needle inserted through the skin, without a surgical incision.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed in clinic under local anaesthetic. A hypodermic needle is inserted through the skin at multiple points along the Dupuytren's cord. The needle is used to perforate and weaken the cord, which is then snapped by extending the finger. No incision or stitches are needed. The procedure takes 15–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Needle fasciotomy is suitable for well-defined palpable cords, particularly in the palm, in elderly patients, or those wanting a quick recovery. It is less suited for complex or recurrent disease."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation (if contracture is mild), collagenase injection (Xiapex, where available), and open fasciectomy for more definitive treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Clinic-based procedure. No fasting needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate correction of the contracture. Quick recovery with minimal wound care. Recurrence rates are higher than open surgery (approximately 50–65% at five years) but the procedure can be repeated."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "Higher recurrence rate than open fasciectomy. Approximately 50-65% at five years.",
            "freq": "Common"
          },
          {
            "risk": "Skin tears",
            "detail": "Small skin splits at the puncture sites when the finger is straightened.",
            "freq": "Common"
          },
          {
            "risk": "Bruising",
            "detail": "Local bruising and swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Digital nerve injury",
            "detail": "The cord sits close to the digital nerves. Risk approximately 1-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon injury",
            "detail": "Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "At needle puncture sites.",
            "freq": "Rare"
          },
          {
            "risk": "Incomplete correction",
            "detail": "The cord may not fully release.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic infiltration only."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Immediate use of the hand. Night extension splint for three to six months. Hand therapy for stretching and range of motion. Return to work within days."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "New numbness or tingling in the finger",
          "Wound redness or discharge",
          "Increasing pain",
          "Inability to bend the finger"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks with hand therapy. Splinting for three to six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the contracture come back?",
            "a": "Yes, recurrence is common (50-65% at five years). However, the procedure can be repeated if needed and has minimal downtime."
          },
          {
            "q": "Why not just have open surgery?",
            "a": "Needle fasciotomy offers quicker recovery with minimal wound. Open fasciectomy has lower recurrence but greater recovery time and wound complications."
          }
        ]
      }
    ]
  },
  "guyons-canal": {
    "name": "Guyon's Canal Release",
    "region": "Hand & Wrist",
    "tag": "Nerve",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Guyon's canal release is an operation to decompress the ulnar nerve at the wrist, where it passes through a narrow tunnel (Guyon's canal). Compression here causes numbness in the ring and little fingers and weakness of the hand muscles.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made on the inner (ulnar) side of the wrist/palm. The roof of Guyon's canal is divided, releasing pressure on the ulnar nerve. Any ganglion, anomalous muscle, or other cause of compression is identified and addressed. The operation takes 20–30 minutes and is usually a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when ulnar nerve compression at the wrist causes persistent numbness, tingling in the ring and little fingers, or weakness of the small hand muscles, and has not responded to activity modification or splinting."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Activity modification (avoiding sustained pressure on the palm), wrist splinting, and ergonomic adjustments. If symptoms are caused by a ganglion, aspiration may be tried."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Nerve conduction studies to confirm the site of compression. Ultrasound or MRI to identify space-occupying lesions. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of numbness and tingling. Recovery of hand muscle strength depends on the duration and severity of compression — early surgery gives the best results."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar tenderness",
            "detail": "Tenderness at the incision site.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete recovery",
            "detail": "If nerve damage was advanced before surgery, some weakness may persist.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve injury",
            "detail": "Damage during decompression.",
            "freq": "Rare"
          },
          {
            "risk": "Ulnar artery injury",
            "detail": "The artery runs alongside the nerve in Guyon's canal.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "Symptoms may recur if compression is not fully addressed.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Light dressing for one to two weeks. Stitches removed at 10–14 days. Gentle hand use immediately. Full recovery of strength takes weeks to months depending on pre-operative nerve damage."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing numbness or weakness",
          "Wound problems",
          "Fever",
          "Bleeding from the wound"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this the same as carpal tunnel?",
            "a": "No. Carpal tunnel affects the median nerve, causing numbness in the thumb, index, and middle fingers. Guyon's canal affects the ulnar nerve, causing numbness in the ring and little fingers."
          }
        ]
      }
    ]
  },
  "tfcc-repair": {
    "name": "TFCC Repair",
    "region": "Hand & Wrist",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "TFCC (triangular fibrocartilage complex) repair is an arthroscopic operation to fix a tear in the cartilage and ligament complex on the ulnar (little finger) side of the wrist. The TFCC is a critical stabiliser and shock absorber.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through small portals on the wrist. The torn TFCC is identified, debrided (trimmed) if it is a degenerative tear, or repaired with sutures if it is a peripheral (outer) tear with healing potential. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for TFCC tears causing persistent ulnar-sided wrist pain, clicking, or instability that has not responded to splinting, activity modification, and corticosteroid injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wrist splinting, activity modification, corticosteroid injection, and physiotherapy. Many TFCC tears improve with conservative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or MR arthrogram to confirm the tear. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Debridement provides good pain relief for central tears. Repair of peripheral tears restores DRUJ stability. Approximately 80% of patients report good outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wrist stiffness",
            "detail": "Temporary loss of motion, especially after repair.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Wrist swelling for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Failure of repair",
            "detail": "The repair may not heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Persistent instability",
            "detail": "DRUJ instability may persist.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal sensory branch of ulnar nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon injury",
            "detail": "Extensor tendons near the portals.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Debridement: splint for one to two weeks, then exercises. Repair: cast for four to six weeks, then physiotherapy. Return to full activity at three to four months after repair."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wrist instability",
          "Increasing pain",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the TFCC?",
            "a": "The triangular fibrocartilage complex is a cushion and stabiliser between the ulna and the carpal bones. It allows the wrist to rotate and absorbs forces during gripping."
          }
        ]
      }
    ]
  },
  "wrist-fusion": {
    "name": "Wrist Fusion (Arthrodesis)",
    "region": "Hand & Wrist",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Wrist fusion (arthrodesis) is an operation to permanently stiffen the wrist joint by joining the radius to the carpal bones using a plate and screws. It eliminates painful wrist motion and provides a strong, pain-free wrist.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the back of the wrist. The cartilage is removed from the wrist joint surfaces. The bones are aligned in a functional position (slight extension) and fixed with a plate and screws. Bone graft is used to promote fusion. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Wrist fusion is recommended for severe wrist arthritis (post-traumatic, inflammatory, or degenerative), failed previous wrist surgery, wrist instability not amenable to reconstruction, and severe wrist deformity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wrist splinting, activity modification, corticosteroid injection, pain medication, and partial wrist fusions that preserve some motion (such as four-corner fusion)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and CT scan. Discussion of functional impact — loss of wrist flexion and extension."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief and a strong, stable wrist. Grip strength is usually well preserved or improved. Forearm rotation (pronation/supination) is preserved."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of wrist motion",
            "detail": "Expected — the wrist no longer flexes or extends. Forearm rotation is preserved.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent plate",
            "detail": "The plate on the back of the wrist may be palpable under thin skin.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Hand swelling for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to fuse. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon irritation",
            "detail": "Extensor tendons may rub on the plate, rarely causing rupture.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sensory nerve branches on the back of the wrist.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Rare"
          },
          {
            "risk": "Plate removal",
            "detail": "May be needed if prominent or causing tendon irritation.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast or splint for six to eight weeks. Finger exercises begin immediately. Grip strengthening from six weeks. Return to manual work at three months. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months to confirm fusion."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How will I manage without wrist movement?",
            "a": "Most people adapt well. Forearm rotation is preserved, and many daily tasks are performed with the wrist in a neutral or slightly extended position anyway. Grip strength is usually maintained or improved."
          },
          {
            "q": "Is partial fusion an option?",
            "a": "Yes, procedures like four-corner fusion or scaphoid excision preserve some wrist motion. These are suitable for specific patterns of arthritis and will be discussed if appropriate."
          }
        ]
      }
    ]
  },
  "proximal-row-carpectomy": {
    "name": "Proximal Row Carpectomy",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Proximal row carpectomy is an operation to remove the three bones of the proximal carpal row (scaphoid, lunate, and triquetrum), allowing the capitate to articulate directly with the radius. It is a motion-preserving alternative to wrist fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the back of the wrist. The scaphoid, lunate, and triquetrum bones are carefully removed. The capitate (the central bone of the distal row) drops into the radius socket, creating a new articulation. No implant or fusion is needed. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Proximal row carpectomy is suitable for certain patterns of wrist arthritis (SLAC or SNAC wrist stages I-II), failed scaphoid treatment, and Kienböck's disease (lunate AVN). It preserves wrist motion unlike total wrist fusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting, injection, pain medication. Surgical alternatives include four-corner fusion, total wrist fusion, or wrist replacement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays to confirm preserved cartilage on the capitate head and lunate fossa of the radius — essential for a good result."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of approximately 60% of normal wrist motion and 80% of grip strength. Good pain relief. Avoids fusion."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Reduced wrist motion",
            "detail": "Approximately 60% of normal range is preserved.",
            "freq": "Expected"
          },
          {
            "risk": "Reduced grip strength",
            "detail": "Approximately 80% of normal. Usually functionally adequate.",
            "freq": "Expected"
          },
          {
            "risk": "Clicking",
            "detail": "Some patients notice clicking in the new wrist joint.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Progressive arthritis",
            "detail": "The new capitate-radius joint may develop arthritis over time, potentially requiring later fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "Instability",
            "detail": "The new joint may be unstable.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal sensory nerve branches.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Conversion to fusion",
            "detail": "If the procedure fails, wrist fusion remains available.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for two to four weeks. Active wrist exercises from two to four weeks. Grip strengthening from six weeks. Return to manual work at two to three months. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why remove bones rather than fuse?",
            "a": "Proximal row carpectomy preserves wrist motion and is a simpler procedure than fusion. It is particularly good for younger patients who want to maintain mobility."
          }
        ]
      }
    ]
  },
  "distal-ulna-excision": {
    "name": "Distal Ulna Excision (Darrach Procedure)",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal ulna excision (Darrach procedure) is an operation to remove the end of the ulna bone at the wrist. It is performed for painful arthritis or instability of the distal radioulnar joint (DRUJ).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the ulnar side of the wrist. The distal 1–2 cm of the ulna is removed. Soft tissues are repaired to stabilise the remaining ulna stump. The TFCC remnants may be used to create a soft tissue cap. The operation takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Darrach procedure is recommended for painful DRUJ arthritis (rheumatoid or post-traumatic), malunited distal radius fractures with DRUJ incongruity, and failed other DRUJ procedures, particularly in lower-demand patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting, corticosteroid injection, activity modification. The Sauvé-Kapandji procedure is a surgical alternative that preserves the ulnar head."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays. Standard pre-assessment. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved forearm rotation. Works well in low-demand patients and rheumatoid arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulna stump instability",
            "detail": "The remaining ulna stump may be unstable and click or clunk.",
            "freq": "Common"
          },
          {
            "risk": "Reduced grip strength",
            "detail": "Some weakness due to loss of the ulnar buttress.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Painful stump impingement",
            "detail": "The remaining ulna may impinge on the radius during rotation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Ulnar translocation",
            "detail": "The carpus may shift ulnarward over time.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal cutaneous branch of ulnar nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for two weeks. Gentle rotation exercises from two weeks. Full activity at six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose strength?",
            "a": "Some grip strength reduction is expected, but most patients find the pain relief outweighs the small strength loss. In lower-demand patients, this is rarely a problem."
          }
        ]
      }
    ]
  },
  "thumb-cmc-fusion": {
    "name": "Thumb CMC Joint Fusion",
    "region": "Hand & Wrist",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Thumb CMC (carpometacarpal) joint fusion is an operation to permanently stiffen the joint at the base of the thumb by fusing the metacarpal to the trapezium. It provides a strong, pain-free thumb but sacrifices some motion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the base of the thumb. The cartilage is removed from the CMC joint. The bones are positioned in a functional pinch position and fixed with screws, a plate, or wires. Bone graft may be used. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "CMC fusion is typically recommended for younger, high-demand patients with CMC arthritis who need a strong, stable thumb for heavy manual work, or for post-traumatic arthritis. Trapeziectomy is more commonly chosen for older patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Thumb splinting, corticosteroid injection, activity modification. Trapeziectomy (with or without ligament reconstruction) is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays. Assessment of the neighbouring joints (STT joint must be healthy for fusion to work)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Strong, pain-free thumb for heavy grip and pinch. Grip strength is well preserved. Better for high-demand activities than trapeziectomy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of thumb motion",
            "detail": "Reduced range of motion at the base of the thumb.",
            "freq": "Expected"
          },
          {
            "risk": "Difficulty with flat palming",
            "detail": "Placing the hand flat becomes difficult.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to fuse. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint arthritis",
            "detail": "Increased stress on neighbouring joints.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sensory branches to the thumb.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Metalwork problems",
            "detail": "Screw prominence or loosening.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Regional or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Thumb cast for six to eight weeks. Hand therapy for grip strengthening. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why fusion instead of trapeziectomy?",
            "a": "Fusion provides a stronger thumb better suited for heavy manual work. Trapeziectomy preserves more motion but may have less pinch strength initially. The choice depends on your age, activity demands, and personal preference."
          }
        ]
      }
    ]
  },
  "pip-dip-fusion": {
    "name": "Finger Joint Fusion (PIP/DIP)",
    "region": "Hand & Wrist",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Finger joint fusion (arthrodesis) is an operation to permanently stiffen a painful or unstable finger joint — either the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joint. It provides a pain-free, stable finger in a functional position.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the affected joint. The cartilage is removed from both sides of the joint. The bones are aligned in a functional position (typically 20-40 degrees of flexion for PIP joints, 0-10 degrees for DIP joints) and fixed with a screw, wire, or plate. The operation takes 30-45 minutes per joint."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Fusion is recommended for painful arthritis (osteoarthritis or inflammatory), joint instability, mallet finger deformity not responding to splinting, and failed joint replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting, corticosteroid injection, and activity modification. Joint replacement is an alternative for PIP joints in selected patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief and a stable finger. DIP fusion has minimal functional impact. PIP fusion eliminates pain but reduces overall finger function more significantly."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of joint motion",
            "detail": "Expected — the fused joint is permanently stiff in a fixed position.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "Wire or screw may be palpable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure to fuse. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malposition",
            "detail": "The joint may fuse in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or bone infection.",
            "freq": "Rare"
          },
          {
            "risk": "Cold intolerance",
            "detail": "Some patients report increased sensitivity to cold.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local digital block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint or K-wire protection for four to six weeks. Exercises for adjacent joints begin immediately. K-wire removal at four to six weeks if used. Full recovery two to three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at six weeks to confirm fusion."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I notice the loss of movement?",
            "a": "DIP fusion has minimal functional impact — most people barely notice it. PIP fusion has a greater impact but provides a stable, pain-free finger that is more functional than a painful, stiff arthritic joint."
          }
        ]
      }
    ]
  },
  "tendon-transfer": {
    "name": "Tendon Transfer",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tendon transfer is an operation to reroute a functioning tendon from its normal attachment to a new position, replacing the function of a damaged or paralysed tendon or muscle. It restores lost movements in the hand.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "One or more incisions are made in the forearm and/or hand. A functioning expendable tendon (the donor) is detached from its insertion, rerouted through the tissues, and attached to the insertion of the non-functioning tendon (the recipient). The tension is carefully set. Common transfers include PT-to-ECRB for wrist extension, FDS-to-EDC for finger extension, and opponensplasty for thumb opposition. The operation takes one to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Tendon transfer is recommended for irreversible nerve injuries (radial, ulnar, or median nerve palsy), tendon ruptures that cannot be directly repaired, and conditions such as rheumatoid tendon ruptures or spinal cord injury."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting and adaptive devices can compensate for some lost functions. Nerve repair or grafting may restore function if performed early enough. Tendon transfer is typically performed when nerve recovery is not expected."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Detailed assessment of available donor tendons and recipient needs. The donor tendon must be expendable, have adequate strength, and have appropriate excursion (range of pull). Pre-operative hand therapy."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of lost movement. Outcomes depend on the specific transfer, patient compliance with rehabilitation, and the underlying condition. Most well-selected transfers provide useful functional improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited power",
            "detail": "The transferred tendon may not be as strong as the original muscle.",
            "freq": "Expected"
          },
          {
            "risk": "Rehabilitation demands",
            "detail": "Retraining the brain to use the transferred tendon for a new function takes dedicated practice.",
            "freq": "Expected"
          },
          {
            "risk": "Adhesions",
            "detail": "Scar tissue may limit tendon glide.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Transfer failure",
            "detail": "The transferred tendon may pull out, rupture, or not function adequately.",
            "freq": "Uncommon"
          },
          {
            "risk": "Loss of donor function",
            "detail": "Some loss of the original function of the donor tendon.",
            "freq": "Expected"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "Joint stiffness from prolonged splinting.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Protective splinting for four to six weeks. Hand therapy begins immediately and is critical — retraining the brain to use the transferred tendon takes weeks of practice. Active use from six weeks. Full rehabilitation three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sudden loss of the restored function (possible tendon rupture)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews with hand therapy over three to six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does the brain learn to use the tendon differently?",
            "a": "Through repetitive practice, the brain creates new neural pathways. Initially, you activate the transferred tendon by thinking about its original function. Gradually, the movement becomes automatic."
          }
        ]
      }
    ]
  },
  "digital-nerve-repair": {
    "name": "Digital Nerve Repair",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Digital nerve repair is an operation to suture a cut nerve in the finger, restoring sensation. It is performed for lacerations that divide one or both digital nerves, causing numbness in part of the finger.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The wound is explored, and the cut nerve ends are identified under magnification. The ends are trimmed to healthy tissue and sutured together using extremely fine sutures (finer than a human hair) under an operating microscope. If there is a gap, a nerve graft or conduit may be used to bridge it. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for clean lacerations dividing a digital nerve, particularly on the side of the finger used for pinch grip (radial side of the index, thumb) or in the dominant hand. Without repair, the affected side of the finger remains permanently numb."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation may be appropriate for injuries to the non-critical side of non-dominant fingers, particularly in elderly patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Early repair (within days of injury) gives the best results. Delayed repair beyond three weeks becomes progressively more difficult."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Return of protective sensation in most patients. Full, normal sensation is rarely achieved — most patients recover useful but imperfect sensation. Younger patients recover better than older patients. Repaired nerves regenerate at approximately 1 mm per day."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Incomplete recovery",
            "detail": "Full, normal sensation is rarely restored. Most patients recover useful protective sensation.",
            "freq": "Expected"
          },
          {
            "risk": "Cold intolerance",
            "detail": "Hypersensitivity to cold in the repaired finger.",
            "freq": "Common"
          },
          {
            "risk": "Hypersensitivity",
            "detail": "Tingling and tenderness during nerve regeneration.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Neuroma",
            "detail": "Painful scar tissue at the repair site.",
            "freq": "Uncommon"
          },
          {
            "risk": "No recovery",
            "detail": "The nerve may fail to regenerate.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "Finger stiffness from splinting and scar tissue.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Protective splint for two to three weeks. Gentle finger movement begins early. Desensitisation therapy when tingling begins (indicates nerve regeneration). Sensory recovery continues for 12–18 months. The nerve regenerates at approximately 1 mm per day from the repair site to the fingertip."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing pain at the repair site",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Sensation monitoring at six weeks, three months, six months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long until sensation returns?",
            "a": "Nerves regenerate at approximately 1 mm per day. For a finger laceration, useful sensation typically returns over three to six months, continuing to improve for up to 18 months."
          },
          {
            "q": "Will my sensation be completely normal?",
            "a": "Full normal sensation is rarely restored. Most patients recover useful protective sensation — enough to feel heat, cold, and sharp objects — but fine touch discrimination may remain impaired."
          }
        ]
      }
    ]
  },
  "medial-meniscus-repair": {
    "name": "Medial Meniscus Repair",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Medial meniscus repair is an arthroscopic operation to stitch together a torn medial meniscus in the knee, preserving this important shock-absorbing structure rather than removing it.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically through small incisions. The tear is identified and the edges are prepared. Sutures are passed through the meniscus to bring the torn edges together, using devices inserted through the arthroscope. A small incision on the inner side of the knee may be needed for inside-out repair techniques. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Repair is preferred over removal whenever possible because the meniscus is vital for knee function and joint protection. Repair is most successful for tears in the outer one-third of the meniscus (red zone) where blood supply supports healing. It is commonly performed alongside ACL reconstruction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and observation may be appropriate for small, stable tears causing minimal symptoms. Partial meniscectomy (trimming) is quicker to recover from but removes protective tissue."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess tear pattern. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of the meniscus protects against future arthritis. Healing rates are approximately 80–90% for repairs in the vascular zone and when combined with ACL reconstruction."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Recovery is slower than after partial meniscectomy due to healing requirements.",
            "freq": "Expected"
          },
          {
            "risk": "Knee stiffness",
            "detail": "Temporary loss of full flexion.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Failure to heal",
            "detail": "The repair may not heal, requiring later partial meniscectomy. Risk approximately 10-20%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-tear",
            "detail": "The repaired meniscus may tear again with return to sport.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Saphenous nerve branch may be damaged with inside-out repair, causing numbness on the inner knee.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT during restricted weight-bearing.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with a nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches and limited flexion for four to six weeks. Progressive range of motion under physiotherapy guidance. No deep squatting or pivoting for three months. Running at three to four months. Return to sport at six months. Full recovery six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Locking or catching of the knee",
          "Wound redness or discharge",
          "Fever",
          "Calf pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months. MRI may be used to assess healing."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why repair instead of remove?",
            "a": "The meniscus distributes load across the knee. Removing even part of it increases the risk of arthritis. Preservation through repair is preferred whenever the tear pattern allows it."
          },
          {
            "q": "Why is recovery longer than a meniscectomy?",
            "a": "The repair needs time to heal. Early overloading can cause the stitches to pull out. Meniscectomy removes tissue, so there is nothing that needs to heal."
          }
        ]
      }
    ]
  },
  "lateral-meniscectomy": {
    "name": "Partial Meniscectomy",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Partial meniscectomy is an arthroscopic operation to trim and remove the damaged, unstable portion of a torn meniscus in the knee, while preserving as much healthy tissue as possible.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically through two or three small incisions. The torn, unstable portion of the meniscus is identified, trimmed back to a stable rim using motorised shavers and small instruments, and removed. As much healthy meniscus as possible is preserved. The operation takes 20–40 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Partial meniscectomy is recommended for symptomatic meniscal tears causing locking, catching, or persistent swelling that have not responded to physiotherapy, particularly tears in the inner (avascular) zone where repair is unlikely to heal."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, anti-inflammatory medication, and time. Many degenerative meniscal tears improve with non-operative treatment, particularly in patients over 40 without mechanical symptoms."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess the tear. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of mechanical symptoms (locking, catching) in approximately 85–90% of patients. Quick recovery."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Some patients continue to have discomfort, particularly with degenerative tears and underlying arthritis.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling for one to two weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Accelerated arthritis",
            "detail": "Removing meniscal tissue reduces shock absorption and may accelerate cartilage wear.",
            "freq": "Long-term"
          },
          {
            "risk": "Re-tear",
            "detail": "Another area of the meniscus may tear in the future.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection. Risk approximately 0.3%.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT. Very rare after knee arthroscopy.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Crutches for comfort for a few days. Return to desk work within days. Driving at one to two weeks. Running at four to six weeks. Return to sport at six to eight weeks. Full recovery six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain after initial improvement",
          "Locking of the knee",
          "Wound redness or discharge",
          "Fever",
          "Calf pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will removing part of the meniscus cause arthritis?",
            "a": "Removing meniscal tissue does increase the long-term risk of arthritis in the affected compartment. This is why surgeons preserve as much tissue as possible and attempt repair when feasible."
          },
          {
            "q": "How quickly can I return to sport?",
            "a": "Most patients return to sport at six to eight weeks, though this varies with the extent of the tear and the sport."
          }
        ]
      }
    ]
  },
  "mcl-repair": {
    "name": "MCL Repair / Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "MCL (medial collateral ligament) repair or reconstruction is an operation to restore stability to the inner side of the knee after a significant MCL injury that has not healed with non-operative treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the inner side of the knee. For acute repair, the torn ligament is reattached to bone with suture anchors. For chronic injuries, a tendon graft may be needed to reconstruct the ligament. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Most MCL injuries heal without surgery. Surgical repair or reconstruction is reserved for complete tears that remain unstable despite bracing and rehabilitation, particularly when combined with other ligament injuries (multi-ligament knee injury)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bracing and physiotherapy are effective for the majority of MCL injuries, including many complete tears."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and stress X-rays. Pre-operative physiotherapy to restore range of motion."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of medial knee stability. Most patients achieve good stability and return to sport."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Particularly loss of full flexion.",
            "freq": "Common"
          },
          {
            "risk": "Medial knee pain",
            "detail": "Tenderness over the repair site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Saphenous nerve injury",
            "detail": "Numbness on the inner calf and knee. Common with medial knee surgery.",
            "freq": "Common"
          },
          {
            "risk": "Failure of repair",
            "detail": "The ligament may stretch or re-tear.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hinged brace for six weeks. Crutches for four to six weeks. Progressive rehabilitation. Running at three to four months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Knee giving way",
          "Increasing numbness on inner calf"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why don't most MCL injuries need surgery?",
            "a": "The MCL has an excellent blood supply and heals well with bracing and rehabilitation. Surgery is only needed for injuries that fail to heal or are part of complex multi-ligament injuries."
          }
        ]
      }
    ]
  },
  "distal-femoral-osteotomy": {
    "name": "Distal Femoral Osteotomy",
    "region": "Knee",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Distal femoral osteotomy is an operation to realign the lower end of the thighbone to correct a knock-knee (valgus) deformity. It shifts weight-bearing away from the damaged outer compartment of the knee.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the inner side of the lower thigh. A wedge of bone is removed (closing wedge) or the bone is cut and opened (opening wedge) to correct the alignment. The osteotomy is fixed with a plate and screws. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Distal femoral osteotomy is recommended for younger, active patients with unicompartmental knee arthritis affecting the lateral (outer) compartment due to valgus malalignment. It preserves the native knee joint."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, lateral wedge insoles, activity modification, injections. Total or partial knee replacement are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Long-leg alignment X-rays and CT scan for planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief by offloading the damaged compartment. Delay or avoidance of knee replacement. Most patients achieve good results lasting 10+ years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of knee flexion.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Thigh and knee swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Metalwork prominence",
            "detail": "The plate may be palpable on the inner thigh.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union or delayed union",
            "detail": "Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction or under-correction",
            "detail": "Imperfect correction of alignment.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Through the osteotomy site.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neurovascular injury",
            "detail": "Peroneal nerve and popliteal vessels at risk.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Partial weight-bearing for six to eight weeks. Knee exercises begin immediately. Full weight-bearing by three months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Foot drop or numbness on outer leg (peroneal nerve)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this better than knee replacement?",
            "a": "For younger, active patients with lateral compartment arthritis and valgus alignment, osteotomy preserves the natural knee and allows continued high-level activity. It delays the need for replacement."
          }
        ]
      }
    ]
  },
  "biceps-tenotomy": {
    "name": "Biceps Tenotomy",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Biceps tenotomy is an arthroscopic procedure to release the long head of the biceps tendon from its attachment inside the shoulder joint. It is performed for painful biceps tendon conditions and is a simpler alternative to tenodesis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through small incisions. The long head of the biceps tendon is identified at its attachment to the superior labrum and simply cut with arthroscopic scissors. The tendon retracts into the bicipital groove and scars in place. The operation takes 10–15 minutes and is often performed during other arthroscopic shoulder procedures."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Tenotomy is recommended for biceps tendinopathy, partial tears of the long head of biceps, and SLAP tears in patients over 55 or those with low physical demands. It is a quicker, simpler alternative to tenodesis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, corticosteroid injection, activity modification. Tenodesis is a surgical alternative that preserves biceps contour."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Usually performed during another arthroscopic procedure. Minimal additional preparation needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief from the biceps source. Very simple procedure with minimal additional recovery time."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Popeye deformity",
            "detail": "The biceps muscle may bunch in the upper arm when the tendon retracts. Occurs in approximately 30–40%.",
            "freq": "Common"
          },
          {
            "risk": "Mild cramping",
            "detail": "Biceps cramping with heavy use.",
            "freq": "Common"
          },
          {
            "risk": "Cosmetic concern",
            "detail": "The bulge may be noticeable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Strength loss",
            "detail": "Approximately 10–15% loss of elbow flexion and supination strength. Rarely clinically significant in older patients.",
            "freq": "Common"
          },
          {
            "risk": "Persistent pain",
            "detail": "Some patients continue to have shoulder pain from other pathology.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block (as part of the accompanying procedure)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is determined by the main procedure performed. Tenotomy itself adds minimal recovery time. Immediate elbow and forearm use is allowed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "As per the main procedure performed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose strength?",
            "a": "There is a small loss of supination and flexion strength, but this is rarely noticeable in daily life, particularly in patients over 55. Younger, active patients may prefer tenodesis to preserve strength."
          },
          {
            "q": "Will the Popeye deformity bother me?",
            "a": "Many patients do not notice it or are not concerned. If cosmetic appearance is important to you, tenodesis may be preferred."
          }
        ]
      }
    ]
  },
  "ddh-open-reduction": {
    "name": "Open Reduction for DDH",
    "region": "Paediatric Orthopaedics",
    "tag": "Hip",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Open reduction for developmental dysplasia of the hip (DDH) is an operation to place a dislocated hip back into the socket in a child when closed (non-operative) reduction has been unsuccessful or is not appropriate.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the hip (anterior approach). Soft tissue obstructions preventing reduction are removed, including a tight psoas tendon and thickened ligamentum teres. The femoral head is placed back into the acetabulum. A hip spica cast (a body cast from the chest to the knees) is applied to hold the hip in place while it stabilises. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Open reduction is needed when DDH is diagnosed late (after six months), when closed reduction under anaesthesia has failed, or when the hip cannot be maintained in a reduced position."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Pavlik harness (for infants under six months), closed reduction under anaesthesia, and hip spica casting. These are tried first when age-appropriate."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or arthrogram to assess the hip. The child needs to be fit for a general anaesthetic and prepared for six to twelve weeks in a hip spica cast."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Successful relocation of the hip, allowing normal hip development. Earlier treatment gives better outcomes. Most children go on to have a well-functioning hip, though long-term monitoring is essential."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Spica cast complications",
            "detail": "Skin irritation, cast breakage, and difficulty with hygiene and care.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary hip stiffness after cast removal.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis (AVN)",
            "detail": "Loss of blood supply to the femoral head, potentially causing growth disturbance. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-dislocation",
            "detail": "The hip may dislocate again, requiring further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Residual dysplasia",
            "detail": "The socket may remain shallow, requiring later osteotomy.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Growth disturbance",
            "detail": "Damage to the growth plate affecting leg length.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Care with positioning in the hip spica."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hip spica cast for six to twelve weeks. Cast changes may be needed. After cast removal, the child gradually returns to normal activity. Physiotherapy is rarely needed — children adapt quickly. Long-term X-ray monitoring until skeletal maturity to watch for dysplasia or AVN."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Cast becoming too tight",
          "Skin redness or sores under the cast",
          "Toes turning blue or cold",
          "Child in significant distress",
          "Fever",
          "Foul smell from under the cast"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays and clinical reviews throughout childhood to monitor hip development."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long will my child be in a cast?",
            "a": "Typically six to twelve weeks. The cast holds the hip in the correct position while the soft tissues tighten around it."
          },
          {
            "q": "Will my child walk normally?",
            "a": "Most children treated successfully walk normally. Earlier treatment gives better outcomes."
          },
          {
            "q": "Will they need more surgery later?",
            "a": "Some children need further procedures (such as pelvic or femoral osteotomy) if the socket remains shallow as they grow."
          }
        ]
      }
    ]
  },
  "ddh-salter-osteotomy": {
    "name": "DDH Pelvic Osteotomy (Salter)",
    "region": "Paediatric Orthopaedics",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A Salter innominate osteotomy is an operation to redirect the hip socket to provide better coverage of the femoral head in a child with residual hip dysplasia. It is one of the most common pelvic osteotomies performed in children.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the hip. The innominate bone is cut completely and the acetabular fragment is rotated forward and outward to cover the femoral head better. A bone graft (from the iliac crest) is wedged into the osteotomy and the correction is held with one or two pins. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Salter osteotomy is recommended for residual acetabular dysplasia after DDH treatment, typically in children aged 18 months to six years. It improves coverage of the femoral head, reducing the risk of subluxation and arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation if dysplasia is mild and improving on serial X-rays. Bracing is not effective for established bony dysplasia."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and sometimes CT to plan the correction. Pre-operative assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved hip coverage and stability. Good long-term outcomes when performed at the appropriate age. Most children achieve a near-normal hip."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site irritation",
            "detail": "The pins may cause local discomfort and are removed at six to eight weeks.",
            "freq": "Common"
          },
          {
            "risk": "Spica cast",
            "detail": "A hip spica is usually needed for six weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary hip stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "AVN",
            "detail": "Risk to the femoral head blood supply.",
            "freq": "Rare"
          },
          {
            "risk": "Over-correction",
            "detail": "Excessive coverage causing impingement.",
            "freq": "Rare"
          },
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Thigh numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or pin-site infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hip spica cast for six weeks. Pin removal at six to eight weeks (a minor procedure). Gradual return to normal activity over a further six to eight weeks. Children adapt remarkably quickly."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Cast too tight",
          "Toes blue or cold",
          "Fever",
          "Foul smell from cast",
          "Pins becoming loose"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays until skeletal maturity to monitor hip development."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why does the socket need redirecting?",
            "a": "In DDH, the socket is often too shallow and faces too vertically. The Salter osteotomy rotates it to face downward and forward, providing better coverage and stability."
          }
        ]
      }
    ]
  },
  "sufe-pinning": {
    "name": "SUFE (Slipped Epiphysis) Pinning",
    "region": "Paediatric Orthopaedics",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "SUFE (slipped upper femoral epiphysis) pinning is an urgent operation to stabilise the growth plate at the top of the thighbone in a child or adolescent when it has slipped out of position. A single screw is placed across the growth plate to prevent further slippage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, a single cannulated screw is inserted through the outer thigh, across the femoral neck, and into the femoral head epiphysis, crossing the growth plate to prevent further slip. The screw is left permanently. The operation takes 30–60 minutes. For unstable slips, urgent surgery within hours is critical."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "SUFE is an emergency — the growth plate is slipping and further displacement worsens outcomes. Pinning in situ (in its current position) prevents further slip and allows the growth plate to fuse."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no effective non-operative alternatives for SUFE. Without fixation, the slip progresses."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an urgent/emergency procedure. X-rays confirm the diagnosis. The child is kept non-weight-bearing and prepared for theatre."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of further slippage. The growth plate fuses over the following months. Most patients with mild to moderate stable slips have good long-term outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg length discrepancy",
            "detail": "The affected leg may be slightly shorter as growth plate closure is accelerated.",
            "freq": "Common"
          },
          {
            "risk": "Reduced hip rotation",
            "detail": "Internal rotation is typically limited.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "AVN",
            "detail": "Loss of blood supply to the femoral head. Risk is highest in unstable (acute) slips — approximately 20-50% for unstable slips vs less than 5% for stable slips.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chondrolysis",
            "detail": "Cartilage destruction causing stiffness and pain. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Contralateral slip",
            "detail": "The other hip may slip (approximately 20-40% risk). Prophylactic pinning may be discussed.",
            "freq": "Common"
          },
          {
            "risk": "Screw penetration",
            "detail": "The screw may inadvertently enter the joint, damaging cartilage.",
            "freq": "Rare"
          },
          {
            "risk": "Slip progression",
            "detail": "Rarely, the slip may progress despite fixation.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned supine on a fracture table with X-ray guidance."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for four to six weeks. Crutches. Gradual return to full activity. The other hip is monitored closely."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin, thigh, or knee pain in either hip",
          "Difficulty walking",
          "Fever",
          "Wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up with X-rays every three to six months until growth plate closure. The other hip is monitored."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why does my child have knee pain with a hip problem?",
            "a": "SUFE commonly presents with knee pain because the hip and knee share nerve pathways. Any child with unexplained knee or thigh pain should have their hip examined."
          },
          {
            "q": "Will the other hip slip too?",
            "a": "There is a 20-40% risk of the other hip slipping. Your surgeon will discuss whether preventive (prophylactic) pinning of the other hip is advisable."
          }
        ]
      }
    ]
  },
  "clubfoot-tenotomy": {
    "name": "Clubfoot Tenotomy (Ponseti Method)",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Achilles tenotomy as part of the Ponseti method is a minor procedure to release the tight Achilles tendon in a baby being treated for clubfoot (congenital talipes equinovarus). It completes the correction achieved by serial casting.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "After serial casting has corrected most of the deformity, the Achilles tendon is divided through a tiny incision or percutaneously (through the skin with a blade) under local anaesthetic. The foot is placed in a final cast for three weeks while the tendon heals at its new, longer length. The procedure takes five to ten minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Approximately 80-90% of babies treated with the Ponseti casting method require an Achilles tenotomy to correct the residual equinus (downward pointing) of the foot."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Continued casting alone may correct mild equinus, but most clubfeet require tenotomy to achieve full correction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Performed as a day-case procedure, often in clinic. The baby has usually had four to six weekly casts before the tenotomy."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete correction of the equinus component of the clubfoot. The tendon heals within three weeks and is stronger at its new length. Success rates with the Ponseti method exceed 95%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Bleeding",
            "detail": "Minor bleeding from the tenotomy site.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete correction",
            "detail": "Rarely, the equinus may not be fully corrected.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pseudoaneurysm",
            "detail": "Very rare damage to the peroneal artery.",
            "freq": "Rare"
          },
          {
            "risk": "Overcorrection",
            "detail": "Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence of clubfoot",
            "detail": "Approximately 20-30% of clubfeet recur and may need repeat tenotomy or tibialis anterior transfer.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic with sucrose for comfort. Occasionally performed under brief general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Final cast for three weeks. Then transition to a foot abduction brace (boots and bar), worn full-time for three months, then during sleep until age four to five years. Brace compliance is critical to prevent recurrence."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Excessive bleeding from the tenotomy site",
          "Toes turning blue or cold",
          "Cast too tight",
          "Fever",
          "Skin redness under the cast"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Cast change at three weeks. Regular follow-up throughout childhood to monitor for recurrence."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my baby need to wear boots and bar?",
            "a": "Yes, the foot abduction brace is essential to prevent recurrence. It is worn full-time initially, then during sleep until age four to five. Compliance is the single most important factor in preventing recurrence."
          },
          {
            "q": "Does the Achilles tendon grow back?",
            "a": "Yes, the tendon regenerates and heals at its new, corrected length within three weeks. Studies show the regenerated tendon is structurally normal."
          }
        ]
      }
    ]
  },
  "leg-lengthening": {
    "name": "Leg Lengthening",
    "region": "Paediatric Orthopaedics",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Leg lengthening is a surgical procedure to increase the length of a shortened bone using the body's own healing response. The bone is surgically divided and gradually distracted (pulled apart), allowing new bone to form in the gap.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The bone (usually tibia or femur) is divided through a small incision (corticotomy). An internal lengthening nail (such as PRECICE) is placed inside the bone, or an external fixator frame is applied around the limb. Over the following weeks, the nail or frame is gradually adjusted to pull the bone apart at approximately 1 mm per day, and new bone forms in the gap (distraction osteogenesis). The distraction phase takes several weeks; the consolidation phase (while new bone hardens) takes months."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Leg lengthening is recommended for significant leg length discrepancy (usually greater than 3-4 cm), short stature conditions, and congenital limb deficiencies. The discrepancy may be due to growth plate damage, congenital conditions, or previous fracture."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Shoe raises (for discrepancies under 2-3 cm), epiphysiodesis (controlled growth arrest of the longer leg), and acceptance of the discrepancy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Detailed planning with standing X-rays, bone age assessment, and predicted final discrepancy. Psychological preparation of the child and family is important. This is a prolonged treatment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Correction of leg length discrepancy with the patient's own bone. Lengthening of 3-8 cm is routinely achievable. The new bone becomes indistinguishable from normal bone."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged treatment",
            "detail": "The entire process takes many months (distraction plus consolidation).",
            "freq": "Expected"
          },
          {
            "risk": "Pain during distraction",
            "detail": "Daily lengthening can be uncomfortable. Managed with analgesia.",
            "freq": "Expected"
          },
          {
            "risk": "Joint stiffness",
            "detail": "Knee or ankle stiffness from soft tissue tightening as the bone lengthens.",
            "freq": "Common"
          },
          {
            "risk": "Pin site infection",
            "detail": "With external fixators, pin site infections are very common and usually managed with antibiotics and pin care.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Premature consolidation",
            "detail": "The bone may heal before sufficient length is achieved, requiring repeat surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Delayed consolidation",
            "detail": "The new bone may be slow to harden.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve palsy",
            "detail": "Stretching of nerves during lengthening, particularly the peroneal nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Joint subluxation",
            "detail": "The joint above or below may subluxate as the bone lengthens.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Through the regenerate bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "Particularly with external fixation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Psychological impact",
            "detail": "The prolonged treatment can be challenging for children and families.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia for the initial surgery. Subsequent adjustments are done at home (internal nails with external magnets; external fixators with manual adjustment)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Distraction phase: four to eight weeks depending on the amount of lengthening needed. Consolidation phase: two to four months (the new bone hardens). Total treatment time: four to twelve months. Intensive physiotherapy throughout. Weight-bearing as guided by the surgeon. Return to full activity after the nail is removed or frame is taken off and the bone is fully consolidated."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden pain at the lengthening site (possible fracture or premature consolidation)",
          "Joint stiffness not responding to physiotherapy",
          "New foot drop or numbness",
          "Pin site redness, discharge, or loosening",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent X-rays and clinical reviews throughout treatment — typically every two to four weeks during distraction and monthly during consolidation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How much can the bone be lengthened?",
            "a": "Typically 3-8 cm in a single lengthening. Greater amounts may require staged procedures. The rate of lengthening is approximately 1 mm per day."
          },
          {
            "q": "Is an internal nail or external frame better?",
            "a": "Internal lengthening nails (like PRECICE) are more comfortable and have lower infection rates, but are not suitable for very young children whose bones are too small. External fixators remain an excellent option and allow more complex corrections."
          }
        ]
      }
    ]
  },
  "supracondylar-kwire": {
    "name": "Supracondylar Fracture K-Wire Fixation",
    "region": "Paediatric Orthopaedics",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Supracondylar fracture fixation is an urgent operation to realign and pin a broken lower end of the humerus (upper arm bone) near the elbow in a child. It is one of the most common paediatric fracture operations.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, the fracture is reduced (realigned) by manipulation. Two or three K-wires (thin metal pins) are passed through the skin, across the fracture, to hold it in position. The wires protrude through the skin and are bent over. A cast or splint is applied. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is needed for displaced supracondylar fractures (Gartland types II and III). These fractures can damage the brachial artery and nerves around the elbow, so prompt treatment is important."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced fractures (Gartland type I) are treated in a cast or collar-and-cuff sling. Displaced fractures require surgical fixation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency or urgent procedure. Assessment of the nerve and blood supply to the hand is critical before and after surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent outcomes in most children. The fracture heals within three to four weeks and remodelling occurs with growth. Most children regain full elbow movement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site infection",
            "detail": "Superficial infection around the protruding wires. Usually managed with antibiotics.",
            "freq": "Common"
          },
          {
            "risk": "Loss of carrying angle",
            "detail": "A minor change in the angle of the arm at the elbow (cubitus varus). Usually cosmetic only.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "The median, radial, or ulnar nerve may be injured by the fracture or during pinning. Most recover spontaneously.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vascular injury",
            "detail": "The brachial artery may be damaged. Requires urgent assessment. If the hand is pink and warm, the artery is usually intact.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Increased pressure in the forearm muscles. Requires emergency surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Malunion",
            "detail": "Healing in a rotated position. May cause cubitus varus (gunstock deformity).",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "Usually temporary. Children recover movement faster than adults.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast or splint for three to four weeks. K-wires removed in clinic at three to four weeks (quick procedure, usually without anaesthesia). Most children regain full movement within six to eight weeks without formal physiotherapy."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Hand turning white, blue, or cold",
          "Severe forearm pain not relieved by position change or pain relief (possible compartment syndrome — attend A&E immediately)",
          "Inability to move fingers",
          "Increasing swelling",
          "Pin site discharge",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at one week. Wire removal and X-ray at three to four weeks. Final review at six to eight weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this an emergency?",
            "a": "Displaced supracondylar fractures can damage the blood supply or nerves to the hand. Prompt reduction and fixation reduces the risk of these complications."
          },
          {
            "q": "Will the wires hurt when removed?",
            "a": "Wire removal is a quick procedure performed in clinic. Most children experience brief discomfort but tolerate it well."
          },
          {
            "q": "Will my child regain full movement?",
            "a": "Almost all children regain full elbow movement. Children heal and remodel much better than adults."
          }
        ]
      }
    ]
  },
  "epiphysiodesis": {
    "name": "Epiphysiodesis (Growth Modulation)",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Epiphysiodesis is a minimally invasive operation to slow or stop growth at a specific growth plate. It is used to correct leg length discrepancy by slowing growth of the longer leg, or to correct angular deformity by slowing growth on one side of a growth plate.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For permanent epiphysiodesis: small incisions are made over the growth plate. The growth plate is ablated (destroyed) by drilling or curettage. For temporary (reversible) epiphysiodesis: a small plate and screws (8-plate or tension band plate) are placed across one side of the growth plate to guide growth. The procedure takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Epiphysiodesis is recommended for predicted leg length discrepancy (usually 2-5 cm at maturity), angular deformity correction (knock knees or bow legs) in growing children, and Blount's disease."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Shoe raise (for small discrepancies), observation, and leg lengthening of the short side (for larger discrepancies)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Bone age assessment and growth prediction charts to time the procedure correctly. Accurate prediction of remaining growth is essential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Gradual equalisation of leg lengths or correction of angular deformity using the child's own growth. When timed correctly, excellent results are achieved."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Under-correction or over-correction",
            "detail": "If growth prediction is inaccurate, the final leg lengths may not be equal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw prominence",
            "detail": "Hardware may be palpable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Growth plate damage",
            "detail": "Unintended complete physeal arrest causing angular deformity.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Hardware failure",
            "detail": "Plate or screw breakage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Rebound growth",
            "detail": "After temporary plate removal, growth may overshoot.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Day-case procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Minimal recovery. Walking immediately with crutches for comfort. Return to school within days. Full activity at four to six weeks. For temporary epiphysiodesis, plate removal is performed once correction is achieved."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Increasing limb deformity",
          "New knee or ankle pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Standing alignment X-rays every six months until skeletal maturity."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why stop growth rather than lengthen the short leg?",
            "a": "Epiphysiodesis is a much simpler procedure with faster recovery and fewer complications than leg lengthening. It is appropriate when the predicted discrepancy is 2-5 cm and timing allows."
          },
          {
            "q": "How is the timing calculated?",
            "a": "Growth prediction uses bone age (from a hand X-ray) and charts to estimate remaining growth. The procedure is timed so that the longer leg stops growing just as the shorter leg catches up."
          }
        ]
      }
    ]
  },
  "wide-excision-bone": {
    "name": "Wide Local Excision (Bone Tumour)",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Wide local excision is an operation to remove a bone tumour along with a surrounding margin of healthy tissue. It is the standard surgical treatment for primary malignant bone tumours (sarcomas) and some aggressive benign tumours.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the tumour, carefully planned to allow complete removal. The tumour is excised en bloc (as a single piece) with a cuff of normal tissue around it. The biopsy tract is removed with the specimen. The resulting bone defect may be reconstructed with an endoprosthesis (metal implant), bone graft, or a combination. The operation is complex and may take three to six hours depending on the location and reconstruction needed."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is the primary curative treatment for bone sarcomas (osteosarcoma, chondrosarcoma, Ewing's sarcoma after chemotherapy). The goal is complete removal with clear margins while preserving as much limb function as possible."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For some sarcomas, chemotherapy and/or radiotherapy may be used to shrink the tumour before surgery (neoadjuvant therapy). Radiotherapy alone may be used when surgery is not possible. Amputation is a last resort when limb salvage is not feasible."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Staging investigations (MRI, CT, bone scan, PET-CT). Multidisciplinary team discussion. Neoadjuvant chemotherapy may precede surgery. This is performed at specialist sarcoma centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete removal of the tumour with the best chance of cure. Limb salvage is achievable in approximately 85-90% of bone sarcoma cases. Reconstruction aims to preserve function."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Significant recovery",
            "detail": "This is a major operation with a prolonged rehabilitation.",
            "freq": "Expected"
          },
          {
            "risk": "Functional limitation",
            "detail": "Some loss of function is expected depending on the location and extent of resection.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant blood loss. Transfusion is often needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Risk is higher with metallic reconstruction and in patients receiving chemotherapy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Local recurrence",
            "detail": "The tumour may recur locally despite wide margins.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound complications",
            "detail": "Particularly after radiotherapy or chemotherapy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel damage",
            "detail": "May be unavoidable depending on tumour proximity.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Around or through the reconstruction.",
            "freq": "Long-term"
          },
          {
            "risk": "Implant failure",
            "detail": "Endoprosthetic reconstructions may wear, loosen, or break over time.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Significant blood loss requires transfusion capability. Cell salvage is usually avoided in oncology."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks. Rehabilitation depends on the location and reconstruction. Physiotherapy for months. Return to light activity at two to three months. Full recovery six to twelve months. Long-term follow-up is essential."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Fever",
          "Increasing pain",
          "Signs of recurrence (new lump, pain)",
          "Fracture around the reconstruction"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular oncology surveillance: X-rays and CT scans every three months for the first two years, then six-monthly for five years, then annually. Ongoing monitoring of the reconstruction."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I lose my limb?",
            "a": "Limb salvage is achieved in approximately 85-90% of bone sarcoma cases. Amputation is only considered when the tumour involves critical structures that cannot be sacrificed."
          },
          {
            "q": "What is an endoprosthesis?",
            "a": "A custom-made or modular metal implant that replaces the removed section of bone and the adjacent joint. It provides immediate structural support and allows early mobilisation."
          }
        ]
      }
    ]
  },
  "endoprosthetic-reconstruction": {
    "name": "Endoprosthetic Reconstruction",
    "region": "Orthopaedic Oncology",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Endoprosthetic reconstruction is a major operation to replace a section of bone and its adjacent joint with a custom or modular metal implant after tumour resection. It is the most common method of reconstruction following limb-salvage surgery for bone tumours.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "After the tumour-bearing bone segment is removed, a metal prosthesis (endoprosthesis) is implanted to replace the bone and joint. The prosthesis is fixed into the remaining bone with a cemented or uncemented stem. Soft tissues, muscles, and tendons are reattached to the prosthesis where possible. Common sites include the distal femur, proximal tibia, proximal femur, and proximal humerus. The reconstruction phase takes one to three hours (in addition to the resection)."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Endoprosthetic reconstruction provides immediate structural replacement and early mobilisation. It is the most commonly used reconstruction method for bone tumours around the knee, hip, and shoulder."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Biological reconstruction (bone graft or allograft), rotationplasty, or amputation are alternatives depending on the clinical situation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Pre-operative imaging for implant planning. Custom prostheses may need several weeks to manufacture."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of the limb with functional joint replacement. Most patients achieve useful limb function. Modern endoprostheses have good longevity with approximately 75-85% survival at ten years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Functional limitation",
            "detail": "Some loss of function compared to a normal limb is expected.",
            "freq": "Expected"
          },
          {
            "risk": "Infection",
            "detail": "Risk approximately 5-10% — higher than standard joint replacement due to the extensive surgery and often concurrent chemotherapy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Mechanical complications",
            "detail": "Over time, the prosthesis may wear, loosen, fracture, or dislocate.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Deep infection",
            "detail": "May require implant removal and revision surgery or, rarely, amputation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Aseptic loosening",
            "detail": "The implant may become loose over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Soft tissue failure",
            "detail": "Muscles and tendons may fail to reattach adequately, limiting function.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bushing wear",
            "detail": "In hinge-type prostheses, the hinge mechanism wears and may need replacement.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with significant blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks. Rehabilitation programme supervised by a specialist physiotherapist. Weight-bearing depends on the site — lower limb endoprostheses may require protected weight-bearing for six to eight weeks. Upper limb prostheses begin gentle movement early. Return to light activity at three months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Increasing pain or instability",
          "Swelling or new lump near the prosthesis"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance at regular intervals. Prosthesis monitoring with X-rays. Long-term lifelong follow-up."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does an endoprosthesis last?",
            "a": "Modern endoprostheses have approximately 75-85% survival at ten years. Revision surgery to replace worn components is common over a lifetime."
          },
          {
            "q": "Can I run or play sport?",
            "a": "Low-impact activities are encouraged. High-impact sports are generally not recommended as they accelerate implant wear."
          }
        ]
      }
    ]
  },
  "above-knee-amputation": {
    "name": "Above Knee Amputation",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Above knee amputation (transfemoral amputation) is an operation to remove the leg above the knee. In orthopaedic oncology, it is performed when a bone or soft tissue tumour cannot be safely removed with limb salvage surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made around the thigh at the planned level. The muscles, blood vessels, and nerves are divided and the bone is cut. Muscle flaps are shaped to create a well-padded, conical stump suitable for prosthetic fitting. The skin is closed and a compressive dressing is applied. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Amputation is recommended when a tumour involves critical neurovascular structures making limb salvage unsafe, when the resulting limb would be non-functional, when infection has destroyed a previous reconstruction, or when the patient prefers a definitive solution."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Limb salvage surgery (wide excision with reconstruction) is the primary alternative. Radiotherapy may be considered in some cases."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Multidisciplinary team discussion. Pre-operative meeting with the prosthetics team. Psychological support. Pre-operative physiotherapy to strengthen the upper body."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive removal of the tumour. A well-fashioned stump allows prosthetic fitting and return to walking. Many patients achieve excellent functional outcomes with modern prosthetics."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Phantom limb sensation",
            "detail": "Feeling that the amputated limb is still present. Very common and usually manageable.",
            "freq": "Expected"
          },
          {
            "risk": "Phantom limb pain",
            "detail": "Pain perceived in the missing limb. Occurs in approximately 50-80% of amputees.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing problems",
            "detail": "Particularly in patients who have received radiotherapy or chemotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Psychological impact",
            "detail": "Grief, anxiety, and depression are common and need support.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Stump infection",
            "detail": "Wound infection requiring antibiotics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neuroma",
            "detail": "Painful nerve ending in the stump.",
            "freq": "Common"
          },
          {
            "risk": "Stump revision",
            "detail": "The stump may need surgical revision for bony prominence, soft tissue problems, or prosthetic fitting issues.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT in the remaining leg.",
            "freq": "Uncommon"
          },
          {
            "risk": "Psychological morbidity",
            "detail": "Severe depression or adjustment disorder.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with epidural for post-operative pain management."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay five to ten days. Early stump compression and shaping. Prosthetic fitting at six to eight weeks once the stump has healed and matured. Intensive gait training with a prosthetic limb. Psychological support throughout. Most patients are walking with a prosthesis within three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Fever",
          "Severe phantom pain not responding to medication",
          "Stump swelling or colour change",
          "Signs of depression or psychological distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular prosthetic reviews. Oncology surveillance. Psychological support as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When will I walk again?",
            "a": "Most patients begin walking with a prosthesis within three to six months. Modern prosthetics are highly functional and many amputees return to work, sport, and driving."
          },
          {
            "q": "Will phantom pain go away?",
            "a": "Phantom pain typically improves over time. Various treatments are available including medication, mirror therapy, and neurostimulation. Support from the pain team is important."
          }
        ]
      }
    ]
  },
  "below-knee-amputation": {
    "name": "Below Knee Amputation",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Below knee amputation (transtibial amputation) is an operation to remove the leg below the knee, preserving the knee joint. This allows better prosthetic function than above-knee amputation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made around the upper calf. A long posterior muscle flap is created for stump padding. The tibia and fibula are cut, and the posterior flap is brought forward to cover the bone ends. The skin is closed. The knee joint is preserved. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Below knee amputation is performed when the tumour is confined to the lower leg and the knee can be preserved. Preserving the knee provides much better functional outcomes than above-knee amputation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Limb salvage surgery. Rotationplasty in selected cases."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MDT discussion. Prosthetic team involvement. Pre-operative physiotherapy and psychological support."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of the knee joint allows excellent prosthetic function. Most below-knee amputees walk well and many return to running, cycling, and sport with appropriate prosthetics."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Phantom sensation and pain",
            "detail": "Expected.",
            "freq": "Expected"
          },
          {
            "risk": "Wound healing",
            "detail": "Particularly with prior chemotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Stump oedema",
            "detail": "Swelling management with compression is essential.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound breakdown",
            "detail": "May require revision.",
            "freq": "Uncommon"
          },
          {
            "risk": "Knee contracture",
            "detail": "Loss of full knee extension if not maintained with exercises.",
            "freq": "Common"
          },
          {
            "risk": "Neuroma",
            "detail": "Painful nerve endings.",
            "freq": "Common"
          },
          {
            "risk": "Revision to above-knee",
            "detail": "Rarely needed if the stump fails.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with regional block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay five to seven days. Stump compression and shaping. Prosthetic fitting at six to eight weeks. Gait training. Most patients walk independently within two to three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Phantom pain not responding to treatment",
          "Knee stiffness",
          "Psychological distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Prosthetic reviews. Oncology surveillance. Psychological support."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is preserving the knee so important?",
            "a": "The knee joint provides enormous functional advantage for prosthetic walking. Below-knee amputees use approximately 40% more energy to walk than normal, compared to 60-100% more for above-knee amputees."
          }
        ]
      }
    ]
  },
  "limb-salvage": {
    "name": "Limb Salvage Surgery",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Limb salvage surgery is a complex operation to remove a bone or soft tissue tumour while preserving the affected limb. The resected segment is reconstructed to maintain limb function. It is the preferred approach for most bone and soft tissue sarcomas.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The tumour is removed en bloc with a margin of healthy tissue. The resulting defect is reconstructed using an endoprosthesis (metal implant), massive bone allograft (donor bone), vascularised bone graft, or a combination. Plastic surgery may be involved for soft tissue coverage. The operation is complex and may take four to eight hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Limb salvage is preferred over amputation whenever oncologically safe and technically feasible. It preserves the limb and provides better quality of life. Survival rates are equivalent to amputation when margins are clear."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Amputation is the alternative when limb salvage is not safe or would result in a non-functional limb."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Full staging. Multidisciplinary planning. Neoadjuvant chemotherapy if indicated. Custom implant planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of the limb with useful function. Equivalent oncological outcomes to amputation. Improved body image and quality of life."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Functional limitation",
            "detail": "Some loss of function is expected.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Recovery takes many months.",
            "freq": "Expected"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than standard surgery.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Local recurrence",
            "detail": "Risk approximately 5-10% with clear margins.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "May require implant removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Reconstruction failure",
            "detail": "Graft non-union, implant loosening, or fracture.",
            "freq": "Long-term"
          },
          {
            "risk": "Secondary amputation",
            "detail": "May be needed if salvage fails.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with significant blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks. Individualised rehabilitation programme. Full recovery six to eighteen months. Lifelong surveillance."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Pain",
          "New lump",
          "Implant problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Intensive oncology surveillance. Lifelong reconstruction monitoring."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is limb salvage as safe as amputation?",
            "a": "Yes, when performed with clear surgical margins, survival rates are equivalent. The key is achieving complete tumour removal regardless of the method."
          }
        ]
      }
    ]
  },
  "allograft-reconstruction": {
    "name": "Allograft Reconstruction",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Allograft reconstruction uses donor bone (from a bone bank) to replace a segment of bone removed during tumour surgery. It provides a biological scaffold that can incorporate with the patient's own bone over time.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "After tumour resection, a matched donor bone segment (stored frozen in a bone bank) is shaped to fit the defect. It is fixed with plates, screws, and/or an intramedullary nail. The host bone gradually grows into the allograft over months to years. Soft tissues and tendons can be reattached to the allograft. The operation adds one to two hours to the resection."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Allograft reconstruction is preferred in young patients where biological reconstruction offers the possibility of long-term integration without the lifelong revision burden of metal implants. It is particularly useful for intercalary (mid-shaft) defects where the joints at each end are preserved."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Endoprosthetic reconstruction, vascularised bone graft, or amputation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Size-matched allograft sourced from a certified bone bank. The allograft is screened for infection and disease."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Biological reconstruction that can incorporate and last a lifetime. Allows tendon and ligament reattachment. Particularly advantageous in growing children."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged incorporation",
            "detail": "Allograft healing is slow — full incorporation takes one to three years.",
            "freq": "Expected"
          },
          {
            "risk": "Protected weight-bearing",
            "detail": "Prolonged restricted weight-bearing is needed.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fracture",
            "detail": "The allograft may fracture before or during incorporation. Risk approximately 15-20%.",
            "freq": "Common"
          },
          {
            "risk": "Non-union",
            "detail": "Failure of the junction between allograft and host bone to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Risk approximately 10-15% — higher than endoprosthesis due to the avascular nature of allograft.",
            "freq": "Uncommon"
          },
          {
            "risk": "Resorption",
            "detail": "The allograft may be gradually resorbed by the body.",
            "freq": "Long-term"
          },
          {
            "risk": "Disease transmission",
            "detail": "Extremely rare with modern screening.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Part of a larger tumour resection procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Protected weight-bearing for six to twelve months depending on incorporation. Physiotherapy throughout. Full incorporation at one to three years."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain at the graft site",
          "Sudden pain suggesting fracture",
          "Wound problems",
          "Fever",
          "New lump"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays and oncology surveillance. Long-term monitoring of graft incorporation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Where does the donor bone come from?",
            "a": "From a registered bone bank. Donors are carefully screened and the bone is processed and stored frozen. The risk of disease transmission with modern screening is extremely low."
          }
        ]
      }
    ]
  },
  "trochanteric-bursectomy": {
    "name": "Trochanteric Bursectomy and ITB Release",
    "region": "Hip",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Trochanteric bursectomy is an operation to remove the inflamed bursa over the outer hip (greater trochanter) and release a tight iliotibial band (ITB). It is performed for greater trochanteric pain syndrome that has not responded to non-operative treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the outer hip. The inflamed bursa is removed. The iliotibial band may be lengthened or partially released if it is tight and contributing to snapping. Any gluteal tendon tears may be repaired at the same time. The procedure can also be performed arthroscopically through small incisions. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for persistent lateral hip pain that has not responded to at least six months of physiotherapy, corticosteroid injection, shockwave therapy, and activity modification. It is most effective when a specific structural cause (torn gluteal tendon, thickened bursa) is identified on MRI."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (gluteal strengthening programme), corticosteroid injection, shockwave therapy, and activity modification. These are effective for the majority of patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess the bursa and gluteal tendons. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of lateral hip pain. If gluteal tendon repair is included, improved hip abductor strength and reduced Trendelenburg gait."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound soreness",
            "detail": "Discomfort over the outer hip.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Local swelling for several weeks.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Some patients have persistent discomfort.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "The bursa may reform.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Numbness on the outer thigh.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection requiring drainage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for one to two weeks for comfort. Physiotherapy for gluteal strengthening begins at two weeks. Return to normal activities at six to eight weeks. Full recovery three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing difficulty walking",
          "Persistent limping"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes greater trochanteric pain?",
            "a": "It is most commonly caused by gluteal tendinopathy or tears, bursitis, and ITB tightness. It is often triggered by overuse, changes in activity, or hip mechanics. It is not caused by 'bursitis' alone in most cases — the underlying gluteal tendon problem should be addressed."
          }
        ]
      }
    ]
  },
  "psoas-release": {
    "name": "Psoas Tendon Release",
    "region": "Hip",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Psoas tendon release is a procedure to lengthen or release the iliopsoas tendon where it crosses the front of the hip joint. It is performed for painful internal snapping hip or psoas impingement after hip replacement or arthroscopy.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure can be performed arthroscopically (release from inside the hip joint at the level of the labrum) or through a small open incision in the groin (at the lesser trochanter). The tendon is partially cut or lengthened, relieving the snapping and pain. The operation takes 20–40 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for painful internal snapping hip that has not responded to physiotherapy and injection, or for psoas impingement after hip replacement causing painful clunking in the groin."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (psoas stretching and hip flexor rebalancing), ultrasound-guided corticosteroid injection around the psoas tendon, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Ultrasound or MRI to confirm the diagnosis. Diagnostic injection may help confirm the psoas as the source."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Resolution of painful snapping in approximately 85–90% of patients. Minimal long-term functional impact."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Hip flexor weakness",
            "detail": "Mild temporary weakness of hip flexion, particularly noticeable going upstairs or getting out of a car.",
            "freq": "Common"
          },
          {
            "risk": "Groin soreness",
            "detail": "Local discomfort.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent weakness",
            "detail": "Hip flexion weakness that doesn't fully recover. Uncommon.",
            "freq": "Uncommon"
          },
          {
            "risk": "Femoral nerve injury",
            "detail": "Very rare with open approach.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence of snapping",
            "detail": "Possible if release is incomplete.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia (if arthroscopic) or local/regional anaesthesia (if open)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking immediately. Physiotherapy for hip flexor retraining from one to two weeks. Return to full activity at four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin pain",
          "Difficulty lifting the leg",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I notice the weakness?",
            "a": "Most patients notice mild temporary hip flexion weakness for two to four weeks. It is rarely functionally significant long-term."
          }
        ]
      }
    ]
  },
  "proximal-femur-fixation": {
    "name": "Proximal Femur (Hip) Fracture Fixation",
    "region": "Hip",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Proximal femur fracture fixation covers the surgical options for broken bones around the hip — including dynamic hip screws, intramedullary nails, and cannulated screws. The choice depends on the fracture pattern, patient age, and bone quality.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "There are three main fixation methods. Dynamic hip screw (DHS): an incision on the outer thigh, a large screw is placed into the femoral head and connected to a plate on the femur. Used for intertrochanteric fractures. Intramedullary nail: a rod inserted into the femoral canal with screws into the femoral head. Used for intertrochanteric and subtrochanteric fractures. Cannulated screws: three parallel screws placed percutaneously into the femoral head. Used for undisplaced or minimally displaced neck of femur fractures in younger patients. Operations take one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip fractures require urgent surgical fixation (ideally within 36 hours) to relieve pain, allow mobilisation, and reduce complications. The type of fixation is chosen based on the fracture pattern. Displaced neck of femur fractures in elderly patients are usually treated with hemiarthroplasty or total hip replacement rather than fixation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-operative treatment is rarely appropriate due to the severe impact on mobility, pain, and mortality. It may be considered only in patients who are too unwell for any anaesthetic."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency pathway with rapid pre-operative assessment. Optimisation of medical conditions. Surgery within 36 hours is the national standard."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief, early mobilisation, and reduced mortality. Hip fracture surgery is one of the most time-critical orthopaedic emergencies. Early surgery significantly improves outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Medical complications",
            "detail": "Elderly hip fracture patients have high rates of delirium, chest infection, urinary infection, and cardiac events.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant blood loss. Transfusion may be needed.",
            "freq": "Common"
          },
          {
            "risk": "Pain",
            "detail": "Post-operative pain requiring regular medication.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Metalwork failure",
            "detail": "The screw may cut out of osteoporotic bone. Risk approximately 5-10% for DHS and nails.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union (neck of femur)",
            "detail": "Neck fractures fixed with screws have a non-union rate of 10-30% and AVN rate of 10-20%.",
            "freq": "Common"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the femoral head after neck fractures.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or pulmonary embolism. Very common without prophylaxis.",
            "freq": "Common"
          },
          {
            "risk": "Mortality",
            "detail": "One-year mortality after hip fracture in the elderly is approximately 20-30%, primarily from pre-existing medical conditions.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Regional nerve blocks for pain management. Spinal anaesthesia may be preferred in high-risk patients."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients begin mobilising the day after surgery with physiotherapy support. Walking aids (frame or crutches) are used for six to twelve weeks. Many elderly patients require inpatient rehabilitation. Return to pre-fracture function is the goal but is not always achievable, particularly in frail patients. Falls prevention and osteoporosis treatment are essential."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden increase in hip or groin pain (possible metalwork failure)",
          "Difficulty mobilising after initial progress",
          "Confusion or drowsiness",
          "Chest pain or breathlessness",
          "Calf pain or swelling",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at six weeks and three months. Bone health assessment and osteoporosis treatment. Falls prevention programme. Regular medical review."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is early surgery so important?",
            "a": "Every hour of delay increases the risk of medical complications and mortality. National guidelines recommend surgery within 36 hours of admission."
          },
          {
            "q": "Will I walk again?",
            "a": "Most patients return to walking with aids. However, hip fractures in the elderly are serious injuries, and return to full pre-fracture function is not always achievable, particularly in frail patients."
          },
          {
            "q": "Do I need osteoporosis treatment?",
            "a": "Yes. A hip fracture is a strong indicator of osteoporosis. Bone-strengthening medication, calcium, vitamin D, and falls prevention significantly reduce the risk of further fractures."
          }
        ]
      }
    ]
  },
  "lcl-reconstruction": {
    "name": "LCL / Posterolateral Corner Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "LCL (lateral collateral ligament) and posterolateral corner reconstruction is an operation to restore stability to the outer side and back-outer corner of the knee after a significant ligament injury. These injuries often occur with other knee ligament damage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the outer side of the knee. Tendon grafts (allograft or autograft) are used to reconstruct the damaged ligaments — typically the LCL, popliteus tendon, and popliteofibular ligament. The grafts are passed through bone tunnels and fixed with screws. The peroneal nerve is identified and protected. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Reconstruction is recommended for symptomatic posterolateral instability causing the knee to give way, particularly into hyperextension and varus (bowing outward). It is usually performed as part of multi-ligament knee surgery (e.g., combined with ACL or PCL reconstruction)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and bracing may be attempted for isolated partial injuries. Complete posterolateral corner injuries rarely heal adequately without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and stress X-rays. Varus alignment should be corrected with osteotomy before or at the time of ligament reconstruction."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of posterolateral stability. Most patients achieve improved stability and function, though outcomes are more variable than isolated ACL reconstruction."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Loss of full flexion and extension is common.",
            "freq": "Common"
          },
          {
            "risk": "Lateral knee numbness",
            "detail": "From surgical dissection.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Peroneal nerve injury",
            "detail": "The common peroneal nerve wraps around the fibula and is at risk. Injury causes foot drop. Risk approximately 3-5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft failure",
            "detail": "The reconstruction may stretch or fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrent instability",
            "detail": "Despite reconstruction.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hinged brace locked in extension for six weeks. Crutches for six weeks. Progressive rehabilitation. Running at six months. Return to sport at nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Foot drop (inability to lift the foot — attend urgently)",
          "Knee giving way"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is the peroneal nerve at risk?",
            "a": "The common peroneal nerve runs around the neck of the fibula on the outer knee, directly in the surgical field. It is carefully identified and protected during surgery."
          }
        ]
      }
    ]
  },
  "lateral-release": {
    "name": "Lateral Retinacular Release",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lateral retinacular release is an arthroscopic procedure to divide the tight lateral retinaculum — the band of tissue on the outer side of the kneecap — to improve patellar tracking and reduce anterior knee pain.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically. The tight lateral retinaculum is divided using electrocautery or scissors from inside the joint. This allows the patella to sit more centrally in the trochlear groove. The procedure takes 15–20 minutes and is often performed as part of other knee surgery."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Lateral release is considered for lateral patellar tilt or compression syndrome causing anterior knee pain, when conservative treatment has failed. It is less commonly performed in isolation now and is more often combined with medial-side procedures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (VMO strengthening, patellar taping), orthotics, and activity modification. These are effective for most patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays (skyline view) and MRI. Evidence of lateral patellar tilt is needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduction of anterior knee pain from lateral patellar compression in well-selected patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Haemarthrosis",
            "detail": "Bleeding into the knee joint. The most common complication — approximately 10-20%.",
            "freq": "Common"
          },
          {
            "risk": "Persistent pain",
            "detail": "Lateral release alone may not resolve all anterior knee pain.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Medial patellar instability",
            "detail": "Excessive release may cause the patella to dislocate medially.",
            "freq": "Rare"
          },
          {
            "risk": "Wound healing",
            "detail": "Over the release site.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Reflex sympathetic dystrophy",
            "detail": "Chronic pain syndrome.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Compression bandage for haemarthrosis prevention. Physiotherapy for quadriceps and patellar tracking. Return to activity at four to six weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Significant knee swelling (haemarthrosis)",
          "Kneecap dislocating medially",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Further as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is lateral release done less often now?",
            "a": "It was historically overused as a standalone procedure. Current evidence supports it mainly as part of a comprehensive patellar realignment rather than in isolation."
          }
        ]
      }
    ]
  },
  "oats-mosaicplasty": {
    "name": "OATS / Mosaicplasty",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "OATS (osteochondral autograft transfer system) or mosaicplasty is an operation to transplant plugs of healthy cartilage and bone from a non-weight-bearing area of the knee to fill a cartilage defect in a weight-bearing area.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "One or more cylindrical plugs of cartilage and underlying bone are harvested from a non-weight-bearing area of the knee (usually the edge of the trochlea) using a special coring instrument. The damaged area is prepared and the plugs are press-fit into the defect, recreating a smooth joint surface. For small defects, this can be done arthroscopically; larger defects require a small open incision. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "OATS is recommended for localised, full-thickness cartilage defects (1–4 cm²) in the weight-bearing area of the femoral condyle, particularly in young, active patients. It provides true hyaline cartilage coverage of the defect."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, injections, microfracture (for smaller defects), and ACI/MACI (for larger defects). Osteotomy may be needed if alignment is abnormal."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess defect size and location. Arthroscopy may be performed first to assess suitability."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the joint surface with the patient's own hyaline cartilage. Good to excellent results in approximately 80–90% of well-selected patients at ten years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Donor site discomfort",
            "detail": "Pain or clicking at the harvest site. Usually mild and improves.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Six to nine months for full return to sport.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling during healing.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "Plugs may not integrate or may subside.",
            "freq": "Uncommon"
          },
          {
            "risk": "Donor site morbidity",
            "detail": "Cartilage damage at the harvest site.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "Loss of knee flexion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Partial weight-bearing for six to eight weeks. CPM machine may be used. Physiotherapy for range of motion and strengthening. Running at four to six months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months. MRI to assess graft incorporation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the difference between OATS and microfracture?",
            "a": "OATS transplants true hyaline cartilage from elsewhere in the knee, providing durable joint surface restoration. Microfracture stimulates fibrocartilage formation, which is less durable. OATS is preferred for many defects between 1 and 4 cm²."
          },
          {
            "q": "What about larger defects?",
            "a": "For defects larger than 4 cm², ACI/MACI (laboratory-grown cartilage) or allograft transplantation may be more appropriate."
          }
        ]
      }
    ]
  },
  "aci": {
    "name": "ACI (Autologous Chondrocyte Implantation)",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "ACI is a two-stage procedure to treat large cartilage defects in the knee using the patient's own laboratory-cultured cartilage cells. It provides biological regeneration of the joint surface.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Stage 1: A small arthroscopic biopsy of healthy cartilage is taken and sent to a laboratory where the cartilage cells (chondrocytes) are cultured and multiplied over four to six weeks. Stage 2: Through a small incision, the cartilage defect is prepared and the cultured cells are implanted, either on a collagen membrane (MACI — matrix-assisted) or under a periosteal patch. The second operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ACI/MACI is recommended for large, full-thickness cartilage defects (typically greater than 2–3 cm²) in the knee in young, active patients. It is the gold standard for large defects where OATS would require too many plugs."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, microfracture (for smaller defects), OATS (for defects up to 4 cm²), and osteotomy if alignment is abnormal."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and arthroscopy to assess the defect. The first stage (biopsy) is a short arthroscopic procedure. Four to six weeks between stages for cell culture."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Regeneration of hyaline-like cartilage over the defect. Good to excellent results in approximately 75–85% of patients at five to ten years. Best results in patients under 40 with single defects."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Very prolonged recovery",
            "detail": "Full return to sport takes twelve to eighteen months.",
            "freq": "Expected"
          },
          {
            "risk": "Graft hypertrophy",
            "detail": "Overgrowth of the repair tissue, causing catching. May need arthroscopic trimming.",
            "freq": "Uncommon"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling during the healing phase.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "The cultured cells may not form adequate cartilage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Delamination",
            "detail": "The repair tissue may detach.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "Loss of knee flexion.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT during prolonged restricted weight-bearing.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Stage 1: local or general anaesthesia. Stage 2: general or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. CPM machine. Progressive physiotherapy for twelve to eighteen months. Running at nine to twelve months. Full sport at twelve to eighteen months. The repair tissue continues to mature for up to two years."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling or pain",
          "Locking or catching (possible graft hypertrophy)",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular reviews at two weeks, six weeks, three months, six months, and one year. MRI at six months and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why does it take so long to recover?",
            "a": "The cultured cartilage cells need many months to mature into functional joint surface tissue. Premature loading can damage the immature repair tissue."
          },
          {
            "q": "Is MACI better than traditional ACI?",
            "a": "MACI (matrix-assisted) is the modern evolution of ACI, using a collagen scaffold instead of a periosteal patch. It is technically simpler and has comparable or better results."
          }
        ]
      }
    ]
  },
  "perthes-containment": {
    "name": "Perthes Disease Containment Surgery",
    "region": "Paediatric Orthopaedics",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Containment surgery for Perthes disease involves osteotomy (bone-cutting) of the femur or pelvis to keep the softened femoral head contained within the acetabulum during the healing phase, maintaining a spherical shape as the bone regenerates.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The most common procedures are femoral varus osteotomy (cutting the thighbone and angling it inward to deepen the femoral head within the socket) or Salter innominate osteotomy (redirecting the socket to cover the femoral head better). The osteotomy is fixed with a plate and screws. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for children over six to eight years with significant femoral head involvement (lateral pillar classification B or B/C) where non-operative containment (bracing, activity modification) is insufficient. The aim is to maintain femoral head sphericity during the revascularisation phase."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Activity modification, physiotherapy (range of motion exercises), anti-inflammatory medication, and observation. Many children with Perthes disease, particularly those under six, do well without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Serial X-rays and MRI to assess disease stage. Arthrogram may be used intra-operatively."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Maintenance of a spherical femoral head, which is the key determinant of long-term hip function. Children treated with appropriate containment have better outcomes than those with uncovered, deformed femoral heads."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg length discrepancy",
            "detail": "Particularly with femoral osteotomy. Usually mild and manageable.",
            "freq": "Common"
          },
          {
            "risk": "Limp",
            "detail": "Temporary during recovery.",
            "freq": "Expected"
          },
          {
            "risk": "Metalwork prominence",
            "detail": "Plates and screws are palpable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Overcorrection",
            "detail": "Excessive varus may cause trochanteric prominence.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "Hip stiffness. Early physiotherapy is important.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal. Rare in children.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Rare"
          },
          {
            "risk": "Continued femoral head deformity",
            "detail": "Despite containment, some deformity may persist.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches or wheelchair for six to eight weeks. Physiotherapy for hip range of motion. Return to normal activity at three to four months. Metalwork removal at twelve to eighteen months. Long-term X-ray follow-up."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing hip pain",
          "Difficulty walking",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays every three to six months until femoral head regeneration is complete (typically two to four years)."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is Perthes disease?",
            "a": "Perthes disease occurs when the blood supply to the femoral head is temporarily disrupted, causing the bone to soften and potentially deform. It affects children between four and ten years of age and is self-limiting — the bone eventually revascularises and regenerates."
          },
          {
            "q": "Does my child definitely need surgery?",
            "a": "Not all children with Perthes disease need surgery. Children under six often do well without intervention. Surgery is considered for older children with significant femoral head involvement."
          }
        ]
      }
    ]
  },
  "clubfoot-release": {
    "name": "Clubfoot Posteromedial Release",
    "region": "Paediatric Orthopaedics",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Clubfoot posteromedial release is an open surgical procedure to release the tight ligaments, tendons, and joint capsules on the inner and back of the foot in a child with clubfoot that has not responded to Ponseti casting and bracing.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made around the inner and back of the ankle and foot (Cincinnati incision). The tight posterior and medial structures are systematically released — including the Achilles tendon, posterior ankle capsule, subtalar capsule, talonavicular capsule, and contracted ligaments. The foot is corrected into a normal position and held with K-wires. A cast is applied. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Posteromedial release is reserved for resistant or recurrent clubfeet that have not responded to the Ponseti method (casting, tenotomy, and bracing), or for complex clubfeet associated with other conditions."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "The Ponseti method (serial casting, Achilles tenotomy, boots-and-bar bracing) is successful in over 95% of clubfeet and is the first-line treatment. Surgery is only considered when Ponseti treatment fails."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Thorough assessment by a paediatric orthopaedic surgeon. Documentation of previous treatment attempts."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Correction of the foot deformity allowing plantigrade (flat) weight-bearing. However, extensive surgical release is associated with more stiffness and higher rates of overcorrection than the Ponseti method."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Foot stiffness",
            "detail": "The released joints often become stiff. This is the main long-term concern.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "A large scar around the ankle.",
            "freq": "Expected"
          },
          {
            "risk": "Wound healing",
            "detail": "The incision is extensive and in a difficult location.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Overcorrection",
            "detail": "The foot may be corrected into a flat or rocker-bottom position. Difficult to treat.",
            "freq": "Uncommon"
          },
          {
            "risk": "AVN of the talus",
            "detail": "Damage to the blood supply of the talus.",
            "freq": "Rare"
          },
          {
            "risk": "Undercorrection",
            "detail": "Residual deformity requiring further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound breakdown",
            "detail": "Particularly in complex or multiply-operated feet.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "Posterior tibial neurovascular bundle at risk.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast for six to eight weeks. K-wire removal at six weeks. Boots-and-bar bracing continues. Long-term follow-up throughout childhood. Custom orthotics may be needed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Cast too tight",
          "Toes blue or cold",
          "Fever",
          "Wound problems under cast",
          "Child in severe distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular follow-up throughout childhood and adolescence."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is Ponseti preferred over surgery?",
            "a": "The Ponseti method produces more flexible, functional feet with fewer long-term complications than extensive surgical release. Surgery is reserved for the small number of feet that fail Ponseti treatment."
          }
        ]
      }
    ]
  },
  "cp-multilevel": {
    "name": "Cerebral Palsy Multi-Level Surgery",
    "region": "Paediatric Orthopaedics",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Multi-level surgery for cerebral palsy is a coordinated set of operations performed at the same time to correct multiple musculoskeletal deformities in a child with cerebral palsy, reducing the number of anaesthetics and recovery periods.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Multiple procedures are performed in a single session, tailored to the individual child's pattern of deformity. Common components include hamstring lengthening, psoas lengthening, adductor release, rectus femoris transfer, gastrocnemius recession or Achilles lengthening, and femoral or tibial derotation osteotomy. Procedures may involve both legs. The operation takes three to five hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Multi-level surgery is recommended for ambulant children with cerebral palsy (GMFCS levels I-III, typically aged 8-12) whose gait is deteriorating due to progressive musculoskeletal deformities. Pre-operative computerised gait analysis guides the surgical plan."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, botulinum toxin injections, serial casting, ankle-foot orthoses, and intrathecal baclofen. These manage spasticity but do not correct fixed deformities."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Computerised 3D gait analysis to identify the specific biomechanical problems. Multidisciplinary assessment (physiotherapy, orthotics, occupational therapy). Detailed discussion with the child and family about expectations and the rehabilitation commitment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved walking pattern, better efficiency, reduced falls, and delayed deterioration. The aim is to optimise the child's function rather than achieve 'normal' gait. Most families report significant improvement in mobility and quality of life."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Recovery takes six to twelve months of intensive physiotherapy.",
            "freq": "Expected"
          },
          {
            "risk": "Pain",
            "detail": "Significant post-operative pain requiring multimodal management.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary regression",
            "detail": "Walking ability may be worse initially before improving.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Multiple procedures cause cumulative blood loss. Transfusion may be needed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Overcorrection",
            "detail": "Muscles may be overlengthened, causing weakness. Difficult to correct.",
            "freq": "Uncommon"
          },
          {
            "risk": "Undercorrection",
            "detail": "Deformities may recur as the child grows.",
            "freq": "Common"
          },
          {
            "risk": "Fracture",
            "detail": "Osteoporotic bone may fracture during osteotomy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "During muscle releases.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Rare but possible with extensive surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Wound problems",
            "detail": "Multiple incisions.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with epidural or regional blocks for post-operative pain management. Careful blood loss monitoring."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay five to ten days. Casts or splints for six to eight weeks. Intensive inpatient or outpatient physiotherapy for six to twelve months. Progressive return to standing and walking. Orthotics usually needed. Full benefit of surgery may take twelve to eighteen months to become apparent."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain not controlled by medication",
          "Cast or splint too tight",
          "Toes blue or cold",
          "Wound problems",
          "Fever",
          "Sudden increase in spasticity"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent physiotherapy reviews. Surgeon review at six weeks, three months, six months, and one year. Repeat gait analysis at one year. Long-term follow-up through adolescence."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why do all the procedures at once?",
            "a": "Performing all corrections in a single session means one anaesthetic, one recovery period, and one rehabilitation programme rather than multiple separate operations and recoveries. This is better for the child and family."
          },
          {
            "q": "Will my child need more surgery?",
            "a": "Some children need further soft tissue releases as they grow, particularly during growth spurts. The aim is to optimise function and delay the need for further intervention."
          },
          {
            "q": "What is gait analysis?",
            "a": "Computerised 3D gait analysis uses cameras and sensors to measure precisely how your child walks. It identifies the specific biomechanical problems at each joint, allowing a targeted surgical plan."
          }
        ]
      }
    ]
  },
  "forequarter-amputation": {
    "name": "Forequarter Amputation",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Forequarter amputation is a major operation to remove the entire upper limb including the shoulder blade (scapula) and collarbone (clavicle). It is performed for large, aggressive tumours of the shoulder girdle when limb salvage is not possible.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An extensive incision is made around the shoulder and chest wall. The major blood vessels and nerves to the arm are divided. The entire upper limb is removed along with the scapula, clavicle, and surrounding muscles. Skin flaps are fashioned to close the defect. The operation takes three to five hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Forequarter amputation is reserved for locally advanced tumours that encase the brachial plexus or major vessels, making limb salvage impossible. It may also be considered for fungating or infected tumours causing severe symptoms."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Limb salvage surgery if oncologically feasible. Radiotherapy for palliation. Chemotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Full staging. MDT discussion. Psychological preparation and support."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive local tumour control. Relief of pain and functional burden of a non-functional limb. Wound healing allows progression to adjuvant treatment."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Phantom limb sensation and pain",
            "detail": "Expected.",
            "freq": "Expected"
          },
          {
            "risk": "Significant psychological impact",
            "detail": "Loss of the entire upper limb profoundly affects body image and function.",
            "freq": "Expected"
          },
          {
            "risk": "Wound complications",
            "detail": "Large wound with risk of seroma and delayed healing.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Brachial plexus stump pain",
            "detail": "Chronic pain from the divided nerves.",
            "freq": "Common"
          },
          {
            "risk": "Wound infection",
            "detail": "Increased risk with prior radiotherapy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chest wall complications",
            "detail": "Pneumothorax or respiratory compromise.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with significant blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks. Wound healing. Prosthetic options are limited but cosmetic prostheses are available. Intensive psychological support. Occupational therapy for adaptation to one-handed function."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown",
          "Fever",
          "Severe phantom pain",
          "Respiratory difficulty",
          "Psychological distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance. Prosthetic and rehabilitation review. Psychological support."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is limb salvage not possible?",
            "a": "When the tumour involves the major nerves (brachial plexus) and blood vessels, the limb cannot be preserved with a functional outcome. Forequarter amputation provides the best chance of complete tumour removal."
          }
        ]
      }
    ]
  },
  "hindquarter-amputation": {
    "name": "Hindquarter Amputation",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hindquarter amputation (hemipelvectomy) is a major operation to remove the entire lower limb along with part of the pelvis. It is performed for large, locally advanced tumours of the pelvis or proximal thigh when limb salvage is not possible.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An extensive incision is made around the hip and pelvis. The pelvic bone is cut, and the entire lower limb with the hemipelvis is removed. Large myocutaneous flaps are fashioned to close the defect. The operation is one of the most extensive in orthopaedic oncology and takes four to six hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hindquarter amputation is reserved for locally advanced pelvic or proximal thigh tumours that encase major neurovascular structures, making limb salvage unsafe. It is a rare but sometimes necessary operation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Internal hemipelvectomy (limb salvage with pelvic resection), radiotherapy, and chemotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Full staging. MDT discussion. Comprehensive pre-operative assessment. Psychological preparation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete local tumour removal when no other option is available. Relief of pain from a non-functional or tumour-burdened limb."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Phantom limb pain",
            "detail": "Very common and may be severe.",
            "freq": "Expected"
          },
          {
            "risk": "Profound functional impact",
            "detail": "Loss of the entire lower limb and part of the pelvis.",
            "freq": "Expected"
          },
          {
            "risk": "Wound complications",
            "detail": "Very large wound with significant risk of delayed healing.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Major blood loss requiring transfusion.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound infection or breakdown",
            "detail": "Particularly with prior radiotherapy.",
            "freq": "Common"
          },
          {
            "risk": "Pelvic floor dysfunction",
            "detail": "Bowel, bladder, or sexual dysfunction.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hernia",
            "detail": "Through the pelvic floor defect.",
            "freq": "Uncommon"
          },
          {
            "risk": "Psychological morbidity",
            "detail": "Severe impact on quality of life.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with massive blood loss potential."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Prolonged hospital stay. Sitting rehabilitation (custom seating). Some patients achieve walking with specialised prosthetics but this is physically demanding. Wheelchair use is common. Intensive psychological support. Occupational therapy."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown",
          "Fever",
          "Severe phantom pain",
          "Bowel or bladder problems",
          "Psychological distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance. Rehabilitation and prosthetic review. Long-term psychological support."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I be able to walk?",
            "a": "Some patients achieve walking with specialised prosthetics, but this requires significant effort and fitness. Many patients use a wheelchair for longer distances. Quality of life can still be good with appropriate support and adaptation."
          }
        ]
      }
    ]
  },
  "pelvic-ring-fixation": {
    "name": "Pelvic Ring Fixation (Anterior and Posterior)",
    "region": "Pelvis & Acetabulum",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pelvic ring fixation is an operation to stabilise fractures of the anterior (front) and/or posterior (back) pelvic ring using plates, screws, or external fixation. The approach depends on which part of the ring is disrupted.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Anterior ring: an incision is made in the lower abdomen (Pfannenstiel or ilioinguinal approach). The pubic symphysis or pubic rami fractures are reduced and fixed with a plate and screws. Alternatively, a retrograde pubic screw can be placed percutaneously. Posterior ring: may be fixed with percutaneous SI screws, posterior plating through an incision over the sacrum, or a combination. Often both anterior and posterior fixation are needed. Total operating time is two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is required for unstable pelvic ring injuries — fractures that disrupt both the anterior and posterior ring, causing the pelvis to be mechanically unstable. This is common in high-energy trauma."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stable pelvic fractures (e.g., isolated pubic rami fractures) are managed with pain relief and mobilisation. Only unstable injuries require fixation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with 3D reconstruction for planning. May require emergency stabilisation with an external fixator or pelvic binder first."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of pelvic stability allowing weight-bearing and mobilisation. Most patients with successfully treated pelvic ring injuries return to walking."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Pelvic injuries are major trauma with six to twelve month recovery.",
            "freq": "Expected"
          },
          {
            "risk": "Pain",
            "detail": "Chronic pelvic pain is common after high-energy injuries.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "High DVT risk.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "L5 root, lumbosacral plexus at risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Asymmetric healing causing leg length discrepancy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sexual/urological dysfunction",
            "detail": "From the injury and/or surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Significant blood loss potential."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions for six to twelve weeks. Physiotherapy essential. Crutches or frame for several months. Return to desk work at six to eight weeks. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Difficulty passing urine",
          "Numbness in the legs or genital area"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How are unstable pelvic fractures classified?",
            "a": "The Young-Burgess or Tile classification systems describe the injury pattern. Lateral compression, anteroposterior compression, and vertical shear patterns each require different fixation strategies."
          }
        ]
      }
    ]
  },
  "proximal-humerus-fixation": {
    "name": "Proximal Humerus Fracture Fixation (Plate or Nail)",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Proximal humerus fracture fixation is an operation to realign and stabilise a broken upper end of the arm bone (humerus) near the shoulder, using a locking plate or intramedullary nail. It is performed for displaced fractures that cannot be managed in a sling.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For plate fixation: an incision is made over the front or side of the shoulder. The fracture fragments (including the greater and lesser tuberosities) are reduced and fixed with a contoured locking plate and screws. For nailing: a shorter incision allows insertion of a nail through the top of the humeral head into the canal. Sutures may be used to secure the tuberosity fragments. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for significantly displaced proximal humerus fractures (3- and 4-part fractures), fracture-dislocations, and in younger patients where anatomical restoration is important. In elderly patients with very comminuted fractures, hemiarthroplasty or reverse shoulder replacement may be preferred."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Many proximal humerus fractures (up to 80%) can be managed in a sling with early physiotherapy. Non-operative treatment is appropriate for undisplaced or minimally displaced fractures and for frail elderly patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for fracture classification and planning. Surgery within one to two weeks of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Anatomical restoration of the proximal humerus allowing earlier rehabilitation. Outcomes depend heavily on fracture pattern, bone quality, and patient age."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Very common. Intensive physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Screw penetration",
            "detail": "Screws may penetrate into the joint as osteoporotic bone settles.",
            "freq": "Uncommon"
          },
          {
            "risk": "Subacromial impingement",
            "detail": "The plate may impinge under the acromion.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the humeral head, particularly with 4-part fractures. Risk 10-30%.",
            "freq": "Common"
          },
          {
            "risk": "Non-union or malunion",
            "detail": "Failure to heal or healing in a poor position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Axillary nerve injury",
            "detail": "Weakness of deltoid muscle. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Metalwork failure",
            "detail": "Plate or screw breakage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair or lateral position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for two to four weeks. Pendular exercises begin within the first week. Active movement from four to six weeks depending on fixation stability. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Some permanent loss of overhead reach is common."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Loss of shoulder movement despite exercises",
          "Clicking or grinding in the shoulder"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Would a shoulder replacement be better?",
            "a": "For elderly patients with severely comminuted fractures and poor bone quality, hemiarthroplasty or reverse shoulder replacement may give more predictable results. Your surgeon will recommend the best option for your specific fracture."
          },
          {
            "q": "Will I regain full overhead reach?",
            "a": "Some loss of overhead reach is common after proximal humerus fractures, regardless of treatment. Most patients achieve a functional range sufficient for daily activities."
          }
        ]
      }
    ]
  },
  "monteggia-fixation": {
    "name": "Monteggia Fracture-Dislocation Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Monteggia fracture-dislocation fixation is an operation to fix a fracture of the ulna combined with dislocation of the radial head at the elbow. Accurate ulna fixation is critical — when the ulna length and alignment are restored, the radial head usually reduces spontaneously.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the ulna. The ulna fracture is anatomically reduced and fixed with a plate and screws. Once the ulna is restored to its correct length and alignment, the radial head is checked — it typically reduces into the joint spontaneously. If the radial head remains dislocated, the annular ligament may need repair. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All Monteggia fracture-dislocations in adults require surgery. Without accurate ulna fixation, the radial head remains dislocated, causing chronic elbow instability and loss of forearm rotation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "In children, many Monteggia injuries can be managed with closed reduction and casting. In adults, surgical fixation is the standard treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays must include the full forearm and elbow to identify the radial head dislocation. CT may be helpful for complex patterns."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of elbow stability and forearm rotation. When recognised and treated promptly, outcomes are generally good."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Elbow stiffness",
            "detail": "Some loss of terminal extension is common.",
            "freq": "Common"
          },
          {
            "risk": "Forearm rotation limitation",
            "detail": "Mild loss of pronation or supination.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent radial head instability",
            "detail": "May require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Posterior interosseous nerve palsy",
            "detail": "Temporary weakness of finger extension. Usually recovers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Ulna fracture failing to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation limiting elbow movement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early elbow movement is critical. Splint between exercise sessions for two to four weeks. Active forearm rotation from the first week. Return to desk work at two to four weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Elbow clunking or feeling unstable",
          "Loss of finger extension"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What if the Monteggia injury is missed?",
            "a": "A missed Monteggia (chronic radial head dislocation) is much harder to treat and may require radial head excision or complex reconstruction. This is why full forearm X-rays including the elbow are essential for all forearm fractures."
          }
        ]
      }
    ]
  },
  "galeazzi-fixation": {
    "name": "Galeazzi Fracture-Dislocation Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Galeazzi fracture-dislocation fixation is an operation to fix a fracture of the radius combined with disruption of the distal radioulnar joint (DRUJ). The radius fracture is fixed with a plate, and the DRUJ stability is assessed.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the anterior (Henry) approach to the radius. The radius fracture is anatomically reduced and fixed with a plate and screws. The DRUJ is then tested for stability. If stable after radius fixation, no further intervention is needed. If unstable, the DRUJ may be pinned with a K-wire in a reduced position, or the TFCC may be repaired. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All Galeazzi fracture-dislocations in adults require surgery. Without accurate radius fixation, the DRUJ remains disrupted, causing chronic wrist instability and pain with forearm rotation."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Not appropriate in adults. Surgical fixation is the standard treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays of the full forearm and wrist. CT may be used to assess the DRUJ."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of radius length and alignment with stable DRUJ. Good outcomes when treated promptly."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Forearm stiffness",
            "detail": "Some loss of pronation or supination.",
            "freq": "Common"
          },
          {
            "risk": "DRUJ symptoms",
            "detail": "Residual clicking or discomfort at the wrist.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent DRUJ instability",
            "detail": "May require further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Radius fracture failing to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Superficial radial nerve or posterior interosseous nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for two to four weeks (longer if DRUJ pinned). K-wire removal at six weeks if used. Active forearm rotation exercises. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Wrist clicking or instability",
          "Loss of forearm rotation"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the DRUJ?",
            "a": "The distal radioulnar joint is where the radius and ulna bones meet at the wrist. It allows the forearm to rotate (pronation and supination). Disruption causes pain and instability with turning movements like opening a door or using a screwdriver."
          }
        ]
      }
    ]
  },
  "tibial-shaft-plating": {
    "name": "Tibial Shaft Fracture Plating",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tibial shaft fracture plating is an operation to fix a fracture of the shinbone using a plate and screws applied to the bone surface. It is an alternative to intramedullary nailing and is chosen for specific fracture patterns or locations.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the fracture site on the medial (inner) or anterolateral aspect of the tibia. The fracture is reduced and a plate is applied to the bone surface. Minimally invasive percutaneous plate osteosynthesis (MIPPO) uses smaller incisions and a plate slid under the skin with screws placed through stab incisions. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Plating is preferred for proximal and distal tibial shaft fractures (near the knee or ankle) where nailing may not provide adequate fixation, fractures extending into the joint, open fractures requiring access for debridement, and in specific fracture patterns not suited to nailing."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Intramedullary nailing is the standard for most tibial shaft fractures. Cast or functional brace may be used for undisplaced fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-length tibial X-rays and CT if the fracture extends into a joint. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Anatomical reduction and stable fixation. MIPPO preserves the blood supply to the fracture, promoting healing."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound problems",
            "detail": "The skin over the medial tibia is thin and vulnerable.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Leg swelling for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Prominent metalwork",
            "detail": "The plate is palpable under thin skin.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Delayed union or non-union",
            "detail": "The tibial shaft can be slow to heal. Risk approximately 5-10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection. Risk is higher with open fractures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A surgical emergency.",
            "freq": "Rare"
          },
          {
            "risk": "Plate failure",
            "detail": "The plate may bend or break if union is delayed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT despite preventive measures.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on fracture pattern — partial weight-bearing initially in most cases. Physiotherapy for knee and ankle range of motion. Full recovery four to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Severe tightness in the calf (possible compartment syndrome — attend A&E urgently)",
          "Wound breakdown"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why plating instead of a nail?",
            "a": "Plating is preferred for fractures near the joints (proximal or distal third), fractures extending into the knee or ankle joint, and certain open fracture patterns. Nailing remains the standard for most mid-shaft fractures."
          }
        ]
      }
    ]
  },
  "supracondylar-femur-fixation": {
    "name": "Supracondylar Femur Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Supracondylar femur fracture fixation is an operation to stabilise a fracture of the lower thighbone just above the knee, using a locking plate or retrograde intramedullary nail.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For plating: an incision on the outer side of the lower thigh. A pre-contoured locking plate is applied along the lateral femur and fixed with multiple screws. For retrograde nailing: a nail is inserted through a small incision at the knee into the femoral canal. Both methods take one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is needed for displaced supracondylar femur fractures. These injuries are common in elderly patients with osteoporosis and in patients with existing knee replacements (periprosthetic fractures)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Rarely appropriate for displaced fractures. Traction is not a definitive treatment in adults."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-length femur X-rays. CT if the fracture extends into the knee joint. Assess for existing knee implants."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of femoral alignment and length allowing knee rehabilitation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Very common. Early physiotherapy is essential.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant blood loss. Transfusion may be needed.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Significant thigh and knee swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Risk approximately 5-10%, higher in elderly patients with poor bone quality.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Malalignment affecting gait.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around metalwork.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Plate bending or screw pull-out in osteoporotic bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT or PE.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on fixation quality — restricted for six to twelve weeks in many cases. Knee range of motion exercises begin within the first few days. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Increasing knee stiffness",
          "Sudden thigh pain suggesting implant failure"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this the same as a distal femur fracture?",
            "a": "They overlap significantly. 'Supracondylar' specifically refers to the area just above the femoral condyles. Treatment principles are the same."
          }
        ]
      }
    ]
  },
  "lumbar-microdiscectomy": {
    "name": "Lumbar Microdiscectomy",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lumbar microdiscectomy is a minimally invasive operation to remove the portion of a herniated disc that is pressing on a nerve root, causing sciatica. It is the most commonly performed spinal surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (2–3 cm) is made in the midline of the lower back. Using an operating microscope or magnification, a small window of bone (laminotomy) is removed to access the spinal canal. The herniated disc fragment pressing on the nerve is identified and removed. The nerve root is decompressed. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Microdiscectomy is recommended for sciatica (leg pain from a herniated disc) that has not improved with at least six to twelve weeks of non-operative treatment, or earlier if there is progressive neurological deficit or cauda equina syndrome (a surgical emergency)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain medication, nerve root injection, activity modification, and time. Approximately 85% of disc herniations improve without surgery within six to twelve weeks. Surgery is for those who do not improve."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming disc herniation correlating with symptoms. Day-case or overnight procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Rapid relief of leg pain in approximately 85–95% of patients. Leg pain typically improves faster than back pain. Numbness and weakness may take longer to recover."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent disc herniation",
            "detail": "The disc may herniate again at the same level. Risk approximately 5-10% over a lifetime.",
            "freq": "Common"
          },
          {
            "risk": "Back pain",
            "detail": "Leg pain improves reliably, but back pain may persist.",
            "freq": "Common"
          },
          {
            "risk": "Temporary leg pain increase",
            "detail": "Some patients have temporary nerve irritation.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dural tear",
            "detail": "Tear in the membrane around the nerves, causing CSF leak. Risk approximately 1-3%. Usually repaired during surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve root injury",
            "detail": "Damage to the nerve root. Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or disc space infection (discitis). Risk approximately 1-2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Cauda equina syndrome",
            "detail": "Very rare worsening of nerve compression.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection compressing nerves. Rare but requires urgent drainage.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone (face down)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home the same day or next morning. Walking encouraged immediately. Avoid prolonged sitting for two to four weeks. Driving at two to four weeks. Return to desk work at two to four weeks. Manual work at six to eight weeks. Core strengthening programme from four to six weeks. Full recovery six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "New or worsening leg weakness",
          "New bladder or bowel problems (attend A&E immediately)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the difference between discectomy and microdiscectomy?",
            "a": "Microdiscectomy uses magnification (microscope or loupes) and a smaller incision, causing less tissue damage and faster recovery. The outcomes are equivalent."
          },
          {
            "q": "Can the disc herniate again?",
            "a": "Yes, the risk of recurrence at the same level is approximately 5-10% over a lifetime. Maintaining core strength and good spinal health reduces this risk."
          },
          {
            "q": "Should I have waited longer before surgery?",
            "a": "Most disc herniations improve without surgery. Surgery is recommended when pain is severe, not improving, or when there is progressive nerve damage. The timing is always a shared decision."
          }
        ]
      }
    ]
  },
  "lumbar-laminectomy-multilevel": {
    "name": "Lumbar Laminectomy (Single or Multi-Level)",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lumbar laminectomy is an operation to relieve pressure on the spinal nerves by removing the lamina (bony arch) and thickened ligamentum flavum at one or more levels. It is performed for lumbar spinal stenosis causing leg pain, numbness, and difficulty walking.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline incision is made over the affected levels. The muscles are retracted. The lamina and thickened ligament are removed to widen the spinal canal and free the compressed nerves. Multiple levels (typically two to four) may be decompressed. Minimally invasive techniques using tubular retractors may be used for single-level decompression. The operation takes one to two hours depending on the number of levels."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Laminectomy is recommended for symptomatic lumbar spinal stenosis causing neurogenic claudication (leg pain and heaviness with walking) that has not responded to physiotherapy, epidural injections, and activity modification."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, epidural steroid injections, neuropathic pain medication, activity modification, and use of a walking frame or shopping trolley (leaning forward opens the spinal canal and reduces symptoms)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming stenosis. Standard pre-assessment. Many patients are elderly with medical comorbidities requiring optimisation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improvement in walking distance and leg symptoms in approximately 70–80% of patients. Back pain is less reliably improved. Symptoms may recur over time as degeneration continues."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Back pain",
            "detail": "Pre-existing back pain may not improve with decompression alone.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence of stenosis",
            "detail": "Degenerative changes may cause new stenosis at adjacent levels over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Leg numbness persistence",
            "detail": "Pre-existing numbness may not fully recover, particularly if long-standing.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dural tear",
            "detail": "Risk approximately 5-10%, higher in multi-level surgery and revision cases.",
            "freq": "Common"
          },
          {
            "risk": "Nerve root injury",
            "detail": "Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Instability",
            "detail": "Removing bone at multiple levels may cause the spine to become unstable, potentially requiring fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Epidural haematoma",
            "detail": "Blood collection compressing nerves. Rare but requires urgent surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Cauda equina syndrome",
            "detail": "Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone. Careful attention to medical comorbidities in elderly patients."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to three days. Walking encouraged immediately — most patients notice improved walking distance quickly. Return to light activities at two to four weeks. Driving at two to four weeks. Core strengthening programme from six weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks. Further follow-up as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my back pain improve?",
            "a": "Laminectomy reliably improves leg symptoms (claudication) but is less effective for isolated back pain. If back pain is the dominant problem, fusion may be considered."
          },
          {
            "q": "Will I need fusion as well?",
            "a": "Not usually for standard laminectomy. Fusion is added if there is pre-existing instability (spondylolisthesis) or if the decompression creates instability."
          },
          {
            "q": "Can the stenosis come back?",
            "a": "New stenosis can develop at adjacent levels over time as degeneration continues. The original levels may also re-stenose if scar tissue or further disc degeneration occurs."
          }
        ]
      }
    ]
  },
  "thoracic-fusion": {
    "name": "Thoracic Decompression and Fusion",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Thoracic decompression and fusion is an operation to relieve pressure on the spinal cord in the thoracic (mid-back) spine and stabilise the affected levels with screws, rods, and bone graft. It is performed for thoracic stenosis, fractures, tumours, or deformity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline incision is made over the thoracic spine. Pedicle screws are placed into the vertebrae above and below the affected levels. The spinal canal is decompressed by removing the lamina and any compressive pathology. Rods are connected to the screws to stabilise the spine. Bone graft is placed to promote fusion. The operation takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for thoracic myelopathy (spinal cord compression causing leg weakness and balance problems), thoracic fractures with instability or neurological compromise, thoracic spinal tumours, and kyphotic deformity with cord compression."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation for mild or stable conditions, bracing for fractures, and radiotherapy for certain tumours. Progressive myelopathy generally requires surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for planning. Pulmonary function tests in patients with kyphosis. This is a major procedure requiring thorough preparation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of neurological deterioration. Some patients improve, but recovery of established spinal cord damage is variable."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-operative pain",
            "detail": "Significant for several weeks. The thoracic spine has extensive muscle coverage.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "More than lumbar surgery. Transfusion may be needed.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "The fused segment is rigid.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "The thoracic spinal cord has limited tolerance for manipulation. Risk approximately 1-2%.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw malposition",
            "detail": "Thoracic pedicle screws are technically demanding.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pseudarthrosis",
            "detail": "Failure of fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pulmonary complications",
            "detail": "Chest infection or respiratory compromise, particularly in patients with pre-existing lung disease or kyphosis.",
            "freq": "Uncommon"
          },
          {
            "risk": "Proximal junctional kyphosis",
            "detail": "New kyphosis above the fusion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring (motor and sensory evoked potentials). Positioned prone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay three to seven days. Walking encouraged from day one. Brace may be worn for six to twelve weeks. Return to desk work at six to eight weeks. Avoid heavy lifting for three to six months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Worsening leg weakness or new difficulty walking",
          "Increasing kyphosis or back deformity",
          "Respiratory difficulty"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. CT scan to assess fusion if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is thoracic surgery more risky than lumbar?",
            "a": "The thoracic spinal cord is less tolerant of compression and manipulation than the lumbar nerve roots. Neuromonitoring is used throughout surgery to reduce the risk of cord injury."
          }
        ]
      }
    ]
  },
  "microfracture": {
    "name": "Microfracture (Cartilage)",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Microfracture is an arthroscopic procedure to stimulate the body to create new cartilage in an area of full-thickness cartilage loss in the knee. Small holes are made in the underlying bone to release stem cells that form a repair tissue.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically. The damaged cartilage is debrided to a stable rim. Using an awl (a sharp pick), multiple small holes (3–4 mm apart) are made in the exposed bone. This allows bone marrow blood and stem cells to fill the defect and form a fibrocartilage clot. The operation takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Microfracture is recommended for small to medium full-thickness cartilage defects (typically less than 2–3 cm²) in patients under 40–45 years, particularly for lesions on the femoral condyle."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, injections, weight management. OATS or ACI/MACI are alternatives for larger defects."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess defect size. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Formation of fibrocartilage repair tissue. Good short-term results in approximately 75–85% of patients. However, fibrocartilage is less durable than native hyaline cartilage, and results may deteriorate over five to ten years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-weight-bearing for six to eight weeks to protect the healing tissue.",
            "freq": "Expected"
          },
          {
            "risk": "Knee swelling",
            "detail": "Common during healing.",
            "freq": "Expected"
          },
          {
            "risk": "Fibrocartilage durability",
            "detail": "The repair tissue is less resilient than normal cartilage and may degrade over time.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Treatment failure",
            "detail": "The repair tissue may not form adequately.",
            "freq": "Uncommon"
          },
          {
            "risk": "Overgrowth",
            "detail": "Excessive fibrocartilage formation.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "Loss of knee flexion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. CPM machine may be used. Progressive rehabilitation. Running at four to six months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How is this different from OATS or ACI?",
            "a": "Microfracture is the simplest technique but produces fibrocartilage (less durable). OATS transplants true hyaline cartilage plugs. ACI grows hyaline-like cartilage in a laboratory. For small defects, microfracture is a good first-line option."
          }
        ]
      }
    ]
  },
  "medial-meniscectomy": {
    "name": "Medial or Lateral Meniscectomy (Partial)",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Partial meniscectomy — medial or lateral — is an arthroscopic operation to trim and remove the damaged portion of a torn meniscus while preserving as much healthy tissue as possible. It is performed separately for the medial (inner) or lateral (outer) meniscus depending on which side is torn.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The operation is performed arthroscopically through two or three small incisions. The torn, unstable fragment of the medial or lateral meniscus is identified and trimmed back to a stable rim using motorised shavers and small instruments. The remaining healthy meniscus is preserved. The lateral meniscus is particularly important for load distribution, so preservation is emphasised even more strongly on the lateral side. The operation takes 20–40 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Partial meniscectomy is recommended for symptomatic tears causing mechanical symptoms (locking, catching, giving way) that have not responded to physiotherapy, particularly tears in the avascular inner zone where repair is unlikely to heal."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, anti-inflammatory medication, and time. Many degenerative tears improve without surgery. Meniscal repair is preferred when the tear pattern and location allow it."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess the tear. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of mechanical symptoms in approximately 85–90% of patients. Quick recovery compared to meniscal repair."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Some patients have ongoing discomfort, particularly with degenerative tears and underlying arthritis.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Mild knee swelling for one to two weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Accelerated arthritis",
            "detail": "Removing meniscal tissue increases the risk of arthritis in the affected compartment. The lateral meniscus is particularly critical for load distribution.",
            "freq": "Long-term"
          },
          {
            "risk": "Re-tear",
            "detail": "Another area may tear in the future.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection. Risk approximately 0.3%.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Crutches for comfort for a few days. Return to desk work within days. Driving at one to two weeks. Running at four to six weeks. Return to sport at six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling after initial improvement",
          "Locking of the knee",
          "Wound problems",
          "Fever",
          "Calf pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Further follow-up as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is lateral meniscectomy worse than medial?",
            "a": "The lateral meniscus carries a greater proportion of the load in the lateral compartment. Removing lateral meniscal tissue tends to cause faster arthritis progression than medial meniscectomy. Repair is strongly preferred on the lateral side whenever possible."
          },
          {
            "q": "Should the tear be repaired instead?",
            "a": "Repair is preferred when the tear is in the vascular (outer) zone and the pattern allows it. Tears in the avascular inner zone do not heal with repair."
          }
        ]
      }
    ]
  },
  "scaphoid-bone-graft": {
    "name": "Scaphoid Bone Grafting (Non-Union)",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Scaphoid bone grafting is an operation to treat a scaphoid non-union — a scaphoid fracture that has failed to heal. A bone graft is used to fill the gap and stimulate healing, combined with screw fixation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the front (volar) or back (dorsal) of the wrist. The non-union site is exposed, the fibrous tissue is removed, and the bone ends are freshened. A bone graft (usually from the distal radius or iliac crest) is shaped and placed into the defect. A headless compression screw is inserted to stabilise the construct. For proximal pole non-unions with AVN, a vascularised bone graft (from the distal radius with its blood supply intact) may be used. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for established scaphoid non-union to prevent progressive wrist arthritis (SNAC wrist). Without treatment, the abnormal mechanics of the non-united scaphoid lead to predictable arthritis over years."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation may be appropriate in asymptomatic patients with minimal arthritis. However, non-unions do not heal spontaneously and arthritis will progress over time."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to assess the non-union and any cyst formation. MRI to assess vascularity of the proximal pole. X-rays for staging of any arthritis."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Union rates for scaphoid bone grafting are approximately 80–90% for waist non-unions. Proximal pole non-unions with AVN have lower healing rates (60–70%) even with vascularised graft. Successful union prevents arthritis progression."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent non-union",
            "detail": "The scaphoid may still fail to heal despite grafting. Risk approximately 10-20%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wrist stiffness",
            "detail": "Some loss of wrist motion.",
            "freq": "Common"
          },
          {
            "risk": "Graft site pain",
            "detail": "If bone was harvested from the iliac crest.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "AVN progression",
            "detail": "The proximal pole may continue to lose blood supply.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw complications",
            "detail": "Screw prominence or migration.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or bone infection.",
            "freq": "Rare"
          },
          {
            "risk": "SNAC arthritis",
            "detail": "Despite successful union, some arthritis may already be present.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast for six to eight weeks. CT scan at three months to assess union. Hand therapy for wrist movement and grip strength. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Persistent wrist pain after cast removal"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at six weeks. CT at three months to confirm union."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why did my scaphoid not heal?",
            "a": "The scaphoid has a retrograde blood supply that makes it vulnerable to non-union. Missed fractures, delayed treatment, smoking, and proximal pole location all increase the risk."
          },
          {
            "q": "What is SNAC wrist?",
            "a": "Scaphoid Non-union Advanced Collapse — a predictable pattern of wrist arthritis that develops over years when a scaphoid non-union is left untreated."
          }
        ]
      }
    ]
  },
  "sauve-kapandji": {
    "name": "Sauvé-Kapandji Procedure",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "The Sauvé-Kapandji procedure is an operation to fuse the distal radioulnar joint (DRUJ) and create a pseudarthrosis (controlled gap) in the ulna shaft, preserving forearm rotation while eliminating DRUJ pain.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the ulnar side of the wrist. The DRUJ is fused using a screw — the distal ulna is permanently joined to the radius. A segment of ulna shaft (approximately 1 cm) is removed proximal to the fusion site, creating a gap that allows the radius and proximal ulna to rotate around each other. A soft tissue interposition (such as pronator quadratus or extensor carpi ulnaris) may be placed in the gap to prevent the bone ends from reuniting. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Sauvé-Kapandji procedure is recommended for painful DRUJ arthritis (post-traumatic or inflammatory) in younger, more active patients where the Darrach procedure (simple ulna head excision) carries a higher risk of instability. It preserves the ulnar head as a buttress for the carpus."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting, injection, activity modification. Darrach procedure, ulnar head replacement, or wrist arthrodesis are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays. Assessment of forearm rotation and DRUJ pathology."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief from DRUJ fusion, preservation of forearm rotation through the pseudarthrosis, and preservation of the ulnar head as a carpal buttress. Good outcomes in approximately 80–85% of patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Proximal stump instability",
            "detail": "The proximal ulna stump may be unstable and clunk during rotation.",
            "freq": "Common"
          },
          {
            "risk": "Reduced grip strength",
            "detail": "Some reduction in grip.",
            "freq": "Common"
          },
          {
            "risk": "Clicking",
            "detail": "Clicking at the pseudarthrosis site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Stump convergence",
            "detail": "The pseudarthrosis gap may narrow or close, limiting rotation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union of the DRUJ fusion",
            "detail": "The fusion may fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Ulnar nerve irritation",
            "detail": "From the surgical approach.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Regional or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for four to six weeks. Active forearm rotation exercises from four to six weeks. Grip strengthening from six to eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Painful clunking during forearm rotation"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How is this different from the Darrach procedure?",
            "a": "The Darrach removes the entire ulnar head. The Sauvé-Kapandji preserves the ulnar head (which supports the carpus) and creates rotation through a controlled gap in the ulnar shaft. It is better suited for younger, higher-demand patients."
          }
        ]
      }
    ]
  },
  "pollicisation": {
    "name": "Pollicisation",
    "region": "Hand & Wrist",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pollicisation is a complex reconstructive operation to create a thumb by repositioning the index finger (or another finger) into the thumb position. It is most commonly performed for children born without a thumb (thumb aplasia or hypoplasia).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The index finger is shortened, rotated, and repositioned to function as a thumb. The operation involves shortening the metacarpal, repositioning the tendons to provide opposition and pinch function, repositioning the neurovascular bundles, and insetting the finger into the thumb position. The operation is highly technical and takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Pollicisation is recommended for congenital thumb aplasia (absent thumb) or severe hypoplasia (underdeveloped thumb) where the existing thumb cannot be reconstructed. The thumb is essential for hand function — providing 40% of total hand function."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For mild hypoplasia, opponensplasty (tendon transfer) may augment thumb function. Prosthetic thumbs are rarely functional in children. Toe-to-thumb transfer is an alternative but more complex."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Detailed hand assessment. The operation is typically performed at 12–18 months of age, before the child develops compensatory patterns. X-rays and sometimes MRI to assess the skeletal and soft tissue anatomy."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "A functioning thumb that provides pinch grip and opposition. Children who undergo pollicisation develop excellent hand function — they adapt remarkably well to using the reconstructed thumb. The hand appears to have four fingers instead of five."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Cosmetic appearance",
            "detail": "The pollicised thumb is shorter and thinner than a normal thumb.",
            "freq": "Expected"
          },
          {
            "risk": "Reduced pinch strength",
            "detail": "Pinch strength is less than a normal thumb but usually functionally adequate.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "Scars from the reconstruction.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular compromise",
            "detail": "Blood supply to the transposed finger may be compromised. Close post-operative monitoring is essential.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "Joint stiffness in the reconstructed thumb.",
            "freq": "Common"
          },
          {
            "risk": "Web space contracture",
            "detail": "The new thumb web may tighten over time, requiring secondary procedures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Growth disturbance",
            "detail": "The transposed finger may grow differently.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia in a young child. Careful temperature management and fluid balance."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast for four to six weeks. Hand therapy begins after cast removal, though young children adapt largely through play. Occupational therapy to encourage pinch grip activities. Long-term follow-up throughout childhood to monitor growth and function."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Finger turning blue, white, or cold (vascular compromise — attend urgently)",
          "Excessive swelling",
          "Wound problems",
          "Child in significant distress",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Close monitoring in the first 48 hours for vascular status. Reviews at two weeks, six weeks, three months, and regularly throughout childhood."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "At what age should this be done?",
            "a": "Typically 12–18 months, before the child develops compensatory hand patterns. Earlier surgery allows the brain to adapt to the new thumb during the critical period of motor development."
          },
          {
            "q": "Will my child have normal hand function?",
            "a": "Children who undergo pollicisation develop remarkably good hand function. They adapt to using their reconstructed thumb naturally and can perform most activities. Pinch strength is reduced compared to a normal thumb but is usually functionally adequate."
          },
          {
            "q": "Will it look like a normal thumb?",
            "a": "The pollicised thumb is shorter and thinner than a normal thumb, and the hand has four digits instead of five. However, the functional result is far more important than the cosmetic appearance, and most families are very satisfied."
          }
        ]
      }
    ]
  },
  "sufe-osteotomy": {
    "name": "SUFE Corrective Osteotomy",
    "region": "Paediatric Orthopaedics",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "SUFE corrective osteotomy is an operation to realign the upper femur in a child or adolescent with a chronic or severely slipped upper femoral epiphysis (SUFE), where the slip has healed in a deformed position causing impingement and limited hip movement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Several osteotomy techniques are available depending on the severity and location of the deformity. The Imhäuser osteotomy (intertrochanteric flexion, valgus, and internal rotation osteotomy) is the most commonly used. The femur is cut, realigned to compensate for the slip, and fixed with a plate and screws. For severe slips, a modified Dunn procedure (subcapital realignment through a surgical hip dislocation approach) may be considered at specialist centres. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Corrective osteotomy is recommended for chronic SUFE with significant residual deformity causing femoroacetabular impingement, restricted hip movement (particularly internal rotation and flexion), and pain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and activity modification for mild deformity. Arthroscopic osteochondroplasty may address mild cam impingement from healed SUFE. Severe deformity requires osteotomy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with 3D reconstruction for planning. Assessment of hip range of motion. This is a specialist procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved hip range of motion, reduced impingement, and relief of pain. Prevention of early-onset hip arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg length discrepancy",
            "detail": "May result from the osteotomy.",
            "freq": "Common"
          },
          {
            "risk": "Altered gait",
            "detail": "Temporary changes in walking pattern.",
            "freq": "Common"
          },
          {
            "risk": "Hardware prominence",
            "detail": "Plate and screws may be palpable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "AVN",
            "detail": "Risk to the femoral head blood supply, particularly with more aggressive realignment techniques. Risk varies from 5% (intertrochanteric) to 10-15% (subcapital).",
            "freq": "Uncommon"
          },
          {
            "risk": "Chondrolysis",
            "detail": "Cartilage destruction. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The osteotomy may fail to heal.",
            "freq": "Rare"
          },
          {
            "risk": "Over-correction or under-correction",
            "detail": "Imperfect realignment.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned supine or lateral."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for six to eight weeks. Crutches. Physiotherapy for hip range of motion. Full recovery three to six months. Metalwork removal may be planned at twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing hip or groin pain",
          "Difficulty walking",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months. Long-term monitoring of the hip joint."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not just leave the deformity?",
            "a": "A chronically slipped SUFE that heals in a deformed position causes cam-type impingement against the acetabulum. Over time, this damages the labrum and cartilage, leading to early hip arthritis. Corrective osteotomy aims to prevent this."
          },
          {
            "q": "Is the modified Dunn procedure safe?",
            "a": "The modified Dunn directly realigns the epiphysis but has a higher AVN risk (10-15%). It is only performed at specialist centres with experience in this technically demanding procedure."
          }
        ]
      }
    ]
  },
  "meniscal-transplant": {
    "name": "Meniscal Allograft Transplant",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Meniscal allograft transplant replaces a previously removed meniscus with a donor meniscus from a tissue bank, performed in younger patients with a meniscus-deficient knee.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A size-matched donor meniscus is inserted through an incision and sutured into position, replicating native attachments. Bone plugs anchor the horns. Takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For patients under 50 with a removed meniscus, pain, minimal arthritis, stable aligned knee, and intact cartilage."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, unloader bracing, osteotomy, injections. Partial knee replacement in older patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI, alignment X-rays, donor sizing from tissue bank."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduced compartment overload, improved joint protection. 70–85% graft survival at five to ten years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Six to nine months.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "During healing.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "15–30% at ten years.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Disease transmission",
            "detail": "Extremely rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing four to six weeks. Running at four to six months. Sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two, six weeks, three, six months, one year. MRI at one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does a transplant last?",
            "a": "Approximately 70–85% survive at five to ten years."
          }
        ]
      }
    ]
  },
  "multi-ligament-reconstruction": {
    "name": "Multi-Ligament Knee Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Multi-ligament knee reconstruction rebuilds two or more damaged ligaments following knee dislocation — among the most complex knee surgeries.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Multiple incisions. Each ligament reconstructed with tendon grafts through bone tunnels. Common combinations: ACL+PCL, ACL+posterolateral corner. Takes three to five hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For knee dislocations and multi-ligament injuries causing gross instability. Surgery within two to three weeks."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bracing and physiotherapy for partial injuries. Complete disruptions rarely function well without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI. Vascular assessment critical — CT angiography may be needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of knee stability for walking and daily activities."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Arthrofibrosis in 10–20%.",
            "freq": "Common"
          },
          {
            "risk": "Residual laxity",
            "detail": "Particularly PCL.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged rehabilitation",
            "detail": "12–18 months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular injury",
            "detail": "Popliteal artery damage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Peroneal nerve palsy",
            "detail": "Foot drop.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft failure",
            "detail": "One or more ligaments.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "High risk.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Extended operating time."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Brace eight to twelve weeks. Crutches six to eight weeks. Sport at twelve to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Foot going cold or pulseless (attend A&E immediately)",
          "Foot drop"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two, six weeks, three, six months, one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is vascular assessment critical?",
            "a": "Knee dislocations can damage the popliteal artery. Must be identified within six to eight hours."
          }
        ]
      }
    ]
  },
  "first-mtp-fusion": {
    "name": "First MTP Joint Fusion (Hallux Rigidus)",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "First MTP fusion permanently stiffens the big toe joint, eliminating painful arthritic motion. Gold standard for severe hallux rigidus.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Incision over the big toe joint. Cartilage removed. Bones positioned at optimal angle and fixed with plate and screws. Takes 45–75 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For severe hallux rigidus with significant cartilage loss, failed cheilectomy, or severe deformity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stiff-soled shoes, carbon fibre insoles, rocker-bottom shoes, injection. Cheilectomy for earlier-stage disease."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. Assessment of desired fusion position for footwear."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent pain relief in over 90%. Functional walking position."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of toe motion",
            "detail": "Expected — purpose of surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Shoe limitations",
            "detail": "High heels difficult.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Several months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "5–10%. Higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malposition",
            "detail": "Suboptimal angle.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware irritation",
            "detail": "Plate prominence.",
            "freq": "Common"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain under adjacent metatarsals.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local ankle block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Post-op shoe six to eight weeks. Normal footwear at eight to twelve weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Severe pain",
          "Toe turning blue"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can I walk normally?",
            "a": "Yes — most patients walk very well. The toe is set in a slightly upward position allowing normal push-off."
          }
        ]
      }
    ]
  },
  "jones-fracture": {
    "name": "Jones Fracture Fixation (Fifth Metatarsal)",
    "region": "Foot & Ankle",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Jones fracture fixation stabilises a fracture at the base of the fifth metatarsal using an intramedullary screw. This watershed zone has poor blood supply and high non-union rates without surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small incision over the base of the fifth metatarsal. Under X-ray guidance, an intramedullary screw is inserted along the metatarsal canal. Takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For acute Jones fractures in athletes, delayed unions, non-unions, and recurrent stress fractures. Non-union rates up to 25–30% without surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Non-weight-bearing cast six to eight weeks. Higher non-union rates."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays. MRI if stress fracture suspected. Day case."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Union rates approximately 95%. Athletes return faster with fixation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Sural nerve irritation",
            "detail": "Numbness on outer foot.",
            "freq": "Common"
          },
          {
            "risk": "Screw prominence",
            "detail": "Palpable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Despite fixation, approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-fracture",
            "detail": "After return to sport.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw breakage",
            "detail": "If union delayed.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local ankle block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing in boot immediately. Normal shoes at four to six weeks. Running at eight to ten weeks. Sport at ten to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this fracture special?",
            "a": "The Jones zone has a watershed blood supply making healing unpredictable without fixation."
          }
        ]
      }
    ]
  },
  "peroneal-tendon-repair": {
    "name": "Peroneal Tendon Repair",
    "region": "Foot & Ankle",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Peroneal tendon repair addresses tears, subluxation, or tendinopathy of the tendons behind the outer ankle — important for ankle stability and foot eversion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Incision behind the fibula. For tears: debridement or suture repair, with tendon transfer if >50% damaged. For subluxation: retinaculum repair and groove deepening. Takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For peroneal tears causing lateral ankle pain, recurrent subluxation, and chronic instability with tendon damage."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, bracing, boot immobilisation for acute injuries."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or ultrasound. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of lateral ankle pain, resolution of subluxation. Approximately 85% good outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Sural nerve irritation",
            "detail": "Outer foot numbness.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-tear or re-subluxation",
            "detail": "Recurrence.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Lateral ankle skin slow to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adhesions",
            "detail": "Limiting tendon glide.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast or boot four to six weeks. Sport at three to four months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Ankle giving way",
          "Pain behind outer ankle"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two, six weeks, three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes peroneal problems?",
            "a": "Chronic ankle instability, recurrent sprains, cavovarus foot type, and overuse."
          }
        ]
      }
    ]
  },
  "superior-capsular-reconstruction": {
    "name": "Superior Capsular Reconstruction (SCR)",
    "region": "Shoulder",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "SCR restores the superior restraint of the shoulder in massive irreparable rotator cuff tears using a graft placed over the humeral head to prevent upward migration.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically. A thick dermal allograft or fascia lata autograft is secured between the superior glenoid and greater tuberosity, bridging the irreparable cuff defect. Takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For younger, active patients with massive irreparable cuff tears not suitable for reverse shoulder replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, injection, partial repair, tendon transfer, or reverse shoulder replacement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming irreparable tear. Pre-operative physiotherapy."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved function and pain relief. 75–85% satisfaction at two to five years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "10–30% reported.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary.",
            "freq": "Common"
          },
          {
            "risk": "Residual weakness",
            "detail": "Overhead strength limited.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Slightly higher with allograft.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Rare.",
            "freq": "Rare"
          },
          {
            "risk": "Progression to arthropathy",
            "detail": "Long-term deterioration.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling six weeks. Active movement from six weeks. Strengthening from three months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sudden loss of shoulder function"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two, six weeks, three, six months, one year. MRI at six to twelve months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this better than reverse replacement?",
            "a": "SCR preserves the native joint for younger patients. Reverse replacement is more reliable but is a joint replacement."
          }
        ]
      }
    ]
  },
  "tlif": {
    "name": "TLIF (Transforaminal Lumbar Interbody Fusion)",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "TLIF combines posterior decompression with interbody fusion through a single posterior approach — one of the most commonly performed spinal fusion techniques.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Midline incision. Pedicle screws placed. One facet removed to access disc space. Disc removed, cage with bone graft inserted. Rods connected. MIS-TLIF uses smaller incisions. Takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For spondylolisthesis, recurrent disc herniation, degenerative disc disease with instability, and failed decompression."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain management, epidural injections. Standalone decompression if no instability."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI, CT, standing X-rays. Smoking cessation essential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Decompression plus stabilisation. Fusion rates exceed 90%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Back stiffness",
            "detail": "Fused level no longer moves.",
            "freq": "Expected"
          },
          {
            "risk": "Post-operative pain",
            "detail": "One to two weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-fusion",
            "detail": "5–10%. Higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "Long-term.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "1–2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Dural tear",
            "detail": "3–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Cage subsidence",
            "detail": "Sinking into vertebral body.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "2–3%.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital two to four days. Walking day one. No BLT for six to twelve weeks. Desk work at four to six weeks. Full fusion six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three, six months. CT at one year if uncertain."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What about minimally invasive TLIF?",
            "a": "MIS-TLIF uses smaller incisions, less muscle damage, potentially faster recovery. Not suitable for all patients."
          }
        ]
      }
    ]
  },
  "si-fusion-chronic": {
    "name": "Sacroiliac Joint Fusion (Chronic Pain)",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "SI joint fusion for chronic pain uses triangular titanium implants placed minimally invasively to fuse the sacroiliac joint — for debilitating SI pain confirmed with diagnostic injections.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small buttock incision. Two or three triangular titanium implants placed across the SI joint under X-ray guidance. Takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For confirmed SI joint dysfunction with at least two positive diagnostic injections, after six months of failed conservative treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, SI belt, radiofrequency ablation, prolotherapy, medication."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Diagnostic injection confirming 50–75% relief. MRI. Psychological assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Significant pain reduction in 70–80% of carefully selected patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Buttock pain",
            "detail": "Several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Not all patients respond.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve irritation",
            "detail": "L5/S1.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant malposition",
            "detail": "Outside ideal corridor.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-fusion",
            "detail": "Incomplete fusion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or local with sedation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Avoid impact six to eight weeks. Full activity three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing buttock or leg pain",
          "New weakness",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at six weeks, three months. CT at twelve months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do I know it's my SI joint?",
            "a": "Gold standard is diagnostic injection under image guidance providing significant temporary relief."
          }
        ]
      }
    ]
  },
  "hip-fusion": {
    "name": "Hip Arthrodesis (Fusion)",
    "region": "Hip",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip arthrodesis permanently fuses the femoral head to the acetabulum. Rarely performed today but remains an option for very young, high-demand patients with severe unilateral hip disease.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Cartilage removed. Hip positioned in optimal functional position and fixed with plate and screws. Bone graft. Takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For very young patients (under 30–40) with severe unilateral hip arthritis and extreme activity demands, or salvage after failed replacement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Hip replacement, resurfacing, pain management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Assessment of spine and contralateral hip — both must be healthy."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain-free, extremely strong hip lasting a lifetime. Withstands heavy manual labour."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of hip movement",
            "detail": "Expected.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Stiff-legged walking.",
            "freq": "Expected"
          },
          {
            "risk": "Low back pain",
            "detail": "Most significant long-term problem.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Contralateral hip arthritis",
            "detail": "Long-term.",
            "freq": "Long-term"
          },
          {
            "risk": "Lumbar degeneration",
            "detail": "Accelerated.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Spica cast or brace six to twelve weeks. Non-weight-bearing six to eight weeks. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Back or opposite hip pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three, six months. Long-term spine and hip monitoring."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can it be converted to a replacement later?",
            "a": "Yes, conversion to THR is possible when back or knee problems develop from the fusion."
          }
        ]
      }
    ]
  },
  "hip-disarticulation": {
    "name": "Hip Disarticulation",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip disarticulation removes the entire lower limb at the hip joint for tumours of the proximal thigh or hip where more distal amputation cannot achieve clear margins.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Extensive incision around the hip. Vessels and nerves divided. Femoral head disarticulated from acetabulum. Gluteal flaps fashioned for wound coverage. Takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For locally advanced proximal femur or hip tumours where AKA would not achieve clear margins."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Limb salvage, AKA if margins allow, radiotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Sarcoma centre. Full staging. MDT. Psychological preparation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete tumour removal. Well-padded stump may allow prosthetic fitting."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Phantom pain",
            "detail": "Very common.",
            "freq": "Expected"
          },
          {
            "risk": "Major psychological impact",
            "detail": "Expected.",
            "freq": "Expected"
          },
          {
            "risk": "Wound complications",
            "detail": "Large wound area.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound infection",
            "detail": "With prior treatment.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chronic stump pain",
            "detail": "Neuroma formation.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Significant blood loss."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital one to two weeks. Some patients achieve prosthetic walking. Many use wheelchair. Intensive psychological support."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown",
          "Fever",
          "Severe phantom pain",
          "Psychological distress"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance. Rehabilitation. Psychological support."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can I walk?",
            "a": "Hip disarticulation prosthetics exist and some patients achieve walking, but it requires significant energy. Many prefer wheelchair for distance."
          }
        ]
      }
    ]
  },
  "elbow-osteocapsular": {
    "name": "Elbow Osteocapsular Arthroplasty",
    "region": "Elbow",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Elbow osteocapsular arthroplasty removes bone spurs, loose bodies, and contracted capsule to improve range of motion in an arthritic elbow — a joint-preserving alternative to replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic or open. Bone spurs removed from coronoid and olecranon. Capsule released. Loose bodies removed. In the Outerbridge-Kashiwagi procedure, a hole is drilled through the olecranon fossa. Takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "For primary elbow OA with stiffness and pain at extremes of motion, preserved joint space, and mechanical symptoms."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, anti-inflammatory medication, injection."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays showing osteophytes with preserved joint space. CT scan."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improvement of 20–30 degrees of arc. Pain relief from spur removal."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Spur recurrence",
            "detail": "Over time.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness recurrence",
            "detail": "Some loss of gained motion.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve injury",
            "detail": "At risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Through thinned olecranon fossa.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "New bone formation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General with nerve block for immediate exercises."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Aggressive physiotherapy from day of surgery. CPM machine. Most improvement in first three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing stiffness",
          "New numbness in ring/little fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent early reviews to monitor motion."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this suitable for severe arthritis?",
            "a": "Best when joint space is preserved. If severely worn, elbow replacement may be better."
          }
        ]
      }
    ]
  },
  "shoulder-hemiarthroplasty": {
    "name": "Shoulder Hemiarthroplasty",
    "region": "Shoulder",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder hemiarthroplasty is an operation to replace the ball (humeral head) of the shoulder joint with a metal prosthesis, while preserving the native socket (glenoid). It is performed for complex proximal humerus fractures in elderly patients and certain types of arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the shoulder. The fractured or arthritic humeral head is removed. A metal stem with an appropriately sized prosthetic head is cemented or press-fit into the humeral shaft. The tuberosities (with their attached rotator cuff tendons) are carefully repaired around the prosthesis using sutures. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hemiarthroplasty is recommended for comminuted (shattered) proximal humerus fractures in elderly patients where fixation would fail, fracture-dislocations of the shoulder, and certain patterns of arthritis where the glenoid is well-preserved. In fracture cases, it provides immediate pain relief and stability."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Fracture fixation with plate and screws (if the fracture pattern allows), reverse shoulder replacement (increasingly preferred for fractures in the elderly), non-operative treatment in a sling (accepting limited function), and total shoulder replacement for arthritis."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to assess fracture pattern and tuberosity displacement. For fractures, surgery is ideally performed within two weeks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief. Functional outcomes depend heavily on tuberosity healing — if the tuberosities heal in position, good overhead function can be achieved. If they fail to heal, active elevation is limited."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Tuberosity non-healing",
            "detail": "The tuberosities may migrate or fail to heal, limiting active movement. Occurs in approximately 20–30% of fracture cases.",
            "freq": "Common"
          },
          {
            "risk": "Shoulder stiffness",
            "detail": "Limited range of motion, particularly overhead.",
            "freq": "Common"
          },
          {
            "risk": "Persistent pain",
            "detail": "Some patients have ongoing discomfort.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "The prosthesis may dislocate. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection approximately 1–2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant.",
            "freq": "Rare"
          },
          {
            "risk": "Glenoid erosion",
            "detail": "Over time, the metal head may wear the native glenoid.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "Axillary or musculocutaneous nerve.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle pendular exercises from week one. Active assisted movement from four to six weeks. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Tuberosity healing is monitored on X-rays."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder feeling unstable or clunking",
          "Loss of ability to raise the arm"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, three months, and one year to monitor tuberosity healing and implant position."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not a reverse shoulder replacement?",
            "a": "Reverse replacement is increasingly used for fractures in elderly patients as it does not depend on tuberosity healing for function. Your surgeon will recommend the best option based on your specific fracture, bone quality, and activity level."
          },
          {
            "q": "Will I be able to raise my arm above my head?",
            "a": "This depends on tuberosity healing. If the tuberosities heal well, good overhead function is achievable. If they do not heal, active elevation may be limited, though pain relief is usually maintained."
          }
        ]
      }
    ]
  },
  "scapula-fracture-fixation": {
    "name": "Scapula Fracture Fixation",
    "region": "Shoulder",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Scapula fracture fixation is an operation to realign and stabilise a displaced fracture of the shoulder blade. Most scapula fractures are treated non-operatively, but significantly displaced fractures — particularly those involving the glenoid neck or intra-articular glenoid — may require surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the back of the shoulder (posterior approach, typically modified Judet). The fracture is exposed by working between or through the infraspinatus and teres minor muscles. The fragments are reduced and fixed with plates and screws. For intra-articular glenoid fractures, an anterior or combined approach may be needed. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for significantly displaced glenoid neck fractures (medialization greater than 15–20 mm or angulation greater than 30–40 degrees), intra-articular glenoid fractures with a step or gap, and scapula fractures associated with a floating shoulder (combined clavicle and scapula neck fracture)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Most scapula fractures (over 90%) heal well with a sling and physiotherapy. The scapula is surrounded by thick muscles that provide a natural splint."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with 3D reconstruction for planning. Assessment of associated injuries — scapula fractures typically result from high-energy trauma and are often associated with rib fractures, pulmonary contusion, and brachial plexus injuries."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of scapular anatomy, particularly the glenoid articular surface and the relationship between the glenoid and the humeral head. Improved shoulder mechanics and reduced risk of post-traumatic arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Common after scapula surgery. Physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Suprascapular nerve irritation",
            "detail": "Numbness or weakness in the shoulder.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood loss",
            "detail": "More than expected due to the muscular approach.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Suprascapular nerve palsy",
            "detail": "Weakness of external rotation. Usually recovers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware prominence",
            "detail": "Plates may be palpable through thin muscle.",
            "freq": "Common"
          },
          {
            "risk": "Non-union",
            "detail": "Rare in the scapula due to excellent blood supply.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned lateral or prone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for two to four weeks. Gentle exercises from week one. Active movement from four to six weeks. Strengthening from eight weeks. Full recovery four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Difficulty breathing (associated rib injuries)",
          "New weakness in the shoulder"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why don't most scapula fractures need surgery?",
            "a": "The scapula is enclosed in thick muscle that acts as a natural splint. Most fractures heal well with a sling and exercises. Surgery is only needed when displacement significantly affects the shoulder joint mechanics."
          }
        ]
      }
    ]
  },
  "terrible-triad-repair": {
    "name": "Terrible Triad of the Elbow Repair",
    "region": "Elbow",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Terrible triad repair is an operation to address the three components of a complex elbow injury: elbow dislocation, radial head fracture, and coronoid fracture. This injury pattern creates significant instability and requires systematic surgical reconstruction.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through one or two incisions around the elbow, each component is addressed systematically. The coronoid fracture is fixed with screws or sutures. The radial head is fixed with a plate or, if shattered, replaced with a metal prosthesis. The lateral collateral ligament complex is repaired with sutures or suture anchors. The medial collateral ligament may also be repaired if instability persists. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The terrible triad is inherently unstable — without surgery, the elbow redislocates and develops severe stiffness and arthritis. Systematic repair of all three components is essential."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Not appropriate for complete terrible triad injuries. Simple elbow dislocations without fracture can often be managed with brief immobilisation and physiotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan is essential to assess both fractures. Surgery within one to two weeks of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of a stable, concentrically reduced elbow allowing early movement. Most patients achieve a functional arc of motion, though some permanent stiffness is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Elbow stiffness",
            "detail": "Very common. Some loss of full extension is expected.",
            "freq": "Expected"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation. Preventive measures may be used.",
            "freq": "Uncommon"
          },
          {
            "risk": "Ulnar nerve symptoms",
            "detail": "Numbness in the ring and little fingers.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent instability",
            "detail": "Despite repair, the elbow may remain unstable requiring further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Articular cartilage damage from the original injury.",
            "freq": "Long-term"
          },
          {
            "risk": "Implant failure",
            "detail": "Radial head prosthesis loosening or dislocation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with regional arm block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A hinged elbow brace allowing controlled movement. Early supervised physiotherapy is critical — the elbow stiffens rapidly. Active movement from one to two weeks. Strengthening from six to eight weeks. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Elbow feeling unstable or clunking",
          "Increasing stiffness despite physiotherapy",
          "New numbness in ring and little fingers"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent early reviews. X-rays at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this called a 'terrible triad'?",
            "a": "The combination of dislocation, radial head fracture, and coronoid fracture was historically associated with poor outcomes. Modern systematic surgical repair has significantly improved results, but the name persists."
          },
          {
            "q": "Will I get full movement back?",
            "a": "Most patients achieve a functional arc (approximately 30–130 degrees) sufficient for daily activities. Some permanent loss of terminal extension is common but rarely functionally significant."
          }
        ]
      }
    ]
  },
  "gluteal-tendon-repair": {
    "name": "Gluteal Tendon Repair",
    "region": "Hip",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Gluteal tendon repair is an operation to reattach torn gluteus medius and/or minimus tendons to the greater trochanter. These tears are increasingly recognised as a major cause of lateral hip pain and hip abductor weakness.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the greater trochanter on the outer hip. The torn tendons are identified, mobilised, and reattached to the bone using suture anchors. A bursectomy (removal of the inflamed bursa) is usually performed at the same time. The procedure may be performed open or endoscopically. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for significant gluteal tendon tears causing lateral hip pain, abductor weakness (Trendelenburg gait — waddling), and disability that has not responded to physiotherapy and injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (structured gluteal strengthening programme), corticosteroid injection, shockwave therapy, PRP injection, and activity modification. Many patients improve with non-operative treatment."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming the tear. Ultrasound may be used. Pre-operative physiotherapy (prehabilitation) improves outcomes."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved abductor strength. Reduction or elimination of the Trendelenburg lurch. Most patients report significant improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral hip discomfort",
            "detail": "Soreness over the repair site for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Activity restrictions",
            "detail": "No active abduction or side-lying on the operated hip for six weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-tear",
            "detail": "The repair may fail, particularly with large or chronic tears.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Thigh numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Trochanteric fracture",
            "detail": "Rare fracture of the greater trochanter.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for six weeks. No active abduction for six weeks. Sleep on the non-operated side for six weeks. Physiotherapy from two weeks — initially passive, then gradually active. Full recovery six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Worsening limp",
          "Increasing difficulty walking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this similar to a rotator cuff tear?",
            "a": "Yes — it is often called a 'rotator cuff tear of the hip.' The gluteal tendons function similarly to the rotator cuff, and tears cause similar pain and weakness patterns."
          },
          {
            "q": "Why wasn't this diagnosed earlier?",
            "a": "Gluteal tendon tears were historically misdiagnosed as 'trochanteric bursitis.' MRI has improved recognition that the tendons, not just the bursa, are the primary problem."
          }
        ]
      }
    ]
  },
  "girdlestone-excision": {
    "name": "Girdlestone Excision Arthroplasty",
    "region": "Hip",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Girdlestone excision arthroplasty is an operation to remove a failed or infected hip replacement, leaving the hip without a prosthesis. It is a salvage procedure performed when reimplantation is not possible or as a staged procedure before reimplanting a new hip.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the hip (often reopening the previous surgical incision). All prosthetic components, cement, and infected or dead tissue are removed. The wound is thoroughly washed. Antibiotic-loaded cement beads or a spacer may be placed temporarily. The wound is closed, leaving the hip without a prosthesis. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Girdlestone excision is performed for chronic periprosthetic joint infection that cannot be eradicated with implant retention, failed hip replacement with insufficient bone for revision in patients not fit for complex reconstruction, and as the first stage of a two-stage revision for infection (spacer insertion before reimplantation)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Long-term antibiotic suppression of infection (accepting the infected implant), palliative care, and above-knee amputation in extreme cases. Two-stage revision (spacer followed by reimplantation) is the preferred approach when the patient is suitable."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Joint aspiration for microbiology. Blood tests including inflammatory markers. Assessment of bone stock and soft tissue condition. MDT discussion involving microbiologists and infectious disease specialists."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Eradication of infection. Pain relief from removing the loose or infected prosthesis. If planned as a two-stage procedure, reimplantation of a new hip can be performed once infection is cleared (usually three to six months later)."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Leg length discrepancy",
            "detail": "Significant shortening of the affected leg. A shoe raise is needed.",
            "freq": "Expected"
          },
          {
            "risk": "Limp",
            "detail": "Significant limp without a prosthesis. Crutches or walking aids required permanently if reimplantation is not performed.",
            "freq": "Expected"
          },
          {
            "risk": "Weakness",
            "detail": "Loss of hip abductor function.",
            "freq": "Expected"
          },
          {
            "risk": "Persistent pain",
            "detail": "Some patients have ongoing discomfort.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent infection",
            "detail": "Infection may not be fully eradicated.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound complications",
            "detail": "Particularly in previously operated, irradiated, or infected tissue.",
            "freq": "Common"
          },
          {
            "risk": "Dislocation of spacer",
            "detail": "If an antibiotic spacer is used.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients undergoing Girdlestone are elderly with significant comorbidities.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Patient may be medically complex."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks or longer. Mobilisation with walking aids. If planned for reimplantation, six to twelve weeks of intravenous or oral antibiotics before the second stage. If a permanent Girdlestone, lifelong use of walking aids and shoe raise."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Fever",
          "Increasing pain",
          "Medical deterioration"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular blood tests to monitor infection markers. If two-stage planned, joint aspiration before reimplantation to confirm infection clearance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I get a new hip eventually?",
            "a": "If the infection is cleared, most patients are suitable for reimplantation of a new hip (second stage of two-stage revision). This typically occurs three to six months after the Girdlestone, once infection markers have normalised and aspiration confirms no residual infection."
          },
          {
            "q": "Can I walk without a hip replacement?",
            "a": "Yes, but with a significant limp, leg shortening, and the need for walking aids. Function is limited but pain relief is usually good."
          }
        ]
      }
    ]
  },
  "cheilectomy": {
    "name": "Cheilectomy (Hallux Rigidus)",
    "region": "Foot & Ankle",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cheilectomy is an operation to remove bone spurs from the top of the big toe joint to improve range of motion and reduce pain. It is a joint-preserving alternative to fusion for mild to moderate hallux rigidus.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the top of the big toe joint. The dorsal osteophytes (bone spurs) are removed from the metatarsal head and proximal phalanx, along with any loose bodies and inflamed synovium. Approximately 25–30% of the metatarsal head surface is removed. The operation takes 30–45 minutes and is usually a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Cheilectomy is recommended for mild to moderate hallux rigidus (grades I–II) where the main problem is dorsal impingement from bone spurs. It preserves joint motion unlike fusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stiff-soled shoes, rocker-bottom shoes, corticosteroid injection, activity modification, and anti-inflammatory medication."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays to grade the arthritis. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved dorsiflexion range and reduced pain in approximately 80–90% of patients with appropriate grade disease. Joint motion is preserved."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence of spurs",
            "detail": "Bone spurs may regrow over time.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Forefoot swelling for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Residual stiffness",
            "detail": "Some limitation may persist.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Progression of arthritis",
            "detail": "The underlying arthritis may progress, eventually requiring fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "Hallux varus or valgus",
            "detail": "Alteration of toe alignment.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal digital nerve, causing numbness.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local ankle block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Post-operative shoe for two to three weeks. Normal footwear at three to four weeks. Full recovery six to eight weeks. Toe mobilisation exercises immediately."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Increasing stiffness",
          "Toe numbness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What if this doesn't work?",
            "a": "If cheilectomy does not provide lasting relief, first MTP fusion remains available as a definitive solution. Cheilectomy does not compromise future fusion."
          },
          {
            "q": "How long does the benefit last?",
            "a": "Most patients enjoy good results for five to ten years. Some eventually progress to needing fusion as the arthritis advances."
          }
        ]
      }
    ]
  },
  "lapidus-procedure": {
    "name": "Lapidus Procedure (First TMT Fusion)",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "The Lapidus procedure is an operation to fuse the first tarsometatarsal (TMT) joint at the base of the first metatarsal. It corrects bunion deformity at its origin — the hypermobile first ray — providing powerful, durable correction for moderate to severe hallux valgus.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the medial and dorsal aspect of the midfoot. The first TMT joint is exposed, the cartilage removed, and the joint fused using plates and screws. This corrects the metatarsus primus varus (the angular deformity of the first metatarsal). The bunion prominence is trimmed. A distal soft tissue procedure may be performed at the same time. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Lapidus is recommended for moderate to severe bunions, particularly when there is hypermobility of the first ray, recurrent bunions after previous surgery, or first TMT joint arthritis coexisting with bunion deformity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wide footwear, bunion pads, toe spacers, orthotics. Distal metatarsal osteotomy (scarf, chevron) is an alternative for milder deformity."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. Assessment of first ray hypermobility."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Powerful, durable bunion correction at the source of the deformity. Low recurrence rate. Good long-term results."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-weight-bearing for six weeks, longer than distal osteotomies.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Forefoot swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "First TMT stiffness",
            "detail": "Expected — the joint is fused.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Failure of the TMT joint to fuse. Risk approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain under adjacent metatarsal heads.",
            "freq": "Uncommon"
          },
          {
            "risk": "Dorsal malunion",
            "detail": "The first metatarsal may heal in a slightly elevated position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware irritation",
            "detail": "Plates or screws may need removal.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence",
            "detail": "Low risk with Lapidus, but possible.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast or boot for six weeks. Weight-bearing in a boot from six to ten weeks. Normal footwear at ten to twelve weeks. Full recovery four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Toes blue or numb",
          "Increasing pain at midfoot"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, ten weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why Lapidus instead of a standard bunion correction?",
            "a": "The Lapidus corrects the deformity at its origin — the hypermobile first TMT joint. It provides more powerful correction for severe bunions and has a lower recurrence rate, but requires longer non-weight-bearing recovery."
          }
        ]
      }
    ]
  },
  "ankle-distraction": {
    "name": "Ankle Distraction Arthroplasty",
    "region": "Foot & Ankle",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle distraction arthroplasty is a joint-preserving technique for ankle arthritis using an external fixator to gradually separate the joint surfaces, allowing cartilage regeneration. It is an alternative to ankle fusion or replacement in younger patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic debridement of the ankle is performed first — bone spurs, loose bodies, and damaged cartilage are removed. An external fixator (Ilizarov frame or hinged fixator) is then applied with pins in the tibia and foot, distracting (separating) the ankle joint surfaces by approximately 5 mm. The fixator is worn for approximately three months, during which the patient is encouraged to weight-bear. The distraction unloads the cartilage, allowing regeneration."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Ankle distraction is considered for younger patients (under 45–55) with significant ankle arthritis who are too young for ankle replacement and wish to avoid fusion. It may delay the need for definitive surgery by several years."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Ankle brace, rocker-bottom shoes, corticosteroid injection, physiotherapy, and activity modification. Ankle fusion and ankle replacement are definitive surgical options."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standing ankle X-rays and MRI. CT to assess bone quality. Patient must understand the commitment to wearing an external fixator for three months."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduction in ankle pain and potential cartilage regeneration. Studies report approximately 70% of patients maintain improvement at seven to ten years, delaying or avoiding fusion or replacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site infection",
            "detail": "Very common with external fixators. Managed with pin care and antibiotics.",
            "freq": "Common"
          },
          {
            "risk": "Discomfort from fixator",
            "detail": "The frame is bulky and uncomfortable for three months.",
            "freq": "Expected"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Not all patients achieve adequate relief.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Deep infection",
            "detail": "Around pins or in the joint.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pin loosening",
            "detail": "Pins may loosen in bone, requiring replacement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Through pin sites.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Superficial peroneal or sural nerve damage from pin placement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Treatment failure",
            "detail": "Arthritis may progress despite distraction.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia for the initial procedure and frame application."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing in the external fixator immediately. Regular pin site care. Frame worn for approximately three months. After frame removal, progressive ankle exercises and rehabilitation. The full benefit may take six to twelve months to become apparent."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Pin site redness, discharge, or loosening",
          "Fever",
          "Increasing ankle pain or swelling",
          "Frame damage or instability"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular pin site checks every two to four weeks during fixator use. X-rays at frame removal and at three months, six months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why choose distraction over fusion or replacement?",
            "a": "Distraction preserves the native joint and may regenerate cartilage, delaying or avoiding definitive surgery. It is particularly valuable for younger patients who would outlive an ankle replacement and who wish to delay the permanence of fusion."
          },
          {
            "q": "Is it uncomfortable wearing the frame?",
            "a": "Yes, the external fixator is bulky and affects daily activities. However, most patients manage well with support and find the three-month commitment worthwhile for the potential benefit."
          }
        ]
      }
    ]
  },
  "alif": {
    "name": "ALIF (Anterior Lumbar Interbody Fusion)",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "ALIF is a spinal fusion performed through the abdomen to access the front of the lumbar spine. A large cage is placed in the disc space after complete disc removal, combined with posterior pedicle screw fixation for stability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the lower abdomen (or a retroperitoneal flank approach). The abdominal contents are carefully moved aside to access the front of the lumbar spine. The disc is completely removed under direct vision. A large cage filled with bone graft is inserted. The procedure is often combined with posterior pedicle screw fixation (placed in a separate stage or during the same anaesthetic). An access surgeon (vascular or general surgeon) assists with the approach. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ALIF is recommended for L4/5 and L5/S1 disc degeneration, spondylolisthesis, failed previous posterior surgery, and when a large interbody device is needed for sagittal balance correction. The anterior approach provides excellent disc space access and allows placement of the largest cage of any fusion technique."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain management, epidural injections, and activity modification. TLIF, XLIF, and posterior fusion are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for planning. Vascular imaging (CT angiogram or MR angiogram) to assess vessel anatomy. An access surgeon is involved in planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent disc space restoration and fusion rates exceeding 95%. The large cage provides strong structural support and indirect foraminal decompression. Avoids disruption of the back muscles."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ileus",
            "detail": "Temporary slowing of bowel function from abdominal retraction. Very common and resolves.",
            "freq": "Expected"
          },
          {
            "risk": "Abdominal discomfort",
            "detail": "From the surgical approach.",
            "freq": "Expected"
          },
          {
            "risk": "Retrograde ejaculation",
            "detail": "In men, damage to the superior hypogastric plexus can cause retrograde ejaculation. Risk approximately 1–3% at L5/S1.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular injury",
            "detail": "The great vessels (aorta, vena cava, iliac vessels) are directly adjacent. Injury is rare with experienced access surgeons but potentially life-threatening.",
            "freq": "Rare"
          },
          {
            "risk": "Ureteral injury",
            "detail": "The ureter may be damaged during retraction.",
            "freq": "Rare"
          },
          {
            "risk": "Non-fusion",
            "detail": "Despite the large cage. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sympathetic chain damage",
            "detail": "Warm leg or temperature regulation changes.",
            "freq": "Uncommon"
          },
          {
            "risk": "Incisional hernia",
            "detail": "Through the abdominal wound.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "Long-term.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Supine position. An access surgeon manages the approach."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay two to four days. Diet advances gradually as bowel function returns. Walking from day one. BLT restrictions for six to twelve weeks. Return to desk work at four to six weeks. Full fusion six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Abdominal distension or vomiting",
          "Inability to pass urine",
          "Leg temperature or colour change"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. CT scan at one year if fusion uncertain."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why approach from the front?",
            "a": "The anterior approach gives unobstructed access to the disc space, allows complete disc removal, and enables the largest cage placement of any technique. It avoids disrupting the back muscles, potentially reducing post-operative back pain."
          },
          {
            "q": "Why is a vascular surgeon involved?",
            "a": "The major blood vessels (aorta, vena cava) run directly in front of the lumbar spine. An access surgeon with vascular expertise safely mobilises these vessels to expose the spine."
          }
        ]
      }
    ]
  },
  "coccygectomy": {
    "name": "Coccygectomy",
    "region": "Spine",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Coccygectomy is an operation to remove part or all of the coccyx (tailbone). It is performed for chronic coccydynia (tailbone pain) that has not responded to non-operative treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the midline over the coccyx. The coccyx is carefully dissected from its attachments (gluteal muscles, anococcygeal ligament, levator ani) and removed — either partially (distal segments) or completely. Care is taken to avoid the rectum and to close the wound in layers. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Coccygectomy is reserved for severe, disabling coccydynia that has not responded to at least six to twelve months of non-operative treatment including cushioning, physiotherapy, manual therapy, corticosteroid injection, and ganglion impar block."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Coccyx cushion (donut or wedge), physiotherapy (pelvic floor and coccyx mobilisation), corticosteroid injection, ganglion impar block, and ergonomic modifications. Most patients improve without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Dynamic X-rays (sitting/standing) to assess coccygeal mobility. MRI to exclude other pathology. Confirmation that the coccyx is the pain source (ideally with a diagnostic injection providing temporary relief)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief in approximately 80–90% of carefully selected patients. Improvement is gradual over weeks to months as the wound heals."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The location (near the natal cleft) makes wound healing challenging. Risk approximately 10–15%.",
            "freq": "Common"
          },
          {
            "risk": "Sitting discomfort",
            "detail": "Tenderness over the surgical site for several weeks to months.",
            "freq": "Expected"
          },
          {
            "risk": "Seroma",
            "detail": "Fluid collection at the surgical site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound infection",
            "detail": "Risk approximately 5–10% due to the location.",
            "freq": "Uncommon"
          },
          {
            "risk": "Rectal injury",
            "detail": "Very rare but requires immediate repair.",
            "freq": "Rare"
          },
          {
            "risk": "Chronic wound sinus",
            "detail": "A persistent draining tract.",
            "freq": "Uncommon"
          },
          {
            "risk": "Persistent pain",
            "detail": "Approximately 10–20% of patients have ongoing pain despite coccygectomy.",
            "freq": "Common"
          },
          {
            "risk": "Pelvic floor dysfunction",
            "detail": "Rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Positioned prone with the buttocks taped apart."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Avoid sitting directly on the wound for four to six weeks (use a coccyx cushion). Wound care is important. Return to desk work (with cushion) at two to four weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, discharge, or breakdown",
          "Fever",
          "Increasing perianal pain",
          "Rectal symptoms"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Review at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is wound healing a concern?",
            "a": "The wound is in a high-moisture area near the natal cleft, making infection and delayed healing more common than at other surgical sites. Meticulous wound care is important."
          },
          {
            "q": "How long until I can sit comfortably?",
            "a": "Most patients sit comfortably (on a cushion initially) within four to six weeks. Full sitting comfort may take three to six months."
          }
        ]
      }
    ]
  },
  "external-fixation": {
    "name": "External Fixation (Principles)",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "External fixation is a technique to stabilise fractures using pins or wires inserted through the skin into bone, connected by an external frame. It provides rapid stabilisation and is used as temporary or definitive treatment for complex fractures.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, pins (half-pins or through-and-through wires) are inserted into the bone above and below the fracture through small skin incisions. These pins are connected outside the body by rods, bars, or a circular frame (Ilizarov or Taylor Spatial Frame). The fracture is reduced and the frame locks it in position. The operation takes 30–90 minutes depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "External fixation is used for open fractures requiring wound access, fractures with severe soft tissue injury where internal fixation would be unsafe, temporary stabilisation (damage control orthopaedics) before definitive fixation, pelvic fractures requiring emergency stabilisation, fractures requiring gradual correction (deformity correction with circular frames), and infected fractures or non-unions."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Internal fixation (plates, screws, nails) is the main alternative for most fractures. Cast or brace for stable fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Often performed as an emergency or urgent procedure. X-rays. CT may be performed after initial stabilisation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Rapid fracture stabilisation with minimal additional soft tissue disruption. Allows wound access for open fractures. Can be converted to definitive internal fixation when conditions allow."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site infection",
            "detail": "Very common (up to 30%). Managed with pin care, antibiotics, and occasionally pin replacement.",
            "freq": "Common"
          },
          {
            "risk": "Pin site pain",
            "detail": "Discomfort at the pin-skin interface.",
            "freq": "Expected"
          },
          {
            "risk": "Joint stiffness",
            "detail": "Particularly when pins are near joints.",
            "freq": "Common"
          },
          {
            "risk": "Functional limitation",
            "detail": "The frame restricts clothing, sleep position, and some activities.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin loosening",
            "detail": "Pins may loosen in bone over time, requiring replacement or alternative fixation.",
            "freq": "Common"
          },
          {
            "risk": "Fracture through pin sites",
            "detail": "After frame removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neurovascular injury",
            "detail": "From pin insertion near nerves or vessels.",
            "freq": "Uncommon"
          },
          {
            "risk": "Osteomyelitis",
            "detail": "Deep bone infection around pin sites.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Healing in a suboptimal position.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or sometimes local anaesthesia (for emergency application)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Immediate stabilisation allows early mobilisation. Pin site care (daily cleaning) is essential. Frame is worn for weeks to months depending on the indication. Physiotherapy for joint mobility. After frame removal, protection with a cast or brace may be needed. Weight-bearing depends on the fracture and frame configuration."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Pin site redness, warmth, or discharge",
          "Pins feeling loose",
          "Frame damage or instability",
          "Fever",
          "New pain at the fracture site suggesting loss of reduction"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular pin site checks and X-rays every two to four weeks while the frame is on. Planning for frame removal or conversion to internal fixation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long will I have the frame on?",
            "a": "It depends on the indication. Temporary frames for damage control are converted to internal fixation within one to three weeks. Definitive frames for open fractures or deformity correction may be worn for three to twelve months."
          },
          {
            "q": "How do I care for the pin sites?",
            "a": "Daily cleaning with saline or soap and water as instructed by your surgical team. Keep the pin sites clean and dry. Report any signs of infection early."
          }
        ]
      }
    ]
  },
  "talar-fracture-fixation": {
    "name": "Talar Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Talar fracture fixation is an operation to repair a fracture of the talus — a critical bone in the ankle that connects the leg to the foot. Talar fractures are uncommon but important injuries with a high risk of avascular necrosis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach depends on the fracture pattern. For talar neck fractures, incisions are made on the medial (inner) and/or lateral (outer) side of the ankle. The fracture is anatomically reduced and fixed with screws. For talar body fractures, a malleolar osteotomy (cutting the ankle bone) may be needed for access. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All displaced talar fractures require surgical fixation. The talus is critical for ankle and subtalar joint function, and any malreduction leads to severe arthritis. Urgent reduction is important to reduce the risk of avascular necrosis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced talar fractures may be managed in a non-weight-bearing cast for eight to twelve weeks with close X-ray monitoring. Displaced fractures require surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan is essential for planning. Urgent reduction and fixation is recommended to reduce AVN risk."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Anatomical restoration of the talus to preserve ankle and subtalar joint function. Outcomes depend heavily on the initial injury severity — the risk of AVN is directly related to the degree of displacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis (AVN)",
            "detail": "The talus has a vulnerable blood supply. AVN risk: 10–15% for type II, 30–50% for type III fractures.",
            "freq": "Common"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Very common, affecting the ankle or subtalar joint despite good reduction.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged non-weight-bearing",
            "detail": "Eight to twelve weeks minimum.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Malunion",
            "detail": "Healing in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Failure to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound problems",
            "detail": "The skin over the talus is thin.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Talar body collapse",
            "detail": "If severe AVN develops, the talus may collapse, requiring ankle fusion or replacement.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for eight to twelve weeks. Ankle exercises begin once fixation is stable. MRI at three to six months to assess for AVN. Progressive weight-bearing at three months. Full recovery twelve to eighteen months. Some patients eventually require ankle or subtalar fusion if significant arthritis or AVN develops."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing ankle pain despite rest",
          "Wound problems",
          "Fever",
          "Ankle deformity or collapse"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, and six months. MRI at three to six months to monitor for AVN. Long-term surveillance for arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is avascular necrosis?",
            "a": "AVN occurs when the blood supply to the talus is disrupted by the fracture. Without blood supply, the bone dies and may collapse. The risk depends on how severely displaced the fracture was."
          },
          {
            "q": "Will I need further surgery?",
            "a": "Many patients with talar fractures eventually require further procedures — either subtalar fusion, ankle fusion, or ankle replacement — due to post-traumatic arthritis or AVN. This depends on the severity of the original injury."
          }
        ]
      }
    ]
  },
  "flexible-nailing-paediatric": {
    "name": "Flexible Intramedullary Nailing (Paediatric Fractures)",
    "region": "Paediatric Orthopaedics",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Flexible intramedullary nailing (elastic nailing, TENS/Nancy nailing) is a minimally invasive technique to stabilise long bone fractures in children using flexible titanium or steel nails inserted through small incisions near the ends of the bone.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two small incisions are made near the end of the fractured bone (away from the growth plate). Two pre-bent flexible nails are inserted and advanced up the canal, crossing at the fracture site to provide three-point fixation. The fracture is reduced under X-ray guidance. The nail ends are cut short and left protruding slightly under the skin for later removal. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Flexible nailing is the preferred fixation method for displaced long bone fractures in children aged approximately 5–14 years — particularly femoral shaft fractures, tibial shaft fractures, and forearm fractures. It provides stable fixation while respecting the growth plates."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Casting alone (for undisplaced or minimally displaced fractures), traction (rarely used now), and hip spica casting (for younger children with femoral fractures)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard pre-assessment. Surgery usually within 24–48 hours of injury."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Stable fracture fixation allowing early mobilisation. High healing rates in children. The nails are removed after fracture healing (usually at three to six months), allowing the bone to remodel normally."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Nail end irritation",
            "detail": "The protruding nail ends may cause discomfort under the skin.",
            "freq": "Common"
          },
          {
            "risk": "Knee or hip pain",
            "detail": "From nail ends near the entry point.",
            "freq": "Common"
          },
          {
            "risk": "Second procedure for removal",
            "detail": "Nails are routinely removed under anaesthesia at three to six months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nail migration",
            "detail": "The nails may back out.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Healing with some angulation or shortening. Remodelling usually corrects this in children.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Pin site or wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Growth plate damage",
            "detail": "Very rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Rare but requires urgent treatment.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Children recover remarkably quickly. Crutches for four to six weeks for lower limb fractures. Sling for two to four weeks for forearm fractures. Most children return to full activity by six to eight weeks. Nail removal at three to six months (a short general anaesthetic procedure)."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe limb pain or swelling (possible compartment syndrome)",
          "Nail ends protruding through the skin",
          "Wound problems",
          "Fever",
          "Inability to move fingers or toes"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and before nail removal."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why use flexible nails instead of plates?",
            "a": "Flexible nails respect the growth plates, require minimal incisions, and allow the bone to heal with some controlled micromotion, which stimulates healing. They are removed after healing, unlike plates which may be left permanently."
          },
          {
            "q": "Do the nails need to be removed?",
            "a": "Yes, flexible nails are routinely removed at three to six months once the fracture has healed. This is a short procedure under general anaesthesia."
          }
        ]
      }
    ]
  },
  "pavlik-harness-info": {
    "name": "Pavlik Harness Treatment (DDH)",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "The Pavlik harness is the primary non-operative treatment for developmental dysplasia of the hip (DDH) in infants under six months. It holds the hips in a flexed and abducted position, encouraging the femoral head to locate and stay within the developing hip socket.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The Pavlik harness is a soft fabric harness with shoulder straps and stirrups that hold the baby's hips in a flexed, abducted position. It is fitted by an experienced orthopaedic team. The posterior strap limits adduction (prevents the legs from coming together) and the anterior strap maintains flexion. The harness is worn full-time initially, with adjustments made at regular clinic visits. Ultrasound monitoring confirms the hip is reducing and developing normally."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The Pavlik harness is the first-line treatment for DDH diagnosed in infants under six months with dislocatable or dislocated hips detected on clinical examination or ultrasound screening."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For very mild dysplasia in newborns, observation with repeat ultrasound at six weeks may be appropriate, as many mild cases resolve spontaneously. If the Pavlik harness fails, closed reduction under anaesthesia or open reduction may be needed."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Hip ultrasound confirms the diagnosis and guides harness fitting. The harness is fitted by a specialist and parents are taught how to manage it."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Success rates of 85–95% for Pavlik harness treatment in infants under six months with reducible hips. The earlier treatment begins, the higher the success rate."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Skin irritation",
            "detail": "Redness under the straps. Managed with padding and skin care.",
            "freq": "Common"
          },
          {
            "risk": "Harness intolerance",
            "detail": "Some babies are initially unsettled.",
            "freq": "Common"
          },
          {
            "risk": "Nappy management",
            "detail": "Nappies must be placed inside the harness. Parents need instruction.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Femoral nerve palsy",
            "detail": "If the harness is too tight in flexion. The anterior strap must not force excessive flexion. Resolves if recognised and the harness is adjusted.",
            "freq": "Uncommon"
          },
          {
            "risk": "Avascular necrosis",
            "detail": "Forced abduction can damage the femoral head blood supply. Risk is minimised with proper technique — the harness should guide, not force.",
            "freq": "Rare"
          },
          {
            "risk": "Treatment failure",
            "detail": "The hip may not reduce or may re-dislocate. Approximately 5–15% failure rate. Further treatment (closed or open reduction) is then needed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Inferior dislocation",
            "detail": "Very rare, caused by excessive flexion.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia required. The harness is fitted in clinic."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Full-time wear for six to twelve weeks initially, then part-time (night-time) for a further six to twelve weeks as the hip stabilises. Regular ultrasound monitoring. Once the hip is stable and developing normally, the harness is discontinued. Long-term X-ray follow-up is recommended until at least two to three years of age, and ideally until skeletal maturity."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Baby suddenly not moving one or both legs (possible femoral nerve palsy — attend urgently)",
          "Hip 'clunk' felt by parents",
          "Skin breakdown under the harness",
          "Baby persistently distressed beyond the first few days"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Weekly clinic appointments initially for harness adjustment and ultrasound monitoring. Frequency reduces as the hip stabilises. Long-term X-ray follow-up."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Can I bathe my baby in the harness?",
            "a": "The harness is removed briefly for bathing, but the hips must be kept in the flexed, abducted position. Your team will demonstrate safe bathing technique."
          },
          {
            "q": "How long does treatment take?",
            "a": "Typically six to twelve weeks full-time, then a further period of part-time (night-time) wear. Total treatment time is usually three to four months."
          },
          {
            "q": "Will my baby develop normally?",
            "a": "Yes. Babies treated successfully with the Pavlik harness develop normal hips and walk at the normal age. Early treatment gives the best outcomes."
          }
        ]
      }
    ]
  },
  "robotic-knee-replacement": {
    "name": "Robotic-Assisted Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Robotic-assisted knee replacement uses computer navigation and a robotic arm to enhance the accuracy of bone cuts and implant positioning during total or partial knee replacement. The surgery is performed by the surgeon with robotic assistance — the robot does not operate independently.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Before surgery, a CT scan creates a 3D model of the knee. In theatre, the surgeon registers the anatomy using tracking markers. The robotic system creates a personalised surgical plan. The surgeon performs the bone cuts using a robotic arm that provides haptic (tactile) boundaries, ensuring cuts are made exactly as planned. The implant is positioned with sub-millimetre accuracy. The remainder of the operation — soft tissue balancing, closure — is performed conventionally. The operation takes a similar time to conventional knee replacement or slightly longer."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Robotic assistance is used to improve implant alignment and positioning accuracy, achieve more precise ligament balancing, potentially improve early functional outcomes and patient satisfaction, and reduce outliers in implant positioning. It is particularly beneficial for partial knee replacement where positioning accuracy is critical."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All the same non-operative options as for conventional knee replacement: physiotherapy, weight management, injections, bracing. Conventional (non-robotic) knee replacement remains an excellent option with well-established long-term outcomes."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-operative CT scan for surgical planning (in addition to standard pre-assessment). The CT adds a small radiation dose equivalent to a few days of natural background radiation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "More accurate implant positioning with fewer outliers. Early studies suggest potential improvements in early pain scores and functional recovery compared to conventional surgery. Long-term outcomes are expected to be at least equivalent to conventional knee replacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Same risks as conventional knee replacement",
            "detail": "All standard risks of knee replacement apply — infection, blood clots, stiffness, nerve injury, ongoing pain.",
            "freq": "Expected"
          },
          {
            "risk": "CT scan radiation",
            "detail": "A small additional radiation dose from the pre-operative CT.",
            "freq": "Expected"
          },
          {
            "risk": "Longer operating time",
            "detail": "May be slightly longer than conventional surgery, particularly early in a surgeon's learning curve.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site fracture",
            "detail": "The tracking pins placed in bone could theoretically cause a fracture. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Technical failure",
            "detail": "The robotic system may malfunction, requiring conversion to conventional technique.",
            "freq": "Rare"
          },
          {
            "risk": "All standard knee replacement risks",
            "detail": "Infection (approximately 1%), blood clots, stiffness, component loosening, periprosthetic fracture.",
            "freq": "See standard risks"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia — the same as conventional knee replacement."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is the same as conventional knee replacement. Hospital stay one to three days. Physiotherapy from day one. Driving at six weeks. Full recovery six to twelve months. Some studies suggest slightly faster early recovery with robotic assistance."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Increasing knee swelling",
          "Wound problems",
          "Knee feeling unstable"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as conventional knee replacement: reviews at two weeks, six weeks, three months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Does the robot do the surgery?",
            "a": "No. The surgeon performs the entire operation. The robotic arm provides precision guidance and haptic boundaries to ensure bone cuts are made exactly as planned. The surgeon remains in control throughout."
          },
          {
            "q": "Is robotic surgery better than conventional?",
            "a": "Robotic assistance improves implant positioning accuracy. Early results are promising for improved function and satisfaction. Long-term data is still emerging but is expected to be at least as good as conventional surgery."
          },
          {
            "q": "Does robotic surgery cost more?",
            "a": "There is additional cost from the robotic system and pre-operative CT. This may or may not be passed on to the patient depending on the healthcare setting."
          }
        ]
      }
    ]
  },
  "knee-manipulation": {
    "name": "Manipulation Under Anaesthesia (Knee)",
    "region": "Knee",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Manipulation under anaesthesia (MUA) of the knee is a procedure to break down scar tissue (adhesions) inside a stiff knee joint, restoring range of motion. It is performed when physiotherapy alone has not achieved adequate movement after knee surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under general or spinal anaesthesia, the surgeon gently but firmly flexes and extends the knee through its full range, breaking the adhesions that are restricting movement. An audible and palpable release is usually felt. The entire procedure takes 10–15 minutes. Arthroscopic lysis of adhesions may be performed at the same time if needed."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "MUA is recommended when knee flexion is inadequate (typically less than 90 degrees) at six to twelve weeks after total knee replacement, ACL reconstruction, or other knee surgery, despite dedicated physiotherapy. The timing is important — too early risks damaging healing structures, too late allows adhesions to mature."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Intensive physiotherapy, serial splinting (static progressive or dynamic), and time. Many stiff knees improve with persistent rehabilitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Day-case procedure. Assessment of current range of motion. X-ray to confirm implant position if post-arthroplasty."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate improvement in range of motion. Most patients gain 20–40 degrees of additional flexion. The gains must be maintained with intensive physiotherapy in the following weeks."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain",
            "detail": "Significant soreness and swelling for several days after manipulation.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence of stiffness",
            "detail": "Adhesions may reform if physiotherapy is not maintained. Risk approximately 10–20%.",
            "freq": "Common"
          },
          {
            "risk": "Haemarthrosis",
            "detail": "Bleeding into the joint from torn adhesions.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fracture",
            "detail": "Supracondylar femur or proximal tibia fracture, particularly in osteoporotic bone. Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Patellar tendon rupture",
            "detail": "Very rare. Risk is higher with excessive force.",
            "freq": "Rare"
          },
          {
            "risk": "Wound dehiscence",
            "detail": "If performed too early after surgery, the wound may open.",
            "freq": "Rare"
          },
          {
            "risk": "Neurovascular injury",
            "detail": "Extremely rare.",
            "freq": "Rare"
          },
          {
            "risk": "Prosthesis loosening",
            "detail": "Theoretical risk with excessive force around an implant.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with muscle relaxation. The knee must be fully relaxed to allow safe manipulation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive physiotherapy begins immediately — ideally while the anaesthetic is still providing pain relief. CPM machine may be used. Daily exercises at home. Ice and elevation for swelling. The first two weeks after manipulation are critical for maintaining the gained range."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden severe pain suggesting fracture",
          "Inability to straighten the knee",
          "Significant swelling not responding to ice",
          "Wound opening",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Physiotherapy from day one. Surgeon review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When is the best time for MUA?",
            "a": "Usually between six and twelve weeks after surgery. Earlier risks disrupting healing; later allows adhesions to mature and become resistant to manipulation."
          },
          {
            "q": "Will it definitely work?",
            "a": "Most patients gain significant range of motion. However, some knees are resistant, particularly if the stiffness is caused by complex regional pain syndrome or severe arthrofibrosis. Arthroscopic release may be needed."
          }
        ]
      }
    ]
  },
  "sacral-fracture-fixation": {
    "name": "Sacral Fracture Fixation",
    "region": "Spine",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Sacral fracture fixation is an operation to stabilise a fracture of the sacrum — the triangular bone at the base of the spine connecting to the pelvis. Sacral fractures range from insufficiency fractures in osteoporotic bone to high-energy injuries with neurological damage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For displaced or unstable fractures, fixation is typically achieved with percutaneous iliosacral screws placed under CT or fluoroscopic guidance, lumbopelvic fixation using pedicle screws in the lumbar spine connected by rods to iliac screws, or spinopelvic fixation for severely displaced vertical shear injuries. For sacral insufficiency fractures, sacroplasty (cement injection similar to vertebroplasty) may be performed. The procedure takes one to three hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced sacral fractures, fractures with neurological deficit (sacral nerve root compression causing bowel, bladder, or sexual dysfunction), and unstable sacral fractures as part of pelvic ring injuries."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Undisplaced sacral fractures and insufficiency fractures are usually managed with pain relief, restricted weight-bearing, and gradual mobilisation. Osteoporosis treatment is essential for insufficiency fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with 3D reconstruction. MRI to assess neurological compression. Neurological assessment including bladder and bowel function."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Stabilisation of the fracture allowing mobilisation. Decompression of compressed nerve roots may improve neurological function, though recovery of bladder and bowel function is not guaranteed."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Buttock and sacral pain",
            "detail": "Expected for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "These are significant injuries.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve root injury",
            "detail": "L5 and sacral nerve roots are at risk during screw placement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Persistent neurological deficit",
            "detail": "Bladder, bowel, or sexual dysfunction may not fully recover.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw malposition",
            "detail": "The sacral anatomy is complex and variable.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around metalwork.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Sacral fractures may be slow to heal.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Prone or supine positioning depending on technique."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions for six to twelve weeks depending on the injury. Physiotherapy for core and pelvic strengthening. Bladder and bowel rehabilitation if neurological involvement. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "New or worsening bladder or bowel symptoms",
          "Increasing leg weakness or numbness",
          "Wound problems",
          "Fever",
          "Increasing pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays and CT. Neurological monitoring. Osteoporosis management for insufficiency fractures."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my bladder function recover?",
            "a": "Recovery depends on the severity and duration of nerve compression. Some patients recover fully, others partially, and some have permanent deficits. Early decompression gives the best chance of recovery."
          }
        ]
      }
    ]
  },
  "hip-irrigation-debridement": {
    "name": "Hip Irrigation and Debridement (DAIR)",
    "region": "Hip",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "DAIR (debridement, antibiotics, and implant retention) is an urgent operation to treat early infection of a hip replacement. The joint is washed out, infected tissue removed, and modular components exchanged — while retaining the well-fixed implant stems.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The hip is reopened through the previous incision. All infected and necrotic tissue is removed (debridement). The joint is thoroughly washed with several litres of saline (irrigation). The modular components (femoral head and polyethylene liner) are exchanged for new ones. The well-fixed stems and shell are retained. Antibiotic-loaded cement may be used. Multiple tissue samples are taken for microbiology. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "DAIR is appropriate for acute periprosthetic joint infection — either early post-operative (within four to six weeks of the primary surgery) or acute haematogenous (sudden onset infection of a previously well-functioning implant). The implant must be well-fixed to bone. For chronic infections, two-stage revision is usually required instead."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Long-term antibiotic suppression alone (lower success rate). Two-stage revision (implant removal, spacer, then reimplantation). One-stage revision at specialist centres. The choice depends on the timing, organism, and implant fixation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Urgent procedure — performed as soon as infection is suspected. Blood tests (CRP, ESR, white cell count). Joint aspiration for microbiology before starting antibiotics if possible."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Eradication of infection while retaining the implant. Success rates for DAIR are approximately 50–70% for acute infections, depending on the organism and timing. Staphylococcal infections and delayed presentation reduce success rates."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Treatment failure",
            "detail": "DAIR fails to eradicate infection in approximately 30–50% of cases, requiring further surgery.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "Intravenous antibiotics for two to six weeks followed by oral antibiotics for three to six months.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrent dislocation",
            "detail": "The risk of dislocation is higher after DAIR due to soft tissue compromise.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Chronic infection",
            "detail": "Persistent low-grade infection requiring implant removal.",
            "freq": "Common"
          },
          {
            "risk": "Implant loosening",
            "detail": "The infection may have loosened the implant despite appearing well-fixed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients with PJI have significant medical comorbidities.",
            "freq": "Common"
          },
          {
            "risk": "Antibiotic side effects",
            "detail": "Prolonged antibiotic courses carry their own risks.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks for intravenous antibiotics. PICC line for outpatient IV antibiotics. Regular blood tests to monitor infection markers. Oral antibiotics for three to six months. Physiotherapy for hip rehabilitation. Return to normal activity once infection is confirmed cleared."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Recurrence of hip pain, warmth, or swelling",
          "Fever",
          "Wound discharge",
          "Increasing CRP or blood markers",
          "PICC line problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular blood tests (CRP, ESR). Clinical review at two weeks, six weeks, three months, six months, and one year. Long-term surveillance for late recurrence."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What are the chances of keeping my hip replacement?",
            "a": "For acute infections treated promptly with DAIR, approximately 50–70% of patients retain their implant. Success depends on the organism — some bacteria (particularly Staphylococcus aureus) are harder to eradicate."
          },
          {
            "q": "What if DAIR fails?",
            "a": "If the infection is not eradicated, two-stage revision is usually needed — the implant is removed, an antibiotic spacer inserted, and a new implant reimplanted after a period of antibiotics (typically three to six months)."
          }
        ]
      }
    ]
  },
  "shoulder-debridement-infection": {
    "name": "Shoulder Arthroscopic Debridement",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder arthroscopic debridement is a keyhole procedure to clean up the shoulder joint — removing damaged tissue, bone spurs, loose bodies, and inflamed synovium. It may be performed for a variety of shoulder conditions when a specific structural repair is not required.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Small incisions are made around the shoulder. An arthroscope is inserted to visualise the joint. The surgeon may remove inflamed synovium (synovectomy), trim damaged labrum or biceps, remove loose bodies, debride partial-thickness rotator cuff tears, excise acromial spurs (subacromial decompression), and wash out the joint. The specific procedures performed depend on the findings. The operation takes 30–75 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopic debridement is considered for shoulder pain with mechanical symptoms (catching, locking) from loose bodies or labral flaps, early glenohumeral arthritis with preserved joint space, partial-thickness rotator cuff tears not amenable to repair, and diagnostic arthroscopy when imaging has not clarified the diagnosis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, corticosteroid injection, activity modification, and anti-inflammatory medication. These are effective for most shoulder conditions."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess intra-articular pathology. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of mechanical symptoms. Removal of inflammatory tissue. Diagnostic information from direct visualisation. Results are best for specific treatable pathology (loose bodies, labral flaps) rather than diffuse arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Debridement does not halt the progression of arthritis.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Shoulder swelling for several days.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary. Physiotherapy important.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection approximately 0.5%.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Axillary nerve. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Chondral damage",
            "detail": "Inadvertent cartilage damage.",
            "freq": "Rare"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Post-operative stiffness.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair or lateral position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for comfort for a few days. Active movement from day one. Physiotherapy as needed. Return to desk work within one week. Full recovery four to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing shoulder stiffness",
          "Persistent catching or locking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two to six weeks depending on findings."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will this cure my arthritis?",
            "a": "No. Debridement can provide symptomatic relief by removing mechanical irritants, but it does not halt arthritis progression. If arthritis is the main problem, shoulder replacement may eventually be needed."
          }
        ]
      }
    ]
  },
  "hallux-valgus-minimally-invasive": {
    "name": "Minimally Invasive Bunion Correction",
    "region": "Foot & Ankle",
    "tag": "Osteotomy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Minimally invasive (percutaneous) bunion correction is a technique to correct hallux valgus through very small incisions (3–4 mm) using specialised burrs and X-ray guidance, avoiding the larger incisions of traditional open surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through two to four tiny incisions (3–4 mm each), specialised burrs are used to cut the metatarsal bone under X-ray guidance. The bone is shifted into the corrected position and held with one or two small screws inserted percutaneously. Soft tissue releases are performed through the same small incisions. Bandaging in the corrected position helps maintain alignment. The operation takes 45–75 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Minimally invasive bunion correction is suitable for mild to moderate hallux valgus deformity. It offers potentially less post-operative pain, less swelling, better cosmesis (smaller scars), and the possibility of immediate weight-bearing in a post-operative shoe."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wide footwear, bunion pads, toe spacers, orthotics, and night splints. These manage symptoms but do not correct the deformity."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. Assessment of deformity severity. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Correction of the bunion deformity with minimal scarring. Studies show comparable correction to open techniques for mild to moderate deformity. Potentially faster recovery and less post-operative pain."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Forefoot swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Under-correction",
            "detail": "The deformity may not be fully corrected.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction",
            "detail": "Hallux varus (the big toe pointing inward).",
            "freq": "Rare"
          },
          {
            "risk": "Stiffness",
            "detail": "First MTP joint stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Thermal bone necrosis",
            "detail": "Excessive heat from the burr can damage bone. Careful technique and irrigation reduce this risk.",
            "freq": "Rare"
          },
          {
            "risk": "Malunion",
            "detail": "Healing in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The osteotomy may not heal.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "The bunion may recur over time.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal digital nerve causing numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Metatarsalgia",
            "detail": "Pain under adjacent metatarsal heads.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local ankle block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately in a post-operative flat shoe. Post-operative shoe for four to six weeks. Bandaging for six weeks to maintain correction. Normal footwear at six to eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Toe turning blue",
          "Increasing pain",
          "Bandage feeling too tight"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks and six weeks. Review at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is minimally invasive as good as open surgery?",
            "a": "For mild to moderate deformity, studies show comparable correction rates. The main advantages are smaller scars, potentially less pain, and faster early recovery. For severe deformity, open techniques may still be preferred."
          },
          {
            "q": "Can I walk immediately?",
            "a": "Yes — most minimally invasive bunion corrections allow immediate weight-bearing in a post-operative shoe, unlike some open techniques that require non-weight-bearing."
          }
        ]
      }
    ]
  },
  "clavicle-hook-plate": {
    "name": "Acromioclavicular Joint Stabilisation (Hook Plate / Ligament Reconstruction)",
    "region": "Shoulder",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "AC joint stabilisation is an operation to repair or reconstruct the ligaments that hold the collarbone to the shoulder blade at the acromioclavicular joint. It is performed for high-grade AC joint dislocations (Rockwood types III–V) causing pain, weakness, and cosmetic deformity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Several techniques exist. Hook plate: a specially shaped plate is hooked under the acromion with screws in the clavicle, reducing the joint while ligaments heal. The plate is removed at three to four months. Ligament reconstruction: a tendon graft or synthetic ligament is used to reconstruct the coracoclavicular ligaments, with or without a tight-rope device (suture button). Acute repair of the native ligaments may be performed within two to three weeks of injury. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for high-grade AC joint dislocations (types IV, V, VI) and selected type III injuries in young, active patients or manual workers with persistent symptoms after a trial of non-operative treatment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Sling, analgesia, and physiotherapy. Many type III injuries do well without surgery. A trial of three to six months of non-operative management is often recommended before considering surgery for type III."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays including stress views. Assessment of the degree of displacement. Timing depends on the technique — hook plate or acute repair within two to three weeks; reconstruction can be performed later."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of AC joint stability, improvement in overhead strength and function, and correction of the cosmetic deformity. Most patients return to full activity including sport and manual work."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Temporary. Physiotherapy important.",
            "freq": "Common"
          },
          {
            "risk": "Hook plate irritation",
            "detail": "The hook causes subacromial impingement. The plate must be removed at three to four months.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "Visible scar over the top of the shoulder.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Acromial erosion or fracture",
            "detail": "The hook can erode the acromion bone. Risk reduced by timely plate removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrent instability",
            "detail": "The ligaments may fail or stretch after plate removal or graft reconstruction. Risk approximately 10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Coracoid fracture",
            "detail": "With tight-rope devices.",
            "freq": "Rare"
          },
          {
            "risk": "Distal clavicle osteolysis",
            "detail": "Bone resorption at the end of the clavicle.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from one to two weeks. Active overhead movement from six weeks. Strengthening from eight to twelve weeks. If hook plate used, removal at three to four months (a short general anaesthetic). Return to sport at four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Clicking or prominence over the AC joint",
          "Loss of overhead strength"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months. Hook plate removal at three to four months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Do all AC joint injuries need surgery?",
            "a": "No. Most type I and II injuries and many type III injuries heal well with a sling and physiotherapy. Surgery is reserved for high-grade injuries or type III injuries that remain symptomatic."
          },
          {
            "q": "Will the bump on my shoulder go away?",
            "a": "Surgery aims to reduce the AC joint. Some residual prominence may remain but is usually much improved compared to the injury."
          }
        ]
      }
    ]
  },
  "rotator-cuff-debridement": {
    "name": "Rotator Cuff Debridement (Partial Tear)",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Rotator cuff debridement is an arthroscopic procedure to smooth and trim a partial-thickness rotator cuff tear, removing damaged tissue and stimulating healing, without performing a full repair.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through small incisions. The partial tear is identified. The frayed, damaged tendon tissue is trimmed back to a stable edge using a shaver. If the tear involves more than 50% of the tendon thickness, conversion to a full repair may be performed. Subacromial decompression may be done at the same time if there is associated impingement. The operation takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Debridement is considered for low-grade partial-thickness rotator cuff tears (less than 50% thickness) causing pain that has not responded to physiotherapy and injection, and in older or lower-demand patients where a full repair may not be necessary."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (rotator cuff and scapular stabiliser strengthening), subacromial corticosteroid injection, activity modification. Most partial tears improve with non-operative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess tear thickness. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief from removing the frayed tissue and associated bursitis. Approximately 75–85% of patients with low-grade partial tears report good outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Not all patients achieve complete relief.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tear progression",
            "detail": "The partial tear may progress to a full-thickness tear over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary shoulder stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Full-thickness tear development",
            "detail": "Debridement weakens the remaining tendon. The tear may complete.",
            "freq": "Long-term"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Painful stiffness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for one to two weeks for comfort. Active movement from the first week. Rotator cuff strengthening from four to six weeks. Return to sport at six to eight weeks. Full recovery two to three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing weakness suggesting tear progression"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the tear get bigger?",
            "a": "Partial tears can progress to full-thickness tears over time, regardless of whether debridement is performed. Maintaining rotator cuff strength through exercises helps protect the remaining tendon."
          }
        ]
      }
    ]
  },
  "hip-injection": {
    "name": "Hip Joint Injection (Diagnostic and Therapeutic)",
    "region": "Hip",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A hip joint injection is a procedure to inject medication — typically corticosteroid and local anaesthetic — into the hip joint under image guidance. It is used both diagnostically (to confirm the hip as the pain source) and therapeutically (to relieve pain).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The injection is performed under ultrasound or fluoroscopic (X-ray) guidance. The skin is cleaned with antiseptic. Local anaesthetic numbs the injection site. A needle is inserted into the hip joint under image guidance, and a mixture of corticosteroid and local anaesthetic is injected. The procedure takes 10–15 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Diagnostic: to confirm the hip joint as the source of groin pain, particularly when differentiating hip from spine or soft tissue pathology. Therapeutic: to provide temporary relief of hip arthritis pain, delay the need for surgery, or facilitate physiotherapy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Oral medication, topical treatments, physiotherapy, weight management, walking aids, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No fasting required. Inform the team about blood-thinning medications. Performed as an outpatient procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Diagnostic: if the injection provides temporary relief, it confirms the hip as the pain source. Therapeutic: pain relief typically lasts weeks to months. Duration varies — some patients get lasting relief, others benefit for only a short period."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Injection site discomfort",
            "detail": "Soreness for a day or two.",
            "freq": "Common"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary increase in pain for 24–48 hours before the steroid takes effect.",
            "freq": "Uncommon"
          },
          {
            "risk": "Temporary blood sugar rise",
            "detail": "In diabetic patients. Usually returns to normal within a few days.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Joint infection. Risk approximately 1 in 10,000 to 1 in 50,000 with sterile technique.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon weakening",
            "detail": "Repeated steroid injections may weaken surrounding tendons.",
            "freq": "Long-term"
          },
          {
            "risk": "Cartilage damage",
            "detail": "There is some evidence that repeated intra-articular steroid injections may accelerate cartilage damage.",
            "freq": "Long-term"
          },
          {
            "risk": "Skin depigmentation",
            "detail": "Localised lightening of skin at the injection site.",
            "freq": "Rare"
          },
          {
            "risk": "Fat atrophy",
            "detail": "Loss of subcutaneous fat at the injection site.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic only. No sedation or general anaesthesia required."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Rest for 24–48 hours. Avoid strenuous activity for a few days. If the injection provides relief, physiotherapy can begin or be intensified. The effect of the steroid typically takes two to seven days to develop fully."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing hip pain, warmth, or swelling after the first 48 hours (possible infection)",
          "Fever",
          "Redness spreading from the injection site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Record the response — particularly the diagnostic value. If relief is significant, repeat injections may be considered (usually no more than two to three per year). If relief is temporary, further treatment planning (e.g., hip replacement) can proceed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How many injections can I have?",
            "a": "Most clinicians recommend no more than two to three hip injections per year. There is concern that frequent steroid injections may accelerate cartilage damage."
          },
          {
            "q": "How long does the effect last?",
            "a": "Variable — from weeks to many months. Some patients get lasting relief, others only temporary improvement. The diagnostic information (confirming the hip as the pain source) is valuable regardless."
          }
        ]
      }
    ]
  },
  "hip-impingement-open": {
    "name": "Open Hip Osteochondroplasty (Surgical Hip Dislocation)",
    "region": "Hip",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Open hip osteochondroplasty via surgical hip dislocation is a technique to reshape the femoral head and acetabulum for femoroacetabular impingement (FAI) by safely dislocating the hip to gain complete access to the joint — allowing treatment of pathology that cannot be fully addressed arthroscopically.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the lateral hip. The greater trochanter is cut (trochanteric flip osteotomy) and reflected to expose the hip capsule. The hip is carefully dislocated using a technique that preserves the blood supply to the femoral head (the Ganz approach). With the hip fully exposed, cam and pincer impingement is corrected, labral tears repaired, and cartilage damage addressed under direct vision. The hip is relocated, the trochanter repaired with screws, and the wound closed. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgical hip dislocation is recommended for complex FAI not fully addressable arthroscopically — such as posterior cam lesions, femoral head osteochondral defects, labral reconstruction, and combined cam-pincer impingement with large lesions. It provides unparalleled access to the entire joint."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, injection. Hip arthroscopy is the main surgical alternative and is appropriate for most FAI cases."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT with 3D reconstruction and MRI arthrogram. This is a specialist procedure performed at selected centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Complete correction of impingement lesions with direct visualisation. Excellent outcomes in experienced hands. Joint preservation and delay or prevention of arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Trochanteric non-union",
            "detail": "The trochanteric osteotomy may fail to heal. Risk approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation. Preventive medication is given.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral hip numbness",
            "detail": "Lateral femoral cutaneous nerve.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Longer than hip arthroscopy.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis",
            "detail": "The technique is designed to preserve blood supply, but AVN is a rare risk.",
            "freq": "Rare"
          },
          {
            "risk": "Trochanteric non-union requiring revision",
            "detail": "May need re-fixation or bone grafting.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "Wound or joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Dislocation",
            "detail": "Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Sciatic nerve injury",
            "detail": "Rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Lateral decubitus position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for six to eight weeks (trochanteric osteotomy must heal before active abduction). Restricted weight-bearing for six weeks. No active abduction for six weeks. Physiotherapy from two weeks. Return to sport at four to six months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing lateral hip pain (trochanteric non-union)",
          "Clicking in the hip",
          "Difficulty walking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. Assessment of trochanteric healing."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why open surgery instead of arthroscopy?",
            "a": "Surgical dislocation provides 360-degree access to the entire joint — something arthroscopy cannot achieve. It is reserved for complex cases where complete visualisation is needed."
          },
          {
            "q": "Is the blood supply safe?",
            "a": "The Ganz technique was specifically designed to preserve the blood supply to the femoral head. In experienced hands, AVN is extremely rare."
          }
        ]
      }
    ]
  },
  "knee-injection": {
    "name": "Knee Joint Injection (Corticosteroid / Hyaluronic Acid)",
    "region": "Knee",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee joint injection is a procedure to inject medication into the knee — most commonly corticosteroid for anti-inflammatory effect or hyaluronic acid (viscosupplementation) for lubrication and symptom relief in osteoarthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The skin over the knee is cleaned. Local anaesthetic may be applied. A needle is inserted into the joint — commonly through a superolateral (above and to the outside) or infrapatellar approach. For corticosteroid: a mixture of steroid and local anaesthetic is injected. For hyaluronic acid: a viscous gel is injected. The procedure takes five to ten minutes and is performed in clinic."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Corticosteroid: for inflammatory flares of osteoarthritis, rheumatoid arthritis, gout, and other causes of knee swelling and pain. Hyaluronic acid: for mild to moderate knee osteoarthritis when oral medications and physiotherapy have provided insufficient relief. Both are also used as diagnostic tools."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Oral anti-inflammatory and pain medication, topical treatments, physiotherapy, weight management, knee bracing, activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No special preparation. Inform the clinician about blood-thinning medications and any allergies."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Corticosteroid: rapid pain relief within 24–72 hours, lasting weeks to months. Hyaluronic acid: more gradual improvement over two to four weeks, potentially lasting six to twelve months. Response varies significantly between patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Injection site discomfort",
            "detail": "Brief pain during the injection.",
            "freq": "Expected"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary increased pain for 24–48 hours (corticosteroid).",
            "freq": "Uncommon"
          },
          {
            "risk": "No improvement",
            "detail": "Not all patients respond.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Joint infection. Risk approximately 1 in 10,000 to 1 in 50,000.",
            "freq": "Rare"
          },
          {
            "risk": "Skin depigmentation",
            "detail": "Lightening of skin at injection site (corticosteroid).",
            "freq": "Rare"
          },
          {
            "risk": "Fat atrophy",
            "detail": "Loss of subcutaneous fat.",
            "freq": "Rare"
          },
          {
            "risk": "Cartilage concerns",
            "detail": "Evidence suggests frequent corticosteroid injections may accelerate cartilage loss. Limit to two to three per year.",
            "freq": "Long-term"
          },
          {
            "risk": "Allergic reaction",
            "detail": "To the injected substance. Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed beyond local anaesthetic at the injection site."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Rest for 24–48 hours. Avoid strenuous activity for a few days. If the injection helps, intensify physiotherapy to maximise the benefit of the pain-free window."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee pain, warmth, or swelling after 48 hours",
          "Fever",
          "Redness spreading from the injection site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Assess response at two to four weeks. Plan further management based on response."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How many injections can I have?",
            "a": "Most clinicians limit corticosteroid injections to two to three per year per joint. Hyaluronic acid courses can be repeated every six to twelve months."
          },
          {
            "q": "Will this delay the need for knee replacement?",
            "a": "Injections can provide meaningful symptom relief for months to years, potentially delaying surgery. However, they do not halt the underlying arthritis."
          }
        ]
      }
    ]
  },
  "osteochondral-allograft": {
    "name": "Osteochondral Allograft Transplant",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Osteochondral allograft transplantation uses fresh donor cartilage and bone to resurface large areas of damaged joint surface in the knee. It provides mature hyaline cartilage coverage for defects too large for OATS or ACI.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A fresh osteochondral allograft (donor cartilage with underlying bone, stored at 4°C and used within 28 days of harvest) is sized and shaped to match the defect. Through an incision over the knee, the damaged area is prepared using a reamer. The allograft plug is press-fit into the defect, providing an immediately congruent joint surface with living hyaline cartilage. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Osteochondral allograft is recommended for large cartilage defects (typically greater than 3–4 cm²), failed previous cartilage procedures, osteochondritis dissecans (OCD), post-traumatic cartilage loss, and AVN of the femoral condyle. It provides an immediately functional joint surface."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, injections, activity modification. OATS (for smaller defects), ACI/MACI (for moderate defects), and realignment osteotomy (if malalignment contributes) are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to size the defect. A matched fresh allograft is sourced from a tissue bank — availability depends on donor tissue supply. The graft must be used within 28 days to maintain cartilage cell viability."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate congruent joint surface restoration with mature hyaline cartilage. Good to excellent outcomes in approximately 75–85% of patients at ten years. Particularly effective for OCD lesions and post-traumatic defects."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Six to nine months to full activity.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling during healing.",
            "freq": "Expected"
          },
          {
            "risk": "Donor availability",
            "detail": "Fresh allografts may not be immediately available.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "Non-incorporation, subsidence, or cartilage degeneration. Risk approximately 15–25% at ten years.",
            "freq": "Long-term"
          },
          {
            "risk": "Immune reaction",
            "detail": "Low-grade immune response to donor tissue.",
            "freq": "Uncommon"
          },
          {
            "risk": "Disease transmission",
            "detail": "Extremely rare with modern screening.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Continued symptoms",
            "detail": "Pain may persist with extensive joint damage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Partial weight-bearing for six to eight weeks. Physiotherapy for range of motion and strengthening. Running at four to six months. Return to sport at six to nine months. Graft incorporation monitored with MRI."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, six months, and one year. MRI at six months and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the difference between fresh and frozen allograft?",
            "a": "Fresh allografts contain living cartilage cells (chondrocytes) and must be used within 28 days. They provide a biologically active joint surface. Frozen allografts have dead cells and are used as structural bone graft only."
          }
        ]
      }
    ]
  },
  "lumbar-artificial-disc": {
    "name": "Lumbar Disc Replacement (Artificial Disc)",
    "region": "Spine",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lumbar disc replacement is an operation to replace a degenerated lumbar disc with an artificial device that preserves motion at the treated level. It is an alternative to lumbar fusion for selected patients with discogenic back pain.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure is performed through an anterior approach (through the abdomen), similar to ALIF. An access surgeon mobilises the abdominal contents and great vessels. The degenerated disc is completely removed. An artificial disc (typically metal endplates with a polyethylene core) is inserted into the disc space. The device preserves flexion, extension, and rotation at the treated level. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Disc replacement is considered for single-level discogenic low back pain in patients under 55–60, with preserved facet joints, no significant deformity, no spondylolisthesis, and no severe osteoporosis. It preserves motion and may reduce the risk of adjacent segment disease compared to fusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain management, injections, and activity modification. Lumbar fusion (TLIF, ALIF, XLIF) is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI, CT, and discography may be used to confirm the painful level. Vascular imaging for the anterior approach. Strict patient selection criteria."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief equivalent to fusion, with preservation of motion at the treated level. Potentially reduced risk of adjacent segment disease. Most patients experience significant improvement in back pain."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ileus",
            "detail": "Temporary bowel slowing from the anterior approach.",
            "freq": "Expected"
          },
          {
            "risk": "Abdominal discomfort",
            "detail": "From the surgical approach.",
            "freq": "Common"
          },
          {
            "risk": "Retrograde ejaculation",
            "detail": "Risk in men at L5/S1 level, approximately 1–3%.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular injury",
            "detail": "Great vessels are adjacent. Rare but serious.",
            "freq": "Rare"
          },
          {
            "risk": "Device subsidence",
            "detail": "Implant sinking into the vertebral body.",
            "freq": "Uncommon"
          },
          {
            "risk": "Device migration",
            "detail": "Implant shifting position.",
            "freq": "Rare"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation around the device limiting motion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Facet joint arthritis",
            "detail": "Preserved motion may accelerate facet degeneration.",
            "freq": "Long-term"
          },
          {
            "risk": "Revision surgery",
            "detail": "Device failure or ongoing pain may require conversion to fusion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Supine position. Access surgeon assists."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay two to three days. Walking from day one. No brace required. Return to desk work at two to four weeks. Avoid heavy lifting for six to eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Abdominal distension or vomiting",
          "Leg temperature change"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, six months, and one year. Flexion-extension X-rays to confirm motion preservation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is disc replacement better than fusion?",
            "a": "For carefully selected patients, outcomes are equivalent to fusion with the added benefit of motion preservation. However, not all patients are suitable candidates — strict selection criteria are important."
          },
          {
            "q": "How long does an artificial disc last?",
            "a": "Long-term data now extends to 15–20 years with good outcomes. The devices are designed to last a lifetime, though long-term wear data continues to be collected."
          }
        ]
      }
    ]
  },
  "posterior-cervical-fusion": {
    "name": "Posterior Cervical Fusion",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Posterior cervical fusion is an operation to stabilise the cervical spine from the back of the neck using screws and rods. It is performed for instability, fractures, deformity, and multi-level degenerative disease where a posterior approach is preferred.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline incision is made at the back of the neck. The muscles are retracted. Lateral mass screws or pedicle screws are placed into the cervical vertebrae. Rods are connected to the screws to provide stability. Bone graft (local bone, allograft, or synthetic) is placed along the fusion bed. Decompression (laminectomy) may be performed at the same time. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Posterior cervical fusion is recommended for cervical fractures and dislocations, failed anterior cervical fusion, multi-level cervical instability, cervical deformity (kyphosis), rheumatoid cervical instability, and as a supplement to anterior surgery in revision or complex cases."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Cervical collar or halo vest for certain fractures. ACDF for single or two-level anterior pathology. Observation for stable conditions."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT and MRI for screw trajectory planning. Assessment of vertebral artery position. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable stabilisation of the cervical spine. High fusion rates. Effective for conditions not amenable to anterior surgery alone."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Posterior neck pain",
            "detail": "Muscle dissection causes significant post-operative neck and shoulder pain.",
            "freq": "Expected"
          },
          {
            "risk": "Neck stiffness",
            "detail": "The fused levels do not move.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "More than anterior cervical procedures.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Vertebral artery injury",
            "detail": "Risk from screw placement near the artery. Very rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Screw malposition",
            "detail": "May irritate nerve roots.",
            "freq": "Uncommon"
          },
          {
            "risk": "C5 palsy",
            "detail": "Deltoid weakness after decompression.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection approximately 2–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "Long-term stress on adjacent levels.",
            "freq": "Long-term"
          },
          {
            "risk": "Pseudarthrosis",
            "detail": "Failure of fusion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring. Prone or sitting position. Careful neck positioning is critical."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay two to five days. Rigid cervical collar for six to twelve weeks. Return to desk work at four to eight weeks. Avoid heavy lifting for three months. Full fusion at three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E urgently)",
          "Wound redness, discharge, or fluid leak",
          "Fever",
          "Severe headache when upright",
          "Difficulty swallowing",
          "Increasing arm weakness",
          "Collar feels too loose or the neck feels unstable"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. CT scan if fusion is uncertain."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why approach from the back instead of the front?",
            "a": "The posterior approach is preferred for multi-level decompression, fracture-dislocations, posterior ligament injuries, and cases where anterior surgery alone is insufficient. Many conditions benefit from a combined anterior-posterior approach."
          }
        ]
      }
    ]
  },
  "periprosthetic-fracture-fixation": {
    "name": "Periprosthetic Fracture Fixation",
    "region": "Trauma",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Periprosthetic fracture fixation is an operation to stabilise a fracture occurring around or near an existing joint replacement — most commonly around hip or knee replacements. Treatment depends on whether the implant is still well-fixed or has loosened.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Treatment depends on the fracture location and implant stability. If the implant is well-fixed: the fracture is fixed around the existing prosthesis using a plate, cerclage wires, or cables. If the implant is loose: the implant is revised (replaced) with a longer-stemmed prosthesis that bypasses the fracture, combined with fixation of the fracture fragments. The operation takes one and a half to three hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Periprosthetic fractures almost always require surgery. They are increasingly common as more patients live with joint replacements and the population ages. Falls are the most common cause."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Very rarely appropriate. Non-operative management may be considered for undisplaced fractures around well-fixed implants in patients who are not fit for surgery, with strict activity restrictions."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-length X-rays of the affected bone and implant. CT may help assess implant fixation and fracture configuration. Previous operative notes help identify the implant type and size. The correct revision implants must be available."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Stabilisation allowing mobilisation. Outcomes depend on the patient's overall health and the complexity of the fracture-implant combination. Healing rates are lower than standard fractures due to the altered biology around implants."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Delayed healing",
            "detail": "Fractures around implants often heal more slowly than standard fractures.",
            "freq": "Common"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients are elderly with significant comorbidities.",
            "freq": "Common"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant. Transfusion often needed.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Recovery is slower than for a primary fracture or primary joint replacement.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Higher risk than standard fractures, approximately 10–15%.",
            "freq": "Common"
          },
          {
            "risk": "Implant failure",
            "detail": "The plate, wires, or revised prosthesis may fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary fracture fixation, approximately 3–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Dislocation",
            "detail": "If revision arthroplasty is performed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Mortality",
            "detail": "Elderly patients with periprosthetic fractures have significant one-year mortality.",
            "freq": "Common"
          },
          {
            "risk": "Further periprosthetic fracture",
            "detail": "Risk of fracture at another level around the implant.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. These patients often have significant medical comorbidities requiring careful optimisation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on the fracture pattern, fixation, and implant. Protected weight-bearing for six to twelve weeks is common. Physiotherapy essential. Many patients require inpatient rehabilitation. Recovery to pre-fracture function is the goal but not always achievable."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Sudden increase in pain suggesting implant or fixation failure",
          "Medical deterioration",
          "Increasing confusion"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. Regular monitoring of both the fracture and the implant."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why are these fractures harder to treat?",
            "a": "The implant occupies the bone canal, limiting fixation options. The bone around implants is often weakened by stress shielding. The biology of healing is altered. These factors make periprosthetic fractures more complex than standard fractures."
          },
          {
            "q": "Will my joint replacement still work?",
            "a": "If the implant is well-fixed and undamaged, it can often be retained. If it has loosened, revision to a longer-stemmed prosthesis is needed. The replacement usually continues to function well after the fracture heals."
          }
        ]
      }
    ]
  },
  "open-fracture-management": {
    "name": "Open Fracture Management",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Open fracture management is the urgent surgical treatment of a fracture where the bone has broken through the skin or the fracture communicates with an external wound. These injuries require emergency debridement, antibiotics, and stabilisation to prevent infection.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "In the emergency department, the wound is photographed, covered with a saline-soaked dressing, and antibiotics are given immediately. In theatre, the wound is extended and thoroughly debrided — all contaminated and non-viable tissue, including dead muscle and bone fragments, is removed. The wound is washed with litres of saline (irrigation). The fracture is stabilised — typically with external fixation initially, with conversion to internal fixation (nail or plate) once the soft tissue is clean. Wound management depends on the injury: primary closure, delayed closure, negative pressure wound therapy (VAC), or flap coverage for large soft tissue defects. Multiple operations may be needed."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All open fractures require emergency surgical management. Infection rates without adequate debridement are very high. The BOA/BAPRAS standards recommend debridement within 12–24 hours and definitive soft tissue coverage within 72 hours."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no non-operative alternatives for open fractures. Antibiotics alone are insufficient — surgical debridement is essential."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency. Antibiotics are given in the emergency department. Tetanus status is checked. The fracture is splinted. Photography of the wound before dressing. Senior orthopaedic and plastic surgery review."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of infection. Fracture stabilisation. Soft tissue healing. Outcomes have improved dramatically with modern protocols, but open fractures remain challenging injuries with higher complication rates than closed fractures."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Despite best management, infection rates are 3–5% for type I, 5–10% for type II, and 10–30% for type III open fractures.",
            "freq": "Common"
          },
          {
            "risk": "Delayed union",
            "detail": "Open fractures heal more slowly.",
            "freq": "Common"
          },
          {
            "risk": "Multiple operations",
            "detail": "Two to four operations may be needed for wound management and definitive fixation.",
            "freq": "Expected"
          },
          {
            "risk": "Scarring",
            "detail": "Significant scarring from the wound and surgical debridement.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Osteomyelitis",
            "detail": "Deep bone infection. May require prolonged antibiotics and further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Higher non-union rates than closed fractures.",
            "freq": "Common"
          },
          {
            "risk": "Amputation",
            "detail": "In severe open fractures (Gustilo type IIIC with vascular injury), amputation may be needed.",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "A surgical emergency.",
            "freq": "Uncommon"
          },
          {
            "risk": "Flap failure",
            "detail": "If plastic surgery reconstruction is needed, the flap may fail.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia for emergency debridement. Multiple anaesthetics may be needed."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery is prolonged compared to closed fractures. Multiple clinic visits for wound management. Physiotherapy begins when the wound and fixation allow. Return to full function depends on the severity of the original injury — typically six to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound becoming red, hot, or discharging pus",
          "Increasing pain despite medication",
          "Fever",
          "Metalwork or bone visible through the wound",
          "Limb turning cold or pale"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent wound reviews in the first few weeks. Regular X-rays to monitor fracture healing. Plastic surgery follow-up if soft tissue reconstruction was performed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is a Gustilo classification?",
            "a": "Open fractures are classified by severity: Type I (wound <1cm, clean), Type II (wound 1–10cm, moderate contamination), Type III (wound >10cm, high-energy, subdivided into IIIA, IIIB requiring flap coverage, and IIIC with vascular injury). Higher grades have higher complication rates."
          },
          {
            "q": "Why are multiple operations needed?",
            "a": "The initial debridement removes contamination. Further operations may be needed for repeat debridement, definitive fracture fixation (conversion from external to internal fixation), and wound closure or reconstruction."
          }
        ]
      }
    ]
  },
  "paediatric-forearm-orif": {
    "name": "Paediatric Forearm Fracture Fixation",
    "region": "Paediatric Orthopaedics",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Paediatric forearm fracture fixation is an operation to realign and stabilise displaced forearm fractures in children that cannot be adequately managed with casting alone. Techniques include flexible nailing and, in older adolescents, plate fixation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For most children: flexible titanium nails (TENS) are inserted through small incisions near the ends of the bones, crossing the fracture. For older adolescents near skeletal maturity: plate and screw fixation similar to adult technique may be used. The fracture is reduced under X-ray guidance. A cast or splint is applied for additional protection. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for displaced forearm fractures that cannot be reduced or maintained in a cast, open fractures, fractures with neurovascular compromise, and refractures."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Closed reduction and casting is the standard treatment for most paediatric forearm fractures and is successful in the majority. Remodelling potential in children is excellent, and mild angulation is acceptable depending on age and location."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Failed closed reduction attempt or unacceptable alignment on cast X-rays. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Accurate fracture alignment with stable fixation. Excellent healing potential in children. Most children regain full forearm rotation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Nail end irritation",
            "detail": "Protruding nail ends may cause skin irritation.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of rotation. Usually recovers fully.",
            "freq": "Common"
          },
          {
            "risk": "Second operation for nail removal",
            "detail": "At three to six months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Malunion",
            "detail": "Healing with residual angulation or rotation. Remodelling usually corrects this in younger children.",
            "freq": "Uncommon"
          },
          {
            "risk": "Synostosis",
            "detail": "Bridging bone between radius and ulna. Very rare in children.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Requires urgent fasciotomy.",
            "freq": "Rare"
          },
          {
            "risk": "Growth plate injury",
            "detail": "Very rare with careful technique.",
            "freq": "Rare"
          },
          {
            "risk": "Refracture",
            "detail": "After nail removal. Reduced by waiting for adequate healing.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast or splint for four to six weeks. Nail removal at three to six months. Children recover forearm rotation faster than adults. Most return to full activity within six to eight weeks of fracture healing. Formal physiotherapy is rarely needed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain or swelling",
          "Fingers turning blue or numb",
          "Cast too tight",
          "Fever",
          "Nail ends protruding through skin"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at one to two weeks, four to six weeks, and before nail removal."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why do children heal so well?",
            "a": "Children have thicker periosteum (the membrane around bones), better blood supply, and excellent remodelling potential. Most fractures heal within four to six weeks."
          },
          {
            "q": "Can mild angulation be accepted?",
            "a": "Yes, in younger children. The growing bone can remodel and straighten mild angulation over months to years. The acceptable degree depends on the child's age and the fracture location."
          }
        ]
      }
    ]
  },
  "congenital-limb-deformity": {
    "name": "Congenital Limb Deformity Correction",
    "region": "Paediatric Orthopaedics",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Congenital limb deformity correction encompasses a range of surgical procedures to straighten, lengthen, or reshape limbs that have developed abnormally. Techniques include guided growth, osteotomy, and gradual correction with fixators.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach depends on the deformity. Guided growth: small plates placed across one side of a growth plate to gradually straighten a crooked bone as the child grows. Corrective osteotomy: the bone is cut, realigned, and fixed with a plate or nail. Gradual correction: an external fixator (Ilizarov or Taylor Spatial Frame) is applied after osteotomy, allowing slow, precise correction of complex deformities over weeks. These techniques may be combined."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for progressive or functionally significant limb deformity affecting gait, joint loading, or cosmesis. Common conditions include congenital femoral deficiency, fibular hemimelia, tibial bowing, Blount's disease, and post-traumatic growth disturbance."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation (for mild deformity that may improve with growth), orthotics and bracing, shoe raises (for mild leg length discrepancy), and prosthetics (for severe deficiency)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standing alignment X-rays, CT with 3D reconstruction, and mechanical axis planning. Multiple specialists may be involved. Psychological preparation of the child and family."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved limb alignment, equalised leg lengths, better gait mechanics, and improved joint longevity. The goal is a functional, well-aligned limb that will serve the child into adulthood."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged treatment",
            "detail": "Gradual correction may take months. Multiple procedures over childhood may be needed.",
            "freq": "Expected"
          },
          {
            "risk": "Pin site infection",
            "detail": "Very common with external fixators.",
            "freq": "Common"
          },
          {
            "risk": "Joint stiffness",
            "detail": "During frame treatment.",
            "freq": "Common"
          },
          {
            "risk": "Psychological burden",
            "detail": "Prolonged treatment is challenging for children and families.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Overcorrection or undercorrection",
            "detail": "The correction may not be perfect.",
            "freq": "Uncommon"
          },
          {
            "risk": "Premature consolidation",
            "detail": "Bone healing before correction is complete.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve palsy",
            "detail": "Particularly peroneal nerve with angular correction.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "Osteotomy may fail to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Deformity may recur with growth.",
            "freq": "Common"
          },
          {
            "risk": "Joint subluxation",
            "detail": "During lengthening or angular correction.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Multiple anaesthetics may be needed throughout treatment."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Varies greatly depending on the procedure. Guided growth plates are minimally invasive with rapid recovery. Osteotomy requires six to eight weeks of restricted weight-bearing. External fixator treatment lasts months with regular adjustments. Physiotherapy throughout. Long-term follow-up until skeletal maturity."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Frame problems — loosening, pain, discharge",
          "New weakness or foot drop",
          "Joint stiffness not improving",
          "Child in significant distress",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular clinic visits throughout treatment and until skeletal maturity. Frequent X-rays during correction."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How many operations will my child need?",
            "a": "This depends on the condition and severity. Some children need a single procedure. Others with complex deformity or ongoing growth disturbance may need multiple operations throughout childhood."
          },
          {
            "q": "When is the best time for surgery?",
            "a": "Timing depends on the condition. Guided growth is best during active growth (typically 8–14 years). Some conditions require early intervention. Your surgeon will plan the optimal timing."
          }
        ]
      }
    ]
  },
  "anterior-ankle-impingement": {
    "name": "Anterior Ankle Impingement Surgery",
    "region": "Sports Medicine",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Anterior ankle impingement surgery is an arthroscopic procedure to remove bone spurs and soft tissue from the front of the ankle that cause pain and restriction during ankle dorsiflexion — commonly known as 'footballer's ankle'.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through two small incisions at the front of the ankle. Bone spurs (osteophytes) on the front of the tibia and talus are removed with a burr. Thickened, impinging soft tissue and synovium are debrided. Loose bodies are removed if present. The operation takes 30–45 minutes and is usually a day case."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for anterior ankle pain and stiffness during dorsiflexion (bending the ankle up) that has not responded to physiotherapy, injection, and activity modification. It is common in footballers, dancers, and runners."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (ankle mobilisation and strengthening), corticosteroid injection, activity modification, and heel raises to reduce dorsiflexion demand."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays showing anterior osteophytes. MRI to assess for associated pathology. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of anterior ankle pain and improved dorsiflexion in approximately 85–90% of patients. Good outcomes for return to sport."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ankle swelling",
            "detail": "For two to four weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence of spurs",
            "detail": "Osteophytes may regrow over time, particularly if the provocative activity continues.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve irritation",
            "detail": "Superficial peroneal nerve near the anterolateral portal. Usually temporary.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Permanent damage to the superficial peroneal or deep peroneal nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Cartilage damage",
            "detail": "Inadvertent damage during bone spur removal.",
            "freq": "Rare"
          },
          {
            "risk": "Vascular injury",
            "detail": "Anterior tibial artery is nearby. Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or ankle block anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Ankle exercises from day one. Return to running at four to six weeks. Return to sport at six to eight weeks. Full recovery two to three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing ankle pain after initial improvement",
          "Numbness on top of the foot",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Further follow-up as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the spurs come back?",
            "a": "Osteophytes may regrow over time, particularly if the sport or activity that caused them continues. However, many patients enjoy years of relief."
          },
          {
            "q": "Is this the same as ankle arthritis?",
            "a": "Anterior impingement can occur with or without arthritis. Isolated anterior impingement (footballer's ankle) responds well to arthroscopic debridement. If there is generalised ankle arthritis, the results are less predictable."
          }
        ]
      }
    ]
  },
  "posterolateral-ankle-impingement": {
    "name": "Posterior Ankle Impingement Surgery",
    "region": "Sports Medicine",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Posterior ankle impingement surgery is an arthroscopic procedure to remove bone (os trigonum or Stieda's process) and soft tissue from the back of the ankle that causes pain in full plantarflexion — common in ballet dancers, footballers, and fast bowlers.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through two small incisions at the back of the ankle (hindfoot endoscopy). The os trigonum (an accessory bone) or prominent Stieda's process (elongated posterolateral tubercle of the talus) is removed. Impinging soft tissue, including the flexor hallucis longus (FHL) tendon sheath, is debrided. The FHL tendon is released if it is tight or tendinopathic. The operation takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for posterior ankle pain provoked by full plantarflexion (pointing the foot down) — such as going en pointe in ballet, kicking a ball, or bowling in cricket — that has not responded to physiotherapy and injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, corticosteroid injection (posterior ankle under ultrasound guidance), activity modification, and taping. Many cases resolve with non-operative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays or CT showing os trigonum or posterior bony prominence. MRI to assess FHL tendon and surrounding structures. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent pain relief and return to full plantarflexion in approximately 90% of patients. Very high satisfaction rates in dancers and athletes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ankle swelling",
            "detail": "For two to four weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Sural nerve irritation",
            "detail": "Numbness on the outer heel. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "FHL stiffness",
            "detail": "Temporary limitation of big toe flexion if the FHL was released.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Sural nerve injury",
            "detail": "Permanent numbness on the outer foot.",
            "freq": "Uncommon"
          },
          {
            "risk": "FHL tendon injury",
            "detail": "Damage during surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Posterior tibial artery injury",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Incomplete bony removal",
            "detail": "Residual symptoms from remaining bone.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or ankle block anaesthesia. Prone position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Ankle exercises from day one. Return to running at three to four weeks. Return to dance or sport at six to eight weeks. Full recovery two to three months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent posterior ankle pain",
          "Numbness on outer foot",
          "Wound problems",
          "Fever",
          "Big toe weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Return to sport clearance at six to eight weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is an os trigonum?",
            "a": "An os trigonum is a small accessory bone at the back of the talus, present in approximately 10–15% of people. In most people it causes no problems, but in those who repeatedly plantarflex the ankle (dancers, footballers), it can become painful as it is compressed between the tibia and calcaneus."
          },
          {
            "q": "When can a dancer go back en pointe?",
            "a": "Most dancers return to full pointe work at six to eight weeks after posterior impingement surgery."
          }
        ]
      }
    ]
  },
  "knee-washout": {
    "name": "Knee Washout (Irrigation and Debridement)",
    "region": "Knee",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee washout is an urgent arthroscopic or open procedure to wash out an infected or contaminated knee joint. It is performed for septic arthritis, infected knee replacement (DAIR), and penetrating injuries to the knee joint.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic: the knee is accessed through standard portals. The joint is thoroughly irrigated with several litres of saline while infected tissue and debris are removed. Open: a larger incision allows direct access for more thorough debridement. For infected knee replacements, the polyethylene liner is exchanged and the entire joint is debrided. Multiple washouts may be needed. The procedure takes 30–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Knee washout is an emergency for septic arthritis to prevent cartilage destruction. For infected knee replacements, DAIR (debridement, antibiotics, implant retention) within a few days of symptom onset gives the best chance of retaining the prosthesis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Needle aspiration may be performed diagnostically or as temporary treatment. However, established septic arthritis requires surgical washout — antibiotics alone are insufficient."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Joint aspiration for urgent microbiology. Blood tests including CRP, ESR, white cell count. This is an emergency procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Clearance of infection, preservation of the joint surface (native or prosthetic). For native septic arthritis treated promptly, outcomes are generally good. For prosthetic infection, DAIR success is approximately 50–70%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent infection",
            "detail": "May require repeat washout or further surgery.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Post-infectious arthrofibrosis.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "Intravenous then oral for weeks to months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Cartilage destruction",
            "detail": "If septic arthritis is treated late, irreversible cartilage damage may occur.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant removal",
            "detail": "If prosthetic infection cannot be cleared with DAIR.",
            "freq": "Common"
          },
          {
            "risk": "Osteomyelitis",
            "detail": "Bone infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sepsis",
            "detail": "Systemic spread of infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Emergency procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intravenous antibiotics for two to six weeks. PICC line for outpatient IV therapy. Regular blood tests. Physiotherapy once infection is controlled. Full recovery depends on the extent of joint damage."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Recurrence of knee warmth, swelling, or pain",
          "Fever",
          "Rising inflammatory markers",
          "PICC line problems",
          "General deterioration"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular blood tests. Clinical review at two weeks, six weeks, and three months. Long-term monitoring."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How did my joint become infected?",
            "a": "Septic arthritis can occur from bloodstream spread (haematogenous), direct inoculation (injury, injection), or spread from adjacent infection. Prosthetic joints are particularly susceptible because bacteria adhere to implant surfaces."
          }
        ]
      }
    ]
  },
  "knee-synovectomy": {
    "name": "Knee Synovectomy",
    "region": "Knee",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee synovectomy is an arthroscopic or open operation to remove inflamed or diseased synovial lining from the knee joint. It is performed for inflammatory arthritis, PVNS (pigmented villonodular synovitis), and synovial chondromatosis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic: performed through standard portals using motorised shavers to remove the thickened, inflamed synovium from all compartments of the knee. Multiple portals may be needed for thorough access. Open: a larger incision allows more complete removal for diffuse disease. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Synovectomy is recommended for PVNS causing recurrent bloody effusions, synovial chondromatosis with loose body formation, and refractory inflammatory arthritis (rheumatoid) not controlled by modern biological medications."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For inflammatory arthritis: optimisation of disease-modifying medications is the primary treatment. For PVNS: observation for mild disease. Radiosynovectomy (injection of radioactive substance) as an adjunct."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess extent of synovial disease. Blood tests. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reduction in swelling, pain, and recurrent effusions. For PVNS, removal of abnormal tissue prevents joint damage, though recurrence is common with diffuse disease."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "Diffuse PVNS has 20–50% recurrence rate.",
            "freq": "Common"
          },
          {
            "risk": "Knee stiffness",
            "detail": "Common after extensive synovectomy.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged knee effusion.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Haemarthrosis",
            "detail": "Bleeding into the joint.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "With extensive open synovectomy.",
            "freq": "Rare"
          },
          {
            "risk": "Cartilage damage",
            "detail": "From aggressive debridement.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing as tolerated. Intensive physiotherapy to prevent stiffness. Ice and compression for swelling. Full recovery four to twelve weeks. Long-term monitoring for recurrence."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Recurrent bloody effusions",
          "Wound problems",
          "Fever",
          "Locking or catching"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months. MRI surveillance for PVNS — at least five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will PVNS come back?",
            "a": "Localised PVNS has a low recurrence rate. Diffuse PVNS has a high recurrence rate (up to 50%) and may require repeat surgery, radiotherapy, or emerging targeted medications such as pexidartinib."
          }
        ]
      }
    ]
  },
  "calcific-tendinitis-surgery": {
    "name": "Calcific Tendinitis Surgery (Barbotage / Arthroscopic Removal)",
    "region": "Shoulder",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Calcific tendinitis surgery involves removing calcium deposits from the rotator cuff tendon. This can be performed as ultrasound-guided barbotage (needling and aspiration) or arthroscopic excision.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Barbotage: performed in clinic or radiology under ultrasound guidance. Two needles are inserted into the calcium deposit — one to break up and aspirate the calcium, the other to irrigate. Corticosteroid is injected after aspiration. Takes 20–30 minutes. Arthroscopic: performed in theatre through small incisions. The calcium deposit is located within the rotator cuff tendon, incised, and curetted out. Subacromial decompression may be performed at the same time. Takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery or barbotage is considered for calcific tendinitis causing severe pain that has not responded to physiotherapy, anti-inflammatory medication, and corticosteroid injection. Many calcium deposits resolve spontaneously over months to years."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, oral anti-inflammatory medication, subacromial corticosteroid injection, extracorporeal shockwave therapy (ESWT), and observation (many resolve spontaneously)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-ray or ultrasound confirming the calcium deposit. Assessment of deposit size and consistency. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief in approximately 85–90% of patients. Complete resolution of the calcium deposit. Most patients experience significant improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-procedure flare",
            "detail": "Intense pain for 24–72 hours after barbotage or surgery as the calcium is resorbed.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete removal",
            "detail": "Some calcium may remain.",
            "freq": "Uncommon"
          },
          {
            "risk": "Shoulder stiffness",
            "detail": "Temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Rotator cuff tear",
            "detail": "Removing calcium weakens the tendon. Small tears may occur.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Calcium may reform, though this is uncommon after successful removal.",
            "freq": "Rare"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Post-procedural stiffness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection (arthroscopic) or needle site infection (barbotage).",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Barbotage: local anaesthetic with ultrasound guidance. Arthroscopic: general anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Barbotage: immediate recovery, though a post-procedure pain flare is common for two to three days. Arthroscopic: sling for one to two weeks, physiotherapy from one week. Full recovery four to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Severe pain not settling after 72 hours",
          "Increasing shoulder stiffness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at six weeks to confirm deposit resolution. Review at six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the calcium come back?",
            "a": "Recurrence after successful removal is uncommon (approximately 5–10%). Many deposits resolve completely."
          },
          {
            "q": "Why not just wait?",
            "a": "Many calcium deposits do resolve spontaneously over months to years. Surgery is reserved for deposits causing severe, persistent pain that significantly affects quality of life despite non-operative treatment."
          }
        ]
      }
    ]
  },
  "shoulder-stabilisation-posterior": {
    "name": "Posterior Shoulder Stabilisation",
    "region": "Shoulder",
    "tag": "Instability",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Posterior shoulder stabilisation is an arthroscopic operation to repair the posterior labrum and tighten the posterior capsule in patients with recurrent posterior shoulder instability or subluxation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through small incisions. The torn posterior labrum is identified and reattached to the posterior glenoid rim using suture anchors. The posterior capsule is plicated (tightened) with sutures. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for recurrent posterior instability (subluxation or dislocation) that has not responded to physiotherapy. Posterior instability is less common than anterior instability and often presents with subtle symptoms such as pain, apprehension, or a dead-arm feeling."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy focusing on rotator cuff and scapular stabiliser strengthening, activity modification, and avoidance of provocative positions (forward flexion with internal rotation and adduction)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI arthrogram to assess posterior labral pathology. CT to assess glenoid version (retroversion predisposes to posterior instability)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of posterior stability in approximately 85–90% of patients. Good return to sport rates."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of internal rotation",
            "detail": "Expected — some restriction is necessary to prevent re-dislocation.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary posterior shoulder tightness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent instability",
            "detail": "Approximately 10–15% recurrence rate.",
            "freq": "Uncommon"
          },
          {
            "risk": "Suprascapular nerve injury",
            "detail": "The nerve runs close to the posterior glenoid. Very rare with arthroscopic technique.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Over-tightening",
            "detail": "Excessive posterior capsular plication limiting forward flexion.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from one week. Active movement from six weeks. Strengthening from three months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder feeling unstable",
          "Sudden posterior shoulder pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is posterior instability different from anterior?",
            "a": "Yes. Posterior instability is less common, more subtle, and often involves subluxation rather than frank dislocation. It is typically provoked by pushing activities (bench press) rather than the abduction-external rotation that causes anterior instability."
          }
        ]
      }
    ]
  },
  "elbow-epicondyle-surgery": {
    "name": "Golfer's Elbow Surgery (Medial Epicondyle Release)",
    "region": "Elbow",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Golfer's elbow surgery is an operation to release the common flexor tendon origin from the medial epicondyle (inner elbow bone) for chronic medial epicondylitis that has not responded to non-operative treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision is made over the medial epicondyle. The degenerate portion of the common flexor tendon origin is identified and excised. Healthy tendon edges are reattached. The ulnar nerve, which runs directly behind the medial epicondyle, is identified and protected — and may be transposed (moved) if it is contributing to symptoms. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered when medial epicondylitis has not responded to at least six to twelve months of non-operative treatment including physiotherapy (eccentric exercises), corticosteroid injection, shockwave therapy, and activity modification."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (eccentric wrist flexor exercises), counterforce bracing, corticosteroid injection, PRP injection, shockwave therapy, and activity modification. Most patients (80–90%) improve without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Clinical diagnosis. Ultrasound or MRI may show tendon thickening and degeneration. Nerve conduction studies if ulnar nerve symptoms are present. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and restoration of grip strength in approximately 80–85% of patients. Recovery is gradual."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Full strength recovery takes three to six months.",
            "freq": "Expected"
          },
          {
            "risk": "Residual discomfort",
            "detail": "Some patients have persistent mild medial elbow ache.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "Over the medial epicondyle.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve injury",
            "detail": "The ulnar nerve is intimately related to the surgical field. Numbness or tingling in the ring and little fingers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medial instability",
            "detail": "If the MCL is inadvertently damaged during surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Persistent symptoms",
            "detail": "Surgery may not fully resolve symptoms.",
            "freq": "Uncommon"
          },
          {
            "risk": "Elbow stiffness",
            "detail": "Temporary.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional arm block anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for one to two weeks. Gentle wrist and elbow exercises from two weeks. Progressive strengthening from six weeks. Return to desk work at two to four weeks. Manual work at three to four months. Full recovery four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "New numbness in ring and little fingers",
          "Elbow feeling unstable"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is golfer's elbow the same as tennis elbow?",
            "a": "No. Golfer's elbow (medial epicondylitis) affects the inside of the elbow — the common flexor tendon origin. Tennis elbow (lateral epicondylitis) affects the outside — the common extensor tendon origin. Treatment principles are similar but the anatomy and surgical approach differ."
          },
          {
            "q": "Why did non-operative treatment fail?",
            "a": "Approximately 10–20% of patients with medial epicondylitis do not respond adequately to conservative management, particularly those with manual occupations or significant tendon degeneration."
          }
        ]
      }
    ]
  },
  "mallet-finger-surgery": {
    "name": "Mallet Finger Surgery",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Mallet finger surgery is an operation to repair a mallet finger injury — where the extensor tendon at the tip of the finger is torn or avulsed with a bone fragment, causing the fingertip to droop and inability to straighten the distal joint.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For bony mallet (fracture involving more than one-third of the joint surface with subluxation): a small incision is made over the DIP joint. The fracture fragment is reduced and fixed with a small screw or K-wire. For chronic soft tissue mallet or failed splinting: the tendon may be reconstructed or the DIP joint fused in a functional position. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for bony mallet injuries with joint subluxation, open mallet injuries, failed splint treatment with persistent droop, and chronic mallet deformity causing functional problems."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Most mallet finger injuries (both bony and tendinous) are treated with continuous splinting of the DIP joint in extension for six to eight weeks. This is successful in the majority. Surgery is reserved for specific indications."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays to assess fracture size and joint congruity. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of joint congruity and reduction of subluxation for bony mallet. Improvement (though not always complete correction) of the extensor lag for chronic soft tissue mallet."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Residual extensor lag",
            "detail": "Some residual droop (5–10 degrees) is common even after successful treatment.",
            "freq": "Common"
          },
          {
            "risk": "Nail deformity",
            "detail": "The nail may be affected by surgery near the nail bed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "DIP joint stiffness.",
            "freq": "Common"
          },
          {
            "risk": "K-wire infection",
            "detail": "If K-wires are used.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Joint incongruity",
            "detail": "The joint surface may not be perfectly restored.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or joint infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "DIP joint arthritis",
            "detail": "Post-traumatic arthritis.",
            "freq": "Long-term"
          },
          {
            "risk": "Tendon re-rupture",
            "detail": "The repair may fail.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Digital nerve block or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splinting of the DIP joint for six to eight weeks after surgery. K-wire removal at six weeks if used. Gentle DIP flexion exercises begin after splint removal. Full recovery three to four months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Nail deformity developing",
          "K-wire becoming loose or infected",
          "Increasing droop after splint removal",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at two weeks. Splint/wire removal at six weeks. Review at three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why can't splinting fix all mallet injuries?",
            "a": "Splinting is successful for most mallet injuries. Surgery is needed when there is a large fracture fragment with joint subluxation (the joint is not congruent), or when splinting has failed to produce an acceptable result."
          }
        ]
      }
    ]
  },
  "extensor-tendon-repair": {
    "name": "Extensor Tendon Repair",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Extensor tendon repair is an operation to suture a cut or torn extensor tendon on the back of the hand, wrist, or fingers, restoring the ability to straighten the affected digit or wrist.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the site of injury (or the existing laceration is explored). The cut tendon ends are identified and sutured together using specialised techniques appropriate to the zone of injury. The repair is protected with a splint. The operation takes 30–90 minutes depending on the number of tendons and complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Extensor tendon lacerations require surgical repair because the tendons do not heal spontaneously when divided. Even partial cuts may need repair or protection to prevent complete rupture."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Not appropriate for complete tendon lacerations. Partial lacerations involving less than 50% of the tendon width may be managed with splinting alone."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Urgent assessment of tendon function. X-ray to exclude fracture or foreign body. Surgery ideally within 24 hours, though delayed repair up to two to three weeks is possible."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of finger or wrist extension. Outcomes are generally good, though some loss of excursion (range of pull) is common. Results depend on the zone of injury and compliance with splinting and hand therapy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Adhesions",
            "detail": "Scar tissue tethering the tendon, limiting glide. The most common complication.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Loss of full flexion due to adhesions around the repair.",
            "freq": "Common"
          },
          {
            "risk": "Extensor lag",
            "detail": "Some residual inability to fully straighten the finger.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon rupture",
            "detail": "The repair may fail, particularly with premature loading. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Joint stiffness",
            "detail": "Prolonged immobilisation can cause PIP or DIP joint contracture.",
            "freq": "Common"
          },
          {
            "risk": "Tenolysis requirement",
            "detail": "Approximately 10–15% of patients need a second operation to release adhesions.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splinting protocol depends on the zone of injury — typically a hand-based or forearm-based splint for four to six weeks. Early controlled motion protocols (supervised by a hand therapist) begin within the first week and produce better results than static immobilisation. Active movement from four to six weeks. Strengthening from eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of finger extension (possible rupture)",
          "Wound redness or discharge",
          "Increasing stiffness despite exercises",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular hand therapy appointments. Surgeon review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is hand therapy so important?",
            "a": "The balance between protecting the repair and preventing adhesions is critical. Early controlled motion under hand therapist supervision produces significantly better results than simple immobilisation."
          },
          {
            "q": "What if adhesions limit my movement?",
            "a": "If adhesions restrict tendon glide despite therapy, tenolysis (a second operation to release the scar tissue) may be needed. This is performed once the wound and tendon have fully healed, typically at three to six months."
          }
        ]
      }
    ]
  },
  "tibialis-posterior-reconstruction": {
    "name": "Tibialis Posterior Tendon Reconstruction",
    "region": "Foot & Ankle",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tibialis posterior tendon reconstruction is an operation to address a failed or ruptured tibialis posterior tendon — the primary dynamic support for the arch of the foot. It is a key component of adult acquired flatfoot deformity correction.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the inner ankle and foot. The diseased tibialis posterior tendon is assessed — if irreparably damaged, it is debrided or excised. The flexor digitorum longus (FDL) tendon is transferred to replace the function of the tibialis posterior, providing dynamic arch support. This tendon transfer is usually combined with a calcaneal osteotomy and possibly spring ligament repair or lateral column lengthening. The operation takes two to three hours as a combined procedure."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for stage II adult acquired flatfoot deformity (flexible but progressive) with a ruptured or degenerate tibialis posterior tendon causing arch collapse, heel valgus, and pain that has not responded to orthotics and physiotherapy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Custom orthotics with medial arch support, ankle-foot orthosis, tibialis posterior strengthening exercises, supportive footwear, and activity modification. These are effective for many patients, particularly in early-stage disease."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays, MRI to assess tendon quality, and clinical assessment of deformity flexibility. Smoking cessation essential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of arch support, correction of heel alignment, reduced pain, and improved walking. Most patients achieve good pain relief and functional improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-weight-bearing for six to eight weeks. Full recovery nine to twelve months.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged foot and ankle swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "Multiple incisions on the inner foot and ankle.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Donor tendon weakness",
            "detail": "Loss of FDL function may slightly weaken lesser toe flexion. Rarely noticeable.",
            "freq": "Common"
          },
          {
            "risk": "Non-union",
            "detail": "If osteotomy or fusion is included. Higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Tibial nerve or medial plantar nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Multiple incisions increase risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Flatfoot may recur, particularly if orthotics are not used.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast for six to eight weeks. Boot for four to six weeks. Physiotherapy from eight weeks. Custom orthotics long-term. Full recovery nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Fever",
          "Cast too tight",
          "Toes blue or numb",
          "Arch collapsing despite surgery"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why transfer a different tendon?",
            "a": "The tibialis posterior tendon is often too damaged to repair directly. The FDL tendon is the most similar available tendon in terms of direction of pull and provides effective dynamic arch support."
          },
          {
            "q": "Will I need orthotics forever?",
            "a": "Most patients benefit from long-term use of supportive orthotics, even after successful surgery, to maintain the correction."
          }
        ]
      }
    ]
  },
  "tarsal-tunnel-release": {
    "name": "Tarsal Tunnel Release",
    "region": "Foot & Ankle",
    "tag": "Nerve",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Tarsal tunnel release is an operation to decompress the posterior tibial nerve as it passes through the tarsal tunnel behind the inner ankle bone. It is the foot and ankle equivalent of carpal tunnel release in the wrist.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made behind and below the medial malleolus (inner ankle bone). The flexor retinaculum (the roof of the tarsal tunnel) is divided. The posterior tibial nerve and its branches (medial plantar, lateral plantar, and calcaneal nerves) are decompressed. Any space-occupying lesion (ganglion, varicose vein, accessory muscle) is removed. The operation takes 45–75 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for confirmed tarsal tunnel syndrome causing burning, tingling, or numbness in the sole of the foot that has not responded to orthotics, injection, and activity modification. Results are best when a specific compressive lesion (ganglion, varicose vein) is identified."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Orthotics (to correct hindfoot alignment reducing nerve tension), activity modification, corticosteroid injection into the tarsal tunnel, neuropathic pain medication, and physiotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Nerve conduction studies to confirm the diagnosis. MRI or ultrasound to identify space-occupying lesions. Clinical correlation is essential — tarsal tunnel syndrome is often overdiagnosed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Results are less predictable than carpal tunnel release. Approximately 65–80% of patients with a confirmed diagnosis and identifiable compressive lesion achieve good outcomes. Idiopathic (no identifiable cause) tarsal tunnel syndrome has less reliable results."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Incomplete relief",
            "detail": "Results are less predictable than carpal tunnel release.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing",
            "detail": "The medial ankle skin can be slow to heal.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "Over the medial ankle.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Branches of the posterior tibial nerve may be damaged during decompression.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Symptoms may recur from scar formation around the nerve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "Chronic pain syndrome.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or ankle block anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking boot for two to four weeks. Weight-bearing as tolerated. Gentle ankle exercises. Normal footwear at four to six weeks. Full nerve recovery takes weeks to months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing numbness or pain in the sole",
          "Wound problems",
          "Fever",
          "Toes numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why are results less reliable than carpal tunnel release?",
            "a": "The tarsal tunnel contains multiple nerve branches with variable anatomy, the diagnosis is less reliably confirmed with nerve conduction studies, and there are more potential causes of sole-of-foot symptoms. Patient selection is critical."
          },
          {
            "q": "How do I know I have tarsal tunnel syndrome?",
            "a": "Classic symptoms include burning, tingling, or shooting pain in the sole of the foot, often worse at night or with prolonged standing. A positive Tinel's sign (tapping behind the ankle reproducing symptoms) and supportive nerve conduction studies help confirm the diagnosis."
          }
        ]
      }
    ]
  },
  "compartment-syndrome-fasciotomy": {
    "name": "Fasciotomy (Compartment Syndrome)",
    "region": "Trauma",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Fasciotomy is an emergency surgical procedure to release dangerously elevated pressure within a muscle compartment. Compartment syndrome is a limb-threatening emergency — fasciotomy must be performed urgently to prevent irreversible muscle and nerve damage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Long incisions are made through the skin and the fascia (tough membrane surrounding the muscle compartments). In the lower leg, two incisions release all four compartments. In the forearm, a single volar incision releases the volar compartment, with a dorsal incision if needed. The wounds are left open (not stitched) to allow the muscles to swell without restriction. The wounds are covered with negative pressure dressings. Delayed wound closure, skin grafting, or gradual closure is performed days later once swelling settles. The initial fasciotomy takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Fasciotomy is an emergency for confirmed or clinically suspected compartment syndrome. It is most common after tibial fractures, forearm fractures, high-energy injuries, crush injuries, and reperfusion after vascular repair. Delay of more than six to eight hours from onset causes irreversible muscle death and nerve damage."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no non-operative alternatives for established compartment syndrome. It is a surgical emergency."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency requiring immediate surgery. The diagnosis is clinical — severe pain out of proportion to the injury, pain on passive stretch of the muscles, and tense compartments. Compartment pressure monitoring may support the diagnosis but must not delay surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of muscle death and nerve damage. When performed within six hours of onset, outcomes are generally good. Delayed fasciotomy has a much worse prognosis, with risk of permanent muscle contracture (Volkmann's ischaemic contracture in the forearm) and amputation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Open wounds",
            "detail": "The fasciotomy wounds are left open and require further procedures for closure.",
            "freq": "Expected"
          },
          {
            "risk": "Scarring",
            "detail": "Significant scarring from long incisions.",
            "freq": "Expected"
          },
          {
            "risk": "Muscle weakness",
            "detail": "Some muscle damage may have occurred before fasciotomy.",
            "freq": "Common"
          },
          {
            "risk": "Nerve dysfunction",
            "detail": "Nerve damage from the compartment syndrome itself, not from the surgery.",
            "freq": "Common"
          },
          {
            "risk": "Skin grafting",
            "detail": "May be needed if wounds cannot be closed directly.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Irreversible muscle death",
            "detail": "If fasciotomy is too late, muscle may not recover (rhabdomyolysis).",
            "freq": "Uncommon"
          },
          {
            "risk": "Renal failure",
            "detail": "From myoglobin release (rhabdomyolysis) damaging the kidneys.",
            "freq": "Uncommon"
          },
          {
            "risk": "Amputation",
            "detail": "In severe cases with extensive muscle death.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Open wounds are at risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Volkmann's contracture",
            "detail": "Permanent forearm contracture from delayed or missed compartment syndrome.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Emergency surgery — no delay for fasting or optimisation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "The wounds are managed with negative pressure dressings, changed every two to three days. Wound closure or skin grafting at five to seven days once swelling settles. Physiotherapy for muscle and joint rehabilitation begins as soon as possible. Full recovery depends on the severity of muscle damage — weeks to months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain despite fasciotomy (possible inadequate release)",
          "Dark or foul-smelling urine (myoglobinuria — kidney risk)",
          "Wound infection",
          "Fever",
          "Progressive weakness",
          "Toes or fingers not moving"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Daily wound assessment until closure. Physiotherapy throughout. Renal function monitoring. Long-term follow-up for muscle and nerve recovery."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why was this done as an emergency?",
            "a": "Compartment syndrome causes irreversible muscle and nerve death within six to eight hours. Every minute counts. Fasciotomy must be performed as soon as the diagnosis is suspected — waiting for confirmatory tests is not appropriate."
          },
          {
            "q": "Why are the wounds left open?",
            "a": "The purpose of fasciotomy is to release pressure. Closing the wounds immediately would negate the decompression. The wounds are closed once swelling has settled, typically at five to seven days."
          },
          {
            "q": "Will I recover full function?",
            "a": "This depends on how quickly fasciotomy was performed and the extent of muscle damage. Early fasciotomy generally leads to good recovery. Delayed fasciotomy has a worse prognosis."
          }
        ]
      }
    ]
  },
  "achilles-reconstruction": {
    "name": "Achilles Tendon Reconstruction (Chronic Rupture / Re-Rupture)",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Achilles tendon reconstruction is a complex operation to restore continuity and function to a chronically ruptured or re-ruptured Achilles tendon that cannot be directly repaired due to tendon retraction and gap formation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the back of the calf and ankle. The scarred, retracted tendon ends are identified. Depending on the gap size, reconstruction may involve V-Y tendon advancement (lengthening the proximal tendon by cutting it in a V and closing it as a Y), turndown flap (a strip of proximal tendon is turned down to bridge the gap), FHL (flexor hallucis longus) tendon transfer (a nearby tendon is rerouted to augment the repair), or allograft augmentation. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Reconstruction is needed when a chronic Achilles rupture (typically more than four weeks old) has retracted, creating a gap that cannot be bridged with direct repair. Also for re-ruptures after failed primary repair."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For elderly or sedentary patients, acceptance of the chronic rupture with AFO bracing and calf strengthening may provide adequate function. This avoids the risks of complex reconstruction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess the gap size and tendon quality. Assessment of the FHL tendon if transfer is planned."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of Achilles tendon continuity and push-off strength. Most patients achieve functional improvement, though strength is typically 70–80% of normal."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing",
            "detail": "The posterior calf skin is vulnerable, particularly in chronic cases with poor tissue quality.",
            "freq": "Common"
          },
          {
            "risk": "Reduced push-off strength",
            "detail": "Strength rarely returns to full normal.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Six to twelve months.",
            "freq": "Expected"
          },
          {
            "risk": "Sural nerve irritation",
            "detail": "Numbness on the outer foot.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-rupture",
            "detail": "The reconstruction may fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound breakdown",
            "detail": "Particularly in smokers, diabetics, and previously operated tissue.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep infection",
            "detail": "Around the repair or allograft.",
            "freq": "Uncommon"
          },
          {
            "risk": "FHL weakness",
            "detail": "If FHL transfer is performed, big toe flexion is weakened.",
            "freq": "Common"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT during immobilisation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block. Prone position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing in a cast for six to eight weeks. Gradual transition to weight-bearing in a boot with heel raises. Progressive heel raise reduction over four weeks. Physiotherapy for calf strengthening from eight weeks. Return to light sport at six months. Full recovery nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown or discharge",
          "Sudden calf pain (re-rupture)",
          "Fever",
          "Calf swelling",
          "Toes numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Reviews at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why can't a chronic rupture be directly repaired?",
            "a": "Over time, the tendon ends retract and scar tissue fills the gap. The tendon cannot simply be pulled together — it must be bridged or augmented with additional tissue."
          },
          {
            "q": "Will my calf strength return to normal?",
            "a": "Most patients achieve 70–80% of normal strength, which is sufficient for walking and most activities. Return to competitive running or jumping sports is less predictable."
          }
        ]
      }
    ]
  },
  "cuff-tear-arthropathy-management": {
    "name": "Rotator Cuff Tear Arthropathy Management",
    "region": "Shoulder",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Rotator cuff tear arthropathy is the end-stage condition where a massive, irreparable rotator cuff tear has led to superior migration of the humeral head and secondary arthritis. Treatment ranges from non-operative management to reverse shoulder replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The primary surgical treatment is reverse total shoulder replacement — a prosthesis designed to function without the rotator cuff. The ball and socket are reversed: a metal ball (glenosphere) is fixed to the glenoid and a plastic socket is placed on the humerus. This allows the deltoid muscle to power the shoulder instead of the deficient rotator cuff. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for cuff tear arthropathy causing significant pain, weakness, and functional limitation. Reverse shoulder replacement has revolutionised the treatment of this condition, providing reliable pain relief and restoration of overhead function."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (anterior deltoid rehabilitation programme), corticosteroid injection, activity modification, and pain medication. These can be effective for patients with acceptable function."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays showing superior humeral head migration and glenohumeral arthritis. CT scan to assess glenoid bone stock for implant fixation. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief and restoration of overhead reach. Most patients can elevate the arm above shoulder height. Reverse shoulder replacement for cuff tear arthropathy has excellent satisfaction rates exceeding 90%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of rotation",
            "detail": "External and internal rotation are often limited after reverse replacement.",
            "freq": "Expected"
          },
          {
            "risk": "Scapular notching",
            "detail": "Erosion of the scapular neck by the humeral component. Seen on X-ray in approximately 50% but rarely clinically significant.",
            "freq": "Common"
          },
          {
            "risk": "Acromial stress fracture",
            "detail": "The increased deltoid tension may fracture the acromion. Approximately 3–5%.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "Risk approximately 2–5%, higher than anatomic total shoulder replacement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection approximately 2–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Glenoid baseplate loosening",
            "detail": "Long-term concern.",
            "freq": "Long-term"
          },
          {
            "risk": "Nerve injury",
            "detail": "Axillary or brachial plexus stretch from arm lengthening.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from one week. Active elevation from four to six weeks. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Lifetime activity restrictions — no heavy lifting above shoulder level."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder feeling unstable or clunking (possible dislocation)",
          "Sudden loss of ability to raise the arm (possible acromial fracture)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, one year, and then every two years for life."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why reverse instead of normal shoulder replacement?",
            "a": "A standard shoulder replacement requires a functioning rotator cuff to work. In cuff tear arthropathy, the rotator cuff is gone. The reverse design allows the deltoid to power the shoulder instead."
          },
          {
            "q": "How long does a reverse replacement last?",
            "a": "Modern reverse replacements show approximately 90% survival at ten years. Long-term data continues to mature."
          }
        ]
      }
    ]
  },
  "hip-resurfacing-revision": {
    "name": "Birmingham Hip Resurfacing / Metal-on-Metal Follow-Up",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "This consent form covers the ongoing surveillance and potential revision of metal-on-metal hip resurfacing or large-diameter metal-on-metal total hip replacements. Regular monitoring is essential due to the risk of adverse reactions to metal debris.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Surveillance involves regular blood tests for cobalt and chromium metal ion levels, cross-sectional imaging (MARS-MRI — Metal Artefact Reduction Sequence) to assess for soft tissue reactions (pseudotumour, ALVAL), and clinical assessment. If revision is needed, the metal-on-metal components are removed and replaced with conventional implants through an incision over the hip. Revision takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The MHRA mandates annual follow-up for all patients with metal-on-metal hip implants. Revision is recommended when there is evidence of adverse reaction to metal debris (ARMD) — including rising metal ion levels, soft tissue mass on imaging, progressive symptoms, or component malposition."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Continued surveillance without revision if the implant is functioning well, metal ions are low, and imaging is normal. Asymptomatic patients with well-positioned implants and low metal ions may not need revision."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "For revision: full pre-assessment, blood metal ion levels, MARS-MRI, CT scan to assess bone stock, planning for potential bone loss and complex reconstruction."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "For surveillance: early detection of adverse reactions before irreversible damage occurs. For revision: removal of the source of metal debris, resolution of soft tissue reactions, and restoration of hip function."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Revision is more complex than primary surgery",
            "detail": "Longer operating time, more blood loss, and higher complication rates than primary hip replacement.",
            "freq": "Expected"
          },
          {
            "risk": "Bone loss",
            "detail": "Metal debris and pseudotumour may have eroded bone, requiring bone grafting or specialised implants.",
            "freq": "Common"
          },
          {
            "risk": "Soft tissue damage",
            "detail": "The gluteal muscles and capsule may be damaged by the pseudotumour.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dislocation",
            "detail": "Higher risk than primary replacement due to soft tissue damage.",
            "freq": "Common"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sciatic or femoral nerve may be damaged during revision.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary replacement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Periprosthetic fracture during revision.",
            "freq": "Uncommon"
          },
          {
            "risk": "Persistent metal ion elevation",
            "detail": "Even after revision, metal ions may remain elevated for months.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "For revision: general or spinal anaesthesia. Significant blood loss requires transfusion capability."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "For revision: hospital stay two to five days. Hip precautions for six to twelve weeks depending on the reconstruction. Physiotherapy for hip rehabilitation. Full recovery six to twelve months. Continued metal ion monitoring until levels normalise."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "New or worsening groin, thigh, or hip pain",
          "Clicking, clunking, or squeaking from the hip",
          "Swelling around the hip",
          "New limp or leg length change",
          "General malaise"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Annual blood metal ions and clinical review (MHRA requirement). MARS-MRI every one to two years or if symptoms change. Ongoing even if asymptomatic."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Do I definitely need a revision?",
            "a": "Not necessarily. Many metal-on-metal hips function well for years. Revision is only recommended when there is evidence of adverse reaction — rising metal ions, abnormal imaging, or progressive symptoms. Ongoing surveillance identifies who needs revision."
          },
          {
            "q": "What are metal ions?",
            "a": "Cobalt and chromium are released from the bearing surfaces of metal-on-metal implants. In most patients, levels are very low. Elevated levels may indicate increased wear or adverse tissue reaction."
          },
          {
            "q": "Is my hip safe?",
            "a": "Most metal-on-metal hips function well. Regular monitoring ensures any problems are detected early. If your metal ion levels are low and imaging is normal, the risk is low."
          }
        ]
      }
    ]
  },
  "computer-navigated-knee": {
    "name": "Computer-Navigated Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Computer-navigated knee replacement uses an infrared tracking system to guide implant alignment during total or partial knee replacement. Tracking markers on the leg provide real-time information about alignment, bone cuts, and soft tissue balance.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical procedure is largely the same as a conventional knee replacement. Small pins are placed in the femur and tibia to hold infrared tracking markers. A camera system tracks these markers in three dimensions, providing the surgeon with real-time information about mechanical axis alignment, bone cut angles, and soft tissue balance. The bone cuts are made using conventional instruments, guided by the navigation data. The pins are removed at the end. The operation takes a similar time to conventional surgery or slightly longer."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Navigation improves alignment accuracy and reduces outliers compared to conventional instrumentation. It is particularly useful for complex cases, post-traumatic knees, extra-articular deformity, and knees where conventional alignment landmarks are unreliable."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All the same non-operative options as conventional knee replacement. Conventional (non-navigated) and robotic-assisted knee replacement are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No additional imaging is needed for navigation (unlike robotic surgery, which requires a pre-operative CT). Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "More accurate and consistent implant alignment. Reduced outliers. Preservation of the mechanical axis. Potential for improved long-term implant survival, though this is still being evaluated in long-term studies."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Same risks as conventional knee replacement",
            "detail": "All standard risks apply.",
            "freq": "Expected"
          },
          {
            "risk": "Pin site discomfort",
            "detail": "Tracker pin sites may be sore for a few weeks.",
            "freq": "Common"
          },
          {
            "risk": "Slightly longer operating time",
            "detail": "Navigation adds approximately 10-15 minutes.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pin site fracture",
            "detail": "Very rare fracture through the tracker pin holes.",
            "freq": "Rare"
          },
          {
            "risk": "System malfunction",
            "detail": "The navigation system may malfunction, requiring conversion to conventional technique.",
            "freq": "Rare"
          },
          {
            "risk": "All standard knee replacement risks",
            "detail": "Infection, blood clots, stiffness, loosening.",
            "freq": "See standard risks"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia — same as conventional."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Identical to conventional knee replacement."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as conventional knee replacement."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is navigation better than conventional surgery?",
            "a": "Navigation improves alignment accuracy and consistency. Whether this translates to better long-term outcomes is still being studied, but early evidence is promising."
          },
          {
            "q": "How is this different from robotic surgery?",
            "a": "Navigation provides real-time alignment information to guide the surgeon's conventional bone cuts. Robotic surgery uses a robotic arm to physically control the bone cuts with haptic boundaries. Navigation does not require a pre-operative CT scan."
          }
        ]
      }
    ]
  },
  "epidural-blood-patch": {
    "name": "Epidural Blood Patch",
    "region": "Spine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "An epidural blood patch is a procedure to treat a persistent cerebrospinal fluid (CSF) leak causing a post-dural puncture headache — a severe headache that is worse when sitting or standing and improves when lying flat.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small volume (15–25 ml) of the patient's own blood is drawn from a vein in the arm under sterile conditions. Using the same technique as an epidural injection, a needle is inserted into the epidural space near the site of the dural puncture. The autologous blood is slowly injected into the epidural space, where it clots and seals the CSF leak. The procedure takes 15–20 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "An epidural blood patch is recommended for post-dural puncture headache (PDPH) that has not resolved with conservative measures (bed rest, hydration, caffeine, analgesics) within 24–48 hours. PDPH occurs after epidural anaesthesia, spinal anaesthesia, lumbar puncture, or inadvertent dural puncture during spinal surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Conservative treatment: bed rest in a flat position, oral and IV hydration, caffeine (oral or IV), analgesics, and abdominal binders. Most mild PDPHs resolve within a few days to a week with conservative measures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Clinical diagnosis of PDPH (postural headache). No imaging usually needed. Standard blood tests to confirm suitability. The procedure can be performed at the bedside or in theatre."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate or rapid relief of the headache in approximately 85–95% of patients. The blood clot seals the dural hole and prevents further CSF leakage. A second blood patch may be needed if the headache recurs."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Back pain",
            "detail": "Transient back ache at the injection site is common for a few days.",
            "freq": "Common"
          },
          {
            "risk": "Temporary worsening",
            "detail": "Brief increase in headache or back pressure during injection.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Approximately 10–15% of patients need a second blood patch.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Epidural abscess or meningitis. Very rare with sterile technique.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve root irritation",
            "detail": "Temporary radiculopathy from blood tracking along nerve roots.",
            "freq": "Rare"
          },
          {
            "risk": "Subdural haematoma",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Arachnoiditis",
            "detail": "Extremely rare inflammatory response.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic at the needle insertion site. Performed by an anaesthetist with epidural expertise."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Lie flat for one to two hours after the procedure. Avoid straining, heavy lifting, and Valsalva manoeuvre for 48 hours. Increase fluids. Most patients experience relief within hours. Return to normal activities within 24–48 hours."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Headache returning after initial improvement (may need a second blood patch)",
          "Fever or neck stiffness (possible infection — attend urgently)",
          "New leg weakness or numbness",
          "Worsening headache not relieved by lying flat"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at 24–48 hours. Second blood patch at 24–48 hours if headache recurs."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How quickly does it work?",
            "a": "Most patients experience significant relief within minutes to hours. Some experience gradual improvement over 24–48 hours."
          },
          {
            "q": "What if it doesn't work?",
            "a": "A second blood patch can be performed if the headache recurs. The success rate of a second patch is approximately 90–95%."
          },
          {
            "q": "How did the CSF leak happen?",
            "a": "Dural puncture can occur intentionally (spinal anaesthesia, lumbar puncture) or accidentally (during epidural anaesthesia or spinal surgery). The resulting hole allows CSF to leak, reducing pressure around the brain and causing the headache."
          }
        ]
      }
    ]
  },
  "radiofrequency-denervation": {
    "name": "Radiofrequency Denervation (Facet Joint)",
    "region": "Spine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Radiofrequency denervation (RFD) is a minimally invasive procedure to treat chronic facet joint pain by heating and destroying the small medial branch nerves that transmit pain signals from the facet joints. It provides longer-lasting relief than steroid injections.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under fluoroscopic (X-ray) guidance, a radiofrequency needle is placed adjacent to the medial branch nerve at each affected level (typically two nerves per joint — the level above and the level of the joint). The nerve is stimulated to confirm correct position (motor and sensory testing). Local anaesthetic is injected around the nerve. A radiofrequency current is then applied, heating the nerve tip to 80°C for 60–90 seconds, destroying the nerve's ability to transmit pain. Multiple levels are usually treated. The procedure takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "RFD is recommended for chronic facet joint pain that has been confirmed by at least two successful diagnostic medial branch block injections providing at least 50–80% temporary relief. It is used for cervical and lumbar facet joint pain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, oral medication, medial branch block injections (shorter duration of relief), facet joint injections, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Diagnostic medial branch blocks must have been performed on at least two occasions with consistent, significant relief. Informed consent regarding the temporary nature of the relief."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief lasting typically nine to eighteen months (sometimes longer). Approximately 60–70% of carefully selected patients achieve significant benefit. The procedure can be repeated when the nerves regenerate and pain returns."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Post-procedure soreness",
            "detail": "Back or neck ache at the treatment sites for one to two weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary flare",
            "detail": "Pain may temporarily worsen before improving.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Not all patients achieve adequate benefit.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve injury",
            "detail": "Unintended damage to a spinal nerve root — very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "At the needle sites.",
            "freq": "Rare"
          },
          {
            "risk": "Neuritis",
            "detail": "Temporary inflammation of the treated nerve causing increased pain for two to four weeks.",
            "freq": "Uncommon"
          },
          {
            "risk": "Skin burn",
            "detail": "Extremely rare with modern equipment.",
            "freq": "Rare"
          },
          {
            "risk": "Motor nerve damage",
            "detail": "Very rare if the needle is malpositioned.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic with mild sedation. The patient must be awake enough to report symptoms during nerve stimulation testing."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home the same day. Avoid heavy activity for 48 hours. The full benefit may take two to six weeks to develop as inflammation settles. If successful, the relief typically lasts nine to eighteen months before the nerves regenerate."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe worsening of pain not settling after two weeks",
          "New leg or arm weakness",
          "Fever",
          "Headache when upright",
          "Signs of infection at needle sites"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six to eight weeks to assess response. Repeat RFD when pain returns (nerves regenerate over months)."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does the relief last?",
            "a": "Typically nine to eighteen months. When the nerves regenerate, pain returns. The procedure can be repeated."
          },
          {
            "q": "Why do I need two diagnostic injections first?",
            "a": "Diagnostic medial branch blocks confirm that the facet joints are the source of pain. Two blocks are required to reduce the false-positive rate and ensure the RFD is targeting the correct pain source."
          },
          {
            "q": "Is this the same as a steroid injection?",
            "a": "No. Steroid injections reduce inflammation temporarily (weeks to months). RFD destroys the pain-transmitting nerve, providing longer relief (nine to eighteen months). RFD is more effective for confirmed facet joint pain."
          }
        ]
      }
    ]
  },
  "pubic-symphysis-fixation": {
    "name": "Pubic Symphysis Fixation",
    "region": "Pelvis & Acetabulum",
    "tag": "Fracture",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pubic symphysis fixation is an operation to stabilise a disrupted pubic symphysis — the joint at the front of the pelvis where the two pubic bones meet. It is performed for traumatic pelvic ring injuries where the symphysis is widened or disrupted.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the lower abdomen (Pfannenstiel incision, similar to a caesarean section). The disrupted symphysis is exposed. The pubic bones are reduced (brought back together) and fixed with a plate and screws across the symphysis. The operation takes one to one and a half hours. It is often combined with posterior pelvic ring fixation."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Pubic symphysis fixation is required when the symphysis is widened by more than 2.5 cm in the context of an unstable pelvic ring injury (APC type II or III). Isolated symphysis widening without posterior ring injury (APC type I) is usually managed without surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stable pelvic injuries with less than 2.5 cm symphysis widening may be managed with restricted weight-bearing."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan of the pelvis. Assessment of posterior ring injury. May require emergency pelvic binder or external fixation first."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of anterior pelvic ring stability. Combined with posterior fixation, restores overall pelvic stability for weight-bearing."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Scar",
            "detail": "Low transverse abdominal scar.",
            "freq": "Expected"
          },
          {
            "risk": "Plate prominence",
            "detail": "The plate may be palpable over the pubic symphysis.",
            "freq": "Common"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation around the symphysis.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Implant failure",
            "detail": "The plate may break or screws pull out, particularly if the posterior ring is not adequately stabilised.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bladder injury",
            "detail": "The bladder lies directly behind the symphysis.",
            "freq": "Rare"
          },
          {
            "risk": "Sexual dysfunction",
            "detail": "Pubic symphysis injuries may affect sexual function.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Loss of reduction",
            "detail": "The symphysis may re-widen.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions for six to twelve weeks depending on posterior ring stability. Physiotherapy for core and pelvic strengthening. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Difficulty passing urine",
          "Increasing pubic pain or clicking",
          "Wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will the plate need removing?",
            "a": "Not usually. If the plate causes irritation (e.g., during sit-ups or with pressure), removal can be considered after healing."
          }
        ]
      }
    ]
  },
  "high-ankle-sprain-fixation": {
    "name": "High Ankle Sprain (Syndesmosis) Fixation",
    "region": "Sports Medicine",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "High ankle sprain fixation is an operation to stabilise the syndesmosis — the ligament complex that holds the tibia and fibula together above the ankle joint. It is performed for unstable syndesmotic injuries that will not heal with conservative management.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The syndesmosis is reduced (the fibula is positioned correctly in the tibial notch) and held with one or two fixation devices. Options include syndesmotic screws (metal screws through both bones, removed at three to four months), suture buttons (TightRope — a strong suture connecting two buttons on the tibia and fibula, usually not removed), or a combination. The operation takes 30–60 minutes and may be combined with ankle fracture fixation."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for unstable syndesmotic injuries — those with widening of the tibiofibular joint on stress X-rays. Isolated stable syndesmotic sprains can be managed in a boot. Unstable injuries that are not fixed lead to chronic ankle instability and arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Walking boot and physiotherapy for stable syndesmotic sprains. Stable injuries heal well without surgery, though recovery takes longer than a standard ankle sprain (six to twelve weeks)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and stress views. CT may be used to assess fibular position. MRI to assess ligament integrity."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of syndesmotic stability preventing chronic widening and arthritis. Most athletes return to sport at four to six months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Screw removal",
            "detail": "Syndesmotic screws restrict normal tibiofibular motion and are removed at three to four months. This requires a second procedure.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary ankle stiffness.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Longer than a standard ankle sprain.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Screw breakage",
            "detail": "If the screw breaks before removal due to premature weight-bearing.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malreduction",
            "detail": "The fibula may be fixed in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Syndesmosis re-widening",
            "detail": "After screw removal or suture button failure.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation in the interosseous membrane.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six weeks (screws) or partial weight-bearing (suture button). Boot for six to eight weeks. Screw removal at three to four months. Progressive ankle rehabilitation. Return to sport at four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Ankle widening or instability",
          "Wound problems",
          "Fever",
          "Screw prominence or pain",
          "Ankle clunking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at two weeks, six weeks, and three months. Screw removal at three to four months if applicable."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the syndesmosis?",
            "a": "The syndesmosis is the ligament complex (anterior tibiofibular ligament, posterior tibiofibular ligament, interosseous membrane, and transverse ligament) that holds the tibia and fibula together just above the ankle joint. It is critical for ankle stability."
          },
          {
            "q": "Screws or suture buttons?",
            "a": "Both are effective. Screws are well-established but require removal. Suture buttons allow some physiological motion and usually do not need removal. Your surgeon will recommend the best option."
          }
        ]
      }
    ]
  },
  "rotationplasty": {
    "name": "Rotationplasty (Van Nes)",
    "region": "Orthopaedic Oncology",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Rotationplasty is a unique limb-salvage procedure where, after tumour resection around the knee, the lower leg is rotated 180 degrees and reattached so that the ankle functions as a new knee joint — providing excellent prosthetic function for growing children.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The tumour-bearing segment (typically the distal femur and knee joint) is resected. The lower leg is rotated 180 degrees on its vascular pedicle (the blood vessels are preserved) and reattached to the remaining proximal femur. The ankle joint, now facing backwards, functions as a biological knee joint within a below-knee prosthesis. The foot acts as a weight-bearing stump. The operation takes four to six hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Rotationplasty is primarily offered to growing children with tumours around the knee where endoprosthetic reconstruction would require multiple revision operations as they grow. The rotationplasty provides a biological joint that grows with the child and allows high-level physical activity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Expandable endoprosthetic reconstruction (requires multiple lengthening procedures), above-knee amputation, or limb salvage with conventional reconstruction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Full staging. MDT discussion. Extensive psychological preparation — the appearance of the rotated foot is initially striking, and careful counselling is essential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Excellent functional outcome — the ankle joint provides active 'knee' flexion and extension. Children achieve high levels of physical activity, including running and sports. The biological joint grows with the child, avoiding the need for multiple revision surgeries. Energy expenditure during walking is much lower than above-knee amputation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Psychological adjustment",
            "detail": "The appearance of the rotated foot takes time to accept. Comprehensive psychological support is essential.",
            "freq": "Expected"
          },
          {
            "risk": "Growth discrepancy",
            "detail": "The rotated limb may grow at a different rate, requiring shoe modifications.",
            "freq": "Common"
          },
          {
            "risk": "Phantom sensation",
            "detail": "Unusual sensations in the rotated limb.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular compromise",
            "detail": "The blood supply to the rotated limb may be compromised. Close post-operative monitoring is essential.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The bone junction may fail to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve palsy",
            "detail": "Sciatic or peroneal nerve injury.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound complications",
            "detail": "From the extensive surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Local recurrence",
            "detail": "Of the tumour.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with significant blood loss. Prolonged operating time."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay one to two weeks. Close vascular monitoring for 48 hours. Prosthetic fitting at six to eight weeks once healing is confirmed. Gait training with the below-knee prosthesis. Most children achieve excellent walking and running within six to twelve months. Long-term follow-up for oncological surveillance and prosthetic needs."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Foot turning blue, cold, or mottled (vascular emergency)",
          "Wound breakdown",
          "Fever",
          "Increasing pain",
          "Signs of tumour recurrence"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Intensive early monitoring. Oncological surveillance. Regular prosthetic reviews. Psychological support throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why rotate the leg?",
            "a": "By rotating the lower leg 180 degrees, the ankle joint becomes a biological 'knee' joint. This provides active flexion and extension within a below-knee prosthesis, giving far better function than an above-knee amputation. The ankle is a robust joint that grows with the child."
          },
          {
            "q": "Will my child accept the appearance?",
            "a": "Most children and families adapt well with appropriate psychological support. The functional benefits — running, jumping, and sporting activity — are transformative. Many children with rotationplasty participate in competitive sports."
          },
          {
            "q": "Why not an expandable prosthesis instead?",
            "a": "Expandable endoprostheses require multiple surgical lengthening procedures as the child grows (every six to twelve months), each carrying risks of infection and mechanical failure. Rotationplasty provides a biological, growing joint that avoids this burden."
          }
        ]
      }
    ]
  },
  "guided-growth-deformity": {
    "name": "Guided Growth (Hemiepiphysiodesis) for Angular Deformity",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Guided growth is a minimally invasive technique to gradually correct angular limb deformity in growing children by slowing growth on one side of a growth plate using a small plate (8-plate or tension band plate). The opposite side continues to grow, naturally straightening the limb.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A small incision (2–3 cm) is made over the growth plate on the side of the deformity. A small two-hole plate with a central screw hole (8-plate) is placed across the growth plate, with one screw in the epiphysis and one in the metaphysis. This restrains growth on one side while allowing it to continue on the other, gradually correcting the deformity. The plate is removed once correction is achieved. The procedure takes 20–30 minutes per plate. Both legs may be treated."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Guided growth is recommended for angular limb deformity in growing children — genu valgum (knock knees), genu varum (bow legs), and ankle valgus. It is much less invasive than osteotomy and uses the child's own growth to achieve correction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation (physiological genu valgum in young children usually corrects spontaneously), bracing (limited evidence for effectiveness), and corrective osteotomy (more invasive, reserved for older children or those near skeletal maturity)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standing alignment X-rays. Bone age assessment to confirm remaining growth. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Gradual, predictable correction of angular deformity using the child's own growth. Success rates exceed 90% when performed at the appropriate age with sufficient remaining growth."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Over-correction",
            "detail": "If the plate is left too long, the deformity may over-correct.",
            "freq": "Uncommon"
          },
          {
            "risk": "Under-correction",
            "detail": "If growth is insufficient or the plate fails.",
            "freq": "Uncommon"
          },
          {
            "risk": "Second procedure",
            "detail": "Plate removal is always needed — either when correction is achieved or at skeletal maturity.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Growth plate damage",
            "detail": "Permanent physeal arrest from the screws. Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Hardware failure",
            "detail": "Screw breakage or plate dislodgement.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Rebound",
            "detail": "Deformity may recur after plate removal if growth continues.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Day-case procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking immediately. Return to school within days. No activity restrictions. Standing X-rays every six months to monitor correction. Plate removal when correction is achieved (a second short general anaesthetic)."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Worsening rather than improving deformity",
          "Pain over the plate"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Standing alignment X-rays every six months. Plate removal when correction is achieved."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does correction take?",
            "a": "Typically six to eighteen months depending on the degree of deformity and the rate of growth. Younger children with more remaining growth correct faster."
          },
          {
            "q": "Is this better than an osteotomy?",
            "a": "Guided growth is much less invasive than osteotomy — tiny incisions, day-case, immediate walking, and no casting. It is the preferred first-line treatment for angular deformity in growing children with sufficient remaining growth."
          }
        ]
      }
    ]
  },
  "shoulder-denervation": {
    "name": "Shoulder Suprascapular Nerve Block / Denervation",
    "region": "Shoulder",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Suprascapular nerve block or denervation is a minimally invasive procedure to treat chronic shoulder pain by blocking or ablating the suprascapular nerve — the primary sensory nerve of the shoulder joint. It is used for pain relief in patients who are not suitable for surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under ultrasound or fluoroscopic guidance, a needle is directed to the suprascapular notch where the nerve passes. For a diagnostic/therapeutic block: local anaesthetic and corticosteroid are injected around the nerve. For denervation: radiofrequency ablation or pulsed radiofrequency is applied to provide longer-lasting relief. The procedure takes 15–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Suprascapular nerve block is considered for chronic shoulder pain from arthritis, massive irreparable rotator cuff tears, or frozen shoulder in patients who are not candidates for surgery or who wish to avoid it. It is also used as a diagnostic tool."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Oral analgesics, physiotherapy, intra-articular injection, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Outpatient procedure. No fasting required for ultrasound-guided blocks."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Diagnostic block: confirms the shoulder as the pain source. Therapeutic block: pain relief lasting weeks to months. Radiofrequency denervation: relief lasting six to twelve months. Can be repeated."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Temporary weakness",
            "detail": "Suprascapular nerve also supplies the supraspinatus and infraspinatus — temporary weakness of external rotation.",
            "freq": "Common"
          },
          {
            "risk": "Injection site soreness",
            "detail": "For a few days.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pneumothorax",
            "detail": "Very rare with ultrasound guidance. The lung apex is nearby.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Permanent damage is very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "At injection site.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic only. No sedation needed."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Immediate return to normal activities. May notice temporary shoulder weakness for hours to days. If effective, physiotherapy can be intensified during the pain-free window."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Shortness of breath or chest pain (possible pneumothorax — attend A&E)",
          "Persistent shoulder weakness beyond 48 hours",
          "Fever",
          "Injection site infection"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Assess response at two to four weeks. Repeat if effective."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does the relief last?",
            "a": "A single block: weeks to months. Radiofrequency denervation: typically six to twelve months. The procedure can be repeated."
          }
        ]
      }
    ]
  },
  "shoulder-stabilisation-open": {
    "name": "Open Shoulder Stabilisation (Bankart Repair)",
    "region": "Shoulder",
    "tag": "Instability",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Open Bankart repair is an operation to reattach the torn anterior labrum to the glenoid rim through an open incision, restoring stability to a shoulder that dislocates repeatedly. It is an alternative to arthroscopic repair for specific indications.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made at the front of the shoulder. The subscapularis muscle is split or detached to access the joint. The torn labrum is identified and reattached to the glenoid rim using suture anchors. The capsule is tightened. The subscapularis is repaired. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Open Bankart repair may be preferred when there is a large bony defect requiring bone grafting, revision after failed arthroscopic repair, significant capsular laxity requiring open plication, or when the surgeon's preference and experience favours an open approach."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy for rotator cuff and scapular strengthening, activity modification, and bracing. Arthroscopic Bankart repair and Latarjet procedure are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI arthrogram and CT to assess labral tear and bone loss. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Recurrence rates with open Bankart repair are approximately 5–8%, comparable to or slightly better than arthroscopic repair. Reliable restoration of stability."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of external rotation",
            "detail": "Some restriction is expected and necessary for stability.",
            "freq": "Expected"
          },
          {
            "risk": "Subscapularis weakness",
            "detail": "If the subscapularis is detached during the approach.",
            "freq": "Uncommon"
          },
          {
            "risk": "Scar",
            "detail": "Visible anterior shoulder scar.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrent instability",
            "detail": "Despite repair. Approximately 5–8%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Subscapularis failure",
            "detail": "If the muscle does not heal after reattachment.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Axillary or musculocutaneous nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Frozen shoulder",
            "detail": "Post-operative stiffness.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from week one. Active movement from six weeks. Strengthening from three months. Contact sport at six months. Full recovery six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder feeling unstable",
          "Sudden anterior shoulder pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why open instead of arthroscopic?",
            "a": "Open repair gives better visualisation and access for complex cases — bone loss requiring grafting, revision surgery, and severe capsular laxity. For straightforward first-time repairs, arthroscopic technique is usually preferred."
          }
        ]
      }
    ]
  },
  "elbow-aspiration": {
    "name": "Elbow Aspiration and Injection",
    "region": "Elbow",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Elbow aspiration is a procedure to remove fluid from the elbow joint using a needle and syringe. It is performed diagnostically (to analyse the fluid) or therapeutically (to relieve a tense effusion and inject corticosteroid).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The skin is cleaned with antiseptic. The elbow is positioned at 90 degrees of flexion. A needle is inserted into the joint through the 'soft spot' — the triangle between the olecranon, lateral epicondyle, and radial head. Fluid is aspirated. If therapeutic, corticosteroid and local anaesthetic are injected. The procedure takes 5–10 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Aspiration is performed for diagnosis of septic arthritis (emergency), crystal arthropathy (gout or pseudogout), inflammatory arthritis, and to relieve a painful tense effusion after injury or surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Blood tests and imaging can support diagnosis but cannot definitively diagnose joint infection or crystals. When infection is suspected, aspiration is urgent and essential."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No fasting required. Can be performed at the bedside or in clinic."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive fluid analysis for diagnosis. Therapeutic relief of a tense, painful effusion. If corticosteroid is injected, additional pain relief."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Discomfort",
            "detail": "Brief pain during needle insertion.",
            "freq": "Expected"
          },
          {
            "risk": "Bruising",
            "detail": "Minor bruising.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence",
            "detail": "Fluid may reaccumulate if the underlying cause is not treated.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Introduction of infection. Very rare with sterile technique.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Posterior interosseous nerve is nearby. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary pain increase after injection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed beyond local skin anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "No recovery needed. Rest the elbow for 24 hours after injection."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing elbow pain, warmth, or swelling after the procedure",
          "Fever",
          "Redness spreading from the needle site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Fluid results within 24–48 hours. Follow-up based on results."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Where is the 'soft spot'?",
            "a": "The soft spot is the triangle of soft tissue between the olecranon (elbow tip), lateral epicondyle (outer bony bump), and radial head. It provides safe, reliable access to the elbow joint."
          }
        ]
      }
    ]
  },
  "flexor-tendon-repair": {
    "name": "Flexor Tendon Repair",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Flexor tendon repair is an operation to suture a cut flexor tendon in the hand or fingers, restoring the ability to bend the affected digit. Zone II ('no man's land') repairs are the most technically demanding.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The wound is explored and extended with Bruner (zig-zag) incisions to expose the tendon sheath. The cut tendon ends are retrieved and sutured together using a core suture technique (typically four-strand or six-strand) with an epitendinous (running peripheral) suture. Both FDP and FDS tendons are repaired if both are cut. The tendon sheath is repaired when possible. Neurovascular structures are repaired at the same time. The operation takes one to two hours per tendon."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All complete flexor tendon lacerations require surgical repair. Without repair, the ability to bend the finger is permanently lost. Primary repair within days of injury gives the best results. Late presentation (beyond three to four weeks) is much harder to treat."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Not appropriate for complete lacerations. Partial lacerations involving less than 50–60% of the tendon width may be managed with splinting and hand therapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Urgent assessment of tendon, nerve, and vascular function. X-ray to exclude fracture or foreign body. Surgery within 24 hours is ideal, though delayed primary repair up to two to three weeks is possible."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of finger flexion. Results depend on the zone of injury, the number of tendons divided, patient compliance with rehabilitation, and the hand therapy protocol. Zone II (within the flexor sheath) is the most challenging — good to excellent results in approximately 70–80%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Adhesions",
            "detail": "The most common problem. Scar tissue tethers the tendon, limiting glide. Risk is highest in Zone II.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Loss of full extension (flexion contracture) or full flexion.",
            "freq": "Common"
          },
          {
            "risk": "Rupture",
            "detail": "The repair may fail, particularly with premature loading. Risk approximately 3–5% with modern techniques.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tenolysis requirement",
            "detail": "Approximately 10–20% of Zone II repairs need a second operation to release adhesions.",
            "freq": "Common"
          },
          {
            "risk": "Bowstringing",
            "detail": "If the pulleys are not reconstructed, the tendon may pull away from the bone during flexion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Triggering",
            "detail": "Thickening at the repair site may catch on the pulleys.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or sheath infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Joint contracture",
            "detail": "Prolonged immobilisation can cause permanent joint stiffness.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, regional, or wide-awake local anaesthesia with no tourniquet (WALANT). WALANT allows active testing of the repair during surgery."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "A dorsal blocking splint is applied with the wrist and fingers in a protected position. Early active motion protocols (Belfast, Manchester, or equivalent) begin within the first few days under hand therapist supervision — controlled flexion with the splint preventing full extension. Splint for four to six weeks. Progressive active extension from four weeks. Strengthening from eight weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden loss of finger flexion (possible rupture — attend urgently)",
          "Wound redness, swelling, or discharge",
          "Increasing stiffness not improving with exercises",
          "Fever",
          "Triggering or catching of the finger"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Hand therapy appointments twice weekly for six weeks, then weekly. Surgeon review at two weeks and six weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is Zone II so difficult?",
            "a": "Zone II is within the flexor sheath — a tight fibrous tunnel. Both FDP and FDS tendons must glide freely within this confined space. Scar tissue formation (adhesions) is common and restricts the tendon gliding that is essential for finger movement."
          },
          {
            "q": "Why is early movement so important?",
            "a": "Early controlled active motion stimulates tendon healing and prevents adhesions. Modern protocols have dramatically improved outcomes compared to older techniques that immobilised the hand for weeks."
          },
          {
            "q": "What if adhesions limit my movement?",
            "a": "Tenolysis (a second operation to release adhesions) may be needed at three to six months if intensive hand therapy does not restore adequate movement."
          }
        ]
      }
    ]
  },
  "hand-replantation": {
    "name": "Digital Replantation",
    "region": "Hand & Wrist",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Digital replantation is an emergency microsurgical operation to reattach a completely or incompletely amputated finger, thumb, or hand. The severed part is reattached by repairing the bones, tendons, nerves, and blood vessels under a microscope.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The amputated part is carefully preserved in a damp gauze wrap inside a plastic bag placed on ice (not directly on ice). In theatre, the bone is shortened and fixed with K-wires or a plate. The extensor and flexor tendons are repaired. Using an operating microscope, the digital arteries and veins are repaired with microsurgical sutures finer than a human hair. The digital nerves are repaired. The skin is closed loosely. The operation takes four to twelve hours depending on the level and number of digits."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Replantation is strongly indicated for thumb amputations (the thumb provides 40% of hand function), multiple finger amputations, amputations in children (excellent outcomes), and mid-palm or wrist-level amputations. Single finger amputations in adults are more selectively replanted based on the level, mechanism, and patient factors."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Revision amputation (shortening and closing the stump) — this is a valid choice, particularly for single finger amputations in adults where replantation may result in a stiff, painful finger that impairs overall hand function. Prosthetic fingers are available for cosmesis."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency. The amputated part must be preserved correctly — wrapped in moist gauze, placed in a sealed plastic bag, and kept on ice (not frozen). Ischaemia time is critical — ideally less than six hours for fingers (up to 12–24 hours if the part is cooled). The patient must be medically stable for a prolonged anaesthetic."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Successful replantation survival rates are approximately 80–90% at experienced centres. The replanted digit provides useful sensory and motor function, though it is never completely normal. Thumb replantation provides the greatest functional benefit."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "The replanted finger is always stiffer than normal. Total active motion is typically 50–60% of normal.",
            "freq": "Expected"
          },
          {
            "risk": "Cold intolerance",
            "detail": "Hypersensitivity to cold is very common and may be permanent.",
            "freq": "Expected"
          },
          {
            "risk": "Reduced sensation",
            "detail": "Sensation returns but is never fully normal. Protective sensation is achieved in most cases.",
            "freq": "Expected"
          },
          {
            "risk": "Nail deformity",
            "detail": "The nail may be irregular.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Replant failure",
            "detail": "The replanted digit may not survive despite technically successful surgery. Risk approximately 10–20%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vessel thrombosis",
            "detail": "Blood clots in the repaired vessels, most commonly in the first 48–72 hours.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or bone infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Non-union",
            "detail": "The bone may fail to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neuroma",
            "detail": "Painful nerve scar tissue.",
            "freq": "Common"
          },
          {
            "risk": "Secondary procedures",
            "detail": "Tenolysis, nerve grafting, or revision surgery may be needed to optimise function.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia for prolonged surgery. Regional arm block may supplement. Warming, hydration, and vasodilators to optimise blood flow to the replanted part."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay five to seven days with hourly vascular checks of the replanted digit. No smoking (vasospasm risk). Hand therapy begins at two to three weeks once wounds allow. K-wire removal at four to six weeks. Nerve recovery takes months (1 mm/day). Full rehabilitation six to twelve months. Secondary procedures may be needed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Replanted digit turning blue, white, or cold (vascular compromise — contact the team immediately, day or night)",
          "Increasing swelling or tension in the finger",
          "Wound problems",
          "Fever",
          "Dark blood from the fingertip (venous congestion)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Hourly vascular monitoring for 48–72 hours. Daily review for one week. Hand therapy from two to three weeks. Surgeon review at two weeks, six weeks, three months, and six months. Nerve recovery monitoring over twelve to eighteen months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How is the amputated part preserved?",
            "a": "Wrap the part in moist saline-soaked gauze, place it in a sealed plastic bag, and place the bag on ice. Do NOT put the part directly on ice or in water. Do NOT freeze it. Bring it with the patient to hospital."
          },
          {
            "q": "Is it always better to replant?",
            "a": "Not always. A stiff, painful, insensate replanted finger may impair overall hand function more than a well-healed amputation stump. The decision depends on which fingers are amputated, the mechanism of injury, the patient's age and occupation, and ischaemia time. Thumb replantation is almost always attempted."
          },
          {
            "q": "How long does sensation take to return?",
            "a": "Nerves regenerate at approximately 1 mm per day. For a finger amputation, useful sensation typically returns over three to nine months, continuing to improve for up to two years."
          }
        ]
      }
    ]
  },
  "hip-dislocation-closed-reduction": {
    "name": "Closed Reduction of Hip Dislocation",
    "region": "Hip",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Closed reduction of a traumatic hip dislocation is an emergency procedure to relocate a dislocated native hip or prosthetic hip under anaesthesia. Prompt reduction is essential to reduce the risk of avascular necrosis and sciatic nerve injury.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under general anaesthesia or deep sedation with full muscle relaxation, the surgeon applies traction and specific rotational manoeuvres to reduce (relocate) the hip. For posterior dislocations (most common): the Allis or Bigelow manoeuvre is used — longitudinal traction with flexion, adduction, and internal rotation. For anterior dislocations: extension and external rotation. A 'clunk' is felt as the hip reduces. X-ray or CT confirms concentric reduction. The procedure takes 15–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Traumatic hip dislocation is an orthopaedic emergency. The femoral head must be reduced within six hours to minimise the risk of avascular necrosis (loss of blood supply to the femoral head). Every hour of delay increases the AVN risk. Prosthetic hip dislocations also require urgent reduction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no non-operative alternatives. A dislocated hip cannot reduce spontaneously and causes severe pain and neurovascular compromise."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency procedure. X-ray confirms the dislocation and excludes associated fractures. Assessment of sciatic nerve function (foot dorsiflexion, sensation) before reduction. CT after reduction to assess for loose fragments and fractures."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of hip joint congruity. When reduced within six hours, the AVN rate is approximately 5–10%. After six hours, the risk increases significantly."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Sciatic nerve palsy",
            "detail": "Present in approximately 10–20% of posterior dislocations before reduction. May improve after reduction.",
            "freq": "Common"
          },
          {
            "risk": "Recurrent instability",
            "detail": "The hip may be prone to re-dislocation, particularly if there are associated fractures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-traumatic arthritis",
            "detail": "Cartilage damage from the dislocation.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis",
            "detail": "Loss of blood supply to the femoral head. Risk related to time to reduction — approximately 5% if reduced within six hours, up to 50% if delayed beyond twelve hours.",
            "freq": "Uncommon"
          },
          {
            "risk": "Irreducible dislocation",
            "detail": "Soft tissue or bone fragments may block reduction, requiring open surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Iatrogenic fracture",
            "detail": "Fracture during the reduction manoeuvre. Rare with proper technique and muscle relaxation.",
            "freq": "Rare"
          },
          {
            "risk": "Femoral head fracture",
            "detail": "May be missed before reduction — CT after reduction is essential.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with full muscle relaxation is preferred for safe reduction. Deep procedural sedation (e.g., propofol) may be used in the emergency department for experienced teams."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing or partial weight-bearing for four to six weeks. CT scan after reduction to assess for fractures and loose bodies. Physiotherapy for hip range of motion and strengthening. MRI at three to six months to screen for AVN. Full recovery two to six months depending on associated injuries."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Hip feeling unstable or re-dislocating",
          "New leg weakness (foot drop)",
          "Increasing groin or hip pain",
          "Inability to weight-bear after initial improvement"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "CT immediately after reduction. X-ray at six weeks. MRI at three to six months to screen for AVN. Long-term monitoring for post-traumatic arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this an emergency?",
            "a": "The blood supply to the femoral head is compromised while the hip is dislocated. Every hour of delay increases the risk of avascular necrosis — permanent damage to the bone. Reduction within six hours gives the best outcome."
          },
          {
            "q": "Will my hip be normal after reduction?",
            "a": "Most patients recover well if reduction is achieved promptly and there are no associated fractures. However, there is a long-term risk of AVN and post-traumatic arthritis. Regular follow-up with MRI is important."
          },
          {
            "q": "Is there always a sciatic nerve injury?",
            "a": "No. Sciatic nerve injury is present in approximately 10–20% of posterior dislocations. Many recover after reduction, but some have persistent weakness or numbness. Nerve function is carefully assessed before and after reduction."
          }
        ]
      }
    ]
  },
  "toe-amputation": {
    "name": "Toe Amputation",
    "region": "Foot & Ankle",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Toe amputation is an operation to remove part or all of a toe. It is performed for severe infection, non-healing ulcers (particularly in diabetic patients), irreparable deformity, frostbite injury, or tumour.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made around the toe at the planned level of amputation. The toe is removed through the joint (disarticulation) or by cutting through the bone (transmetatarsal if a ray amputation is needed). Skin flaps are fashioned to close the wound. The wound may be left partially open in cases of infection. The operation takes 20–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Amputation is recommended when the toe cannot be salvaged — due to osteomyelitis (bone infection) not responding to antibiotics, non-healing diabetic or vascular ulcers, gangrene, severe irreducible deformity causing skin breakdown, or tumour."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Wound care and antibiotics for infections, vascular assessment and revascularisation for ischaemic toes, offloading for ulcers, and orthotics for deformity. Amputation is considered when these measures fail."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Vascular assessment to ensure adequate blood supply for wound healing. If peripheral vascular disease is present, vascular surgery input is essential. Blood sugar control in diabetic patients. The amputation level is chosen to maximise healing potential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of the source of infection or non-healing tissue. Relief of pain. Most patients walk well after toe amputation — the foot adapts remarkably. Great toe amputation has a greater functional impact than lesser toe amputation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "Particularly in diabetic or vascular patients. The most common complication.",
            "freq": "Common"
          },
          {
            "risk": "Altered gait",
            "detail": "Minor changes in walking pattern, more noticeable with great toe amputation.",
            "freq": "Common"
          },
          {
            "risk": "Transfer lesions",
            "detail": "Increased pressure under adjacent areas of the foot.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Progressive amputation",
            "detail": "If healing fails, a more proximal amputation may be needed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Phantom toe sensation",
            "detail": "Feeling that the amputated toe is still present.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Of the surgical wound.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bone prominence",
            "detail": "Remaining bone may cause pressure problems in shoes.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local digital block, ankle block, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Post-operative shoe or boot until wound healing is confirmed. Daily wound checks in diabetic/vascular patients. Custom insoles to redistribute pressure. Most patients walk well within two to four weeks. Specialist diabetic foot follow-up if applicable."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness, swelling, or discharge",
          "Toes or foot turning dark",
          "Fever",
          "Increasing pain",
          "Foul smell from the wound"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound checks at one week, two weeks, and until healed. Diabetic foot team follow-up. Orthotics assessment."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk normally?",
            "a": "Most patients walk well after toe amputation. Lesser toe amputations have minimal impact. Great toe amputation affects push-off strength and may require a shoe filler or custom insole."
          },
          {
            "q": "Why can't the toe be saved?",
            "a": "When bone is infected (osteomyelitis), blood supply is insufficient, or tissue is dead (gangrene), salvage attempts risk spreading infection or prolonging non-healing wounds. Amputation removes the problem and allows healing."
          }
        ]
      }
    ]
  },
  "midfoot-arthritis-fusion": {
    "name": "Midfoot Arthritis Fusion (TMT Arthrodesis)",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Midfoot arthritis fusion is an operation to permanently stiffen one or more tarsometatarsal (TMT) joints in the midfoot that have become arthritic, typically from previous Lisfranc injury, primary osteoarthritis, or inflammatory arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the top of the midfoot. The cartilage is removed from the affected TMT joints. The joints are aligned in the correct position and fixed with screws, plates, or staples. Bone graft may be used. Multiple joints can be fused in a single operation. The first, second, and third TMT joints are fused more commonly than the fourth and fifth (which are more mobile and rarely fused). The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for painful midfoot arthritis that has not responded to stiff-soled shoes, orthotics, carbon fibre insoles, injection, and activity modification."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Stiff-soled or rocker-bottom shoes, carbon fibre footplate insoles, corticosteroid injection, activity modification, and weight management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT scan. Plan for six to twelve weeks of restricted weight-bearing."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good pain relief in approximately 85–90% of patients. The midfoot joints contribute very little to normal gait, so fusion causes minimal functional limitation for walking."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Swelling",
            "detail": "Prolonged forefoot swelling for several months.",
            "freq": "Expected"
          },
          {
            "risk": "Hardware prominence",
            "detail": "Screws on the dorsum of the foot may be palpable and may need removal.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Expected at the fused joints but well tolerated.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "One or more joints may fail to fuse. Risk approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Dorsal cutaneous nerves causing numbness.",
            "freq": "Uncommon"
          },
          {
            "risk": "Transfer metatarsalgia",
            "detail": "Pain under adjacent metatarsal heads.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Particularly in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malunion",
            "detail": "Fusion in a suboptimal position.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast for six to eight weeks. Weight-bearing boot for four to six weeks. Normal footwear at three to four months. Full recovery six to twelve months. Carbon fibre insoles may improve comfort long-term."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Cast too tight",
          "Toes blue or numb",
          "Increasing midfoot pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months. Hardware removal if symptomatic at six to twelve months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I notice the fusion?",
            "a": "The medial midfoot joints contribute very little to normal walking. Most patients do not notice significant functional limitation. Stiff-soled shoes are generally more comfortable."
          },
          {
            "q": "Is this the same as midfoot (Lisfranc) fusion?",
            "a": "Yes — both involve fusion of the TMT joints. The term 'Lisfranc fusion' is used when the arthritis follows a Lisfranc injury; 'TMT arthrodesis' is used for primary arthritis. The surgical technique is the same."
          }
        ]
      }
    ]
  },
  "spinal-abscess-drainage": {
    "name": "Spinal Epidural Abscess Drainage",
    "region": "Spine",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Spinal epidural abscess drainage is an emergency operation to decompress the spinal cord or nerve roots from a collection of pus in the epidural space. Without urgent treatment, the abscess causes irreversible spinal cord damage and paralysis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline incision is made over the affected spinal level(s). Laminectomy is performed to access the epidural space. The abscess is identified, drained, and thoroughly irrigated. Infected tissue and granulation tissue are debrided. Multiple tissue and fluid samples are taken for microbiology. If the spine is unstable (from vertebral osteomyelitis or discitis), stabilisation with screws and rods may be added. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Emergency surgery is indicated for epidural abscess with neurological deficit (weakness, bladder dysfunction), progressive neurological deterioration, failure of antibiotic treatment alone, or abscess confirmed on MRI with clinical signs of spinal cord compression. Time to surgery directly affects neurological outcome — patients treated within 24–36 hours of neurological onset have the best chance of recovery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Antibiotics alone may be appropriate for small abscesses without neurological deficit, identified early on MRI, with a known organism sensitive to antibiotics, and with the ability for close neurological monitoring. However, any neurological deterioration mandates immediate surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency MRI of the entire spine (abscesses may be multi-level). Blood cultures. Assessment of neurological function. Source identification (urinary, skin, dental, IV drug use). This is a surgical emergency."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Decompression of the spinal cord/nerves, drainage of the infection, and microbiological diagnosis guiding antibiotic therapy. Neurological recovery depends on the duration and severity of deficit before surgery — earlier intervention gives better outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged antibiotics",
            "detail": "Intravenous antibiotics for at least six weeks, often longer.",
            "freq": "Expected"
          },
          {
            "risk": "Incomplete neurological recovery",
            "detail": "If the spinal cord was compressed for more than 24–36 hours, recovery may be partial or absent.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence",
            "detail": "The abscess may recur, requiring repeat surgery.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Permanent neurological deficit",
            "detail": "Paralysis, bladder/bowel dysfunction if the cord was damaged before or during surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spinal instability",
            "detail": "Extensive laminectomy may cause instability requiring later fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound infection",
            "detail": "High risk in the context of systemic infection.",
            "freq": "Common"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear during decompression.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sepsis",
            "detail": "Systemic spread of infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Death",
            "detail": "In severely unwell patients with sepsis and multiple comorbidities.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. The patient may be septic and haemodynamically unstable. Positioned prone."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Intensive care or high-dependency unit initially if septic. IV antibiotics for at least six weeks via PICC line. Regular blood tests (CRP, ESR, white cell count). Repeat MRI to monitor resolution. Physiotherapy for mobility and neurological rehabilitation. Recovery depends on the extent of neurological damage — may require prolonged inpatient rehabilitation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg weakness or new paralysis",
          "Loss of bladder or bowel control",
          "Fever despite antibiotics",
          "Wound discharge or breakdown",
          "Increasing back pain"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Daily neurological assessment initially. Regular blood tests. Repeat MRI at six weeks and three months. Infectious diseases team involvement. PICC line management. Follow-up for months to ensure infection clearance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How did the abscess form?",
            "a": "Spinal epidural abscesses most commonly arise from haematogenous spread (bacteria travelling through the bloodstream from another infection site — skin, urinary, dental, endocarditis) or direct spread from vertebral osteomyelitis/discitis. Risk factors include diabetes, immunosuppression, IV drug use, and recent spinal procedures."
          },
          {
            "q": "Will I recover neurological function?",
            "a": "Recovery depends on the duration and severity of neurological deficit before surgery. Patients treated within 24–36 hours of onset generally have the best chance. Complete paralysis lasting more than 48–72 hours has a much poorer prognosis for recovery."
          }
        ]
      }
    ]
  },
  "bone-grafting-principles": {
    "name": "Bone Grafting (Principles and Techniques)",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Bone grafting is a surgical technique to promote bone healing by placing bone tissue — from the patient (autograft), a donor (allograft), or synthetic material — at a fracture or fusion site. It is used when the body's own healing response needs augmentation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Autograft (patient's own bone): most commonly harvested from the iliac crest (pelvis). An incision is made over the pelvic brim and bone is taken using a gouge or trephine. Alternatively, local bone from the surgical site, the Reamer-Irrigator-Aspirator (RIA), or distal radius may be used. Allograft (donor bone): obtained from a tissue bank, available as chips, struts, or freeze-dried powder. Synthetic: bone substitutes such as tricalcium phosphate, hydroxyapatite, or bone morphogenetic protein (BMP). The graft is placed at the target site — fracture non-union, fusion bed, or bone defect."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Bone grafting is used for fracture non-unions, spinal fusion, filling bone defects after tumour surgery, arthrodesis procedures, and revision arthroplasty with bone loss."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For non-unions: bone stimulators (electromagnetic, ultrasound), PRP/stem cell injections (limited evidence). For bone defects: some defects heal by secondary intention with time."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Assessment of the graft requirement (volume, structural vs. cancellous). If autograft, the iliac crest harvest site is planned. If allograft, the graft is sourced from a tissue bank."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Autograft is the gold standard — it provides living bone cells (osteogenesis), a scaffold for new bone growth (osteoconduction), and growth factors that stimulate bone formation (osteoinduction). Union rates for autograft-augmented non-unions are approximately 85–95%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Donor site pain",
            "detail": "Iliac crest harvest site pain is the most common complaint. Affects 10–30% of patients and may persist for months.",
            "freq": "Common"
          },
          {
            "risk": "Donor site haematoma",
            "detail": "Bleeding at the harvest site.",
            "freq": "Common"
          },
          {
            "risk": "Numbness",
            "detail": "Lateral femoral cutaneous nerve injury causing thigh numbness from iliac crest harvest.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Donor site fracture",
            "detail": "Iliac crest fracture after harvest. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Pelvic instability",
            "detail": "If too much bone is taken. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "At the harvest or recipient site.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft resorption",
            "detail": "Allograft or synthetic graft may be resorbed before incorporation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Disease transmission",
            "detail": "Extremely rare with modern allograft screening.",
            "freq": "Rare"
          },
          {
            "risk": "Hernia",
            "detail": "Through the iliac crest defect. Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia. The harvest site adds a second surgical field."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "The iliac crest harvest site is sore for two to six weeks. Walking is permitted immediately. The recovery from the primary procedure (non-union surgery, fusion, etc.) determines the overall rehabilitation timeline."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, swelling, or redness at the harvest site",
          "Wound discharge from either site",
          "Fever",
          "Haematoma at the iliac crest"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Follow-up is determined by the primary procedure. The graft incorporation is monitored with X-rays."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is autograft better than allograft?",
            "a": "Autograft is living bone with cells, scaffold, and growth factors — the gold standard. Allograft provides scaffold but no living cells. Synthetic substitutes provide scaffold only. Autograft has the highest healing rates but requires a second surgical site."
          },
          {
            "q": "Can bone be harvested from somewhere other than the pelvis?",
            "a": "Yes. Local bone from the surgical site, the RIA system (which harvests bone from the femoral canal), and the distal radius are alternatives. The iliac crest remains the most commonly used and reliable source."
          }
        ]
      }
    ]
  },
  "patellar-tendinopathy-surgery": {
    "name": "Patellar Tendinopathy Surgery (Jumper's Knee)",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Patellar tendinopathy surgery is an operation for chronic patellar tendon pain ('jumper's knee') that has not responded to prolonged non-operative treatment. It involves debridement of the degenerate portion of the tendon, with or without excision of the inferior patellar pole.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The procedure may be performed arthroscopically or through a small open incision. The degenerate portion of the proximal patellar tendon (typically the deep posterior fibres at the inferior pole of the patella) is identified and excised. The inferior pole of the patella may be shaved (patellar pole resection) to remove impinging bone. Open repair: the tendon sheath is opened, degenerate tissue excised, and the remaining tendon repaired. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered after failure of at least six to twelve months of dedicated non-operative treatment — heavy slow resistance (HSR) exercises, eccentric loading programme, activity modification, and potentially shockwave therapy or PRP injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Heavy slow resistance (HSR) or eccentric decline squat programmes (the cornerstone of treatment), isometric loading for pain relief, activity modification, shockwave therapy, PRP injection, and GTN patches. Non-operative treatment is successful in the majority."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Ultrasound or MRI confirming tendinopathy with structural change. Documentation of failed non-operative treatment. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and return to sport in approximately 70–80% of patients. Recovery is gradual — return to full sport takes four to six months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Four to six months to return to full sport.",
            "freq": "Expected"
          },
          {
            "risk": "Anterior knee pain",
            "detail": "Residual anterior knee discomfort.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Not all patients achieve complete relief.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon rupture",
            "detail": "Weakening of the tendon from debridement.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Patellar fracture",
            "detail": "From excessive bone resection at the inferior pole.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "Tendinopathy may recur with return to loading.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Isometric quadriceps exercises from week one. Progressive loading programme supervised by physiotherapy. Jogging at two to three months. Impact sport at four to six months. Full recovery six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden increase in anterior knee pain (possible tendon complication)",
          "Wound problems",
          "Knee swelling",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks. Physiotherapy throughout."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is non-operative treatment tried for so long?",
            "a": "Patellar tendinopathy responds well to structured loading programmes in most patients. Surgery is only considered when a dedicated programme of at least six months has not provided adequate relief. Tendon biology requires time — three to six months — to respond to loading."
          },
          {
            "q": "Can I return to jumping sports?",
            "a": "Most patients return to their sport, though it takes four to six months of graduated rehabilitation. The tendon must be progressively loaded to adapt before returning to high-impact activities."
          }
        ]
      }
    ]
  },
  "knee-dislocation-management": {
    "name": "Knee Dislocation (Emergency Management)",
    "region": "Knee",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee dislocation is a limb-threatening emergency where the tibia displaces completely from the femur, disrupting multiple ligaments and potentially damaging the popliteal artery. Immediate reduction and vascular assessment are critical to save the limb.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Emergency reduction: under sedation or general anaesthesia, the knee is reduced by applying longitudinal traction and reversing the direction of displacement. The knee is splinted in slight flexion. Vascular assessment: pedal pulses are checked, and Ankle-Brachial Pressure Index (ABPI) is measured. If pulses are absent or ABPI is less than 0.9, urgent CT angiography is performed. Vascular repair within six to eight hours if the artery is damaged. External fixation may be applied to maintain reduction. Definitive ligament reconstruction is typically delayed two to three weeks."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Knee dislocation is an emergency because the popliteal artery is at risk — the artery is tethered behind the knee and tears in approximately 20–40% of dislocations. A delay of more than six to eight hours in restoring blood flow results in a high amputation rate."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no alternatives to emergency reduction. Definitive ligament reconstruction may be staged or, rarely, managed non-operatively with bracing in patients unfit for surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency. Reduction first. Vascular assessment immediately after. Splinting and serial neurovascular monitoring. MRI when the patient is stable to plan definitive ligament surgery."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Limb salvage when vascular injury is identified and treated promptly. Restoration of knee stability with staged ligament reconstruction. Most patients achieve a functional knee, though some degree of residual laxity is common."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Vascular injury",
            "detail": "Popliteal artery damage in 20–40% of dislocations.",
            "freq": "Common"
          },
          {
            "risk": "Peroneal nerve palsy",
            "detail": "Common peroneal nerve injury causing foot drop in approximately 25–35%.",
            "freq": "Common"
          },
          {
            "risk": "Knee stiffness",
            "detail": "Very common after multi-ligament injury. Arthrofibrosis in 10–20%.",
            "freq": "Common"
          },
          {
            "risk": "Residual instability",
            "detail": "Some degree of persistent laxity despite reconstruction.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Amputation",
            "detail": "If vascular repair fails or is delayed beyond six to eight hours. Risk approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "From reperfusion injury after vascular repair.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chronic pain",
            "detail": "Complex regional pain syndrome or chronic knee pain.",
            "freq": "Uncommon"
          },
          {
            "risk": "Deep vein thrombosis",
            "detail": "High risk with immobility.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Sedation or general anaesthesia for reduction. General anaesthesia for vascular repair and subsequent procedures."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Initial external fixation or hinged brace. Staged ligament reconstruction at two to three weeks. Prolonged rehabilitation over twelve to eighteen months. Return to sport at twelve to eighteen months. Some patients do not return to high-level sport."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Foot turning cold, white, or pulseless (VASCULAR EMERGENCY — attend A&E immediately)",
          "Severe calf tightness (compartment syndrome)",
          "Foot drop",
          "Increasing knee swelling",
          "Wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Serial vascular assessments in the first 48 hours. MRI for ligament assessment. Staged reconstruction at two to three weeks. Long-term rehabilitation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this different from a patellar dislocation?",
            "a": "A true knee dislocation involves complete displacement of the tibia from the femur — a completely different and much more serious injury than a patellar (kneecap) dislocation. Knee dislocations are limb-threatening emergencies."
          },
          {
            "q": "Will my knee ever be normal?",
            "a": "Most patients achieve a functional, stable knee with staged reconstruction and dedicated rehabilitation. However, some degree of residual laxity, stiffness, or discomfort is common. Return to high-level sport is possible but not guaranteed."
          }
        ]
      }
    ]
  },
  "knee-osteochondritis-dissecans": {
    "name": "Osteochondritis Dissecans (OCD) Treatment",
    "region": "Knee",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Osteochondritis dissecans (OCD) treatment involves surgical intervention for a fragment of cartilage and underlying bone that has separated or is separating from the joint surface. Treatment depends on whether the fragment is stable or unstable.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Arthroscopic drilling: for stable lesions, multiple small holes are drilled through the intact cartilage into the underlying bone to stimulate a healing blood supply. Fixation: for unstable lesions, the fragment is reduced (replaced) and fixed with bioabsorbable pins, headless screws, or fibrin glue. Fragment removal and microfracture: if the fragment is non-viable, it is removed and the defect is treated with microfracture, OATS, ACI, or osteochondral allograft depending on size. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for OCD lesions that are unstable (loose or detaching), causing mechanical symptoms, or have not healed with activity modification and observation. In children with open growth plates, stable lesions may be observed initially."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Activity modification and restricted weight-bearing for stable lesions, particularly in children with open growth plates. Observation with serial MRI to monitor healing. Non-operative management is successful in approximately 50% of juvenile OCD cases."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess lesion stability and size. X-rays including tunnel view. Arthroscopy may be diagnostic and therapeutic."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "For stable lesions treated with drilling: healing rates approximately 80–90% in juveniles. For unstable lesions fixed in situ: healing rates approximately 70–85%. For fragment removal with cartilage restoration: outcomes depend on defect size and chosen technique."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent symptoms",
            "detail": "Ongoing knee pain despite treatment.",
            "freq": "Uncommon"
          },
          {
            "risk": "Swelling",
            "detail": "Knee swelling during healing.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of full range.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fragment non-healing",
            "detail": "The fixed fragment may not heal and may detach again.",
            "freq": "Uncommon"
          },
          {
            "risk": "Progression to arthritis",
            "detail": "If the joint surface is damaged significantly.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "With restricted weight-bearing.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing restrictions for six to eight weeks (depending on the procedure). Physiotherapy for range of motion and strengthening. Running at three to four months. Return to sport at four to six months. MRI to confirm healing."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Knee locking or catching (possible loose body)",
          "Increasing swelling",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "MRI at three and six months to assess healing. X-rays. Long-term monitoring."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes OCD?",
            "a": "The exact cause is unknown. It may involve repetitive microtrauma, reduced blood supply, and genetic factors. It is most common in adolescents and young adults, particularly those active in sport."
          },
          {
            "q": "Will it heal on its own?",
            "a": "In children with open growth plates, approximately 50% of stable OCD lesions heal with activity modification alone. Adults and unstable lesions generally require surgery."
          }
        ]
      }
    ]
  },
  "pectoralis-major-repair": {
    "name": "Pectoralis Major Repair",
    "region": "Shoulder",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Pectoralis major repair is an operation to reattach a torn pectoralis major tendon to the humerus. Rupture typically occurs during heavy bench pressing or other forceful horizontal adduction activities.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the anterior axillary fold (front of the armpit). The retracted tendon stump is identified and mobilised. The humeral insertion site is prepared. The tendon is reattached using suture anchors or through bone tunnels. For chronic ruptures, a tendon graft may be needed. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgical repair is recommended for complete pectoralis major ruptures in active patients, particularly those involved in strength training, contact sports, or manual labour. Without repair, there is permanent loss of adduction and internal rotation strength and a visible cosmetic deformity."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and acceptance of the strength deficit and cosmetic deformity. Non-operative management is reasonable for partial tears, elderly patients, or those with low physical demands."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or ultrasound to confirm the tear and assess retraction. Surgery is ideally performed within six weeks of injury. Chronic repairs (beyond three months) are more complex and outcomes are less predictable."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of pectoralis strength to approximately 90% of normal. Correction of the cosmetic deformity. Most patients return to full bench pressing at six to nine months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Anterior chest/axillary discomfort",
            "detail": "Soreness at the repair site for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Scar",
            "detail": "Visible scar in the axillary fold.",
            "freq": "Expected"
          },
          {
            "risk": "Residual weakness",
            "detail": "Minor strength deficit compared to the uninjured side.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail, particularly with premature heavy loading. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Lateral pectoral nerve or medial pectoral nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection in the chest wall.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "Shoulder stiffness from immobilisation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Beach-chair position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. No bench pressing or heavy pushing for four months. Graduated strengthening from six weeks. Light bench pressing at four months. Full bench pressing at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sudden loss of pectoralis strength (re-rupture)",
          "Chest wall swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does this happen?",
            "a": "Pectoralis major ruptures almost always occur during heavy eccentric loading — typically the lowering phase of a bench press with heavy weight. Risk factors include anabolic steroid use (which weakens tendons), prior corticosteroid injection, and fluoroquinolone antibiotics."
          },
          {
            "q": "Can I bench press again?",
            "a": "Yes — most patients return to full bench pressing at six to nine months. Starting with light weight and gradually progressing under physiotherapy guidance is essential."
          }
        ]
      }
    ]
  },
  "total-hip-revision": {
    "name": "Complex Revision Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Complex revision hip replacement is a major operation to remove a failed, worn, or infected hip replacement and insert new components. It is more complex than primary hip replacement due to bone loss, scar tissue, and altered anatomy.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is reopened (or a new approach used). The old components are carefully removed — this may require specialised instruments, osteotomies (controlled bone cuts), and significant time if the implants are well-fixed or cemented. Bone defects are assessed and reconstructed using bone graft, metal augments, trabecular metal components, or cages. New revision components with longer stems and larger cups are implanted. The operation takes two to five hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision is needed for aseptic loosening (the implant has become loose), periprosthetic infection (after failed DAIR), recurrent dislocation, periprosthetic fracture, wear or failure of bearing surfaces, and adverse reaction to metal debris."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For loosening: observation if asymptomatic and minimally progressive. For infection: long-term antibiotic suppression (accepting persistent infection). For dislocation: constrained liner or bracing. These are rarely definitive solutions."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan with metal artefact reduction for bone stock assessment. Blood tests including metal ions and inflammatory markers. If infection is suspected, joint aspiration. Identification of the existing implant type. Blood available for transfusion. Specialist revision centre."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of hip function and pain relief. Revision hip replacement outcomes are generally good but less predictable than primary surgery. Dislocation, infection, and re-revision rates are higher than primary."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Longer recovery",
            "detail": "Recovery is slower than primary hip replacement.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Significant. Transfusion commonly needed.",
            "freq": "Common"
          },
          {
            "risk": "Leg length discrepancy",
            "detail": "More common than in primary surgery.",
            "freq": "Common"
          },
          {
            "risk": "Dislocation",
            "detail": "Risk approximately 5–10%, higher than primary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Intra-operative fracture",
            "detail": "The weakened bone may fracture during component removal or insertion.",
            "freq": "Common"
          },
          {
            "risk": "Nerve injury",
            "detail": "Sciatic nerve at increased risk due to scar tissue.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Risk approximately 5–10%, much higher than primary surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-revision",
            "detail": "Further revision may be needed over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Bone graft failure",
            "detail": "Allografts may not incorporate.",
            "freq": "Uncommon"
          },
          {
            "risk": "Medical complications",
            "detail": "Many revision patients are elderly with comorbidities.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Prolonged operating time. Cell salvage and transfusion capability essential."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay three to seven days. Weight-bearing may be restricted depending on bone quality and reconstruction. Crutches for six to twelve weeks. Hip precautions for six to twelve weeks. Physiotherapy for hip strengthening. Full recovery six to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Hip feeling unstable or dislocating",
          "Sudden onset groin pain",
          "Wound problems",
          "Increasing leg length discrepancy"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays at six weeks, three months, one year, and then annually. Long-term surveillance of the reconstruction."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is revision more complex than primary?",
            "a": "Bone loss, scar tissue, cement removal, altered anatomy, and compromised soft tissues make revision surgery significantly more challenging. It requires specialist training and equipment."
          },
          {
            "q": "How long will a revision hip last?",
            "a": "Revision implants generally have shorter survival than primary implants. Modern revision constructs have approximately 80–90% survival at ten years, but this depends on the patient, the indication, and the quality of remaining bone."
          }
        ]
      }
    ]
  },
  "diabetic-foot-surgery": {
    "name": "Diabetic Foot Surgery (Charcot Reconstruction / Ulcer Debridement)",
    "region": "Foot & Ankle",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Diabetic foot surgery encompasses a range of procedures to manage the complications of diabetes on the foot — including Charcot neuroarthropathy reconstruction, ulcer debridement, osteomyelitis treatment, and deformity correction to create a plantigrade, shoeable foot.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Charcot reconstruction: the collapsed, deformed midfoot or hindfoot is realigned through osteotomies, bone excision, and fusion using large screws, beams, or circular frames. The goal is a plantigrade (flat) foot that fits in a shoe without pressure points. Ulcer debridement: infected or non-healing tissue is excised, bone may be resected if osteomyelitis is present, and the wound is managed with negative pressure therapy or local flaps. Tendon lengthening (particularly Achilles) may be performed to reduce forefoot pressure. The operation varies from 30 minutes (debridement) to four hours (Charcot reconstruction)."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for Charcot deformity that cannot be braced and causes recurrent ulceration, osteomyelitis not responding to antibiotics, chronic non-healing ulcers with correctable underlying deformity, and acute diabetic foot infections requiring urgent debridement."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Total contact casting for acute Charcot, custom orthotics and bracing, offloading footwear, wound care, antibiotics for infection, and vascular assessment and revascularisation for ischaemia."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Vascular assessment (ABPI, duplex ultrasound, or angiography) — adequate blood supply is essential for healing. Blood sugar optimisation. Infection control. Multidisciplinary diabetic foot team involvement. Nutritional assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Creation of a plantigrade, shoeable foot that can be protected with appropriate footwear and orthotics. Resolution of chronic ulceration by removing the underlying pressure point. Eradication of bone infection."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound healing problems",
            "detail": "The most significant concern. Diabetic patients have impaired wound healing.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged non-weight-bearing",
            "detail": "Six to twelve weeks or longer for Charcot reconstruction.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence",
            "detail": "Ulcers may recur if footwear and offloading are not maintained.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "For osteomyelitis.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Very high risk in Charcot bone. May need revision.",
            "freq": "Common"
          },
          {
            "risk": "Amputation",
            "detail": "If healing fails or infection spreads. Minor (toe/ray) or major (below/above knee).",
            "freq": "Uncommon"
          },
          {
            "risk": "Charcot recurrence",
            "detail": "The Charcot process may continue or recur at adjacent joints.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware failure",
            "detail": "Screws and plates may fail in soft Charcot bone.",
            "freq": "Common"
          },
          {
            "risk": "Deep infection",
            "detail": "Particularly with internal fixation in compromised tissue.",
            "freq": "Uncommon"
          },
          {
            "risk": "Contralateral foot problems",
            "detail": "The other foot is at equal risk.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Regional ankle block for post-operative pain (neuropathic patients may have reduced pain). Careful positioning — insensate feet are vulnerable to pressure injury."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to twelve weeks (Charcot reconstruction). Total contact cast or boot. Gradual transition to weight-bearing in a custom orthotic and diabetic footwear. Lifelong specialist footwear, orthotics, and foot surveillance. Regular podiatry. The contralateral foot must also be monitored."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown or discharge",
          "Foot turning dark or cold",
          "Fever",
          "Increasing foot deformity",
          "New ulceration",
          "Rising blood sugars"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent wound reviews. Regular X-rays. Lifelong diabetic foot surveillance. Multidisciplinary foot team reviews."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is Charcot foot?",
            "a": "Charcot neuroarthropathy is a destructive condition where the bones and joints of the foot collapse and fragment due to loss of protective sensation (neuropathy). The foot becomes deformed, creating pressure points that ulcerate. It is most common in diabetic patients with peripheral neuropathy."
          },
          {
            "q": "Can amputation be avoided?",
            "a": "With prompt, expert management, most diabetic foot complications can be managed without major amputation. The key is early recognition, multidisciplinary care, vascular assessment, infection control, and appropriate offloading."
          }
        ]
      }
    ]
  },
  "occipitocervical-fusion": {
    "name": "Occipitocervical Fusion",
    "region": "Spine",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Occipitocervical fusion is a complex operation to stabilise the junction between the skull (occiput) and the upper cervical spine using screws, rods, and bone graft. It is performed for instability at the craniovertebral junction from rheumatoid arthritis, trauma, tumour, or congenital anomaly.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline incision is made from the base of the skull to the upper cervical spine. Screws are placed into the occiput (skull bone) and into the C1 lateral masses and/or C2 pedicles. Rods are contoured to the normal occipitocervical alignment and connected to the screws. Bone graft is placed to promote fusion. If there is spinal cord compression, decompression may be performed at the same time. The operation takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Occipitocervical fusion is recommended for atlantoaxial instability from rheumatoid arthritis (erosion of the odontoid peg and transverse ligament), traumatic occiput-C1 or C1-C2 injuries, tumours of the upper cervical spine, congenital anomalies (os odontoideum, occipitalisation of C1), and basilar invagination."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Rigid cervical orthosis (halo vest or rigid collar) for specific stable injuries. Observation for stable, asymptomatic subluxation. However, craniovertebral instability with myelopathy generally requires surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT with 3D reconstruction for screw trajectory planning. MRI to assess spinal cord compression. CT angiography to map the vertebral arteries. Assessment of swallowing function (may be affected post-operatively). This is a high-risk procedure performed at specialist centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Stabilisation of the craniovertebral junction, preventing further spinal cord compression and potential quadriplegia or death from brainstem compression. Neurological symptoms may stabilise or improve."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of head rotation",
            "detail": "Significant loss of head rotation (approximately 50% of total cervical rotation occurs at C1-C2).",
            "freq": "Expected"
          },
          {
            "risk": "Posterior neck pain",
            "detail": "From extensive muscle dissection.",
            "freq": "Common"
          },
          {
            "risk": "Dysphagia",
            "detail": "Difficulty swallowing, usually temporary, from soft tissue swelling.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Vertebral artery injury",
            "detail": "The vertebral arteries run through the C1-C2 region. Injury can cause stroke. Risk approximately 2–4%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spinal cord injury",
            "detail": "Risk of quadriplegia or death from manipulation of the unstable craniovertebral junction. Risk approximately 1–2%.",
            "freq": "Rare"
          },
          {
            "risk": "Screw malposition",
            "detail": "Particularly C2 pedicle screws.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pseudarthrosis",
            "detail": "Failure of fusion.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound infection",
            "detail": "Approximately 2–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Subaxial subluxation",
            "detail": "Increased stress on levels below the fusion.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with fibreoptic intubation (the neck must not be extended during intubation). Neuromonitoring throughout. Meticulous positioning — the unstable spine must be protected."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Rigid cervical collar for six to twelve weeks. Hospital stay three to seven days. Swallowing assessment before eating. Return to desk work at six to eight weeks. Avoid heavy lifting for three months. Full fusion at three to six months. Permanent loss of approximately 50% of head rotation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Difficulty breathing or swallowing",
          "Worsening arm or leg weakness",
          "Loss of balance",
          "Wound discharge or swelling at the back of the neck",
          "Fever",
          "Headache"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays and CT at six weeks, three months, and six months. Long-term monitoring for subaxial degeneration."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this so high-risk?",
            "a": "The upper cervical spine houses the brainstem and upper spinal cord — the most critical neurological structures. The vertebral arteries also pass through this region. Surgery here requires extreme precision."
          },
          {
            "q": "Will I be able to turn my head?",
            "a": "Head rotation will be significantly reduced because the C1-C2 joint (which provides 50% of cervical rotation) is fused. Most patients adapt, though driving may require additional mirrors."
          }
        ]
      }
    ]
  },
  "mangled-extremity-assessment": {
    "name": "Mangled Extremity Assessment and Decision-Making",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Mangled extremity assessment is the systematic evaluation of a severely injured limb to determine whether limb salvage or amputation offers the best functional outcome. It is one of the most complex decisions in orthopaedic trauma.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Assessment follows a structured approach evaluating bone injury severity, soft tissue damage, vascular status, nerve function, and patient factors. Scoring systems (MESS, LEAP criteria) provide guidance but do not dictate the decision. The assessment includes: vascular status — is there blood flow to the foot/hand? Nerve function — is the tibial/posterior interosseous nerve intact? Soft tissue — can adequate coverage be achieved? Bone — can the skeleton be reconstructed? Patient factors — age, comorbidities, smoking, occupation, patient wishes. The decision is made by a senior multidisciplinary team including orthopaedic, vascular, and plastic surgeons."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Formal assessment is required for all Gustilo type IIIB and IIIC open fractures, crush injuries with prolonged ischaemia, blast injuries, and any limb where viability is in question. The decision between salvage and amputation profoundly affects the patient's life and must be made carefully."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "This is a decision-making process, not a procedure. The outcome is either limb salvage (with extensive reconstruction) or amputation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency assessment. Vascular status is the most time-critical factor — warm ischaemia beyond six hours dramatically reduces salvage success. Photography of the injury. Senior review."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "A well-informed decision that gives the patient the best functional outcome. Evidence from the LEAP study shows that functional outcomes two years after salvage versus amputation of severe lower limb injuries are similar — the quality of the decision and the rehabilitation are more important than the decision itself."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Uncertainty",
            "detail": "The decision is often not clear-cut. Multiple factors must be weighed.",
            "freq": "Expected"
          },
          {
            "risk": "Emotional burden",
            "detail": "The decision profoundly affects the patient and their family.",
            "freq": "Expected"
          },
          {
            "risk": "Salvage may fail",
            "detail": "Attempted salvage may ultimately fail, requiring secondary amputation — which has worse outcomes than primary amputation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Secondary amputation",
            "detail": "If salvage fails after prolonged treatment. Poorer outcomes than primary amputation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chronic pain",
            "detail": "Both salvage and amputation carry risk of chronic pain.",
            "freq": "Common"
          },
          {
            "risk": "Psychological morbidity",
            "detail": "Depression, PTSD, and adjustment disorder are common after major limb trauma.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Assessment is clinical. Surgical intervention (salvage or amputation) requires general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery depends entirely on the chosen pathway. Salvage: multiple operations over months, prolonged rehabilitation, twelve to twenty-four months to maximum improvement. Amputation: prosthetic fitting at six to eight weeks, gait training, maximum improvement at twelve to eighteen months. Both pathways require intensive physiotherapy and psychological support."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Limb turning cold, mottled, or pulseless",
          "Increasing pain not controlled by medication",
          "Wound infection or breakdown",
          "Psychological crisis"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Intensive multidisciplinary follow-up for both pathways. Psychological support. Regular assessment of function and quality of life."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is amputation always worse than salvage?",
            "a": "No. The LEAP study showed that functional outcomes at two years are similar for salvage and amputation of severe lower limb injuries. A well-functioning amputation with a modern prosthesis can be superior to a chronically painful, stiff salvaged limb. The best outcome depends on individual circumstances."
          },
          {
            "q": "Who makes the decision?",
            "a": "The decision is made collaboratively by the patient (when conscious and able) and a senior multidisciplinary team. The patient's wishes, occupation, activity level, and overall health are central to the discussion."
          },
          {
            "q": "What is the MESS score?",
            "a": "The Mangled Extremity Severity Score (MESS) considers skeletal/soft tissue injury, limb ischaemia, shock, and patient age. A score of 7 or above has historically been considered predictive of amputation, but it has significant limitations and should not be used in isolation."
          }
        ]
      }
    ]
  },
  "paediatric-hip-septic": {
    "name": "Paediatric Septic Arthritis (Hip Washout)",
    "region": "Paediatric Orthopaedics",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Paediatric septic arthritis of the hip is a surgical emergency requiring urgent washout (irrigation and debridement) of the infected hip joint. Delay risks permanent cartilage destruction and growth plate damage.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the hip (anterior approach, typically Smith-Petersen). The joint capsule is opened and pus is drained. The joint is thoroughly washed with saline. Tissue and fluid samples are sent for urgent microbiology. A drain may be left in place. In some centres, arthroscopic washout is used. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Septic arthritis of the hip in a child is an emergency. The hip joint is deep and pus under pressure destroys articular cartilage within hours. The femoral head blood supply can be compromised, leading to avascular necrosis. Kocher's criteria (fever, non-weight-bearing, raised ESR, raised WCC) guide the clinical diagnosis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Needle aspiration under ultrasound may be diagnostic and temporarily therapeutic. However, established septic arthritis with pus requires formal surgical washout — antibiotics alone are insufficient."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency procedure. Blood tests (WCC, CRP, ESR, blood cultures). Ultrasound showing hip effusion. Joint aspiration if time allows (but must not delay surgery). The main differential diagnosis is transient synovitis — distinguishing the two is critical."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Drainage of pus to prevent cartilage destruction and AVN. When treated within 24 hours of onset, outcomes are generally excellent. Delay beyond 48–72 hours is associated with significantly worse outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent infection",
            "detail": "May require repeat washout.",
            "freq": "Uncommon"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for at least three to four weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Hip stiffness",
            "detail": "Temporary — usually recovers well in children.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Avascular necrosis",
            "detail": "Damage to the femoral head blood supply from pus under pressure.",
            "freq": "Uncommon"
          },
          {
            "risk": "Growth plate damage",
            "detail": "May cause growth disturbance and leg length discrepancy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Chronic osteomyelitis",
            "detail": "Spread of infection to bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Cartilage destruction",
            "detail": "If treatment is delayed, the cartilage may be irreversibly damaged.",
            "freq": "Uncommon"
          },
          {
            "risk": "Joint subluxation or dislocation",
            "detail": "From capsular distension.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Emergency case — fasting status may need pragmatic management."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "IV antibiotics for three to four weeks (may transition to oral if clinically and biochemically improving). Hip rest initially, then gradual return to weight-bearing. Most children recover fully. Follow-up X-rays to monitor for AVN and growth disturbance."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent fever despite antibiotics",
          "Refusal to weight-bear after initial improvement",
          "Hip swelling or redness",
          "Child becoming more unwell",
          "Limping persisting beyond four to six weeks"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Daily clinical assessment while inpatient. Blood tests (CRP) to guide antibiotic duration. X-ray at six weeks. Long-term follow-up at six months, one year, and beyond to monitor for AVN and growth disturbance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do you distinguish septic arthritis from transient synovitis?",
            "a": "Both cause a painful, limping child with a hip effusion. Kocher's criteria (fever >38.5°C, non-weight-bearing, ESR >40, WCC >12,000) help differentiate — if three or four criteria are met, the probability of septic arthritis is high. If in doubt, aspiration is performed."
          },
          {
            "q": "Will my child's hip be normal?",
            "a": "When treated promptly (within 24 hours), most children make a full recovery. Delayed treatment increases the risk of cartilage damage, AVN, and growth disturbance. Long-term follow-up is important to monitor hip development."
          }
        ]
      }
    ]
  },
  "hip-adductor-surgery": {
    "name": "Adductor Tendon Surgery (Groin Pain)",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Adductor tendon surgery involves release, debridement, or repair of the adductor longus tendon at its attachment to the pubic bone. It is performed for chronic athletic groin pain (sports hernia / athletic pubalgia) that has not responded to rehabilitation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the groin crease. The adductor longus tendon origin is identified. For chronic tendinopathy: the degenerate tendon is debrided and the origin partially released (adductor tenotomy). For acute avulsion: the tendon is reattached to bone with suture anchors. The procedure may be combined with inguinal repair (Gilmore's groin) if there is an associated posterior inguinal wall deficiency. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is considered for chronic athletic groin pain with confirmed adductor tendinopathy on MRI that has not responded to at least three to six months of dedicated rehabilitation (isometric and heavy slow resistance exercises, graduated return to sport programme)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Structured rehabilitation programme (the Hölmich protocol), activity modification, corticosteroid or PRP injection, and shockwave therapy. Approximately 70–80% of athletes improve with non-operative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to confirm adductor tendinopathy. Clinical assessment to exclude other causes of groin pain (hip joint pathology, inguinal hernia, nerve entrapment). Diagnostic injection may help confirm the source."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Return to sport in approximately 80–85% of athletes. Recovery takes three to four months."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Groin discomfort",
            "detail": "Soreness in the groin for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Residual weakness",
            "detail": "Some loss of adduction strength, particularly after tenotomy.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Not all athletes achieve full pain resolution.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Adductor weakness",
            "detail": "Permanent reduction in adduction power after tenotomy. Usually functionally acceptable.",
            "freq": "Common"
          },
          {
            "risk": "Nerve entrapment",
            "detail": "Obturator nerve or ilioinguinal nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrence",
            "detail": "Symptoms may recur with return to sport.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Light walking immediately. Graduated rehabilitation programme over three to four months. Running at six to eight weeks. Sport-specific training at ten to twelve weeks. Full return to sport at three to four months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin pain",
          "Wound problems",
          "Fever",
          "New numbness in the inner thigh"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks. Graduated return to sport supervised by physiotherapy."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is athletic pubalgia / sports hernia?",
            "a": "Athletic pubalgia is a broad term for exercise-related groin pain involving the adductor tendons, pubic symphysis, and/or posterior inguinal wall. It is not a true hernia in most cases. Multiple structures may be involved simultaneously."
          },
          {
            "q": "Why is groin pain so difficult to treat?",
            "a": "The groin is an anatomical crossroads where multiple structures (adductors, rectus abdominis, inguinal canal, hip joint, obturator nerve) converge. Identifying the primary pain generator requires careful clinical assessment, imaging, and sometimes diagnostic injections."
          }
        ]
      }
    ]
  },
  "mucous-cyst-excision": {
    "name": "Mucous Cyst Excision (DIP Joint)",
    "region": "Hand & Wrist",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Mucous cyst excision is an operation to remove a ganglion-like cyst arising from the distal interphalangeal (DIP) joint. These cysts are associated with underlying osteoarthritis and may cause nail deformity or skin thinning with risk of spontaneous rupture.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the cyst on the back of the fingertip. The cyst is excised along with its stalk connecting it to the DIP joint. The underlying osteophyte (bone spur) is usually removed to reduce recurrence. If the skin is thinned, a local rotation flap may be needed. The operation takes 20–30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for cysts that are enlarging, causing nail deformity, at risk of rupture through thinned skin (which would introduce infection into the joint), recurrent after aspiration, or causing pain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation, aspiration (high recurrence rate), and compression. Many cysts are asymptomatic and can be left alone."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-ray showing DIP joint arthritis and osteophyte. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Removal of the cyst and prevention of recurrence. Nail deformity typically improves over six to twelve months as the nail grows out."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Nail deformity",
            "detail": "May persist if the germinal matrix has been damaged.",
            "freq": "Common"
          },
          {
            "risk": "Scar",
            "detail": "Over the fingertip.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some DIP joint stiffness.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "Approximately 5–10% if the osteophyte is not removed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Skin flap problems",
            "detail": "If the skin was very thin.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Joint damage",
            "detail": "From osteophyte removal.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Digital nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Light dressing for two weeks. Stitches at 10–14 days. Gentle finger movement immediately. Full recovery four to six weeks. Nail regrowth takes four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or discharge",
          "Increasing pain",
          "Nail deformity worsening",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my nail return to normal?",
            "a": "If the nail matrix (root) has not been permanently damaged by the cyst, the nail usually improves as it grows out over four to six months."
          }
        ]
      }
    ]
  },
  "hand-infection-drainage": {
    "name": "Hand Infection Drainage (Flexor Sheath / Deep Space)",
    "region": "Hand & Wrist",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hand infection drainage is an emergency operation to wash out and drain infection from the flexor tendon sheath (flexor tenosynovitis), deep palmar spaces, or other compartments of the hand. Delay risks tendon necrosis and permanent loss of finger function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For flexor sheath infection: incisions at each end of the tendon sheath (proximal palmar and distal finger). A catheter is inserted and the sheath is irrigated with saline until the fluid runs clear. For deep space infections: the infected compartment is opened, pus drained, necrotic tissue debrided, and the wound washed. The wound may be left open or loosely closed. The hand is splinted in the position of safety. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Flexor tenosynovitis is identified by Kanavel's signs: fusiform (sausage-shaped) swelling, flexed posture, tenderness along the sheath, and pain on passive extension. It is a surgical emergency — delay beyond 24–48 hours risks tendon necrosis and a stiff, functionless finger."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Very early cellulitis without Kanavel's signs may respond to IV antibiotics and elevation with close monitoring (reassessment every six to twelve hours). Established flexor sheath infection requires surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency. IV antibiotics started in A&E. X-ray to exclude foreign body or osteomyelitis. Blood tests. The hand is elevated and splinted."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Clearance of infection, preservation of the tendon, and restoration of finger function. When treated within 24 hours, most patients regain good function. Delayed treatment leads to tendon adhesions, necrosis, and stiffness."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Stiffness",
            "detail": "Flexor tendon adhesions from infection and surgery.",
            "freq": "Common"
          },
          {
            "risk": "Multiple operations",
            "detail": "Repeat washout may be needed.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for several days to weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon necrosis",
            "detail": "The tendon may be destroyed by infection, particularly if delayed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Amputation",
            "detail": "Rarely needed for severe, neglected infections.",
            "freq": "Rare"
          },
          {
            "risk": "Osteomyelitis",
            "detail": "Spread of infection to bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Sepsis",
            "detail": "Systemic spread.",
            "freq": "Uncommon"
          },
          {
            "risk": "Permanent stiffness",
            "detail": "A stiff, contracted finger despite treatment.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional arm block anaesthesia. Emergency case."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "IV antibiotics for 48 hours minimum then transition to oral. Elevation for 48 hours. Hand therapy begins at 48–72 hours once infection is controlled. Splinting in the position of safety between exercises. Full rehabilitation takes weeks to months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Spreading redness up the arm",
          "Fever or rigors",
          "Increasing swelling despite treatment",
          "Loss of finger movement",
          "Wound discharge"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Daily wound review while inpatient. Hand therapy from 48–72 hours. Surgeon review at one week and two weeks."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What are Kanavel's signs?",
            "a": "Four classic signs of flexor tenosynovitis: the finger is swollen in a sausage shape, held in a slightly bent position, tender along the whole tendon sheath, and extremely painful when someone tries to straighten it. The presence of three or four signs strongly suggests sheath infection."
          },
          {
            "q": "How did the infection get in?",
            "a": "Usually through a puncture wound, cut, or thorn prick — even a very small wound. Animal bites, particularly cat bites, are notorious causes. Sometimes no wound is identified."
          }
        ]
      }
    ]
  },
  "swan-neck-correction": {
    "name": "Swan Neck Deformity Correction",
    "region": "Hand & Wrist",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Swan neck deformity correction is an operation to address the characteristic finger posture where the PIP joint hyperextends and the DIP joint flexes. It is caused by volar plate laxity, intrinsic muscle imbalance, or rheumatoid arthritis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Multiple techniques exist depending on the cause and flexibility. Flexor digitorum superficialis (FDS) tenodesis: a slip of the FDS tendon is rerouted to act as a checkrein, preventing PIP hyperextension. Spiral oblique retinacular ligament reconstruction (SORL): restores the link between PIP flexion and DIP extension. Volar plate advancement: tightens the volar plate to prevent hyperextension. Dermadesis: a wedge of skin is removed from the volar PIP crease (for mild cases). The operation takes 30–60 minutes per finger."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when the deformity limits hand function — particularly if the finger cannot initiate flexion from the hyperextended position, or if the deformity is progressing."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Ring splints (Silver Ring or Oval-8) that block PIP hyperextension while allowing flexion, hand therapy, and treatment of the underlying cause (rheumatoid disease control)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Assessment of deformity flexibility — the correction technique depends on whether the PIP joint is passively flexible or fixed. X-rays. Hand therapy assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of a functional flexion arc. Prevention of the PIP joint locking in hyperextension. Results depend on the underlying cause and the flexibility of the deformity."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence",
            "detail": "The deformity may recur, particularly in rheumatoid arthritis.",
            "freq": "Common"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of PIP extension.",
            "freq": "Common"
          },
          {
            "risk": "Over-correction",
            "detail": "The PIP joint may develop a flexion contracture.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon complications",
            "detail": "FDS tenodesis may cause triggering or bowstringing.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Neurovascular injury",
            "detail": "Digital nerve damage.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local digital block, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splinting for four to six weeks. Hand therapy for controlled exercises. Ring splints may be used long-term. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Finger locking in a new position",
          "Triggering"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews with hand therapy at two weeks, six weeks, and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes swan neck deformity?",
            "a": "It can result from rheumatoid arthritis (the most common cause), volar plate laxity, intrinsic muscle spasticity, mallet finger (DIP extensor loss leading to PIP hyperextension compensation), and cerebral palsy."
          }
        ]
      }
    ]
  },
  "meniscal-root-repair": {
    "name": "Meniscal Root Repair",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Meniscal root repair is an arthroscopic operation to reattach a torn meniscal root — the anchor point where the meniscus attaches to the tibial plateau. A root tear functionally converts the meniscus to a meniscectomy, causing rapid loss of hoop stress function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically. The torn root is identified. Strong sutures are passed through the meniscal root. A bone tunnel is drilled through the tibial plateau. The sutures are pulled through the tunnel and tied over a button on the anterior tibia, pulling the root back to its anatomical attachment. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Root tears cause loss of meniscal function equivalent to total meniscectomy, leading to rapid arthritis. Repair is recommended for acute or subacute root tears with minimal or no arthritis, particularly medial meniscal posterior root tears and lateral meniscal root tears associated with ACL injury."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy and observation — accepting progressive arthritis. Partial meniscectomy does not restore root function. High tibial osteotomy may protect the compartment if the medial root cannot be repaired."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI showing root tear (the 'ghost sign' — absent meniscal attachment on sagittal images). Standing X-rays to assess for existing arthritis. Patient counselling about the protected rehabilitation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of meniscal root attachment and hoop stress function. Prevention or slowing of articular cartilage degeneration. Healing rates approximately 70–85%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-weight-bearing for six to eight weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary loss of deep flexion.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete healing",
            "detail": "The root may not heal completely, though partial healing still provides benefit.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-tear",
            "detail": "The repaired root may fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tunnel complications",
            "detail": "Bone tunnel fracture or widening.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Progressive arthritis",
            "detail": "Despite repair, some cartilage damage may have already occurred.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. No deep squatting for four months. Physiotherapy for quadriceps strengthening and range of motion. Running at four to six months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee swelling",
          "Locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months. MRI at six months to assess healing."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is a meniscal root?",
            "a": "The meniscal root is the bony attachment point where the C-shaped meniscus anchors to the tibial plateau. Without this anchor, the meniscus cannot generate hoop stresses — it essentially becomes functionless, equivalent to having no meniscus at all."
          },
          {
            "q": "Why is this different from a regular meniscal tear?",
            "a": "Root tears are biomechanically devastating — they cause loss of all meniscal function in that compartment, leading to much faster arthritis progression than typical peripheral or body tears."
          }
        ]
      }
    ]
  },
  "spring-ligament-repair": {
    "name": "Spring Ligament Repair",
    "region": "Foot & Ankle",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Spring ligament repair is an operation to reconstruct or augment the spring ligament (plantar calcaneonavicular ligament) — a critical static support of the medial longitudinal arch. It is performed as part of flatfoot reconstruction when the spring ligament is attenuated or torn.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the inner side of the foot. The attenuated or torn spring ligament is identified. Direct repair with strong sutures may be possible if tissue quality allows. More commonly, the ligament is augmented or reconstructed using an internal brace (suture tape reinforcement), a peroneus longus tendon graft, or allograft tissue. This is almost always combined with other procedures: flexor digitorum longus tendon transfer, calcaneal osteotomy, and possibly lateral column lengthening. The spring ligament repair adds 30–45 minutes to the overall procedure."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The spring ligament is a key static stabiliser of the talonavicular joint and medial arch. When it fails, the arch collapses regardless of other repairs. Addressing the spring ligament during flatfoot reconstruction improves outcomes and reduces recurrence."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Custom orthotics, ankle-foot orthosis, and supportive footwear. These manage symptoms but cannot restore a torn spring ligament."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI showing spring ligament attenuation or tear. Weight-bearing X-rays showing talonavicular uncoverage. Part of comprehensive flatfoot reconstruction planning."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of static medial arch support, improving the durability of the overall flatfoot reconstruction. Reduces the risk of arch collapse recurrence."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Part of a larger reconstruction with non-weight-bearing for six to eight weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Medial ankle and foot swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Repair failure",
            "detail": "The reconstructed ligament may stretch or fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tibial nerve injury",
            "detail": "The posterior tibial nerve and its branches are close to the surgical field.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Medial foot incisions can be slow to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Arch collapse may recur despite repair.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. Boot for four to six weeks. Physiotherapy. Custom orthotics long-term. Full recovery nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Arch collapsing",
          "Numbness on the sole of the foot"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is the spring ligament?",
            "a": "The spring ligament is a thick, fibrocartilaginous band that supports the head of the talus from below. It is the primary static support of the medial arch — without it, the arch collapses under body weight."
          }
        ]
      }
    ]
  },
  "cavus-foot-correction": {
    "name": "Cavus Foot Correction",
    "region": "Foot & Ankle",
    "tag": "Reconstruction",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cavus foot correction encompasses a range of procedures to address a high-arched foot (pes cavus), which may cause instability, pain, callosities, and recurrent ankle sprains. The surgical plan is tailored to the specific deformity.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Cavus foot correction typically involves a combination of: dorsiflexion osteotomy of the first metatarsal (to correct forefoot pronation/plantarflexion), calcaneal osteotomy (Dwyer closing wedge to correct hindfoot varus), plantar fascia release, peroneus longus to brevis tendon transfer, posterior tibial tendon transfer to the dorsum of the foot (for foot drop), and occasionally midfoot or hindfoot fusion for rigid deformity. The specific combination is determined by the Coleman block test and clinical assessment. The operation takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for symptomatic cavus foot causing lateral ankle instability, recurrent sprains, metatarsalgia, callosity formation under the metatarsal heads, difficulty with footwear, and progressive deformity. Common underlying causes include Charcot-Marie-Tooth disease, post-stroke, spinal cord lesions, and idiopathic cavus."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Lateral wedge insoles, custom orthotics with metatarsal domes, ankle bracing, appropriate footwear with a wide toe box, and physiotherapy for peroneal and ankle stability training."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standing X-rays including Coleman block view. Neurological assessment and nerve conduction studies to identify the underlying cause. MRI of the spine if neurological cause is suspected. Comprehensive deformity analysis."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Plantigrade, balanced foot. Improved stability. Reduced callosity and pain. Most patients achieve significant functional improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Multiple procedures require six to twelve weeks non-weight-bearing.",
            "freq": "Expected"
          },
          {
            "risk": "Multiple scars",
            "detail": "From several incisions.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some loss of foot flexibility.",
            "freq": "Common"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged foot swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Osteotomy or fusion sites may fail to heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Over-correction",
            "detail": "Converting a cavus foot to a planus (flat) foot.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve injury",
            "detail": "Peroneal or tibial nerve branches.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Multiple incisions increase risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrence",
            "detail": "Particularly in progressive neurological conditions like CMT.",
            "freq": "Common"
          },
          {
            "risk": "Transfer tendon failure",
            "detail": "The transferred tendon may not function adequately.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. Boot for four to six weeks. Custom orthotics long-term. Physiotherapy for ankle stability and gait retraining. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Foot feeling unstable",
          "New foot drop",
          "Increasing deformity"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months. Long-term monitoring, particularly for progressive neurological conditions."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes cavus foot?",
            "a": "Two-thirds of cavus feet have an underlying neurological cause — most commonly Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy). Other causes include stroke, spinal cord lesions, cerebral palsy, and polio. One-third are idiopathic (no identifiable cause). Any new or progressive cavus foot should prompt neurological investigation."
          },
          {
            "q": "What is the Coleman block test?",
            "a": "A clinical test where the patient stands with the first metatarsal off the edge of a block. If the heel varus corrects (the heel moves into neutral), the cavus is driven by forefoot pronation and is correctable with a first metatarsal osteotomy. If it doesn't correct, the hindfoot is rigid and requires calcaneal osteotomy or fusion."
          }
        ]
      }
    ]
  },
  "latissimus-dorsi-transfer": {
    "name": "Latissimus Dorsi Transfer (Irreparable Rotator Cuff)",
    "region": "Shoulder",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Latissimus dorsi transfer is an operation to reroute the latissimus dorsi muscle and tendon from the back to the top of the shoulder, replacing the function of an irreparable posterosuperior rotator cuff tear. It restores active external rotation.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made in the posterior axillary fold. The latissimus dorsi tendon is detached from its insertion on the humerus. The tendon is rerouted around the humerus and reattached to the greater tuberosity (the normal rotator cuff insertion site) using suture anchors. The muscle then functions as an external rotator instead of an internal rotator. The operation takes two to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Latissimus dorsi transfer is considered for younger, active patients (under 65) with massive, irreparable posterosuperior rotator cuff tears causing loss of active external rotation, who are too young for reverse shoulder replacement. The key indication is a functional deltoid with an intact subscapularis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (anterior deltoid rehabilitation), subacromial injection, superior capsular reconstruction (SCR), partial rotator cuff repair, and reverse shoulder replacement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming irreparable posterosuperior cuff tear with intact subscapularis. CT to assess arthropathy. Functional assessment of external rotation deficit. EMG may be used to confirm latissimus function."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of active external rotation and improvement in overhead function. Approximately 70–80% of carefully selected patients report significant functional improvement. Pain relief is good."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Six to twelve months for full recovery.",
            "freq": "Expected"
          },
          {
            "risk": "Limited overhead strength",
            "detail": "The transferred muscle does not fully replicate normal rotator cuff function.",
            "freq": "Expected"
          },
          {
            "risk": "Axillary discomfort",
            "detail": "Soreness in the posterior axillary fold.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Transfer failure",
            "detail": "The transferred tendon may not heal to its new attachment. Risk approximately 10–15%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Thoracodorsal nerve (motor nerve to latissimus) must be preserved during mobilisation.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Progression to arthropathy",
            "detail": "Despite transfer, the shoulder may develop cuff tear arthropathy over time.",
            "freq": "Long-term"
          },
          {
            "risk": "Axillary nerve injury",
            "detail": "During the re-routing of the tendon.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Lateral decubitus position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling and abduction pillow for six weeks. No active internal rotation (which would stress the transfer) for six weeks. Passive external rotation exercises from two weeks. Active external rotation from six weeks. Strengthening from three months. Full recovery six to twelve months. The brain must learn to use the latissimus for external rotation — a process called 'motor re-education' that takes dedicated practice."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sudden loss of external rotation (transfer failure)",
          "Posterior axillary wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does the brain learn to use the muscle differently?",
            "a": "The latissimus dorsi normally performs internal rotation. After transfer to the rotator cuff footprint, it must perform external rotation. Through repetitive exercises, the brain creates new neural pathways. Initially, the patient activates the muscle by thinking about its original function (pulling the arm toward the body), then gradually the new movement becomes automatic."
          },
          {
            "q": "Why not just do a reverse shoulder replacement?",
            "a": "Reverse replacement is a joint replacement with lifelong activity restrictions and a finite lifespan. Latissimus transfer preserves the native joint, allows higher activity levels, and can delay or avoid the need for replacement. It is best suited for younger, active patients."
          }
        ]
      }
    ]
  },
  "spinal-tumour-surgery": {
    "name": "Spinal Tumour Surgery",
    "region": "Spine",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Spinal tumour surgery involves decompression, stabilisation, and/or resection of tumours affecting the vertebral column and spinal cord. The approach and extent depend on whether the tumour is primary (arising in the spine) or metastatic (spread from cancer elsewhere).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For metastatic tumours (most common): posterior decompression and stabilisation with pedicle screws and rods, sometimes combined with vertebral body resection and cage reconstruction. For primary tumours: en bloc resection (complete removal with a margin) may be attempted for certain tumour types — requiring complex, staged anterior and posterior approaches. Vertebroplasty or kyphoplasty may be used for painful vertebral metastases without neurological compression. Minimally invasive techniques (separation surgery) may be used when radiotherapy will treat the tumour. Operations range from one to eight hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for spinal cord compression from tumour causing neurological deficit or at high risk of neurological deterioration, mechanical instability of the spine from bone destruction, intractable pain not controlled by other means, and curative resection of primary spinal tumours."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Radiotherapy (conventional, stereotactic radiosurgery), chemotherapy, hormonal therapy, immunotherapy, bisphosphonates/denosumab for bone metastases, pain management, bracing, and observation. Many spinal metastases are managed without surgery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full staging. MRI of the entire spine (multiple levels may be affected). CT for surgical planning. Assessment of oncological prognosis (Tokuhashi, Tomita scores). MDT discussion. Preoperative embolisation for vascular tumours (renal, thyroid metastases)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "For decompression and stabilisation: prevention or reversal of neurological deficit, pain relief, and restoration of spinal stability. For curative resection: complete tumour removal with the chance of cure for suitable primary tumours. Quality of life improvement is the primary goal for metastatic disease."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Blood loss",
            "detail": "Spinal tumour surgery can involve significant blood loss, particularly for vascular tumours.",
            "freq": "Common"
          },
          {
            "risk": "Post-operative pain",
            "detail": "From extensive surgical dissection.",
            "freq": "Expected"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients have advanced cancer with poor physiological reserve.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Neurological deterioration",
            "detail": "Worsening weakness or paralysis. Risk depends on tumour location and surgical complexity.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound infection",
            "detail": "Higher risk in immunocompromised patients and those receiving chemotherapy/radiotherapy.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Screws may pull out of tumour-weakened bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear, particularly with intradural tumours.",
            "freq": "Uncommon"
          },
          {
            "risk": "Disease progression",
            "detail": "Cancer may continue to progress despite surgery.",
            "freq": "Common"
          },
          {
            "risk": "DVT/PE",
            "detail": "High risk in cancer patients.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring. Significant blood loss potential — transfusion capability essential. Prone or lateral positioning. May be a prolonged procedure."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital stay varies from two days (vertebroplasty) to two weeks (complex resection). Mobilisation as soon as possible. Bracing may be used for three months. Physiotherapy for mobility and function. Oncological treatment (radiotherapy, chemotherapy) may follow. Recovery depends on the patient's overall condition and the extent of surgery."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg or arm weakness",
          "Loss of bladder or bowel function",
          "Severe increasing pain",
          "Wound problems",
          "Fever",
          "Signs of DVT/PE"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance with regular imaging. Spinal X-rays to monitor instrumentation. Neurological monitoring. MDT review."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will surgery cure my cancer?",
            "a": "For metastatic disease, surgery is almost always palliative — aimed at preserving function and quality of life, not cure. For primary spinal tumours, en bloc resection offers the chance of cure for suitable cases."
          },
          {
            "q": "Why is the decision so complex?",
            "a": "The decision to operate on spinal tumours balances neurological benefit against surgical risk, estimated survival, the tumour's sensitivity to radiotherapy, the patient's overall condition, and their wishes. MDT discussion ensures the best decision for each individual."
          }
        ]
      }
    ]
  },
  "anterolateral-ligament-reconstruction": {
    "name": "Anterolateral Ligament (ALL) Reconstruction",
    "region": "Sports Medicine",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Anterolateral ligament reconstruction is a procedure performed in addition to ACL reconstruction to control rotational instability of the knee. It addresses the anterolateral structures that contribute to the pivot shift phenomenon.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A tendon graft (typically a strip of iliotibial band, gracilis, or allograft) is used to reconstruct the anterolateral ligament. Through a small incision on the outer side of the knee, the graft is fixed to the lateral femoral epicondyle and the proximal tibia at the anatomical ALL insertion. This is performed in addition to standard ACL reconstruction (not instead of it). The combined procedure takes approximately 90 minutes to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ALL reconstruction is considered as an addition to ACL reconstruction in patients at high risk of re-rupture: young athletes (under 25) returning to pivoting sports, revision ACL reconstruction, patients with high-grade pivot shift, and those with a Segond fracture (avulsion of the ALL tibial attachment visible on X-ray)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Standard ACL reconstruction alone (without ALL reconstruction) remains appropriate for most patients. Lateral extra-articular tenodesis (LET) is a similar but slightly different technique that also controls rotation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI showing ACL tear with or without ALL injury. Clinical assessment of pivot shift grade. Assessment of risk factors for re-rupture. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improved rotational control of the knee, reducing the pivot shift. Studies suggest that adding ALL reconstruction or LET to ACL reconstruction reduces re-rupture rates from approximately 10–15% to 4–7% in high-risk patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral knee stiffness",
            "detail": "The ALL reconstruction may restrict terminal flexion slightly.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral knee numbness",
            "detail": "From the incision.",
            "freq": "Common"
          },
          {
            "risk": "Over-constraint",
            "detail": "If the graft is tensioned too tightly, it may limit normal knee kinematics.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft failure",
            "detail": "The ALL graft may stretch or rupture.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral femoral condyle fracture",
            "detail": "From the femoral tunnel.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Iliotibial band irritation",
            "detail": "If ITB is used as graft.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block (same as for ACL reconstruction)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Same rehabilitation protocol as ACL reconstruction. Running at four to six months. Pivoting sport at nine to twelve months. The ALL graft heals concurrently with the ACL graft."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Knee feeling unstable",
          "Lateral knee pain or swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as ACL reconstruction: reviews at two weeks, six weeks, three months, six months, and one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Does everyone having ACL reconstruction need this?",
            "a": "No. ALL reconstruction is an adjunct for high-risk patients — young pivoting athletes, revision ACL surgery, and those with a high-grade pivot shift. Most standard ACL reconstructions do not require an additional lateral procedure."
          },
          {
            "q": "What is the evidence?",
            "a": "The STABILITY trial and other studies have shown that adding a lateral extra-articular procedure (ALL or LET) to ACL reconstruction in young athletes reduces re-rupture rates by approximately 50%. This is an evolving area with growing evidence."
          }
        ]
      }
    ]
  },
  "paediatric-acl-reconstruction": {
    "name": "Paediatric ACL Reconstruction",
    "region": "Paediatric Orthopaedics",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Paediatric ACL reconstruction is a specialised operation to reconstruct a torn ACL in a child or adolescent with open growth plates. Modified techniques are used to avoid damaging the physis (growth plate) while restoring knee stability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Technique depends on skeletal maturity. Pre-pubescent (wide open physes): physeal-sparing techniques — the graft is positioned entirely around (not through) the growth plates. Extra-articular tenodesis or all-epiphyseal tunnels are used. Adolescent (near skeletal maturity): transphyseal technique similar to adult ACL reconstruction with soft tissue graft, using smaller tunnels placed centrally to minimise physeal damage. The hamstring autograft (gracilis and semitendinosus) is most commonly used. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ACL reconstruction in children is recommended for complete ACL tears with symptomatic instability (giving way), meniscal tears requiring concurrent treatment, and children who wish to return to pivoting sports. Non-operative management risks further meniscal and cartilage damage from recurrent instability episodes."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Activity modification (avoiding pivoting sports), bracing, and physiotherapy. This was historically preferred due to growth plate concerns, but evidence now supports early reconstruction with appropriate technique to protect the menisci and cartilage."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming ACL tear and assessing for meniscal injury. Bone age assessment (hand X-ray) to determine skeletal maturity. Assessment of growth remaining. The surgical technique is chosen based on skeletal maturity."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of knee stability, protection of the menisci and cartilage from further injury, and return to sport. Modern physeal-sparing and transphyseal techniques have excellent outcomes with very low rates of growth disturbance."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Temporary. Physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Graft site discomfort",
            "detail": "Hamstring harvest site soreness.",
            "freq": "Common"
          },
          {
            "risk": "Re-rupture",
            "detail": "Children returning to sport have re-rupture rates of approximately 10–20% — higher than adults due to high activity levels and return to pivoting sports.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Growth disturbance",
            "detail": "Risk of growth plate damage causing leg length discrepancy or angular deformity. Risk is very low (less than 2%) with modern techniques.",
            "freq": "Rare"
          },
          {
            "risk": "Graft failure",
            "detail": "Requiring revision reconstruction.",
            "freq": "Uncommon"
          },
          {
            "risk": "Contralateral ACL tear",
            "detail": "The opposite knee is also at risk. Rate approximately 10–15% in young athletes.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "Very rare in children.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for two to four weeks. Brace for four to six weeks. Physiotherapy begins immediately. Running at four to six months. Return to pivoting sport at nine to twelve months. Re-injury prevention programmes (FIFA 11+, neuromuscular training) are essential."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Knee swelling or pain not improving",
          "Knee giving way",
          "Wound redness or discharge",
          "Fever",
          "Limping persisting beyond six weeks"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, six months, and one year. Standing alignment X-rays to monitor for growth disturbance. Long-term follow-up through adolescence."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will surgery damage the growth plates?",
            "a": "Modern techniques are designed to minimise growth plate risk. Physeal-sparing techniques avoid the growth plate entirely. Transphyseal techniques use small soft tissue grafts through the centre of the physis. The risk of clinically significant growth disturbance is very low (less than 2%)."
          },
          {
            "q": "Should we wait until the child stops growing?",
            "a": "Current evidence favours early reconstruction in unstable knees rather than waiting. Recurrent instability episodes damage the menisci and cartilage, which cannot be replaced. Protecting these structures through early reconstruction is more important than the very small risk of growth disturbance."
          },
          {
            "q": "Why is re-rupture so common in young athletes?",
            "a": "Young athletes return to high-risk pivoting sports at high intensity. Their re-rupture rate (10–20%) is higher than adults. Neuromuscular training programmes and graduated return to sport protocols are essential to reduce this risk."
          }
        ]
      }
    ]
  },
  "shoulder-resurfacing": {
    "name": "Shoulder Resurfacing Arthroplasty",
    "region": "Shoulder",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder resurfacing is a bone-conserving arthroplasty that replaces only the damaged articular surface of the humeral head with a metal cap, preserving the humeral bone stock. It is an alternative to stemmed total shoulder replacement for younger patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the front of the shoulder. The humeral head is exposed and reshaped. A metal resurfacing cap is cemented onto the prepared humeral head, covering the damaged cartilage surface. The glenoid may be left unresurfaced (hemiarthroplasty) or replaced with a polyethylene component. No humeral canal reaming or stem insertion is needed. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Resurfacing is considered for younger patients (under 55-60) with glenohumeral arthritis who wish to preserve humeral bone stock for potential future revision, patients with humeral deformity making stemmed implants difficult, and AVN of the humeral head with intact glenoid."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, injection, activity modification. Stemmed total shoulder replacement, hemiarthroplasty, and biological resurfacing are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and CT to assess humeral head shape and glenoid wear. MRI to assess rotator cuff integrity — an intact cuff is essential."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and restoration of movement while preserving humeral bone stock. If revision is needed later, conversion to a stemmed replacement is straightforward."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Glenoid erosion",
            "detail": "If the glenoid is not replaced, the metal cap may wear into the native glenoid.",
            "freq": "Long-term"
          },
          {
            "risk": "Residual pain",
            "detail": "Not all patients achieve complete pain relief.",
            "freq": "Uncommon"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Humeral head collapse",
            "detail": "If AVN progresses under the cap.",
            "freq": "Uncommon"
          },
          {
            "risk": "Loosening",
            "detail": "The cap may loosen from the humeral head.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Humeral neck fracture during or after surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Rotator cuff failure",
            "detail": "Cuff damage during surgery.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for two to four weeks. Gentle exercises from day one. Active movement from two to four weeks. Strengthening from six weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder grinding or clicking",
          "Loss of movement"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, one year, then annually."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why preserve bone?",
            "a": "Younger patients may need revision surgery decades later. Preserving the humeral bone stock makes future revision to a stemmed implant much simpler."
          }
        ]
      }
    ]
  },
  "radial-head-excision": {
    "name": "Radial Head Excision",
    "region": "Elbow",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Radial head excision is an operation to remove the radial head — the top of the radius bone at the elbow. It is performed for severely comminuted radial head fractures that cannot be fixed, chronic post-traumatic arthritis, or rheumatoid elbow disease.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the lateral (outer) elbow using a Kocher approach. The radial head is exposed and excised at the level of the radial neck. The remaining bone is smoothed. The operation takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Excision is considered when the radial head is shattered beyond repair (Mason type III/IV) and radial head replacement is not suitable, for chronic post-traumatic arthritis of the radiocapitellar joint, and in rheumatoid arthritis with a painful, eroded radial head."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Radial head replacement (the preferred alternative for acute fractures to maintain lateral column stability), physiotherapy, injection, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and CT to assess the fracture or arthritis. Assessment of elbow stability — the MCL must be intact. If the MCL is torn, radial head replacement is preferred to maintain stability."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved forearm rotation. Good results for isolated radiocapitellar arthritis. However, long-term consequences of radial head excision must be understood."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Proximal radial migration",
            "detail": "Over time, the radius may migrate proximally (toward the elbow), altering wrist mechanics.",
            "freq": "Long-term"
          },
          {
            "risk": "Valgus instability",
            "detail": "Loss of lateral column support may cause the elbow to become unstable, particularly if the MCL is compromised.",
            "freq": "Long-term"
          },
          {
            "risk": "Wrist pain",
            "detail": "Proximal migration may cause ulnocarpal abutment at the wrist.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Posterior interosseous nerve injury",
            "detail": "The nerve wraps around the radial neck. Risk approximately 1-3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "New bone formation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Elbow instability",
            "detail": "Particularly in the context of multi-ligament injury.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Early active elbow movement from day one. Sling for comfort for a few days only. Return to desk work within one to two weeks. Full recovery six to eight weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Elbow feeling unstable",
          "New wrist pain",
          "Loss of finger extension (nerve injury)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks and six weeks. Long-term monitoring for proximal radial migration."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not replace the radial head instead?",
            "a": "Radial head replacement is generally preferred for acute fractures to maintain lateral column stability. Excision without replacement is reserved for chronic conditions where the elbow is otherwise stable."
          }
        ]
      }
    ]
  },
  "hip-septic-washout": {
    "name": "Septic Hip Washout (Adult)",
    "region": "Hip",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Adult septic hip washout is an emergency operation to drain an infected native or prosthetic hip joint. Prompt surgical drainage combined with antibiotics is essential to prevent cartilage destruction and systemic sepsis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For native hips: an incision over the anterior or lateral hip. The joint capsule is opened, pus drained, and the joint thoroughly irrigated with litres of saline. Multiple tissue samples are taken for microbiology. A drain may be left. For prosthetic hips: DAIR is performed — the joint is debrided, washed, and modular components exchanged. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Septic arthritis of the hip is less common in adults than children but is a serious condition requiring urgent surgery. Risk factors include rheumatoid arthritis, immunosuppression, diabetes, intravenous drug use, and prosthetic joints."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Needle aspiration under imaging guidance may be diagnostic and temporarily therapeutic, but established septic arthritis requires formal surgical washout."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency procedure. Blood cultures, inflammatory markers. Joint aspiration for urgent Gram stain and culture. MRI or ultrasound confirming effusion."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Drainage of infection, joint preservation, and prevention of cartilage destruction. Outcomes depend on timing — earlier treatment gives better results."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for two to six weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Joint stiffness",
            "detail": "Post-infectious arthritis and adhesions.",
            "freq": "Common"
          },
          {
            "risk": "Persistent infection",
            "detail": "May require repeat washout.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Cartilage destruction",
            "detail": "Irreversible if treatment is delayed.",
            "freq": "Uncommon"
          },
          {
            "risk": "AVN",
            "detail": "Rare in adults but possible with intra-articular pressure.",
            "freq": "Rare"
          },
          {
            "risk": "Systemic sepsis",
            "detail": "May worsen before improving.",
            "freq": "Uncommon"
          },
          {
            "risk": "Post-infective arthritis",
            "detail": "Accelerated arthritis requiring future hip replacement.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Emergency."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "IV antibiotics two to six weeks. Physiotherapy for hip mobility once infection controlled. Protected weight-bearing initially. Full recovery depends on cartilage damage."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent fever",
          "Worsening hip pain despite treatment",
          "Medical deterioration",
          "Wound discharge"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular blood tests. Clinical review at two, six weeks, three months. Long-term monitoring for secondary arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I need a hip replacement later?",
            "a": "If the cartilage is damaged by the infection, post-infective arthritis may develop, eventually requiring hip replacement. The risk depends on how quickly the infection was treated."
          }
        ]
      }
    ]
  },
  "knee-pcl-posterolateral-combined": {
    "name": "Combined PCL and Posterolateral Corner Reconstruction",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Combined PCL and posterolateral corner reconstruction is a complex operation to rebuild both the posterior cruciate ligament and the posterolateral ligament complex of the knee, typically after a knee dislocation or severe multi-ligament injury.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Multiple incisions are made around the knee. The PCL is reconstructed using an Achilles tendon allograft or quadriceps tendon autograft passed through tibial and femoral tunnels. The posterolateral corner (LCL, popliteus tendon, popliteofibular ligament) is reconstructed using additional tendon grafts through bone tunnels in the fibula and femur. The peroneal nerve is identified and protected throughout. The operation takes three to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Combined reconstruction is needed when both the PCL and posterolateral corner are torn — usually from a high-energy knee dislocation. Without reconstruction, the knee has severe posterior and varus-rotational instability, making walking and stairs very difficult."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bracing and physiotherapy may be attempted but are rarely successful for combined PCL/posterolateral corner injuries. Most require surgical reconstruction."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI, stress X-rays, vascular assessment. Surgery within two to three weeks of injury. Specialist knee ligament centre."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of posterior and lateral knee stability. Most patients achieve a functional, stable knee for daily activities. Return to sport is possible but less predictable than isolated ligament reconstruction."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Knee stiffness",
            "detail": "Very common. Loss of full flexion expected initially.",
            "freq": "Common"
          },
          {
            "risk": "Residual laxity",
            "detail": "Some degree of persistent posterior laxity is common.",
            "freq": "Common"
          },
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Twelve to eighteen months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Peroneal nerve palsy",
            "detail": "Foot drop. Risk approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Graft failure",
            "detail": "One or more grafts may stretch or fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vascular injury",
            "detail": "Popliteal artery at risk.",
            "freq": "Rare"
          },
          {
            "risk": "Arthrofibrosis",
            "detail": "Severe stiffness requiring further surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "High DVT risk.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Extended operating time."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hinged brace for twelve weeks. Crutches for eight weeks. No active hamstring exercises for twelve weeks (protects PCL graft). Graduated rehabilitation. Running at six to nine months. Sport at twelve to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Foot drop",
          "Knee giving way posteriorly",
          "Calf swelling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent reviews at two, six weeks, three, six months, one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is the peroneal nerve at risk?",
            "a": "The common peroneal nerve wraps around the fibular neck on the outer knee, directly in the posterolateral surgical field. It is carefully identified and protected."
          }
        ]
      }
    ]
  },
  "total-talus-replacement": {
    "name": "Total Talus Replacement",
    "region": "Foot & Ankle",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Total talus replacement is a cutting-edge procedure to replace the entire talus bone with a custom-made 3D-printed metal implant. It is an alternative to tibiotalocalcaneal fusion for patients with severe talar AVN, collapse, or failed previous surgery.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A pre-operative CT scan is used to design and 3D-print a custom cobalt-chrome talus implant matched to the patient's anatomy. Through anterior and/or lateral incisions, the damaged talus is removed. The custom implant is inserted, articulating with the tibial plafond above and the calcaneus below. The surrounding ligaments are repaired to stabilise the implant. The operation takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Total talus replacement is considered for severe talar AVN with collapse, failed talar fracture treatment, post-infective talar destruction, and revision of failed ankle replacement or fusion where talar bone stock is insufficient. It preserves ankle and subtalar motion unlike tibiotalocalcaneal fusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Ankle-foot orthosis, tibiotalocalcaneal fusion (the established alternative — fuses ankle and subtalar joints), and custom-moulded footwear."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan for implant design and manufacture (lead time four to six weeks for custom implant). MRI to assess surrounding soft tissues. This is performed at specialist centres only."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of ankle and subtalar motion. Functional weight-bearing. Early results are promising but long-term data is limited. It avoids the significant morbidity of tibiotalocalcaneal fusion."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited long-term data",
            "detail": "This is an evolving procedure. Long-term outcomes are not yet established.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Some limitation of motion compared to normal.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Prolonged ankle swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Implant subsidence",
            "detail": "The implant may sink into surrounding bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "The implant may subluxate if ligamentous support is insufficient.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant wear",
            "detail": "Long-term bearing surface wear. Data is limited.",
            "freq": "Long-term"
          },
          {
            "risk": "Conversion to fusion",
            "detail": "If the implant fails, salvage tibiotalocalcaneal fusion may be needed.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six weeks. Progressive weight-bearing in a boot. Physiotherapy for ankle mobility. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Ankle instability or giving way",
          "Wound problems",
          "Fever",
          "Increasing pain",
          "Ankle deformity"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular X-rays and clinical review. Long-term surveillance as outcomes data matures."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this experimental?",
            "a": "Total talus replacement is an established procedure in specialist centres, with published case series showing promising early results. However, it is relatively new and long-term data (beyond ten years) is not yet available."
          },
          {
            "q": "Why not just fuse the ankle?",
            "a": "Tibiotalocalcaneal fusion eliminates motion at both the ankle and subtalar joints, significantly affecting gait on uneven ground and stairs. Total talus replacement preserves motion at both joints, providing a more natural gait."
          }
        ]
      }
    ]
  },
  "cauda-equina-decompression": {
    "name": "Cauda Equina Syndrome Emergency Decompression",
    "region": "Spine",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cauda equina syndrome (CES) emergency decompression is an urgent operation to relieve pressure on the nerve roots at the bottom of the spinal canal. CES is one of the few true spinal surgical emergencies — delay causes irreversible bladder, bowel, and sexual dysfunction.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An emergency lumbar decompression (wide laminectomy) is performed. A midline incision is made over the lower lumbar spine. The lamina is removed at one or more levels to expose the compressed cauda equina nerve roots. The compressing pathology — usually a large central disc herniation, but occasionally a tumour, haematoma, or abscess — is removed. The nerve roots are confirmed to be decompressed. The operation takes one to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "CES is diagnosed by the combination of bilateral leg pain/weakness, saddle anaesthesia (numbness around the anus, perineum, and genitals), and bladder dysfunction (urinary retention or incontinence). Any of these features in combination with back pain or sciatica is an emergency requiring MRI and urgent surgical assessment."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no non-operative alternatives for established CES. Delay in decompression directly worsens the prognosis for bladder and bowel recovery."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Emergency MRI confirming cauda equina compression. Urinary catheterisation to measure bladder residual volume. This is a time-critical emergency — ideally decompressed within 24–48 hours of symptom onset, though earlier is better."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention or reversal of bladder, bowel, and sexual dysfunction. Relief of leg pain and weakness. The outcome depends critically on the timing of surgery — patients decompressed before complete urinary retention have significantly better outcomes than those decompressed after."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Incomplete recovery",
            "detail": "Even with prompt surgery, some patients have permanent bladder, bowel, or sexual dysfunction.",
            "freq": "Common"
          },
          {
            "risk": "Persistent leg pain or numbness",
            "detail": "Nerve damage from the compression may not fully resolve.",
            "freq": "Common"
          },
          {
            "risk": "Back pain",
            "detail": "Post-operative back pain is common.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Permanent bladder dysfunction",
            "detail": "The longer the compression, the higher the risk of permanent incontinence or retention. Risk is highest when complete retention has been present for more than 48 hours.",
            "freq": "Common"
          },
          {
            "risk": "Permanent bowel dysfunction",
            "detail": "Faecal incontinence.",
            "freq": "Uncommon"
          },
          {
            "risk": "Permanent sexual dysfunction",
            "detail": "Erectile dysfunction, loss of genital sensation.",
            "freq": "Common"
          },
          {
            "risk": "Dural tear",
            "detail": "Risk approximately 5–10% in emergency surgery.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Wound or disc space infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrent disc herniation",
            "detail": "The disc may herniate again.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Emergency. Prone positioning. May be performed at any hour."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Urinary catheter management — may take days to weeks for bladder function to recover. Physiotherapy for leg weakness. Pelvic floor rehabilitation. Sexual health support. Many patients require ongoing bladder management. Recovery continues over twelve to eighteen months — nerves recover slowly."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening bladder or bowel function after surgery",
          "New or worsening leg weakness",
          "Severe back pain",
          "Wound problems",
          "Fever",
          "Increasing saddle numbness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Bladder function assessment at two weeks, six weeks, three months, and six months. Neurological monitoring. Urology referral if bladder dysfunction persists. Pelvic floor physiotherapy."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this such an emergency?",
            "a": "The cauda equina nerves control the bladder, bowel, and sexual function. Once damaged by prolonged compression, these functions may never recover. Every hour of delay worsens the prognosis. Patients with suspected CES should attend A&E immediately."
          },
          {
            "q": "Will my bladder function recover?",
            "a": "Recovery depends on timing. Patients decompressed before complete urinary retention have a much better prognosis than those decompressed after. Some degree of permanent bladder dysfunction is common in CES, but many patients achieve significant recovery with time."
          },
          {
            "q": "What should I tell patients to watch for?",
            "a": "Any patient with back pain or sciatica who develops difficulty passing urine, loss of bladder or bowel control, or numbness in the saddle area (around the anus, perineum, or genitals) should attend A&E immediately — do not wait for a GP or outpatient appointment."
          }
        ]
      }
    ]
  },
  "nail-dynamisation": {
    "name": "Intramedullary Nail Dynamisation",
    "region": "Trauma",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Nail dynamisation is a minor procedure to remove one or more locking screws from an intramedullary nail, allowing controlled axial compression at the fracture site. It is performed when a fracture is showing delayed healing and needs additional stimulus.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under X-ray guidance, the locking screw(s) at one end of the intramedullary nail are identified through a small skin incision. The screws are removed with a screwdriver, converting the nail from a 'statically locked' configuration (no motion at the fracture) to a 'dynamically locked' configuration (allowing axial compression). This permits the fracture ends to compress together with weight-bearing, stimulating healing. The procedure takes 15–30 minutes under local or general anaesthesia."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Dynamisation is considered for fractures that are showing delayed union — typically at three to six months post-nailing, when callus formation is inadequate on X-ray. By allowing axial compression, it increases the mechanical stimulus for healing."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Continued observation and weight-bearing (some fractures will eventually heal without intervention), bone stimulator (electromagnetic or ultrasound), and exchange nailing (replacing the nail with a larger one) for more established non-unions."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays confirming delayed union with gap at the fracture site. Review of the original nail configuration. Day-case or outpatient procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Healing following dynamisation in approximately 50–70% of cases with delayed union. It is a simple, low-risk intervention that avoids the morbidity of exchange nailing."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shortening",
            "detail": "Removal of locking screws allows the fracture to shorten by a few millimetres. Usually clinically insignificant.",
            "freq": "Common"
          },
          {
            "risk": "No benefit",
            "detail": "Dynamisation may not stimulate healing if the fracture biology is the primary problem.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Excessive shortening",
            "detail": "If significant fracture comminution is present, shortening may be more than expected.",
            "freq": "Uncommon"
          },
          {
            "risk": "Rotational malunion",
            "detail": "Loss of rotational control.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nail migration",
            "detail": "The nail may back out without distal locking.",
            "freq": "Rare"
          },
          {
            "risk": "Need for exchange nailing",
            "detail": "If dynamisation fails, exchange nailing is the next step.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthesia with sedation, or brief general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Immediate full weight-bearing to maximise axial compression. Follow-up X-rays at six weeks and three months to assess healing response."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain at the fracture site",
          "Visible deformity or shortening",
          "Nail prominence",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months post-dynamisation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How does removing a screw help healing?",
            "a": "The locking screws prevent the fracture from compressing. By removing them, weight-bearing forces push the fracture ends together, stimulating a healing response (Wolff's law)."
          },
          {
            "q": "What if dynamisation doesn't work?",
            "a": "If the fracture has not healed by three months post-dynamisation, exchange nailing (replacing the nail with a larger-diameter nail and adding bone graft) is usually the next step."
          }
        ]
      }
    ]
  },
  "adductor-longus-repair": {
    "name": "Proximal Hamstring Tendon Repair (Revision / Chronic)",
    "region": "Sports Medicine",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision or chronic proximal hamstring tendon repair is an operation to reattach the hamstring tendons to the ischial tuberosity (sit bone) when a previous repair has failed or when an acute rupture was missed and has become chronic (retracted).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A transverse incision is made in the gluteal crease. The sciatic nerve is identified and protected — it often runs directly over or through the scar tissue. The retracted hamstring tendons are mobilised (freed from scar tissue), which can be technically demanding in chronic cases. The ischial tuberosity is prepared and the tendons are reattached using suture anchors or through bone tunnels. Allograft augmentation may be needed for severely damaged tendons. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for failed primary hamstring repair, chronic hamstring avulsion causing posterior thigh weakness and sitting pain, and retracted proximal hamstring ruptures (typically more than four to six weeks old) in active patients."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, and acceptance of the strength deficit. Some patients function adequately despite chronic hamstring deficiency, particularly if low-demand."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess tendon retraction and quality. Assessment of sciatic nerve relationship to the scar. Pre-operative physiotherapy (prehabilitation)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of hamstring strength and reduction of sitting pain. Outcomes for chronic repair are less predictable than acute repair — approximately 70–80% of patients report significant improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Sciatic nerve irritation",
            "detail": "The nerve is often embedded in scar tissue. Temporary numbness or tingling is common post-operatively.",
            "freq": "Common"
          },
          {
            "risk": "Sitting discomfort",
            "detail": "May persist for months.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete strength recovery",
            "detail": "Strength rarely returns to 100% in chronic cases.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Sciatic nerve injury",
            "detail": "Permanent damage is rare but the nerve is at significant risk in revision/chronic surgery.",
            "freq": "Uncommon"
          },
          {
            "risk": "Re-rupture",
            "detail": "The repair may fail again.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Haematoma",
            "detail": "Blood collection in the posterior thigh.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Prone position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for six weeks. Avoid sitting on hard surfaces for six weeks. Prone lying and gentle stretching. Progressive strengthening from six to eight weeks. Running at four to six months. Return to sport at six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "New sciatic symptoms (foot numbness, calf weakness)",
          "Increasing posterior thigh swelling",
          "Sitting pain not improving"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is chronic repair harder?",
            "a": "The tendons retract and scar into surrounding tissue. The sciatic nerve becomes adherent to the scar, making dissection more hazardous. The tendon quality deteriorates over time, sometimes requiring graft augmentation."
          }
        ]
      }
    ]
  },
  "spica-casting": {
    "name": "Hip Spica Casting",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A hip spica cast is a body cast extending from the chest to one or both legs, used to immobilise the hip joint in children. It is applied after hip surgery (DDH reduction, femoral osteotomy) or for femoral fractures in young children.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under general anaesthesia (usually combined with the surgical procedure), the child is positioned on a spica frame. Padding is applied over bony prominences. Fibreglass or plaster of Paris casting material is applied from the upper chest, around the hips, and down to one leg (single spica) or both legs (double spica). The hips are positioned in the desired angle of flexion and abduction. A window may be cut for wound access. The cast takes 20–30 minutes to apply and sets within 30 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Spica casts are used for femoral shaft fractures in children under approximately five years (who are too young for nailing), post-operative immobilisation after DDH surgery (open reduction, pelvic or femoral osteotomy), and post closed reduction of DDH."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For femoral fractures in older children: flexible nailing (TENS). For DDH: Pavlik harness in infants under six months."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Parents are counselled extensively on spica care — feeding, hygiene, nappy management, and car seat requirements (special car seats may be needed). The child may stay in hospital for one to two days after application to ensure the family is confident with care."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Effective immobilisation of the hip and femur. For femoral fractures: healing in three to four weeks. For DDH: maintains reduction while the hip stabilises."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Skin irritation",
            "detail": "Redness, rubbing, or breakdown under the cast, particularly around the groin and waistline.",
            "freq": "Common"
          },
          {
            "risk": "Hygiene challenges",
            "detail": "Nappy management and bathing are difficult. Parents need detailed instruction.",
            "freq": "Expected"
          },
          {
            "risk": "Child distress",
            "detail": "Some children are initially distressed by the restriction. Most adapt within days.",
            "freq": "Common"
          },
          {
            "risk": "Cast soiling",
            "detail": "Keeping the perineal area clean and dry is challenging.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Pressure sores",
            "detail": "If the cast is too tight or padding is inadequate.",
            "freq": "Uncommon"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "Very rare in spica casting.",
            "freq": "Rare"
          },
          {
            "risk": "Vascular compromise",
            "detail": "If the cast is too tight around the thigh.",
            "freq": "Rare"
          },
          {
            "risk": "Cast syndrome",
            "detail": "Superior mesenteric artery syndrome — abdominal distension, vomiting, and pain from compression of the duodenum. Rare but serious.",
            "freq": "Rare"
          },
          {
            "risk": "Skin infection",
            "detail": "Under the cast from soiling.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Applied under the same general anaesthetic as the surgical procedure. Alternatively, applied under sedation for non-surgical indications."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Cast worn for three to twelve weeks depending on the indication. Regular position changes to prevent pressure sores. The cast may be replaced (cast change) under anaesthesia if it becomes soiled or damaged. After cast removal, the child's joints are initially stiff but recover rapidly — children are remarkably resilient. Formal physiotherapy is rarely needed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Cast becoming too tight — check toes for colour, warmth, and movement",
          "Skin redness or sores visible at the cast edges",
          "Foul smell from the cast",
          "Child in persistent significant distress",
          "Fever",
          "Abdominal distension or vomiting (cast syndrome — attend urgently)",
          "Toes turning blue, cold, or swollen"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray within one week to confirm position. Cast removal at the planned time. Post-removal X-ray. Clinical review."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do I manage nappies?",
            "a": "Place the nappy inside the cast, tucking it carefully around the perineal window. Change frequently. Waterproof cast edges with moleskin or plastic wrap may help. Your nursing team will demonstrate the technique before discharge."
          },
          {
            "q": "Can my child sit in a car seat?",
            "a": "Standard car seats do not accommodate a hip spica. A modified car seat or travel bed may be needed. Your occupational therapist will advise on safe transport options."
          },
          {
            "q": "How will my child cope?",
            "a": "Most children adapt surprisingly quickly — within a few days. They find ways to play, roll, and move within the cast. The first few days are the hardest for both child and parents. Support is available from the nursing and play therapy teams."
          }
        ]
      }
    ]
  },
  "internal-hemipelvectomy": {
    "name": "Internal Hemipelvectomy (Pelvic Tumour Resection)",
    "region": "Pelvis & Acetabulum",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Internal hemipelvectomy is a major operation to resect part of the pelvis containing a tumour while preserving the limb. It is performed for primary bone tumours (chondrosarcoma, osteosarcoma, Ewing's sarcoma) and aggressive benign tumours of the pelvis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach and extent depend on the tumour location within the pelvis (classified by Enneking/Dunham zones). The affected portion of the pelvis is resected with a margin of healthy tissue. Reconstruction options include no reconstruction (flail hip — accepted for iliac wing resections), custom pelvic prosthesis, saddle prosthesis, allograft reconstruction, or hip transposition (if the acetabulum is preserved). The operation takes four to eight hours and often involves orthopaedic, vascular, urological, and plastic surgical teams."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Internal hemipelvectomy is the limb-preserving alternative to hindquarter amputation for pelvic tumours. It preserves the limb while achieving adequate tumour margins."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Hindquarter amputation (if limb salvage is not feasible), radiotherapy (for radiosensitive tumours), chemotherapy, and observation for slow-growing tumours in elderly patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Specialist sarcoma centre. Full staging. CT and MRI with 3D reconstruction for surgical planning. CT angiography for vascular anatomy. MDT discussion. Pre-operative embolisation may be needed. Psychological preparation."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Limb preservation with tumour removal. Functional outcomes vary depending on the extent of resection and reconstruction — some patients walk independently, others require aids."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Major surgery",
            "detail": "This is one of the most complex operations in orthopaedic surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Significant blood loss",
            "detail": "Transfusion always needed. Cell salvage not used in oncology.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged recovery",
            "detail": "Hospital stay one to three weeks. Full recovery twelve to eighteen months.",
            "freq": "Expected"
          },
          {
            "risk": "Functional limitation",
            "detail": "Depending on the resection, hip abductor weakness, limb shortening, and gait alteration are common.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Wound complications",
            "detail": "Very common due to the extensive surgery. Risk approximately 20–30%.",
            "freq": "Common"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection. Risk approximately 10–15%.",
            "freq": "Common"
          },
          {
            "risk": "Sciatic or femoral nerve injury",
            "detail": "May be unavoidable depending on tumour location.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vascular injury",
            "detail": "Iliac vessels at risk.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant/reconstruction failure",
            "detail": "Custom prostheses may loosen or dislocate. Allografts may fracture.",
            "freq": "Long-term"
          },
          {
            "risk": "Local recurrence",
            "detail": "Despite adequate margins.",
            "freq": "Uncommon"
          },
          {
            "risk": "DVT/PE",
            "detail": "Very high risk.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Major surgery with massive blood loss potential. Invasive monitoring. ICU bed booked."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "ICU or HDU for 24–48 hours. Hospital stay one to three weeks. Weight-bearing depends on reconstruction — may be restricted for three to six months. Intensive physiotherapy. Walking aids long-term. Full rehabilitation twelve to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound breakdown",
          "Fever",
          "Deep vein thrombosis",
          "Increasing pain or new lump suggesting recurrence",
          "Leg weakness or numbness",
          "Difficulty with bladder or bowel function"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Oncology surveillance with regular imaging. Reconstruction monitoring. Lifelong follow-up."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk again?",
            "a": "Most patients with acetabular-sparing resections walk well with aids. Acetabular resections with reconstruction allow walking but with a significant limp and often the need for a crutch. The functional outcome depends on the extent of resection."
          },
          {
            "q": "Why is this so complex?",
            "a": "The pelvis houses major blood vessels, nerves, the bladder, bowel, and reproductive organs. Tumour surgery must navigate these structures while achieving complete tumour removal. It requires a multidisciplinary team and extensive experience."
          }
        ]
      }
    ]
  },
  "unicompartmental-revision": {
    "name": "Revision of Unicompartmental Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision of a unicompartmental (partial) knee replacement is an operation to convert a failed partial knee replacement to a total knee replacement. It is one of the advantages of partial replacement — revision to TKR is generally straightforward with good outcomes.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is reopened or extended. The unicompartmental components (femoral and tibial) are removed. The remaining joint surfaces are prepared. Standard primary total knee replacement components are typically sufficient — revision-type implants with stems are only needed if there is significant bone loss. Bone defects are filled with cement, graft, or augments. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision is needed for loosening of the unicompartmental components, polyethylene bearing wear, progression of arthritis in the other compartments, persistent unexplained pain, infection, or fracture around the implant."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For pain without loosening: physiotherapy, injection, investigation for other causes. For confirmed mechanical failure: revision is usually required."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays, CT if bone loss suspected. If infection suspected, aspiration first. Assessment of the cause of failure guides the revision plan."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Good outcomes — revision of UKR to TKR generally produces results comparable to primary TKR. This is one of the key advantages of choosing UKR initially."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recovery similar to primary TKR",
            "detail": "Hospital stay one to three days. Full recovery six to twelve months.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Temporary. Physiotherapy essential.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Bone loss",
            "detail": "Removing the UKR may reveal bone defects requiring augmentation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary TKR, approximately 2–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "Ligament balancing may be more challenging.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT/PE.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Periprosthetic fracture.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Same as primary TKR. Hospital one to three days. Physiotherapy from day one. Driving at six weeks. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Knee feeling unstable",
          "Wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as primary TKR: reviews at two weeks, six weeks, three months, one year."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Are the results as good as a primary TKR?",
            "a": "Yes — evidence shows that revision of UKR to TKR produces results comparable to primary TKR. This is a significant advantage of choosing partial replacement initially."
          }
        ]
      }
    ]
  },
  "knee-aspiration": {
    "name": "Knee Aspiration (Diagnostic and Therapeutic)",
    "region": "Knee",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee aspiration is a procedure to remove fluid from the knee joint using a needle and syringe. It is performed to diagnose the cause of a swollen knee (infection, crystals, blood) or to relieve a painful tense effusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The skin is cleaned with antiseptic. The knee is positioned in slight flexion. A needle is inserted into the joint — commonly through a superolateral approach (above and to the outer side of the kneecap). Fluid is aspirated and sent for analysis: microscopy for crystals (gout, pseudogout), culture and sensitivity (infection), cell count, and appearance. If therapeutic, corticosteroid may be injected after aspiration. The procedure takes five to ten minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Aspiration is performed urgently if septic arthritis is suspected (hot, red, swollen knee with fever), for crystal analysis in suspected gout or pseudogout, to relieve a tense, painful effusion after injury or surgery, and diagnostically for unexplained chronic effusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Blood tests and imaging may support a diagnosis but cannot definitively identify infection or crystals. When septic arthritis is suspected, aspiration is mandatory."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No fasting required. Can be performed at the bedside or in clinic. Stop anticoagulants if safe to do so (discuss with prescribing team)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Definitive fluid analysis for diagnosis. Therapeutic relief of a tense effusion. If corticosteroid is injected, additional pain relief for inflammatory conditions."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Discomfort",
            "detail": "Brief pain during needle insertion.",
            "freq": "Expected"
          },
          {
            "risk": "Bruising",
            "detail": "Minor bruising.",
            "freq": "Common"
          },
          {
            "risk": "Recurrence",
            "detail": "Fluid may reaccumulate.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Introduction of infection. Very rare with sterile technique (approximately 1 in 10,000–50,000).",
            "freq": "Rare"
          },
          {
            "risk": "Haemarthrosis",
            "detail": "Bleeding into the joint, particularly in anticoagulated patients.",
            "freq": "Rare"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary pain increase after injection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic spray or infiltration. No sedation needed."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "No recovery needed. Rest for 24 hours after injection."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing knee warmth, swelling, or pain after 48 hours",
          "Fever",
          "Redness spreading from the needle site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Fluid results within 24–48 hours. Urgent results if sepsis suspected. Follow-up based on diagnosis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is the aspiration painful?",
            "a": "There is brief discomfort as the needle passes through the skin and into the joint. Local anaesthetic spray or injection at the skin site reduces this. Most patients find it tolerable."
          },
          {
            "q": "When is aspiration an emergency?",
            "a": "If septic arthritis is suspected — a hot, red, swollen joint with fever or elevated inflammatory markers — aspiration must be performed urgently before starting antibiotics, to identify the organism."
          }
        ]
      }
    ]
  },
  "shoulder-injection": {
    "name": "Shoulder Injection (Subacromial / Glenohumeral / AC Joint)",
    "region": "Shoulder",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder injection is a procedure to inject corticosteroid and local anaesthetic into the shoulder — targeting the subacromial space, the glenohumeral (shoulder) joint, or the acromioclavicular joint depending on the diagnosis.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Subacromial injection: the needle is inserted from the lateral or posterior approach into the space between the acromion and the rotator cuff. Glenohumeral injection: the needle enters the shoulder joint, typically from a posterior approach. AC joint injection: a small needle is inserted directly into the acromioclavicular joint from above. The injection may be performed using anatomical landmarks alone or with ultrasound guidance for accuracy. The procedure takes five to ten minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Subacromial: for rotator cuff tendinopathy, bursitis, and impingement. Glenohumeral: for glenohumeral arthritis, adhesive capsulitis (frozen shoulder), and as a diagnostic tool. AC joint: for AC joint arthritis or osteolysis. Injections serve both diagnostic (confirming the pain source) and therapeutic (anti-inflammatory) purposes."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, oral anti-inflammatory medication, activity modification, and topical treatments. These should be combined with injection — not replaced by it."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No fasting. Clinical or ultrasound-guided. Inform clinician about blood thinners and allergies."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Diagnostic: if the injection relieves pain, it confirms the targeted structure as the source. Therapeutic: pain relief lasting weeks to months. Enables more effective physiotherapy during the pain-free window."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Injection site discomfort",
            "detail": "For a few hours to days.",
            "freq": "Expected"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary pain increase for 24–48 hours.",
            "freq": "Uncommon"
          },
          {
            "risk": "Blood sugar rise",
            "detail": "In diabetic patients. Usually normalises within days.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Very rare with sterile technique.",
            "freq": "Rare"
          },
          {
            "risk": "Tendon weakening",
            "detail": "Repeated subacromial injections may weaken the rotator cuff. Limit to two to three per year.",
            "freq": "Long-term"
          },
          {
            "risk": "Skin depigmentation",
            "detail": "Localised skin lightening.",
            "freq": "Rare"
          },
          {
            "risk": "Facial flushing",
            "detail": "Systemic steroid effect. Temporary.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed. The injection contains local anaesthetic."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Normal activities immediately. Avoid heavy shoulder use for 48 hours. Maximise the pain-free window with structured physiotherapy."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing shoulder pain, warmth, or swelling after 48 hours",
          "Fever",
          "Redness spreading from the injection site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Assess response at two to four weeks. Plan further management based on response."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How many injections can I have?",
            "a": "Most clinicians limit to two to three subacromial injections per year. Repeated injections may weaken the rotator cuff. Glenohumeral and AC joint injections have similar limitations."
          },
          {
            "q": "Is ultrasound guidance necessary?",
            "a": "For subacromial injections, landmark-guided technique is usually accurate. Glenohumeral and AC joint injections benefit from ultrasound guidance for improved accuracy."
          }
        ]
      }
    ]
  },
  "hip-resurfacing-primary": {
    "name": "Hip Resurfacing (Primary)",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip resurfacing is a bone-conserving alternative to total hip replacement where a metal cap is placed over the femoral head (rather than removing it) and a metal cup is placed in the acetabulum. It preserves more bone and is suited to younger, active male patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through an incision over the hip (typically posterior approach), the femoral head is reshaped and capped with a metal (cobalt-chrome) resurfacing component. A metal cup is impacted into the acetabulum. The metal-on-metal bearing allows a large-diameter head, providing excellent stability and range of motion. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip resurfacing is considered for younger male patients (under 55–60) with good bone quality, adequate femoral head size, and an active lifestyle who wish to preserve bone stock and maintain high activity levels. It is particularly suitable for patients wanting to return to sport."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, injection, activity modification. Total hip replacement (ceramic-on-polyethylene or ceramic-on-ceramic) is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and MRI to assess femoral head vascularity and size. CT may be used for component planning. Patient selection is critical — best outcomes in men with large femoral heads."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Bone conservation, excellent stability (virtually no dislocation risk), near-normal proprioception and gait, and high activity levels including sport. Well-selected male patients have excellent long-term results — over 95% survival at fifteen years in specialist centres."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Metal ion elevation",
            "detail": "Cobalt and chromium levels rise. Lifelong monitoring is needed.",
            "freq": "Expected"
          },
          {
            "risk": "Learning curve",
            "detail": "Results are highly surgeon-dependent.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "ARMD",
            "detail": "Adverse reaction to metal debris causing soft tissue damage. More common in women and with smaller heads. Risk approximately 1–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Femoral neck fracture",
            "detail": "Early post-operative fracture. Risk approximately 1–2%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Loosening",
            "detail": "Femoral or acetabular component loosening.",
            "freq": "Long-term"
          },
          {
            "risk": "AVN under the cap",
            "detail": "If the femoral head blood supply is compromised.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection approximately 1%.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital one to three days. Walking with crutches from day one. Driving at four to six weeks. Return to sport at three to six months. No restrictions on activity once recovered — unlike some THR bearing surfaces. Lifelong metal ion monitoring annually."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Groin pain or clicking (possible ARMD)",
          "General malaise or fatigue (metal ion effects)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Annual blood metal ion levels (MHRA requirement). X-rays at one year then as needed. MARS-MRI if symptoms develop or metal ions rise."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this mainly for men?",
            "a": "Women generally have smaller femoral heads, which generate more metal debris per step due to higher bearing surface pressures. This increases the risk of ARMD. Men with larger heads have much better outcomes."
          },
          {
            "q": "Can I run and play sport?",
            "a": "Yes — this is one of the key advantages. Hip resurfacing preserves natural proprioception and bone stock, allowing return to running, cycling, football, and other high-demand activities. Many resurfacing patients are more active than THR patients."
          }
        ]
      }
    ]
  },
  "ankle-osteochondral-lesion": {
    "name": "Ankle Osteochondral Lesion Treatment",
    "region": "Foot & Ankle",
    "tag": "Cartilage",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ankle osteochondral lesion (OCL) treatment involves arthroscopic or open surgical management of a cartilage and bone defect on the talar dome — typically caused by a previous ankle sprain or fracture.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "For small lesions (less than 15 mm): arthroscopic debridement and microfracture — the damaged cartilage is removed and small holes are drilled into the bone to stimulate healing. For larger or cystic lesions: retrograde drilling through the calcaneus to address subchondral cysts, OATS (osteochondral autograft from the knee), particulated juvenile cartilage allograft (DeNovo), or bone grafting with cartilage restoration. A malleolar osteotomy (cutting the ankle bone) may be needed for surgical access to posterior lesions. Operations take 45 minutes to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for symptomatic osteochondral lesions causing persistent deep ankle pain, swelling, and catching that have not responded to physiotherapy, activity modification, and injection."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, ankle bracing, activity modification, and corticosteroid or PRP injection. Many OCLs are asymptomatic and discovered incidentally on MRI."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT to assess lesion size, location, and subchondral bone involvement. Standing X-rays. The surgical approach depends on lesion location."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved function in approximately 75–85% of patients with microfracture. OATS and biological techniques may provide more durable cartilage restoration for larger lesions."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-weight-bearing for six to eight weeks for microfracture and OATS.",
            "freq": "Expected"
          },
          {
            "risk": "Ankle swelling",
            "detail": "Prolonged swelling.",
            "freq": "Expected"
          },
          {
            "risk": "Incomplete symptom relief",
            "detail": "Not all patients achieve complete resolution.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Fibrocartilage durability",
            "detail": "Microfracture produces fibrocartilage that may degrade over five to ten years.",
            "freq": "Long-term"
          },
          {
            "risk": "Donor site morbidity",
            "detail": "If knee OATS is performed, knee donor site pain.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malleolar osteotomy non-union",
            "detail": "If an osteotomy was needed for access.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          },
          {
            "risk": "Progression to ankle arthritis",
            "detail": "Despite treatment.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. Boot for two to four weeks. Physiotherapy for ankle range of motion and strengthening. Return to sport at four to six months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent deep ankle pain",
          "Ankle locking or catching",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks. MRI at six months and one year to assess cartilage healing."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What causes osteochondral lesions?",
            "a": "Most are caused by ankle sprains or fractures — the cartilage and underlying bone are damaged by the injury. Some occur spontaneously without clear trauma. The medial talar dome is the most common location."
          }
        ]
      }
    ]
  },
  "cervical-myelopathy-management": {
    "name": "Cervical Myelopathy Management (ACDF / Laminectomy / Laminoplasty)",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Cervical myelopathy management encompasses the surgical options for spinal cord compression in the neck. The choice between anterior (ACDF/corpectomy), posterior (laminectomy with fusion or laminoplasty), or combined approaches depends on the location, extent, and pattern of compression.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical approach is tailored to each patient. Anterior: ACDF or corpectomy for one to two level anterior compression. Posterior: laminectomy with fusion or laminoplasty for multi-level (three or more levels) posterior compression with maintained lordosis. Combined: anterior and posterior surgery for severe multi-level disease, kyphotic deformity, or OPLL. Each approach is described in its respective ConsentIQ leaflet — this overview helps patients understand how the decision is made."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended for progressive cervical myelopathy — spinal cord compression causing hand clumsiness, gait imbalance, leg stiffness, and bladder dysfunction. Myelopathy tends to progress in a stepwise fashion and rarely improves without surgical decompression."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation with serial examination for very mild, stable myelopathy. Physiotherapy for balance and proprioception. Cervical collar for comfort. However, progressive myelopathy generally requires surgery — the spinal cord does not recover well from prolonged compression."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI showing cord compression. CT for bony anatomy and surgical planning. Myelopathy assessment scores (mJOA, Nurick). Assessment of cervical alignment (lordosis vs kyphosis) guides the surgical approach."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Prevention of neurological deterioration. Approximately 60–80% of patients stabilise or improve. Earlier surgery (before severe cord damage) gives better outcomes. The goal is to decompress the cord before irreversible damage occurs."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Neck stiffness",
            "detail": "Expected after fusion, particularly multi-level.",
            "freq": "Expected"
          },
          {
            "risk": "Axial neck pain",
            "detail": "Posterior approaches cause more post-operative neck pain.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete recovery",
            "detail": "Long-standing cord compression may not fully recover.",
            "freq": "Common"
          },
          {
            "risk": "C5 palsy",
            "detail": "Weakness of deltoid after decompression. Usually recovers.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Spinal cord injury",
            "detail": "Risk approximately 1–2%. The compressed cord is vulnerable during surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Dysphagia",
            "detail": "Swallowing difficulty with anterior approaches. Usually temporary.",
            "freq": "Common"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "New degeneration above or below the fusion.",
            "freq": "Long-term"
          },
          {
            "risk": "CSF leak",
            "detail": "Dural tear.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Hardware failure",
            "detail": "Screw loosening, cage subsidence, rod breakage.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with neuromonitoring (SSEPs and MEPs). Careful intubation technique to avoid neck extension."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital two to five days. Collar for four to twelve weeks depending on procedure. Balance and gait rehabilitation. Hand dexterity exercises. Return to desk work at four to eight weeks. Full recovery three to twelve months. Neurological recovery continues for up to eighteen months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening hand clumsiness or dropping objects",
          "Increasing gait difficulty or falls",
          "New bladder symptoms",
          "Wound problems",
          "Fever",
          "Difficulty swallowing (anterior approach)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, six months, and one year. X-rays and/or CT. Neurological assessment at each visit."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How is the surgical approach chosen?",
            "a": "The decision depends on the number of levels compressed, whether compression is mainly from the front or back, cervical alignment (lordosis or kyphosis), and patient factors. Anterior approaches are preferred for one to two level anterior compression. Posterior approaches are preferred for multi-level disease with maintained lordosis."
          },
          {
            "q": "Will my hand function improve?",
            "a": "Many patients experience improvement in hand dexterity, though recovery depends on the duration and severity of compression. Earlier surgery gives better results. Some patients have permanent residual dysfunction if the cord was severely compressed for a prolonged period."
          }
        ]
      }
    ]
  },
  "antibiotic-cement-spacer": {
    "name": "Antibiotic Cement Spacer (Prosthetic Joint Infection)",
    "region": "Trauma",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "An antibiotic cement spacer is a temporary implant made of antibiotic-loaded bone cement placed in a joint after removal of an infected prosthesis. It delivers high concentrations of antibiotics locally, maintains joint space, and allows limited mobility while the infection is treated.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "After the infected prosthesis is removed and the joint is thoroughly debrided, a spacer is fashioned intra-operatively from antibiotic-loaded bone cement (polymethylmethacrylate — PMMA). Hip spacers are typically articulating (shaped like a prosthesis to allow walking). Knee spacers may be static (block) or articulating (shaped like a knee replacement). High-dose antibiotics (vancomycin, gentamicin, or organism-specific) are mixed into the cement. The spacer is inserted and the wound closed. The operation takes one and a half to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Spacers are the standard first stage of two-stage revision for chronic prosthetic joint infection — the most reliable method of eradicating established PJI with approximately 85–95% infection cure rates."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "One-stage revision (at specialist centres for selected cases), DAIR (for acute infections only), long-term antibiotic suppression (accepting persistent infection), resection arthroplasty (Girdlestone — leaving no implant), or amputation (last resort)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Joint aspiration for microbiology. Blood inflammatory markers. CT to assess bone stock. MDT discussion with microbiologists. Planning the revision implant for the second stage."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Eradication of infection in approximately 85–95% of patients with two-stage revision. The spacer delivers high local antibiotic concentrations directly to the infected tissue. Articulating spacers allow limited walking during the inter-stage period."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited mobility",
            "detail": "Walking is restricted with a spacer — crutches or a frame are needed.",
            "freq": "Expected"
          },
          {
            "risk": "Spacer dislocation",
            "detail": "Particularly hip spacers. May need repositioning.",
            "freq": "Common"
          },
          {
            "risk": "Inter-stage period",
            "detail": "Four to twelve weeks between stages. This is a challenging period.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for two to six weeks, then oral for several weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent infection",
            "detail": "The infection may not be fully eradicated despite the spacer. Risk approximately 5–15%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spacer fracture",
            "detail": "The cement spacer may break, particularly in heavier patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bone loss",
            "detail": "Cement removal at second stage may cause additional bone loss.",
            "freq": "Common"
          },
          {
            "risk": "Wound complications",
            "detail": "In previously operated, infected tissue.",
            "freq": "Common"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients with PJI have significant comorbidities.",
            "freq": "Common"
          },
          {
            "risk": "Antibiotic toxicity",
            "detail": "High-dose local and systemic antibiotics carry toxicity risks (renal, ototoxicity).",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. The patient may be medically complex."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital one to two weeks. IV antibiotics via PICC line for two to six weeks. Regular blood tests (CRP, ESR, renal function, antibiotic levels). Limited weight-bearing with aids. Joint aspiration before second stage to confirm infection clearance. Second stage (reimplantation) at six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Fever or new systemic unwellness",
          "Spacer dislocation (hip feels unstable)",
          "Wound discharge",
          "Rising inflammatory markers",
          "PICC line problems",
          "Antibiotic side effects (rash, diarrhoea, hearing changes)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular blood tests twice weekly during IV antibiotics. Clinical review at two, four, and six weeks. Joint aspiration before second stage. MDT review to confirm readiness for reimplantation."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long between first and second stage?",
            "a": "Typically six to twelve weeks. During this time, antibiotics are given and infection markers are monitored. The second stage is only performed when clinical and laboratory evidence confirms infection clearance."
          },
          {
            "q": "What is the success rate?",
            "a": "Two-stage revision has the highest infection cure rate of any method — approximately 85–95%. The inter-stage period is challenging but gives the best chance of a permanent, infection-free joint replacement."
          }
        ]
      }
    ]
  },
  "platelet-rich-plasma": {
    "name": "Platelet-Rich Plasma (PRP) Injection",
    "region": "Sports Medicine",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Platelet-rich plasma (PRP) injection is a procedure to inject a concentrated preparation of the patient's own platelets into an injured tendon, ligament, or joint. The platelets release growth factors that may promote tissue healing.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A blood sample (15–60 ml) is taken from the patient's arm. The blood is spun in a centrifuge to separate and concentrate the platelets. The resulting platelet-rich plasma is injected into the affected area under ultrasound guidance. Some protocols include leukocyte-rich PRP (LR-PRP) and others leukocyte-poor PRP (LP-PRP) depending on the indication. The procedure takes 30–45 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "PRP is considered for chronic tendinopathies (tennis elbow, patellar tendinopathy, Achilles tendinopathy, gluteal tendinopathy), early knee osteoarthritis, muscle injuries in athletes, and plantar fasciitis. The evidence base is strongest for lateral epicondylitis (tennis elbow) and knee osteoarthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (the mainstay of treatment for tendinopathy), corticosteroid injection (faster relief but shorter duration and potential tendon damage), shockwave therapy, activity modification, and structured loading programmes."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Stop anti-inflammatory medication (NSAIDs) for at least one week before the procedure — they inhibit the platelet function that PRP relies on. Outpatient procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Evidence suggests PRP provides modest, gradual improvement over weeks to months for certain conditions — particularly lateral epicondylitis (Level 1 evidence) and knee osteoarthritis (moderate evidence). For other conditions, evidence is still emerging."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Injection site pain",
            "detail": "Significant pain flare for 48–72 hours is common and expected — the growth factors cause local inflammation as part of the healing response.",
            "freq": "Expected"
          },
          {
            "risk": "No improvement",
            "detail": "Not all patients respond. Evidence is moderate for most indications.",
            "freq": "Common"
          },
          {
            "risk": "Multiple injections",
            "detail": "Some protocols recommend two to three injections at weekly intervals.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Very rare — the patient's own blood is used.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve or vessel damage",
            "detail": "From the injection. Rare with ultrasound guidance.",
            "freq": "Rare"
          },
          {
            "risk": "Tissue damage",
            "detail": "Theoretical risk of excessive inflammatory response.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed beyond local anaesthetic at the injection site. Some clinicians avoid local anaesthetic as it may inhibit platelet function."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Rest the affected area for 48–72 hours. Do NOT take anti-inflammatory medication for two weeks after (they counteract the PRP mechanism). Gentle rehabilitation from one week. Progressive loading from two to four weeks. Maximum benefit may take six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain beyond 72 hours",
          "Signs of infection (increasing redness, warmth, fever)",
          "Worsening of symptoms beyond two weeks"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at four to six weeks to assess response. Repeat injection at six to twelve weeks if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is PRP evidence-based?",
            "a": "The strongest evidence supports PRP for lateral epicondylitis (tennis elbow) and intra-articular PRP for mild to moderate knee osteoarthritis. For other conditions (Achilles tendinopathy, rotator cuff tears, muscle injuries), the evidence is promising but less definitive. Research is ongoing."
          },
          {
            "q": "Why can't I take anti-inflammatories?",
            "a": "PRP works by delivering concentrated platelets that release growth factors and trigger a healing inflammatory response. Anti-inflammatory drugs suppress this response, potentially negating the benefit of the PRP."
          },
          {
            "q": "Is PRP available on the NHS?",
            "a": "PRP is not widely available on the NHS due to variable evidence. It is commonly available privately. NICE guidelines are evolving as more evidence becomes available."
          }
        ]
      }
    ]
  },
  "paediatric-spine-scoliosis-monitoring": {
    "name": "Scoliosis Monitoring and Bracing (Paediatric)",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Scoliosis monitoring involves regular clinical and radiographic assessment of spinal curvature in growing children. For curves between 25–45 degrees, bracing may be used to prevent progression during the growth spurt. Surgery is reserved for curves exceeding 45–50 degrees.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Monitoring: clinical examination for trunk asymmetry using the Adam's forward bend test (scoliometer measurement). Standing full-spine X-rays (PA and lateral) at intervals determined by age and curve magnitude. Low-dose imaging protocols (EOS) reduce radiation. Bracing: a custom-moulded rigid brace (Boston, Chêneau, or night-time Providence) is worn for the prescribed number of hours daily (typically 18–23 hours for full-time bracing, 8–10 hours for night-time bracing). The brace applies corrective forces to the curve."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Monitoring is recommended for all children with scoliosis greater than 10 degrees, particularly during the growth spurt (ages 10–15 in girls, 12–17 in boys). Bracing is recommended for curves between 25–45 degrees in skeletally immature patients (Risser 0–2) to prevent progression to the surgical threshold."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (Schroth method — scoliosis-specific exercises), observation alone for small curves, and acceptance of the curve if the patient is near skeletal maturity and the curve is stable."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Not a surgical procedure. Initial full-spine X-rays for baseline. Bone age assessment (hand X-ray or Risser sign) to estimate remaining growth."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The BrAIST trial demonstrated that bracing successfully prevents curve progression to the surgical threshold in approximately 72% of patients with curves 25–40 degrees, compared to 48% with observation alone. The more hours the brace is worn, the better the outcome."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-compliance",
            "detail": "The biggest challenge. Adolescents may resist wearing the brace, particularly during school hours and social situations.",
            "freq": "Common"
          },
          {
            "risk": "Skin irritation",
            "detail": "Pressure sores, redness, and discomfort under the brace.",
            "freq": "Common"
          },
          {
            "risk": "Psychological impact",
            "detail": "Body image concerns, social embarrassment, and frustration.",
            "freq": "Common"
          },
          {
            "risk": "Curve progression despite bracing",
            "detail": "Approximately 28% of braced patients still progress to the surgical threshold.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Missed progression",
            "detail": "If monitoring intervals are too long, rapid curve progression may be missed.",
            "freq": "Rare"
          },
          {
            "risk": "Overcorrection",
            "detail": "Very rare with modern bracing.",
            "freq": "Rare"
          },
          {
            "risk": "Rib deformity",
            "detail": "Pressure from the brace may cause temporary rib cage asymmetry.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia required. Bracing is entirely non-invasive."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Bracing continues until skeletal maturity (Risser 4–5, typically age 15–17 in girls, 17–19 in boys). Gradual weaning over six to twelve months. Scoliosis-specific physiotherapy throughout. Sport and physical activity are encouraged — the brace is removed for sport. Final assessment at skeletal maturity determines whether the curve is stable."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Rapid increase in curve on X-ray",
          "Increasing pain (unusual in adolescent idiopathic scoliosis — warrants investigation)",
          "Neurological symptoms (very rare in AIS — should prompt MRI)",
          "Brace causing skin breakdown",
          "Respiratory difficulty in the brace"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays every four to six months during the growth spurt. Clinical review at each visit. Brace adjustment as the child grows. Final assessment at skeletal maturity."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Does my child definitely need a brace?",
            "a": "Bracing is recommended for curves between 25–45 degrees in growing children. Below 25 degrees, observation is usually sufficient. Above 45 degrees, surgery is typically discussed. The decision depends on the curve magnitude, remaining growth, and risk of progression."
          },
          {
            "q": "How many hours per day?",
            "a": "Full-time bracing (18–23 hours/day) is most effective. The BrAIST trial showed a dose-response — more hours equals better results. Night-time-only bracing (8–10 hours) is an option for moderate curves but is less effective for larger curves."
          },
          {
            "q": "Can my child still do sport?",
            "a": "Yes — sport and physical activity are strongly encouraged. The brace is removed for sport and physical education. Swimming, dance, and gymnastics are particularly beneficial for core strength and flexibility."
          },
          {
            "q": "Will the curve get worse after bracing stops?",
            "a": "Curves that remain below 30 degrees at skeletal maturity are unlikely to progress significantly in adulthood. Curves above 50 degrees at maturity tend to progress slowly (approximately 1 degree per year) and may eventually require surgery."
          }
        ]
      }
    ]
  },
  "anterolateral-tenodesis": {
    "name": "Lateral Extra-Articular Tenodesis (LET / Lemaire)",
    "region": "Knee",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lateral extra-articular tenodesis is a procedure performed alongside ACL reconstruction to control rotational knee instability. A strip of iliotibial band is rerouted around the lateral femoral epicondyle to act as a checkrein against the pivot shift.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through an incision on the outer knee, a strip of the iliotibial band (leaving it attached distally) is passed deep to the lateral collateral ligament, through a tunnel in the lateral femoral epicondyle, and sutured back to itself. This creates a lateral checkrein that resists tibial internal rotation — the component of instability responsible for the pivot shift. It is always performed in addition to ACL reconstruction, not instead of it. Adds approximately 20 minutes to the ACL operation."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "LET is recommended alongside ACL reconstruction for patients at high risk of re-rupture: those under 25 returning to pivoting sports, revision ACL reconstruction, high-grade pivot shift, and patients with radiographic signs of lateral instability (Segond fracture, lateral capsular sign)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Standard ACL reconstruction without LET is appropriate for most patients. LET is specifically for high-risk groups."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Same as ACL reconstruction. Assessment of pivot shift grade. Risk factor assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The STABILITY trial showed that adding LET to hamstring ACL reconstruction reduced graft rupture from 11% to 4% in young athletes. It significantly improves rotational control."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral knee stiffness",
            "detail": "Mild restriction of deep flexion possible but uncommon with modern technique.",
            "freq": "Uncommon"
          },
          {
            "risk": "Lateral numbness",
            "detail": "From skin incision near lateral cutaneous nerves.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Over-constraint",
            "detail": "If tensioned too tightly. Modern techniques minimise this risk.",
            "freq": "Rare"
          },
          {
            "risk": "ITB irritation",
            "detail": "At the harvest or rerouting site.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Same as ACL reconstruction — general or spinal with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Same protocol as ACL reconstruction. No additional restrictions. Running at four to six months. Sport at nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Lateral knee pain not settling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as ACL reconstruction."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this the same as ALL reconstruction?",
            "a": "They are similar but not identical. LET uses a strip of ITB rerouted around the lateral epicondyle. ALL reconstruction uses a free graft placed in the anatomical ALL position. Both control rotation. LET has more long-term data supporting it (the STABILITY trial)."
          }
        ]
      }
    ]
  },
  "custom-knee-replacement": {
    "name": "Custom / Patient-Specific Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Custom or patient-specific knee replacement uses pre-operative CT or MRI imaging to create personalised cutting guides and, in some systems, a custom-manufactured implant matched to the patient's unique knee anatomy.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Pre-operative imaging (CT or MRI) is obtained. For patient-specific instrumentation (PSI): 3D-printed cutting blocks are manufactured to match the patient's knee, guiding bone cuts without intramedullary alignment rods. For true custom implants: the prosthesis itself is designed and manufactured to match the patient's specific anatomy. The surgical procedure is otherwise similar to standard TKR. The operation takes a similar time to conventional surgery."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Custom instrumentation may be recommended to improve alignment accuracy, avoid intramedullary canal violation (reducing fat embolism risk), reduce surgical steps, and in patients with unusual anatomy (previous fracture, extra-articular deformity, hardware in the canal)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All standard non-operative options for knee arthritis. Standard (off-the-shelf) TKR with conventional, navigated, or robotic instrumentation are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Pre-operative CT or MRI (four to six weeks before surgery for guide manufacture). Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Potentially improved implant positioning accuracy. Reduced intraoperative steps. No canal violation (for PSI). For true custom implants: theoretically better fit and kinematics. Long-term outcome data is still maturing."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Same risks as standard TKR",
            "detail": "All standard risks apply.",
            "freq": "Expected"
          },
          {
            "risk": "Manufacturing lead time",
            "detail": "Four to six weeks for guide or implant production.",
            "freq": "Expected"
          },
          {
            "risk": "Imaging radiation",
            "detail": "Additional CT radiation dose.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Guide or implant inaccuracy",
            "detail": "Manufacturing error. Backup conventional instruments should always be available.",
            "freq": "Rare"
          },
          {
            "risk": "All standard TKR risks",
            "detail": "Infection, blood clots, stiffness, loosening.",
            "freq": "See standard risks"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Same as standard TKR."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Identical to standard TKR."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as standard TKR."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is a custom knee better than a standard one?",
            "a": "Custom instrumentation improves positioning accuracy in some studies. Whether this translates to better long-term outcomes or patient satisfaction compared to well-performed standard, navigated, or robotic TKR is not yet proven. It is particularly useful for patients with unusual anatomy."
          }
        ]
      }
    ]
  },
  "shoulder-arthroscopy-general": {
    "name": "Shoulder Arthroscopy (General Principles)",
    "region": "Shoulder",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Shoulder arthroscopy is a keyhole surgical technique to visualise and treat conditions within and around the shoulder joint. It is used for diagnosis, rotator cuff surgery, labral repair, impingement treatment, capsular release, and many other shoulder conditions.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two to five small incisions (portals, each 5–8 mm) are made around the shoulder. An arthroscope (a small camera) is inserted into the joint, displaying the image on a monitor. Saline fluid distends the joint for visibility. Surgical instruments are inserted through additional portals to perform the required procedure. Common arthroscopic procedures include subacromial decompression, rotator cuff repair, labral repair (Bankart), SLAP repair, capsular release, biceps procedures, AC joint excision, and diagnostic assessment. Operating time varies from 20 minutes (simple diagnostic) to two hours (complex cuff repair)."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopy is recommended when imaging and clinical assessment suggest an intra-articular or subacromial pathology that would benefit from surgical treatment, or when the diagnosis is uncertain and direct visualisation would help."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, corticosteroid injection, activity modification, and time. Many shoulder conditions improve without surgery. Arthroscopy is reserved for conditions that have not responded to adequate conservative management."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or ultrasound to assess the pathology. Standard pre-assessment. Day-case for many procedures."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Minimally invasive access to the shoulder joint with smaller scars, less pain, and faster recovery than open surgery for many conditions. Excellent visualisation of the joint."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Temporary. Physiotherapy is essential.",
            "freq": "Common"
          },
          {
            "risk": "Portal site soreness",
            "detail": "Discomfort at the small incision sites.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Fluid extravasation into surrounding tissues causing temporary swelling.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Frozen shoulder",
            "detail": "Post-operative adhesive capsulitis.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Axillary, musculocutaneous, or suprascapular nerve. Risk less than 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Shoulder joint infection approximately 0.3–0.5%.",
            "freq": "Rare"
          },
          {
            "risk": "Chondral damage",
            "detail": "Inadvertent cartilage damage from instruments.",
            "freq": "Rare"
          },
          {
            "risk": "Fluid extravasation",
            "detail": "Excessive fluid tracking causing swelling, rarely airway compromise.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with interscalene nerve block for post-operative pain relief. Beach-chair (sitting) or lateral decubitus (lying on the side) position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Recovery depends entirely on the procedure performed — ranging from days (simple diagnostic or debridement) to six months (rotator cuff repair). Sling use, exercise restrictions, and rehabilitation protocols are specific to each procedure. Please refer to the relevant condition-specific ConsentIQ leaflet."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing shoulder stiffness",
          "Significant swelling of the shoulder, arm, or neck (fluid extravasation — usually resolves within 24 hours)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Depends on the procedure. Typically two weeks for wound check, six weeks for progress review."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is arthroscopy always better than open surgery?",
            "a": "For most shoulder conditions, arthroscopy produces equivalent or better outcomes with smaller incisions and faster early recovery. However, some conditions (certain fractures, large bone defects, some instability patterns) are better treated with open surgery."
          },
          {
            "q": "How many incisions are needed?",
            "a": "Typically two to five small incisions (5–8 mm each), depending on the procedure. These heal to small, barely visible scars."
          }
        ]
      }
    ]
  },
  "hip-arthroscopy-fai-labral": {
    "name": "Hip Arthroscopy for FAI and Labral Tears (Overview)",
    "region": "Hip",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip arthroscopy is a minimally invasive technique to treat femoroacetabular impingement (FAI) and labral tears — the most common indications for hip arthroscopy. It involves reshaping the femoral head-neck junction and/or acetabular rim while repairing or reconstructing the labrum.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under general anaesthesia, the leg is placed in traction to open the hip joint space. Two to three small incisions (portals) are made around the hip. An arthroscope is inserted to visualise the joint. For cam impingement: the bone bump on the femoral head-neck junction is shaved (osteochondroplasty). For pincer impingement: the over-coverage of the acetabular rim is trimmed. For labral tears: the torn labrum is repaired with suture anchors or, if severely damaged, reconstructed with a graft. Damaged cartilage is assessed and treated. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip arthroscopy is recommended for FAI with confirmed cam and/or pincer morphology on imaging causing groin pain and limitation that has not responded to at least three months of activity modification, physiotherapy, and injection. The best results are in patients with labral tears and minimal or no arthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (hip-specific rehabilitation programme), activity modification, corticosteroid or PRP injection, and NSAID medication. Many patients with FAI morphology are asymptomatic — surgery treats symptoms, not imaging findings."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays (AP pelvis, Dunn view for cam) and MRI arthrogram showing FAI morphology and labral tear. Diagnostic injection confirming intra-articular pain source. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain relief and improved function in approximately 80–90% of carefully selected patients. Best outcomes in patients under 40 with labral tears and minimal arthritis. Return to sport in most athletic patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Traction-related numbness",
            "detail": "Temporary perineal or pudendal numbness from traction. Resolves within hours to days.",
            "freq": "Common"
          },
          {
            "risk": "Hip stiffness",
            "detail": "Temporary. Physiotherapy essential.",
            "freq": "Common"
          },
          {
            "risk": "Residual groin pain",
            "detail": "Some patients have persistent symptoms.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral femoral cutaneous nerve injury",
            "detail": "Numbness on the outer thigh from portal placement. Risk approximately 1–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Heterotopic ossification",
            "detail": "Unwanted bone formation. NSAIDs are given as prophylaxis.",
            "freq": "Uncommon"
          },
          {
            "risk": "Femoral neck fracture",
            "detail": "If excessive bone is removed during cam osteochondroplasty.",
            "freq": "Rare"
          },
          {
            "risk": "AVN of femoral head",
            "detail": "Very rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Traction injury",
            "detail": "Sciatic or pudendal nerve palsy from traction. Usually temporary.",
            "freq": "Rare"
          },
          {
            "risk": "Fluid extravasation",
            "detail": "Fluid tracking causing abdominal distension. Usually self-limiting.",
            "freq": "Uncommon"
          },
          {
            "risk": "Cartilage damage",
            "detail": "Inadvertent damage from instruments.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Hip joint infection. Rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Supine or lateral position with traction. Traction time is limited to two hours to reduce nerve palsy risk."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches for two to four weeks. Physiotherapy from one week — hip flexor stretching and gluteal activation. Avoid deep flexion and impact for four to six weeks. Return to running at eight to twelve weeks. Return to sport at three to six months. Full recovery six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing groin pain despite treatment",
          "Hip clicking or locking",
          "Numbness on outer thigh not resolving",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months. X-ray at six weeks to confirm adequate bone reshaping."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will arthroscopy prevent hip replacement?",
            "a": "In patients without significant arthritis, successful hip arthroscopy may delay or prevent the need for hip replacement. However, if there is already established arthritis (Tönnis grade 2 or higher), arthroscopy outcomes are less predictable and hip replacement may still be needed in the future."
          },
          {
            "q": "How do I know if I have FAI?",
            "a": "FAI is diagnosed by the combination of clinical symptoms (groin pain with certain movements), clinical signs (positive impingement test), and imaging findings (cam or pincer morphology on X-ray/MRI). All three elements should be present — many people have FAI morphology on imaging without symptoms."
          }
        ]
      }
    ]
  },
  "achilles-augmented-repair": {
    "name": "Achilles Tendon Repair with Augmentation (FHL Transfer)",
    "region": "Foot & Ankle",
    "tag": "Soft Tissue",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Augmented Achilles tendon repair involves repairing a ruptured Achilles tendon with additional reinforcement using a tendon transfer — most commonly the flexor hallucis longus (FHL). It is performed for delayed presentations, re-ruptures, or when the tendon quality is poor.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made along the back of the calf. The ruptured Achilles tendon is repaired with strong sutures. The FHL tendon (which runs deep and medial to the Achilles) is harvested through the same incision, passed through a bone tunnel in the calcaneus, and secured alongside the repair to augment it. The FHL adds bulk, blood supply, and an in-phase power transfer. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Augmentation is recommended for neglected Achilles ruptures (more than four weeks old), re-ruptures after previous repair, ruptures in elderly or diabetic patients with poor tissue quality, and insertional ruptures with tendon degeneration."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For acute ruptures: non-augmented direct repair or functional rehabilitation. For chronic ruptures: acceptance with AFO bracing (in sedentary patients)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI or ultrasound to assess the gap and tendon quality. Standard pre-assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of Achilles continuity and push-off power. The FHL transfer adds a functioning muscle-tendon unit that supplements the weakened Achilles. Most patients achieve functional improvement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Six to twelve months for full recovery.",
            "freq": "Expected"
          },
          {
            "risk": "Wound healing",
            "detail": "The posterior calf has limited blood supply.",
            "freq": "Common"
          },
          {
            "risk": "FHL weakness",
            "detail": "Loss of big toe plantarflexion power — rarely noticed functionally.",
            "freq": "Expected"
          },
          {
            "risk": "Sural nerve irritation",
            "detail": "Numbness on the outer foot.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-rupture",
            "detail": "Despite augmentation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound breakdown",
            "detail": "Particularly in smokers and diabetics.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "DVT",
            "detail": "During prolonged immobilisation.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block. Prone position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast for six to eight weeks. Boot with graduated heel raises for four weeks. Physiotherapy for calf strengthening from ten weeks. Running at four to six months. Full recovery nine to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound redness or breakdown",
          "Sudden calf pain (re-rupture)",
          "Fever",
          "Calf swelling",
          "Toes numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Wound check at two weeks. Reviews at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I notice the loss of FHL?",
            "a": "Most patients do not notice significant functional loss from FHL harvest. The FDL and other toe flexors compensate. Ballet dancers may notice reduced big toe push-off."
          }
        ]
      }
    ]
  },
  "cervical-arthroplasty-two-level": {
    "name": "Two-Level Cervical Disc Replacement",
    "region": "Spine",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Two-level cervical disc replacement involves replacing two adjacent degenerated cervical discs with artificial disc prostheses in a single operation. It preserves motion at both treated levels, potentially reducing the risk of adjacent segment disease compared to two-level fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The approach is identical to single-level cervical disc replacement — through an anterior incision in the neck. Both affected discs are completely removed under microscope magnification. Two artificial discs are implanted into the prepared disc spaces. Each prosthesis consists of metal endplates articulating against a polyethylene core, allowing flexion, extension, lateral bending, and rotation. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Two-level disc replacement is considered for younger patients (under 55–60) with cervical disc disease at two adjacent levels causing radiculopathy or myelopathy, who have preserved facet joints, no significant instability, and wish to maintain cervical motion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, pain management, cervical epidural injection. Two-level ACDF (fusion) is the main surgical alternative."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI and CT for planning. Assessment of facet joint status at both levels. Vascular imaging may be needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Motion preservation at two levels, potentially reducing the risk of adjacent segment disease. Studies show non-inferiority to two-level ACDF at seven to ten year follow-up, with maintenance of segmental motion."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Dysphagia",
            "detail": "Swallowing difficulty. More common with two-level than single-level anterior surgery. Usually temporary.",
            "freq": "Common"
          },
          {
            "risk": "Hoarseness",
            "detail": "Recurrent laryngeal nerve irritation. Usually temporary.",
            "freq": "Uncommon"
          },
          {
            "risk": "Neck stiffness",
            "detail": "Temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Heterotopic ossification",
            "detail": "Bone formation limiting motion at one or both levels. Reported in 10–40% but clinically significant restriction in fewer.",
            "freq": "Common"
          },
          {
            "risk": "Device migration or subsidence",
            "detail": "One or both prostheses may shift.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spinal cord injury",
            "detail": "Risk approximately 0.5–1%.",
            "freq": "Rare"
          },
          {
            "risk": "Vertebral artery injury",
            "detail": "Rare.",
            "freq": "Rare"
          },
          {
            "risk": "Oesophageal injury",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Adjacent segment disease",
            "detail": "May still occur despite motion preservation.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Supine with neck extended. Neuromonitoring may be used."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Hospital one to two days. No collar needed (unlike fusion). Gentle neck exercises from one week. Return to desk work at two to four weeks. Driving at two to four weeks. Full activity at six to eight weeks. No smoking restrictions as fusion is not the goal."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Difficulty swallowing worsening after 48 hours",
          "Hoarse voice persisting beyond two weeks",
          "Arm weakness or numbness",
          "Breathing difficulty",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks (including flexion-extension views) and six months. Annual review for five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why two discs instead of two fusions?",
            "a": "Fusing two levels significantly restricts neck motion and doubles the stress on adjacent segments. Preserving motion at both levels maintains more natural neck mechanics and may reduce long-term adjacent segment disease."
          },
          {
            "q": "Can heterotopic ossification be prevented?",
            "a": "NSAIDs taken for two to four weeks after surgery may reduce heterotopic bone formation. Even when HO occurs, clinically significant motion loss is less common than the radiographic appearance suggests."
          }
        ]
      }
    ]
  },
  "nonunion-management": {
    "name": "Fracture Non-Union Management",
    "region": "Trauma",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Fracture non-union management involves surgical treatment of a fracture that has failed to heal — typically defined as no radiographic progression of healing by six to nine months. Treatment combines biological stimulation (bone grafting) with mechanical optimisation (revision fixation).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The non-union site is exposed. Fibrous tissue between the bone ends is excised. The bone ends are freshened to bleeding cancellous bone. Autologous bone graft (usually from the iliac crest or via RIA from the femoral canal) is packed around the non-union. The fixation is revised — either replacing or augmenting the existing metalwork — to provide stable compression and/or alignment. For infected non-unions, radical debridement is performed and antibiotic treatment precedes or accompanies reconstruction. The operation takes one and a half to four hours depending on complexity."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is recommended when a fracture shows no healing progress by six to nine months, with pain at the fracture site and motion at the non-union. Risk factors for non-union include smoking, diabetes, NSAID use, infection, inadequate fixation, poor blood supply, bone loss, and soft tissue interposition."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bone stimulators (electromagnetic, low-intensity pulsed ultrasound — limited evidence), smoking cessation and metabolic optimisation, and acceptance of the non-union (rarely appropriate for lower limb)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-length X-rays and CT to assess the non-union. Blood tests to exclude infection (CRP, ESR, WCC). Assessment of bone quality and defect size. Metabolic screen (vitamin D, calcium, thyroid, PTH) to identify correctable factors. Smoking cessation is mandatory."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Healing rates for non-union surgery with bone grafting and stable fixation are approximately 85–95%. Identification and correction of the underlying cause (infection, mechanical instability, biological impairment) is the key to success."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged recovery",
            "detail": "Non-unions take longer to heal than primary fractures — three to six months after revision surgery.",
            "freq": "Expected"
          },
          {
            "risk": "Bone graft donor site pain",
            "detail": "Iliac crest pain is common (10–30%).",
            "freq": "Common"
          },
          {
            "risk": "Persistent non-union",
            "detail": "Approximately 5–15% of revised non-unions still fail to heal.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Higher risk than primary fixation, particularly if occult infection is present.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "The revision metalwork may fail if the non-union does not heal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve or vessel injury",
            "detail": "From surgery through scar tissue.",
            "freq": "Uncommon"
          },
          {
            "risk": "Donor site fracture",
            "detail": "Iliac crest fracture after graft harvest. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Amputation",
            "detail": "For recalcitrant infected non-unions in severe cases. Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia. Two surgical sites if iliac crest graft is used."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing depends on the fixation and bone quality. Regular X-rays every six to eight weeks to monitor healing. Physiotherapy for joint mobility and muscle strengthening. Full recovery six to twelve months after non-union surgery. Smoking cessation is essential — smokers have five times the failure rate."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent pain at the fracture site",
          "Movement at the fracture",
          "Wound problems at either surgical site",
          "Fever",
          "Increasing deformity"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays every six to eight weeks until union confirmed. Blood tests if infection was a concern. Metabolic reassessment."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why did my fracture not heal?",
            "a": "Common causes include smoking (the single biggest modifiable risk factor), inadequate fixation, infection, poor blood supply, fracture gap or bone loss, diabetes, vitamin D deficiency, and NSAID use. Often multiple factors contribute."
          },
          {
            "q": "What can I do to help it heal?",
            "a": "Stop smoking completely (this is the most important thing), ensure adequate vitamin D and calcium, avoid NSAIDs, optimise diabetes control, maintain good nutrition, and follow weight-bearing guidance. These factors significantly influence healing."
          }
        ]
      }
    ]
  },
  "hip-arthroscopy-sports": {
    "name": "Hip Arthroscopy for Sports Injuries",
    "region": "Sports Medicine",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip arthroscopy for sports injuries addresses intra-articular hip pathology in athletes — including labral tears, chondral injuries, ligamentum teres tears, and FAI — allowing return to competitive sport with a native hip joint.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under traction, arthroscopic portals are established. The central compartment is assessed first — labral tears are repaired with suture anchors, chondral damage is addressed (microfracture or debridement), and the ligamentum teres is inspected and debrided if torn. The peripheral compartment is then assessed — cam morphology is corrected with osteochondroplasty, the capsule is managed (repair vs release), and any synovitis is debrided. Capsular closure is performed to prevent post-operative instability. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Hip arthroscopy is recommended for athletes with confirmed intra-articular hip pathology causing groin pain during sport, who have not improved with at least three months of sport-specific rehabilitation and activity modification."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Hip-specific rehabilitation programme (adductor strengthening, hip flexor flexibility, core stability), activity modification, injection (diagnostic and therapeutic), and sport modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI arthrogram, X-rays including alpha angle assessment, diagnostic injection confirming intra-articular source. Pre-operative sport-specific assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Return to sport in approximately 85–90% of athletes. Return to pre-injury level in approximately 70–80%. Best outcomes in patients with FAI morphology and labral tears without significant arthritis."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Traction-related numbness",
            "detail": "Temporary perineal numbness. Usually resolves within hours.",
            "freq": "Common"
          },
          {
            "risk": "Hip flexor irritation",
            "detail": "From portal placement. Temporary.",
            "freq": "Common"
          },
          {
            "risk": "Residual symptoms",
            "detail": "Not all athletes achieve complete symptom resolution.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "LFCN injury",
            "detail": "Lateral femoral cutaneous nerve numbness. Risk 1–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Capsular redundancy",
            "detail": "If the capsule is not repaired, post-operative instability may develop.",
            "freq": "Uncommon"
          },
          {
            "risk": "HO",
            "detail": "Heterotopic ossification. NSAIDs given prophylactically.",
            "freq": "Uncommon"
          },
          {
            "risk": "Femoral neck fracture",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Hip joint infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with supine traction."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Crutches two to four weeks. Sport-specific rehabilitation programme over three to six months. Running at eight to twelve weeks. Non-contact training at three to four months. Full contact sport at four to six months. Elite athletes may return at three to four months with accelerated rehabilitation."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent groin pain beyond six weeks",
          "Hip clicking or locking",
          "Wound problems",
          "Fever"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, and three months. Return to sport clearance assessment."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Which sports cause hip problems?",
            "a": "Sports involving repetitive hip flexion and rotation — football, hockey, martial arts, ballet, and running — are most commonly associated with FAI symptoms and labral tears."
          },
          {
            "q": "Can I return to elite sport?",
            "a": "The majority of professional and elite athletes return to their previous level. Return rates are highest for FAI with labral repair in patients without arthritis."
          }
        ]
      }
    ]
  },
  "elbow-prosthesis-revision": {
    "name": "Revision Elbow Replacement",
    "region": "Elbow",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Revision elbow replacement is an operation to remove a failed elbow prosthesis and implant new components. It is a complex procedure performed for loosening, infection, wear, instability, or periprosthetic fracture.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The previous incision is reopened. The ulnar nerve is identified and protected (or transposed if not already done). The existing components are removed — this may require bone windows, osteotomies, or specialised extraction instruments, particularly for well-cemented stems. Cement is removed from the humeral and ulnar canals. Bone defects are assessed and may require strut allografts, impaction grafting, or mesh reconstruction. Longer-stemmed revision components are implanted. The operation takes two to four hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Revision is needed for aseptic loosening, infection (after DAIR failure), polyethylene bushing wear, instability, periprosthetic fracture, and implant fracture."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "For loosening: observation if minimally symptomatic. For infection: long-term antibiotic suppression. For pain: analgesics and splinting. Resection arthroplasty (removing the prosthesis without reimplantation) is a salvage option."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT for bone stock assessment. If infection suspected, aspiration. Identification of existing implant type. Specialist revision components and instruments must be available."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of elbow function and pain relief. Outcomes are less predictable than primary elbow replacement and complication rates are higher."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve dysfunction",
            "detail": "The nerve is at significant risk in revision surgery. Approximately 10–20%.",
            "freq": "Common"
          },
          {
            "risk": "Reduced range of motion",
            "detail": "Less motion than after primary replacement.",
            "freq": "Common"
          },
          {
            "risk": "Wound healing",
            "detail": "Previously operated tissue is vulnerable.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Intraoperative fracture",
            "detail": "During component removal. Risk approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Higher risk than primary. Approximately 5–10%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Revision components have shorter survivorship.",
            "freq": "Long-term"
          },
          {
            "risk": "Triceps weakness",
            "detail": "From repeated surgical exposure.",
            "freq": "Common"
          },
          {
            "risk": "Bone loss",
            "detail": "Progressive with each revision.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Prolonged operating time."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for two to four weeks. Gentle exercises from one to two weeks. Progressive strengthening from six weeks. Lifelong activity restrictions (no more than 1 kg repeated lifting, 5 kg single lift). Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Elbow instability",
          "Increasing numbness in ring and little fingers",
          "Wound breakdown"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and annually long-term."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How many times can an elbow be revised?",
            "a": "Each revision becomes progressively more difficult with less bone stock. Most patients can undergo one or two revisions, but salvage options (resection arthroplasty or arthrodesis) may eventually be needed."
          }
        ]
      }
    ]
  },
  "paediatric-flatfoot-treatment": {
    "name": "Paediatric Flatfoot Assessment and Treatment",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Paediatric flatfoot assessment covers the evaluation and management of flat feet in children — from physiological (normal variant) flatfoot to pathological conditions requiring treatment. Most flat feet in children are flexible, painless, and require no intervention.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Assessment: clinical examination includes the Jack's test (great toe dorsiflexion test — if the arch reconstitutes, the foot is flexible), tip-toe standing (if the heel corrects to varus, the posterior tibial tendon is functioning), and assessment for tightness of the Achilles tendon. Imaging: weight-bearing X-rays if pathology is suspected. Treatment: observation for flexible asymptomatic flatfoot. Stretching and physiotherapy for symptomatic flexible flatfoot with tight Achilles. Custom orthotics for symptomatic feet. Subtalar arthroereisis (a spacer implant in the sinus tarsi) for persistent symptomatic flexible flatfoot in selected cases. Surgical reconstruction (calcaneal osteotomy, tendon transfer, spring ligament repair) for rigid or progressive flatfoot."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Assessment is recommended for children with painful flat feet, progressive deformity, rigid flatfoot, shoe wear problems, or flatfoot associated with an underlying condition (cerebral palsy, Down syndrome, tarsal coalition)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Observation (the majority of children with flat feet need no treatment), Achilles stretching, supportive footwear, and activity encouragement. Custom orthotics for symptomatic flexible flatfoot."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays. CT if tarsal coalition is suspected. Assessment of Achilles tightness and subtalar motion."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Most children with flat feet do not need treatment — the arch often develops by age six to eight. For those who do, treatment aims to create a comfortable, functional foot. Orthotics relieve symptoms; surgery is reserved for persistent symptomatic or pathological flatfoot."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Over-treatment",
            "detail": "The most common 'risk' — treating a normal variant that would have resolved spontaneously.",
            "freq": "Common"
          },
          {
            "risk": "Orthotic dependency",
            "detail": "Children may become reliant on orthotics unnecessarily.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Subtalar arthroereisis complications",
            "detail": "The implant may cause sinus tarsi pain, shift position, or need removal.",
            "freq": "Uncommon"
          },
          {
            "risk": "Surgical complications",
            "detail": "Standard surgical risks if reconstruction is needed.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia for clinical assessment. General anaesthesia for surgical procedures."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "For observation: no restrictions. For orthotics: wear as guided. For surgery: weight-bearing restrictions for six to eight weeks depending on the procedure."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing foot pain despite treatment",
          "Rigid flatfoot developing in a previously flexible foot",
          "Difficulty walking or running",
          "New limp"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Clinical review every six to twelve months during growth. X-rays only when clinically indicated."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will my child grow out of flat feet?",
            "a": "Most children with flexible, painless flat feet develop a normal arch by age six to eight. No treatment is needed in the majority."
          },
          {
            "q": "Do flat feet need orthotics?",
            "a": "Most do not. Orthotics are recommended for children with symptomatic flat feet — pain, fatigue, or difficulty with activities. There is no evidence that orthotics change the natural development of the arch in asymptomatic children."
          },
          {
            "q": "When should I be concerned?",
            "a": "Concern is warranted for rigid (non-flexible) flatfoot, painful flatfoot, progressive deformity, flatfoot with tight Achilles tendon, or flatfoot associated with neurological conditions."
          }
        ]
      }
    ]
  },
  "wrist-replacement": {
    "name": "Wrist Replacement (Total Wrist Arthroplasty)",
    "region": "Hand & Wrist",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Total wrist replacement is an operation to replace the damaged wrist joint surfaces with a metal and polyethylene prosthesis. It preserves some wrist motion unlike wrist fusion, and is an option for patients with inflammatory arthritis or severe degenerative disease.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the back of the wrist. The extensor tendons are retracted. The damaged carpal bones are removed (partial or complete carpectomy depending on the design). The distal radius is prepared and a metal component is cemented or press-fit. A polyethylene component articulates against the radial component and is fixed to the remaining carpus or into the metacarpals. Modern designs are modular and low-profile. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Wrist replacement is considered for patients with inflammatory arthritis (rheumatoid) or severe degenerative arthritis who wish to preserve motion and have low physical demands. It is an alternative to wrist fusion for patients who need bilateral wrist surgery (having one fused and one replaced preserves more overall function)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Splinting, injection, medication (particularly disease-modifying drugs for rheumatoid), and activity modification. Wrist fusion (arthrodesis) is the main surgical alternative and is more durable but eliminates motion."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and CT to assess bone stock. Assessment of tendon integrity. Discussion of activity restrictions — wrist replacement is not suited for heavy manual work."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Preservation of approximately 30–50 degrees of the flexion-extension arc. Pain relief. Improved hand function for daily activities. Modern implant designs have improved survivorship compared to earlier generations."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Limited arc of motion",
            "detail": "Approximately 30–50 degrees of total flexion-extension. Less than normal but more than fusion.",
            "freq": "Expected"
          },
          {
            "risk": "Reduced grip strength",
            "detail": "Less than wrist fusion but adequate for most daily activities.",
            "freq": "Expected"
          },
          {
            "risk": "Activity restrictions",
            "detail": "No heavy lifting, impact activities, or manual work with the replaced wrist.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Loosening",
            "detail": "Component loosening. The most common cause of failure. Higher risk than hip or knee replacement.",
            "freq": "Long-term"
          },
          {
            "risk": "Imbalance and dislocation",
            "detail": "Component dislocation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Tendon rupture",
            "detail": "Extensor tendons may be damaged by the implant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "Fracture around the implant.",
            "freq": "Uncommon"
          },
          {
            "risk": "Conversion to fusion",
            "detail": "If the replacement fails, conversion to wrist fusion is the salvage procedure.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or regional anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Splint for four to six weeks. Gentle wrist exercises from four weeks. Hand therapy for grip strengthening. Lifelong activity restrictions — no heavy lifting, impact, or twisting. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Clicking or instability in the wrist",
          "Sudden loss of finger extension (tendon rupture)",
          "Increasing wrist deformity"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, one year, then annually. Lifelong surveillance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is wrist replacement less common than hip or knee replacement?",
            "a": "The wrist bears less weight than the hip or knee but the forces during gripping are significant. The bones are small, making fixation challenging. Loosening rates are higher than lower limb replacements. Wrist fusion remains the gold standard for durability, but replacement is a good option for lower-demand patients who need motion."
          },
          {
            "q": "Can I have both wrists fused?",
            "a": "Bilateral wrist fusion significantly impairs hand function — particularly personal hygiene and fine motor tasks. If both wrists need surgery, having one fused (for strength) and one replaced (for motion) provides the best overall function."
          }
        ]
      }
    ]
  },
  "shoulder-massive-cuff-management": {
    "name": "Massive Rotator Cuff Tear — Decision-Making Guide",
    "region": "Shoulder",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "This guide helps patients understand the treatment options for massive, irreparable rotator cuff tears — one of the most complex decision-making scenarios in shoulder surgery. Multiple surgical and non-operative pathways exist, and the choice depends on patient age, activity level, arthritis status, and the specific tear pattern.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The options span a spectrum. Non-operative: anterior deltoid rehabilitation programme — effective for many patients with pseudoparalysis who retain a concentric glenohumeral joint. Partial repair: repairing what can be repaired — often the subscapularis and infraspinatus — to restore the force couple. Superior capsular reconstruction (SCR): bridging the irreparable gap with a graft. Tendon transfer: latissimus dorsi or lower trapezius transfer for external rotation deficit. Balloon spacer (InSpace): a biodegradable subacromial spacer inserted arthroscopically to lower the humeral head. Reverse shoulder replacement: the definitive solution for cuff tear arthropathy — reliably restores overhead function using the deltoid. Each option is described in detail in its respective ConsentIQ leaflet."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "This decision-making guide is appropriate when a rotator cuff tear has been confirmed as irreparable on MRI and/or at arthroscopy — meaning the tendon cannot be mobilised back to its footprint despite full release. The choice between options depends on age, functional demands, arthritis status, and which tendons remain."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Structured anterior deltoid rehabilitation is the first-line treatment for all massive cuff tears. Approximately 50–70% of patients achieve satisfactory function without surgery. Surgery is reserved for those who remain significantly disabled despite dedicated rehabilitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to assess tear size, tendon retraction, fatty infiltration (Goutallier grade), and muscle atrophy. X-rays for superior humeral head migration and glenohumeral arthritis. CT if reverse replacement or SCR is planned. Functional assessment including active elevation, external rotation lag, and hornblower's sign."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The expected benefit depends on the chosen pathway. Non-operative rehabilitation: 50–70% achieve satisfactory function. Partial repair: pain relief and restoration of the force couple. SCR: 75–85% satisfaction at two to five years. Tendon transfer: 70–80% improvement in external rotation. Reverse replacement: over 90% satisfaction for established arthropathy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Decision complexity",
            "detail": "Multiple valid options exist — the 'right' answer varies for each patient.",
            "freq": "Expected"
          },
          {
            "risk": "Staged approach",
            "detail": "Some patients progress through multiple treatments over time.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete recovery",
            "detail": "No option fully restores a normal rotator cuff.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Treatment-specific risks",
            "detail": "Each option carries its own risk profile — please refer to the specific ConsentIQ leaflet for the chosen treatment.",
            "freq": "See individual leaflets"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Depends on the chosen procedure — from none (rehabilitation) to general anaesthesia (reverse replacement)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Rehabilitation: ongoing. Arthroscopic procedures: three to six months. Tendon transfer: six to twelve months. Reverse replacement: six to twelve months. All pathways require dedicated physiotherapy."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening shoulder function despite treatment",
          "Sudden loss of active elevation",
          "Increasing pain not responding to analgesia"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Regular clinical assessment. Imaging as indicated by the chosen treatment pathway."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do you decide which option is best?",
            "a": "The decision matrix considers: Age under 65 with no arthritis → SCR, partial repair, or tendon transfer. Age over 65 or established arthritis → reverse replacement. External rotation deficit → latissimus dorsi or lower trapezius transfer. Minimal symptoms with rehabilitation → continue non-operative management."
          },
          {
            "q": "Can I try non-operative treatment first?",
            "a": "Absolutely. Anterior deltoid rehabilitation is always the first step. Many patients achieve satisfactory function without surgery. If rehabilitation fails after three to six months, surgical options are discussed."
          },
          {
            "q": "What if the first treatment doesn't work?",
            "a": "The treatment ladder allows progression. Failed rehabilitation → arthroscopic options (partial repair, SCR, balloon). Failed arthroscopic treatment → tendon transfer or reverse replacement. Reverse replacement remains available as the definitive salvage."
          }
        ]
      }
    ]
  },
  "knee-infection-two-stage": {
    "name": "Two-Stage Revision Knee Replacement (Infection)",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Two-stage revision is the gold standard treatment for chronic periprosthetic knee joint infection. The infected prosthesis is removed, an antibiotic spacer is inserted, antibiotics are given for six to twelve weeks, and then a new knee replacement is implanted once infection is confirmed cleared.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Stage 1 (Explantation): the infected knee prosthesis is removed. All cement, infected tissue, and biofilm are thoroughly debrided. An antibiotic-loaded cement spacer (static block or articulating) is inserted. Multiple tissue samples are taken for culture. IV antibiotics begin. Stage 2 (Reimplantation): after six to twelve weeks of antibiotics, the spacer is removed, the joint is re-debrided, and new revision knee replacement components are implanted. Each stage takes two to three hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Two-stage revision is recommended for chronic (established) periprosthetic knee infection — defined as infection present for more than four weeks, or infection with difficult-to-treat organisms (MRSA, fungal). It has the highest infection cure rate of any treatment strategy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "DAIR (for acute infection only — within four weeks). One-stage revision (at specialist centres for selected cases). Long-term antibiotic suppression (accepting persistent infection). Above-knee amputation (last resort for uncontrollable infection). Arthrodesis (knee fusion — a salvage option)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Joint aspiration for microbiology. Full blood tests including inflammatory markers. CT for bone stock. MDT discussion with microbiologists. Planning for both stages. Counselling about the inter-stage period."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Infection cure rate approximately 85–95% with two-stage revision. This is the most reliable method of eradicating chronic prosthetic joint infection. Most patients achieve a well-functioning revision knee replacement."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Inter-stage period",
            "detail": "Six to twelve weeks between stages with limited mobility, an antibiotic spacer, and crutches/frame.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for two to six weeks, then oral for several weeks.",
            "freq": "Expected"
          },
          {
            "risk": "Stiffness",
            "detail": "Arthrofibrosis is common, particularly with static spacers.",
            "freq": "Common"
          },
          {
            "risk": "Functional limitation",
            "detail": "Revision knee replacement outcomes are less predictable than primary.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent infection",
            "detail": "Despite two-stage revision, approximately 5–15% of patients have persistent or recurrent infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spacer complications",
            "detail": "Dislocation, fracture, or extrusion of the spacer.",
            "freq": "Uncommon"
          },
          {
            "risk": "Bone loss",
            "detail": "Each revision causes additional bone loss.",
            "freq": "Expected"
          },
          {
            "risk": "Wound complications",
            "detail": "In previously operated, infected tissue.",
            "freq": "Common"
          },
          {
            "risk": "Medical complications",
            "detail": "Many patients are elderly with comorbidities.",
            "freq": "Common"
          },
          {
            "risk": "Periprosthetic fracture",
            "detail": "During component removal or reimplantation.",
            "freq": "Uncommon"
          },
          {
            "risk": "Amputation",
            "detail": "For uncontrollable infection. Very rare.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia for both stages. The patient may be medically complex."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Stage 1: hospital one to two weeks. PICC line for IV antibiotics. Limited mobility with spacer. Regular blood tests. Stage 2: reimplantation once infection markers normalise and aspiration is negative. Recovery after stage 2 is similar to revision TKR — hospital three to five days, physiotherapy, full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Fever or systemic unwellness during inter-stage period",
          "Spacer problems (knee unstable, painful, or swollen)",
          "Wound discharge at either stage",
          "Rising inflammatory markers",
          "PICC line problems",
          "Antibiotic side effects"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Twice-weekly blood tests during IV antibiotics. Clinical review every two weeks during inter-stage. Joint aspiration before stage 2. Post-reimplantation: standard revision TKR follow-up."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long between the two stages?",
            "a": "Typically six to twelve weeks. The timing depends on normalisation of inflammatory markers, clearance of the organism on aspiration, and the patient's overall condition. Rushing to stage 2 before the infection is cleared risks failure."
          },
          {
            "q": "What is the success rate?",
            "a": "Two-stage revision has the highest published cure rate — approximately 85–95%. The inter-stage period is challenging but gives the best chance of a long-term, infection-free knee replacement."
          },
          {
            "q": "What if the infection comes back after reimplantation?",
            "a": "Options include repeat two-stage revision, long-term antibiotic suppression, knee fusion (arthrodesis), or, as a last resort, above-knee amputation. Fortunately, with careful technique and appropriate antibiotics, re-infection after two-stage revision is uncommon."
          }
        ]
      }
    ]
  },
  "elbow-contracture-release": {
    "name": "Elbow Contracture Release (Open / Column Procedure)",
    "region": "Elbow",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Open elbow contracture release is an operation to restore range of motion in a severely stiff elbow by systematically releasing the contracted capsule, excising heterotopic bone, and removing impinging osteophytes through open incisions — used when arthroscopic release is not feasible.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A lateral (column procedure) or combined medial-lateral approach is used. The contracted anterior capsule is released. Coronoid and olecranon osteophytes are removed. Heterotopic ossification is excised. The posterior capsule may be released. The ulnar nerve is identified and transposed anteriorly (moved to the front of the elbow) to protect it as the elbow is mobilised. The elbow is taken through a full range of motion intra-operatively. Prophylaxis against recurrent HO (NSAIDs and/or single-dose radiation) is given. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Open release is recommended for severe elbow contracture (functional arc less than 100 degrees — less than 30-130 degrees) that has failed physiotherapy and serial splinting, particularly when there is significant heterotopic ossification, ulnar nerve symptoms, or when the anatomy makes arthroscopic release unsafe."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Intensive physiotherapy, static progressive splinting (JAS or Dynasplint), serial casting, and arthroscopic capsular release for milder contractures without HO."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT scan to map heterotopic bone and plan the approach. Nerve conduction studies if ulnar nerve symptoms. Ensure HO is mature (at least six to twelve months from injury) — premature excision increases recurrence risk."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Improvement of approximately 40–60 degrees of total arc. Most patients achieve a functional arc (30–130 degrees). Maintaining gains requires immediate, aggressive post-operative physiotherapy."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Recurrence of stiffness",
            "detail": "Without aggressive physiotherapy, stiffness recurs. HO may reform.",
            "freq": "Common"
          },
          {
            "risk": "Pain",
            "detail": "Significant post-operative pain requiring regional block and multimodal analgesia.",
            "freq": "Expected"
          },
          {
            "risk": "Swelling",
            "detail": "Marked elbow swelling.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ulnar nerve injury",
            "detail": "Risk approximately 5–10%, even with transposition.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrent HO",
            "detail": "Despite prophylaxis. Risk approximately 10–20%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Fracture",
            "detail": "Through weakened bone after HO excision.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "Multiple incisions around the elbow.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection.",
            "freq": "Rare"
          },
          {
            "risk": "Instability",
            "detail": "Excessive release may destabilise the elbow.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with continuous regional nerve block (catheter) for 48–72 hours of pain-free intensive exercises."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Continuous passive motion (CPM) machine begins immediately in recovery. Regional block catheter provides pain relief for intensive exercises. Physiotherapy three times daily for the first week. Splinting between exercise sessions. NSAIDs or single-dose radiation for HO prophylaxis. The first two weeks are critical — gains made in this period determine the long-term outcome. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Increasing stiffness despite exercises (possible recurrent HO)",
          "New numbness in ring and little fingers",
          "Elbow feeling unstable"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent early reviews — weekly for the first month. X-ray at six weeks and three months for HO surveillance."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is immediate physiotherapy so critical?",
            "a": "The elbow forms scar tissue and heterotopic bone rapidly. The motion gained in surgery must be maintained immediately with continuous, aggressive movement. The regional nerve block catheter provides pain relief during these critical early exercises. Delay of even a few days allows new scar tissue to form."
          },
          {
            "q": "What if the HO comes back?",
            "a": "Recurrence occurs in approximately 10–20% despite prophylaxis. If significant, repeat excision can be performed — but only after the new HO has matured (six to twelve months)."
          }
        ]
      }
    ]
  },
  "hip-ceramic-bearing": {
    "name": "Ceramic-on-Ceramic Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Ceramic-on-ceramic total hip replacement uses alumina or composite ceramic bearings for both the femoral head and the acetabular liner. It provides the lowest wear rate of any bearing combination and is particularly suited for younger, more active patients.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical procedure is identical to standard total hip replacement. The difference is the bearing surface: a ceramic femoral head articulates against a ceramic acetabular liner instead of the more common ceramic-on-polyethylene combination. Modern fourth-generation ceramics (delta ceramics) are alumina-matrix composites with very low fracture risk. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Ceramic-on-ceramic bearings are considered for younger patients (under 55–60), active patients with high wear demands, patients with metal sensitivity, and those who wish to minimise bearing-related complications over a long lifespan."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All standard non-operative hip arthritis treatments. Other bearing options: ceramic-on-polyethylene (most common), metal-on-polyethylene, and ceramic-on-crosslinked polyethylene."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard THR pre-assessment. Discussion of bearing options including the specific characteristics of ceramic bearings."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "The lowest volumetric wear rate of any bearing combination. Excellent biocompatibility — no metal ion concerns. Potential for the longest implant survival, making it attractive for younger patients who need their hip to last decades."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Squeaking",
            "detail": "Audible squeaking during certain movements. Occurs in approximately 1–10% of patients. Usually intermittent and tolerable.",
            "freq": "Uncommon"
          },
          {
            "risk": "All standard THR risks",
            "detail": "Dislocation, infection, blood clots, leg length discrepancy.",
            "freq": "See standard risks"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Ceramic fracture",
            "detail": "Modern delta ceramics have a fracture risk of approximately 1 in 10,000. If the ceramic breaks, emergency revision is needed to remove ceramic fragments.",
            "freq": "Rare"
          },
          {
            "risk": "Stripe wear",
            "detail": "If the hip subluxes (edge-loading), a stripe of wear may develop on the ceramic head.",
            "freq": "Uncommon"
          },
          {
            "risk": "Impingement fracture",
            "detail": "The ceramic liner may chip if it impinges against the metal shell or the femoral neck.",
            "freq": "Rare"
          },
          {
            "risk": "Limited revision options",
            "detail": "If revision is needed, ceramic-on-ceramic cannot be revised to metal-on-polyethylene (retained ceramic fragments may cause catastrophic wear of a metal head). Must be revised to ceramic.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Same as standard THR — general or spinal anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Identical to standard THR. Hospital one to three days. Walking from day one. Driving at six weeks. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Loud squeaking from the hip",
          "Sudden onset severe hip pain (possible ceramic fracture — attend urgently)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as standard THR: X-rays at six weeks, one year, then every two to five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is squeaking a problem?",
            "a": "Squeaking is usually intermittent, occurs with specific movements, and is tolerable. It does not indicate implant failure. If persistent and troublesome, it can be addressed with revision surgery, but this is rarely needed."
          },
          {
            "q": "What happens if the ceramic breaks?",
            "a": "Ceramic fracture is very rare with modern ceramics (approximately 1 in 10,000). If it occurs, urgent revision is needed to remove ceramic debris. The hip must be revised to another ceramic bearing — not metal — because retained microscopic ceramic particles would destroy a metal head."
          },
          {
            "q": "Is ceramic better than polyethylene?",
            "a": "Ceramic-on-ceramic has the lowest wear rate but carries the small risk of fracture and squeaking. Ceramic-on-highly-crosslinked-polyethylene has extremely low wear rates with no fracture risk and is the most commonly used bearing combination worldwide. Both are excellent choices — the decision depends on patient age, activity level, and preference."
          }
        ]
      }
    ]
  },
  "spine-endoscopy": {
    "name": "Endoscopic Spine Surgery (Transforaminal / Interlaminar)",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Endoscopic spine surgery is a minimally invasive technique to decompress spinal nerves through a single small incision (7–8 mm) using an endoscope — a thin tube with a camera and working channel. It offers the least tissue disruption of any decompression technique.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through a single 7–8 mm skin incision, a tubular endoscope is inserted to the spine under X-ray guidance. Two approaches are used. Transforaminal: the endoscope enters through the neural foramen (the nerve exit hole) from the side, accessing the disc and nerve root without removing any bone. Interlaminar: the endoscope enters between the laminae from the back, similar to a micro-decompression but through a smaller corridor. The herniated disc or stenotic tissue is removed under direct endoscopic visualisation with magnification. The operation takes 45–90 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Endoscopic surgery is suitable for contained and extruded lumbar disc herniations, foraminal stenosis, lateral recess stenosis, and selected cases of central stenosis. It offers faster recovery and less tissue damage than open microdiscectomy or laminectomy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, epidural injection, pain medication, and time — the same non-operative options as for standard disc surgery. Open microdiscectomy and standard laminectomy are more established surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming the pathology. Assessment of suitability for endoscopic approach — not all disc herniations or stenosis patterns are amenable. Day-case procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Outcomes comparable to open microdiscectomy for appropriate indications. Advantages include smaller incision, less muscle damage, less post-operative pain, faster recovery, and same-day discharge in most cases."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Conversion to open",
            "detail": "If the pathology cannot be adequately addressed endoscopically, conversion to open microdiscectomy may be needed. Risk approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Recurrent herniation",
            "detail": "Similar recurrence rate to open surgery (approximately 5–10%).",
            "freq": "Common"
          },
          {
            "risk": "Leg dysaesthesia",
            "detail": "Temporary irritation of the nerve root. More common with the transforaminal approach.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Nerve root injury",
            "detail": "Risk approximately 1%, similar to open surgery.",
            "freq": "Rare"
          },
          {
            "risk": "Dural tear",
            "detail": "Risk approximately 1–3%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Discitis or wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Incomplete decompression",
            "detail": "The limited visualisation field may miss additional pathology.",
            "freq": "Uncommon"
          },
          {
            "risk": "Vascular injury",
            "detail": "Very rare with transforaminal approach — the iliac vessels are nearby.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia or local anaesthesia with sedation (awake endoscopic surgery is possible, allowing real-time patient feedback)."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home the same day. Walking immediately. Return to desk work within one to two weeks. Driving at one to two weeks. Return to sport at four to six weeks. Core strengthening from two to four weeks. Full recovery four to eight weeks — generally faster than open surgery."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or new weakness",
          "New bladder or bowel symptoms (attend A&E immediately)",
          "Wound redness or discharge",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two to six weeks. Further follow-up only if needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is endoscopic surgery as good as open surgery?",
            "a": "For appropriate indications, published outcomes are comparable to open microdiscectomy. The advantages are in the recovery — less pain, less tissue damage, and faster return to activity. However, it requires specialist training and equipment, and is not suitable for all spinal conditions."
          },
          {
            "q": "Can I have this done awake?",
            "a": "Yes — transforaminal endoscopic discectomy can be performed under local anaesthesia with sedation. The patient provides real-time feedback about nerve irritation during the procedure. This is not suitable for all patients or all approaches."
          },
          {
            "q": "Why can't all spinal surgery be done endoscopically?",
            "a": "Endoscopic surgery works through a narrow corridor with a limited field of view. Complex conditions (severe stenosis at multiple levels, large central disc herniations, instability requiring fusion, tumours) require wider access than an endoscope can provide."
          }
        ]
      }
    ]
  },
  "trauma-rehabilitation-principles": {
    "name": "Fracture Rehabilitation Principles",
    "region": "Trauma",
    "tag": "General",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "This guide outlines the principles of rehabilitation after fracture fixation or conservative fracture management. Structured rehabilitation is essential for optimal recovery — the surgery or casting only fixes the bone; rehabilitation restores function.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Fracture rehabilitation follows a structured progression. Phase 1 (Protection, weeks 0–6): pain management, oedema control (elevation, compression), gentle range of motion within safe limits, isometric muscle activation, and weight-bearing as permitted. Phase 2 (Early mobilisation, weeks 6–12): progressive range of motion, active strengthening, progressive weight-bearing, scar management, and return to light activities. Phase 3 (Strengthening, weeks 12–24): resistance training, sport-specific or occupation-specific rehabilitation, proprioceptive training, and cardiovascular fitness. Phase 4 (Return to activity, 6+ months): full sport or occupational demands, ongoing maintenance, and injury prevention."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "All patients with fractures benefit from structured rehabilitation. Without it, joints stiffen, muscles waste, proprioception is lost, and functional recovery is incomplete. The fracture may heal perfectly, but without rehabilitation the outcome may still be poor."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "This IS the non-operative treatment pathway. Self-directed exercise is possible but supervised physiotherapy produces better outcomes for most significant fractures."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No surgery required for rehabilitation. Pre-rehabilitation (prehabilitation) before planned fracture surgery improves post-operative outcomes."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of range of motion, strength, proprioception, and function. Patients who engage actively with rehabilitation recover faster and more completely than those who do not."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain during exercises",
            "detail": "Expected — rehabilitation involves working through discomfort (not severe pain). Medication timing can help.",
            "freq": "Expected"
          },
          {
            "risk": "Slow progress",
            "detail": "Recovery is often non-linear — plateaus and temporary setbacks are normal.",
            "freq": "Common"
          },
          {
            "risk": "Time commitment",
            "detail": "Effective rehabilitation requires consistent, regular exercise over weeks to months.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Re-fracture",
            "detail": "Premature loading before adequate healing. Follow your surgeon's weight-bearing guidance.",
            "freq": "Rare"
          },
          {
            "risk": "Metalwork failure",
            "detail": "Overloading fixation before fracture union.",
            "freq": "Rare"
          },
          {
            "risk": "Complex regional pain syndrome",
            "detail": "Chronic pain and dysfunction. Rare but requires early recognition and treatment.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia required for rehabilitation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Timeline varies by fracture. Upper limb fractures: functional range typically by six to eight weeks, full recovery three to six months. Lower limb fractures: weight-bearing progression over six to twelve weeks, full recovery six to twelve months. Principles: start early, progress gradually, respect pain, follow weight-bearing guidance, and stay committed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Sudden increase in pain at the fracture site",
          "Visible deformity or shortening",
          "Inability to weight-bear when expected",
          "Joint getting stiffer despite exercises",
          "Persistent swelling not responding to elevation",
          "Signs of CRPS: burning pain, colour changes, temperature differences, excessive sweating"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Physiotherapy appointments typically one to two times per week initially, reducing as independence increases. Surgeon reviews at intervals dictated by the fracture."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How often should I do exercises?",
            "a": "Most fracture rehabilitation programmes prescribe exercises three to four times daily in short sessions (10–15 minutes each) during the early phases. Quality and consistency matter more than duration."
          },
          {
            "q": "Should exercises be painful?",
            "a": "Exercises should produce discomfort but not severe pain. A useful guide: pain during exercise is acceptable if it settles within 30 minutes of stopping. If pain persists or worsens, you may be doing too much."
          },
          {
            "q": "When can I drive?",
            "a": "You can drive when you can safely perform an emergency stop (lower limb) or control the steering wheel (upper limb). This typically means adequate strength, range of motion, and reaction time. Your surgeon or physiotherapist can advise. Inform your insurance company."
          },
          {
            "q": "When can I return to work?",
            "a": "Desk work: often possible at two to six weeks for upper limb fractures and four to eight weeks for lower limb fractures. Manual work: typically three to six months depending on the fracture and the demands of the job. Your surgeon or physiotherapist can provide a specific timeline and phased return plan."
          }
        ]
      }
    ]
  },
  "lower-trapezius-transfer": {
    "name": "Lower Trapezius Transfer",
    "region": "Shoulder",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Lower trapezius transfer is an operation to reroute the lower trapezius muscle and tendon to the rotator cuff footprint to restore active external rotation in patients with massive irreparable posterosuperior rotator cuff tears. It is an alternative to latissimus dorsi transfer with a more anatomical line of pull.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through a posterior incision, the lower trapezius tendon is harvested with a strip of the scapular spine periosteum. Because the native tendon is short, an Achilles tendon allograft is used to extend it. The graft-tendon construct is passed subcutaneously and attached to the greater tuberosity (rotator cuff footprint) using suture anchors. The lower trapezius then functions as an external rotator with a more anatomical direction of pull than the latissimus dorsi. The operation takes two to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Lower trapezius transfer is increasingly preferred over latissimus dorsi transfer for external rotation deficit from irreparable posterosuperior cuff tears, because its vector of pull more closely matches the infraspinatus — the muscle it replaces. It is particularly effective when combined with an intact or repairable subscapularis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Anterior deltoid rehabilitation, latissimus dorsi transfer (alternative tendon transfer), SCR, partial cuff repair, and reverse shoulder replacement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming irreparable posterosuperior cuff tear with intact subscapularis. CT to assess arthropathy. EMG to confirm lower trapezius function. Assessment of external rotation lag and hornblower's sign."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of active external rotation. Early published results show significant improvement in external rotation strength and patient satisfaction in approximately 80–85% of cases."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged rehabilitation",
            "detail": "Six to twelve months for full recovery.",
            "freq": "Expected"
          },
          {
            "risk": "Posterior wound discomfort",
            "detail": "From the harvest site.",
            "freq": "Common"
          },
          {
            "risk": "Donor site weakness",
            "detail": "Some loss of lower trapezius function — rarely noticed.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Transfer failure",
            "detail": "The graft-tendon construct may not heal to the tuberosity. Risk approximately 10–15%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Allograft complications",
            "detail": "Immune reaction, infection, or failure of the extender graft.",
            "freq": "Uncommon"
          },
          {
            "risk": "Spinal accessory nerve injury",
            "detail": "The nerve supplying the trapezius must be preserved.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Lateral decubitus position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling and abduction pillow for six weeks. No active internal rotation for six weeks (protects the transfer). Passive external rotation from two weeks. Active external rotation from six weeks. Motor re-education: learning to use the lower trapezius for external rotation. Strengthening from three months. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Sudden loss of external rotation (transfer failure)",
          "Posterior wound problems"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why lower trapezius instead of latissimus dorsi?",
            "a": "The lower trapezius has a more anatomical line of pull for external rotation — it approaches the cuff footprint from a posterior-superior direction, closely matching the infraspinatus vector. The latissimus approaches from below, which is less anatomical. Early results suggest the lower trapezius transfer may produce better external rotation."
          }
        ]
      }
    ]
  },
  "shoulder-bone-block": {
    "name": "Arthroscopic Bone Block (Eden-Hybinette / Bristow)",
    "region": "Shoulder",
    "tag": "Instability",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Arthroscopic bone block procedures address anterior shoulder instability with significant glenoid bone loss using an arthroscopic approach — providing the bone augmentation of a Latarjet without open surgery. Techniques include the arthroscopic Bristow, Eden-Hybinette (iliac crest graft), and free bone block procedures.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through several portals. For arthroscopic Bristow: the coracoid tip with its attached conjoint tendon is transferred through a subscapularis split and fixed to the anterior glenoid with a screw — the same principle as the open Latarjet but through keyhole incisions. For Eden-Hybinette: a free bone block (iliac crest autograft or distal tibia allograft) is shaped and fixed to the anterior glenoid with screws through an arthroscopic approach. The labrum is repaired over the bone block. The operation takes one and a half to two and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopic bone block is considered when glenoid bone loss exceeds 15–20% (the threshold where soft tissue Bankart repair alone has unacceptable recurrence), in revision instability after failed Bankart repair, and in contact athletes with significant bone loss. It offers the benefits of bone augmentation with potentially less morbidity than open Latarjet."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, activity modification, bracing. Arthroscopic Bankart repair (for bone loss under 15%). Open Latarjet procedure (the established gold standard for bone loss)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "CT with 3D reconstruction to quantify glenoid bone loss and plan the bone block size and position. MRI arthrogram for labral assessment."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of the glenoid arc and shoulder stability. Published recurrence rates are comparable to open Latarjet (approximately 2–5%) in experienced hands. Potentially less post-operative pain and faster recovery than open surgery."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Shoulder stiffness",
            "detail": "Temporary. Physiotherapy essential.",
            "freq": "Common"
          },
          {
            "risk": "Loss of external rotation",
            "detail": "Some restriction, similar to open Latarjet.",
            "freq": "Common"
          },
          {
            "risk": "Technically demanding",
            "detail": "This is an advanced arthroscopic procedure with a significant learning curve.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Graft non-union or resorption",
            "detail": "The bone block may not heal or may be resorbed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw complications",
            "detail": "Malposition, migration, or prominence.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Musculocutaneous nerve (Bristow) or axillary nerve.",
            "freq": "Rare"
          },
          {
            "risk": "Recurrent instability",
            "detail": "Despite bone block, approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Conversion to open",
            "detail": "May be needed if the arthroscopic procedure cannot be completed safely.",
            "freq": "Uncommon"
          },
          {
            "risk": "Donor site pain",
            "detail": "Iliac crest pain if autograft is used.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia with nerve block. Beach-chair or lateral position."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for four to six weeks. Gentle exercises from one week. Active movement from six weeks. Strengthening from three months. Contact sport at six months. Full recovery six to nine months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Shoulder feeling unstable",
          "Clicking or clunking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "CT at three months to assess bone block healing and position. Reviews at two weeks, six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this better than open Latarjet?",
            "a": "Arthroscopic techniques offer potentially less pain and faster early recovery but are technically very demanding with a significant learning curve. Long-term results appear comparable to open Latarjet in experienced hands. The open Latarjet remains the most widely performed and best-studied bone block procedure."
          }
        ]
      }
    ]
  },
  "knee-debridement-arthritis": {
    "name": "Knee Arthroscopic Debridement (Arthritis)",
    "region": "Knee",
    "tag": "Arthroscopy",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Knee arthroscopic debridement for arthritis involves washing out the knee and tidying up loose flaps of cartilage, removing loose bodies, and trimming meniscal tears in a knee with underlying osteoarthritis. Its role is limited and carefully selected.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Performed arthroscopically through two to three small incisions. The joint is irrigated (washed out). Loose bodies are removed. Unstable cartilage flaps are trimmed. Degenerate meniscal tears are debrided. Impinging synovium or plica are excised. The operation takes 20–40 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopic debridement for arthritis has a very limited role. It may be considered for specific mechanical symptoms (true locking from a loose body or an unstable meniscal flap) in a knee with arthritis, when the mechanical symptom is clearly the predominant problem. It is NOT recommended as a general treatment for osteoarthritis."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, analgesics, corticosteroid or hyaluronic acid injection, unloader bracing, and activity modification. These are the primary treatments for knee osteoarthritis and are more effective than arthroscopic debridement for most patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays confirming arthritis. MRI showing a specific treatable mechanical lesion (loose body, unstable meniscal flap). Clinical correlation — the mechanical symptom must be the dominant complaint."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Relief of specific mechanical symptoms (catching, locking from loose bodies). Does NOT treat the underlying arthritis. Patients must understand that arthroscopic debridement does not slow arthritis progression, restore cartilage, or provide long-term pain relief from arthritis itself."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "No improvement",
            "detail": "If the pain is primarily from arthritis rather than a mechanical lesion, debridement will not help.",
            "freq": "Common"
          },
          {
            "risk": "Temporary flare",
            "detail": "The knee may be more painful and swollen for one to two weeks after arthroscopy.",
            "freq": "Common"
          },
          {
            "risk": "Short-lived benefit",
            "detail": "Any benefit may be temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Worsening symptoms",
            "detail": "Some patients feel worse after arthroscopy on an arthritic knee.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Joint infection approximately 0.3%.",
            "freq": "Rare"
          },
          {
            "risk": "Blood clots",
            "detail": "DVT. Rare after knee arthroscopy.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General, spinal, or local anaesthesia. Day case."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Weight-bearing immediately. Return to normal activities within days to weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing swelling",
          "Wound redness or discharge",
          "Fever",
          "Knee locking"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at two weeks. Long-term management of the underlying arthritis."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will this help my arthritis?",
            "a": "No. Arthroscopic debridement does not treat osteoarthritis. High-quality studies (the MOSAIC and Kirkley trials) showed no benefit of arthroscopic lavage/debridement over sham surgery or physiotherapy for osteoarthritis. It is only appropriate for specific mechanical symptoms in a knee that happens to also have arthritis."
          },
          {
            "q": "Why is this still done if the evidence is poor?",
            "a": "It is only appropriate in carefully selected patients with a clear mechanical problem (a loose body causing true locking, or a flap tear causing catching) where the mechanical symptom is the dominant complaint. It is not appropriate as a general treatment for knee arthritis."
          }
        ]
      }
    ]
  },
  "cryotherapy-knee": {
    "name": "Cryoneurolysis / Genicular Nerve Ablation",
    "region": "Knee",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Genicular nerve ablation (radiofrequency or cryoneurolysis) is a minimally invasive procedure to treat chronic knee pain by destroying the small sensory nerves around the knee joint. It is an option for patients with knee arthritis who are not suitable for or wish to delay knee replacement.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "First, diagnostic genicular nerve blocks are performed — local anaesthetic is injected around the superior medial, superior lateral, and inferior medial genicular nerves under fluoroscopic or ultrasound guidance. If these provide at least 50% temporary relief, ablation is offered. For radiofrequency ablation: a needle is placed at each nerve location and heated to destroy the nerve. For cryoneurolysis: a probe freezes the nerve. The procedure takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Genicular nerve ablation is considered for moderate to severe knee osteoarthritis pain in patients who are not candidates for knee replacement (medical comorbidities, patient preference), waiting for knee replacement, or wishing to delay surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, weight management, analgesics, corticosteroid or hyaluronic acid injection, bracing, and PRP injection."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Diagnostic genicular nerve blocks must have provided at least 50% relief on at least one occasion. Outpatient procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Pain reduction in approximately 60–70% of patients who had a positive diagnostic block. Relief typically lasts six to twelve months for radiofrequency and three to six months for cryoneurolysis. The procedure can be repeated."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Temporary pain flare",
            "detail": "Increased pain for a few days after ablation.",
            "freq": "Common"
          },
          {
            "risk": "Incomplete relief",
            "detail": "Not all patients achieve adequate pain reduction.",
            "freq": "Common"
          },
          {
            "risk": "Temporary numbness",
            "detail": "Around the ablation sites.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "At needle sites. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Skin burn",
            "detail": "Rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Motor nerve damage",
            "detail": "Very rare — genicular nerves are purely sensory.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic with mild sedation."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Normal activities immediately. Full benefit develops over two to four weeks as post-procedure inflammation settles."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain not settling after one week",
          "Signs of infection at needle sites",
          "Fever",
          "New knee instability"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Assess response at four to six weeks. Repeat when pain returns."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How long does it last?",
            "a": "Radiofrequency ablation: six to twelve months typically. Cryoneurolysis: three to six months. The nerves regenerate over time and the procedure can be repeated."
          },
          {
            "q": "Will this replace a knee replacement?",
            "a": "No — it treats the symptom (pain) not the disease (arthritis). It is best used as a bridge to surgery, for patients who cannot have surgery, or as part of a multimodal pain management strategy."
          }
        ]
      }
    ]
  },
  "direct-anterior-thr": {
    "name": "Direct Anterior Approach Total Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "The direct anterior approach (DAA) to total hip replacement is a muscle-sparing surgical technique that accesses the hip joint through the front of the thigh between muscles (the Smith-Petersen interval) without cutting any muscles. It may offer faster early recovery compared to posterior or lateral approaches.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made on the front of the thigh, centred over the tensor fasciae latae. The surgeon accesses the hip joint through the interval between the sartorius/rectus femoris and tensor fasciae latae — no muscles are cut or detached. The hip is dislocated anteriorly, the femoral head removed, the socket prepared and cup implanted, and the femoral stem inserted. A specialised operating table with traction capability may be used. The implants are the same as any other approach. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "The DAA is offered by surgeons trained in this approach who believe the muscle-sparing nature provides benefits in early recovery — potentially less pain, faster mobilisation, shorter hospital stay, and fewer hip precautions than posterior or lateral approaches."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All standard non-operative hip arthritis treatments. Other surgical approaches (posterior, lateral, anterolateral) are alternatives — all produce excellent long-term outcomes."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard THR pre-assessment. X-rays and templating. The approach is determined by the surgeon's training and preference."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Potential advantages: reduced early pain, faster return to walking, shorter hospital stay, lower dislocation rate (no posterior capsule disruption), and fewer post-operative hip precautions. Long-term outcomes (implant survival, function) are equivalent to other approaches."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Lateral femoral cutaneous nerve irritation",
            "detail": "Numbness or tingling on the outer thigh. Occurs in approximately 5–15%.",
            "freq": "Common"
          },
          {
            "risk": "All standard THR risks",
            "detail": "Dislocation, infection, blood clots, leg length discrepancy.",
            "freq": "See standard risks"
          },
          {
            "risk": "Learning curve",
            "detail": "The DAA has a recognised learning curve for surgeons.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Femoral fracture",
            "detail": "Slightly higher risk of intra-operative femoral fracture, particularly early in the surgeon's learning curve.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound complications",
            "detail": "The anterior thigh incision may have higher wound complication rates in obese patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Component malposition",
            "detail": "May be more challenging with the anterior approach, particularly on a standard table.",
            "freq": "Uncommon"
          },
          {
            "risk": "Anterior dislocation",
            "detail": "While posterior dislocation is very rare, anterior dislocation can occur with hyperextension.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia. Supine on a specialised or standard table."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Walking on the day of surgery. Hospital stay one to two days. Fewer hip precautions than posterior approach — no restrictions on crossing legs or bending beyond 90 degrees in most protocols. Driving at two to four weeks. Full recovery three to six months. Long-term outcomes are the same regardless of approach."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb",
          "Anterior thigh numbness persisting",
          "Wound problems on the anterior thigh"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as standard THR: reviews at six weeks, one year, then every two to five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is the anterior approach better than the posterior?",
            "a": "The anterior approach may offer faster early recovery, but long-term outcomes (ten to twenty years) are equivalent regardless of approach. The best approach is the one your surgeon is most experienced and comfortable with. A well-performed posterior approach gives excellent results, as does a well-performed anterior approach."
          },
          {
            "q": "Why doesn't every surgeon use this approach?",
            "a": "The DAA has a significant learning curve and requires familiarity with different anatomy. Some surgeons find it more challenging for complex cases, revision surgery, or very muscular/obese patients. Many excellent hip surgeons prefer the posterior or lateral approach and achieve outstanding outcomes."
          }
        ]
      }
    ]
  },
  "hindfoot-nail-fusion": {
    "name": "Hindfoot Fusion Nail (Tibiotalocalcaneal Arthrodesis)",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A hindfoot fusion nail is a retrograde intramedullary nail used to fuse the ankle and subtalar joints simultaneously (tibiotalocalcaneal arthrodesis). It provides powerful fixation for severe hindfoot arthritis, Charcot deformity, failed ankle replacement, or talar AVN with collapse.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The joint surfaces of the ankle (tibiotalar) and subtalar joints are prepared — cartilage is removed and bone surfaces freshened. A retrograde intramedullary nail is inserted through the heel (calcaneus), across both joint lines, and into the tibial shaft. Locking screws secure the nail proximally and distally. Bone graft is packed around the fusion sites. The nail provides immediate rigid fixation allowing earlier weight-bearing than screws or plates alone. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "A hindfoot nail is recommended for combined ankle and subtalar arthritis, failed ankle replacement requiring conversion to fusion, talar AVN with collapse, Charcot neuroarthropathy of the ankle, and severe post-traumatic arthritis. It is the most powerful fixation method for hindfoot fusion."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Ankle-foot orthosis, custom footwear, pain management, and activity modification. Ankle replacement (if joint surfaces are salvageable) is a motion-preserving alternative. Isolated ankle or subtalar fusion (if only one joint is affected)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT scan. Assessment of bone quality (particularly in Charcot patients). Vascular assessment in diabetic patients. Smoking cessation — fusion failure rates are dramatically higher in smokers."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Reliable pain relief and a stable, plantigrade foot. Union rates approximately 85–95% for the ankle joint and 90–95% for the subtalar joint. Most patients walk comfortably in supportive shoes with a rocker-bottom sole."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of ankle and subtalar motion",
            "detail": "Expected — both joints are permanently fused.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Stiff ankle gait with reduced push-off. Walking on uneven ground is difficult.",
            "freq": "Expected"
          },
          {
            "risk": "Shoe limitations",
            "detail": "Requires flat or rocker-bottom shoes.",
            "freq": "Expected"
          },
          {
            "risk": "Limb shortening",
            "detail": "One to two centimetres from joint compression during fusion.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "Risk approximately 5–15%. Higher in smokers, diabetics, and Charcot patients.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound healing",
            "detail": "The hindfoot skin is vulnerable, particularly in diabetic and vascular patients.",
            "freq": "Common"
          },
          {
            "risk": "Nail prominence",
            "detail": "The nail entry point at the heel may cause plantar discomfort.",
            "freq": "Common"
          },
          {
            "risk": "Stress fracture",
            "detail": "Above the nail tip.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint arthritis",
            "detail": "Increased stress on the midfoot and knee.",
            "freq": "Long-term"
          },
          {
            "risk": "Infection",
            "detail": "Deep infection around the nail.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with nerve block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing for six to eight weeks. Boot with progressive weight-bearing from eight to twelve weeks. Rocker-bottom shoes long-term. Physiotherapy for gait retraining and proximal strengthening. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Heel pain from nail prominence",
          "Cast too tight",
          "Increasing deformity",
          "Toes blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months. CT if non-union suspected."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Will I walk normally?",
            "a": "You will walk with a stiff ankle gait — shorter stride on the affected side and reduced push-off. Most patients walk comfortably for daily activities. Rocker-bottom shoes help. Running is generally not possible."
          },
          {
            "q": "Why fuse both joints?",
            "a": "When both the ankle and subtalar joints are arthritic or destroyed (as in talar AVN or Charcot), fusing both provides the most reliable pain relief and stability. Fusing one joint in isolation when both are affected often leads to persistent pain."
          }
        ]
      }
    ]
  },
  "vertebral-column-resection": {
    "name": "Vertebral Column Resection (VCR)",
    "region": "Spine",
    "tag": "Surgery",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Vertebral column resection is one of the most complex spinal operations — complete removal of one or more vertebral bodies to correct severe spinal deformity (kyphosis, scoliosis, or kyphoscoliosis) that cannot be corrected by any other technique.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Through a posterior-only or combined anterior-posterior approach, pedicle screws are placed above and below the planned resection. The vertebral body, both pedicles, and both laminae are completely removed — the spinal cord is left suspended in space. The spine is then shortened, translated, and rotated into the corrected position. A cage or structural graft is placed anteriorly. The correction is held with rods. Neuromonitoring is essential throughout. The operation takes six to twelve hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "VCR is reserved for the most severe spinal deformities — rigid kyphosis exceeding 80 degrees, rigid kyphoscoliosis not correctable by osteotomy, congenital hemivertebra causing severe deformity, post-infectious spinal collapse, and revision of failed previous deformity correction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Bracing (ineffective for rigid deformity), observation (if deformity is not progressive or functionally limiting), and lesser osteotomies (Smith-Petersen, pedicle subtraction — if sufficient correction is achievable)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Full-length standing spinal X-rays, CT with 3D reconstruction, MRI of the entire spine. Pulmonary function tests (severe kyphosis impairs breathing). Nutritional assessment. Blood bank preparation. ICU bed booked. This is performed only at specialist spinal deformity centres."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Correction of severe, rigid deformity. Improved cosmesis, pulmonary function, and sagittal balance. Prevention of neurological deterioration from progressive deformity."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Major surgery",
            "detail": "One of the most extensive spinal operations with significant physiological stress.",
            "freq": "Expected"
          },
          {
            "risk": "Blood loss",
            "detail": "Average blood loss three to five litres. Transfusion always required.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged ICU stay",
            "detail": "ICU for 24–72 hours minimum.",
            "freq": "Expected"
          },
          {
            "risk": "Prolonged hospital stay",
            "detail": "One to three weeks.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Neurological deficit",
            "detail": "Risk of spinal cord injury approximately 5–10%. The cord is at maximal risk during the correction manoeuvre.",
            "freq": "Uncommon"
          },
          {
            "risk": "Wound infection",
            "detail": "Approximately 5–10% for these complex procedures.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pseudarthrosis",
            "detail": "Non-union at the resection site.",
            "freq": "Uncommon"
          },
          {
            "risk": "Implant failure",
            "detail": "Rod breakage or screw pull-out.",
            "freq": "Uncommon"
          },
          {
            "risk": "Proximal junctional kyphosis",
            "detail": "New kyphosis above the construct.",
            "freq": "Common"
          },
          {
            "risk": "Medical complications",
            "detail": "Pneumonia, DVT/PE, cardiac events.",
            "freq": "Common"
          },
          {
            "risk": "Mortality",
            "detail": "Reported mortality approximately 1–3% for VCR.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Full neuromonitoring (SSEPs, MEPs, EMG). Invasive arterial and central venous monitoring. Cell salvage. Planned ICU admission. Positioned prone for extended periods — meticulous pressure point care."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "ICU for 24–72 hours. Hospital one to three weeks. TLSO brace for three to six months. Gradual mobilisation. Pulmonary physiotherapy. Full recovery six to eighteen months. Long-term spinal surveillance."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg weakness or new paralysis",
          "Loss of bladder or bowel control",
          "Difficulty breathing",
          "Wound breakdown or discharge",
          "Fever",
          "Increasing pain",
          "Implant prominence"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Frequent early reviews. Standing full-spine X-rays at six weeks, three months, six months, one year, then annually for five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is this so risky?",
            "a": "VCR involves removing an entire vertebral body while the spinal cord passes through it — the cord is essentially suspended in space during the correction. This is the most technically demanding spinal procedure with the highest neurological risk."
          },
          {
            "q": "Can lesser operations achieve the same correction?",
            "a": "For rigid deformities exceeding 80 degrees or requiring translation/rotation, VCR may be the only option. Lesser osteotomies (PSO, SPO) correct 25–40 degrees per level and are preferred when sufficient. VCR is reserved for when nothing else will work."
          }
        ]
      }
    ]
  },
  "intraosseous-access": {
    "name": "Intraosseous (IO) Access",
    "region": "Trauma",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Intraosseous access is an emergency procedure to establish vascular access by inserting a needle into the bone marrow cavity when intravenous access cannot be obtained. It allows rapid administration of fluids, blood products, and medications in life-threatening situations.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A specialised IO needle (manual or powered drill device such as EZ-IO) is inserted through the cortex of a long bone into the marrow cavity. Common sites: proximal tibia (most common in adults), distal tibia, proximal humerus, or distal femur. In adults, a powered drill device is preferred. The needle is confirmed in position by aspiration of marrow (though absence does not exclude correct placement). Fluids and medications are then infused through the marrow cavity and enter the systemic circulation rapidly. The procedure takes 30–60 seconds."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "IO access is indicated when peripheral intravenous access cannot be obtained within 60–90 seconds in a critically ill or injured patient — cardiac arrest, severe trauma, burns, dehydration, septic shock, or status epilepticus. It is a bridging measure until definitive IV or central venous access is established."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Peripheral intravenous access (first line), central venous access (femoral, internal jugular, subclavian — takes longer to establish), and surgical cut-down (rarely used now)."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency procedure performed without delay when IV access fails. No preparation beyond standard resuscitation is needed."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Rapid vascular access in under 60 seconds. All medications and fluids that can be given IV can be given IO — including blood products, vasopressors, antibiotics, anaesthetic agents, and crystalloids. Flow rates are adequate for resuscitation."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain on infusion",
            "detail": "Awake patients experience pain during fluid infusion through the IO. Lidocaine flush reduces this.",
            "freq": "Expected"
          },
          {
            "risk": "Extravasation",
            "detail": "Fluid may leak around the insertion site if the needle is not secure.",
            "freq": "Uncommon"
          },
          {
            "risk": "Local haematoma",
            "detail": "Bruising at the insertion site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Osteomyelitis",
            "detail": "Bone infection. Very rare with short-term use (under 24 hours).",
            "freq": "Rare"
          },
          {
            "risk": "Compartment syndrome",
            "detail": "If fluid extravasates into the soft tissue compartment. Monitor calf circumference.",
            "freq": "Rare"
          },
          {
            "risk": "Fat embolism",
            "detail": "Theoretical risk of marrow entering the bloodstream. Clinically very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Fracture",
            "detail": "Through the insertion site, particularly in children with small bones.",
            "freq": "Rare"
          },
          {
            "risk": "Growth plate injury",
            "detail": "In children if the needle is placed too close to the physis.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed in cardiac arrest. In conscious patients, local anaesthetic is infiltrated at the insertion site and lidocaine (preservative-free) is flushed into the marrow cavity before infusion."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "IO access is temporary — typically removed within 24 hours once definitive IV access is established. The insertion site is covered with a dressing. No specific rehabilitation needed."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Calf swelling around the insertion site (possible extravasation or compartment syndrome)",
          "Redness or discharge at the insertion site",
          "Fever after IO use (possible infection)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "IO needle removed within 24 hours. Site monitored for infection. No long-term follow-up needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this safe?",
            "a": "IO access is an established, life-saving emergency technique. Complications are rare and the procedure is recommended by all major resuscitation guidelines (ALS, ATLS, ERC) when IV access fails."
          },
          {
            "q": "Does it hurt?",
            "a": "In conscious patients, insertion causes brief pain similar to an injection. Fluid infusion through the marrow can be painful — a flush of lidocaine into the marrow cavity before infusion significantly reduces this."
          }
        ]
      }
    ]
  },
  "shockwave-therapy": {
    "name": "Extracorporeal Shockwave Therapy (ESWT)",
    "region": "Sports Medicine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Extracorporeal shockwave therapy is a non-invasive treatment that delivers focused or radial acoustic pressure waves to injured tendons, bones, and soft tissues. It stimulates healing by promoting neovascularisation, collagen synthesis, and local growth factor release.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The affected area is identified and ultrasound gel is applied. A shockwave device is placed against the skin and delivers a series of acoustic pulses. Focused ESWT: high-energy pulses precisely targeted to the pathology. Radial ESWT: lower-energy waves spread over a wider area. A typical session delivers 1,500–3,000 pulses over 10–15 minutes. Most protocols require three to five sessions at weekly intervals. No anaesthesia is needed — though the treatment is uncomfortable."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "ESWT is considered for chronic tendinopathies that have not responded to three to six months of structured rehabilitation — plantar fasciitis, calcific shoulder tendinitis, lateral epicondylitis (tennis elbow), patellar tendinopathy, Achilles tendinopathy, and greater trochanteric pain syndrome. It is also used for fracture non-union and myositis ossificans."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (the primary treatment for tendinopathy), eccentric and heavy slow resistance exercise programmes, corticosteroid injection, PRP injection, and activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Outpatient clinic procedure. No fasting. Stop anti-inflammatory medication for 48 hours before (NSAIDs may inhibit the healing response that ESWT stimulates)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Evidence is strongest for plantar fasciitis (Level 1) and calcific shoulder tendinitis (Level 1). Approximately 60–80% of patients report significant improvement. Benefits develop gradually over six to twelve weeks after the treatment course."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Pain during treatment",
            "detail": "The pulses are uncomfortable, particularly at higher energy levels. Tolerable for most patients.",
            "freq": "Expected"
          },
          {
            "risk": "Temporary pain flare",
            "detail": "Increased pain for 24–48 hours after treatment. Normal and expected.",
            "freq": "Common"
          },
          {
            "risk": "Redness and bruising",
            "detail": "At the treatment site.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Tendon rupture",
            "detail": "Theoretical risk of weakening a severely degenerate tendon. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Skin breakdown",
            "detail": "With very high energy. Rare with proper technique.",
            "freq": "Rare"
          },
          {
            "risk": "Nerve irritation",
            "detail": "Temporary numbness in the treated area.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia. The treatment is tolerable — intensity is adjusted to the patient's comfort level."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Normal activities immediately. Avoid high-impact loading of the treated area for 48 hours. Continue (or begin) the structured rehabilitation programme — ESWT works best when combined with exercise. Benefits develop over six to twelve weeks."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Severe pain not settling after 48 hours",
          "Tendon suddenly giving way",
          "Skin breakdown at treatment site"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Sessions at weekly intervals for three to five weeks. Assess response at six to twelve weeks after completing the course."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Does it work?",
            "a": "The best evidence supports ESWT for plantar fasciitis and calcific shoulder tendinitis. For other tendinopathies, evidence is moderate but growing. It is most effective when combined with a structured exercise programme, not as a standalone treatment."
          },
          {
            "q": "Why can't I take anti-inflammatories?",
            "a": "ESWT works by stimulating an inflammatory healing response. Anti-inflammatory drugs may inhibit this response and reduce the effectiveness of the treatment."
          },
          {
            "q": "Is it available on the NHS?",
            "a": "NICE has conditionally approved ESWT for calcific shoulder tendinitis and plantar fasciitis. Availability varies by region. It is widely available privately."
          }
        ]
      }
    ]
  },
  "paediatric-hip-surveillance": {
    "name": "Hip Surveillance Programme (Cerebral Palsy)",
    "region": "Paediatric Orthopaedics",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Hip surveillance in cerebral palsy is a structured monitoring programme to detect progressive hip displacement in children with CP before it becomes symptomatic. Regular hip X-rays are taken at scheduled intervals to identify hip migration early, when preventive treatment is most effective.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An anteroposterior (AP) pelvic X-ray is taken with the child lying flat with legs parallel. The Reimer's migration percentage (MP) is measured — the percentage of the femoral head that is uncovered by the acetabulum. Normal: less than 30%. At risk: 30–40%. Subluxated: 40–60%. Dislocated: over 60%. X-rays are repeated at intervals determined by the child's GMFCS level and the migration percentage. Non-walkers (GMFCS IV–V) are X-rayed every six months until age seven, then annually. Walkers (GMFCS I–III) are monitored annually."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Children with cerebral palsy have a high risk of hip displacement — approximately 35% of all children with CP, rising to 75–90% in non-ambulant children (GMFCS IV–V). Undetected hip displacement leads to painful dislocation, windswept deformity, and significant deterioration in quality of life. Surveillance enables early intervention — soft tissue release at 30–40% migration, bony reconstruction at 40–60%."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "This IS the non-operative monitoring programme. The alternative — not monitoring — risks late diagnosis of hip displacement at a stage when only major salvage surgery is possible."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "No preparation needed for X-rays. The programme is coordinated by the child's orthopaedic and physiotherapy team. In the UK, the CPIPS (Cerebral Palsy Integrated Pathway Scotland) and similar regional programmes standardise surveillance."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Early detection of hip displacement at a treatable stage. Prevention of painful hip dislocation. The Swedish hip surveillance programme reduced the rate of hip dislocation in CP from 10% to less than 0.5% over twenty years."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Radiation exposure",
            "detail": "Multiple pelvic X-rays over childhood. The dose from each X-ray is very low and the benefit of surveillance far outweighs the minimal radiation risk.",
            "freq": "Expected"
          },
          {
            "risk": "False positives",
            "detail": "A single elevated MP may not indicate progressive displacement — serial measurements showing a trend are more reliable.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Missed displacement",
            "detail": "If the programme is not followed or X-rays are not taken at the scheduled intervals.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed. The child lies on an X-ray table for a few seconds."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "No recovery needed. If hip displacement is detected, treatment is discussed — ranging from physiotherapy and positioning to botulinum toxin injection, adductor release, or reconstructive hip surgery, depending on the degree of displacement."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Child becoming irritable or distressed during care (possible painful hip)",
          "Asymmetric hip abduction (one hip does not open as far as the other)",
          "Windswept posture developing",
          "Difficulty with sitting, positioning, or personal care"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "GMFCS IV–V: pelvic X-ray every six months until age seven, then annually until skeletal maturity. GMFCS III: annually. GMFCS I–II: baseline and as clinically indicated. Continue until skeletal maturity."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why is hip displacement so common in CP?",
            "a": "Spasticity and muscle imbalance cause the hip adductors and flexors to overpower the abductors and extensors, gradually pulling the femoral head out of the socket. The acetabulum does not develop normally without the stimulus of a well-located femoral head."
          },
          {
            "q": "Does surveillance prevent dislocation?",
            "a": "Surveillance itself does not prevent dislocation — it detects displacement early so that timely intervention can prevent dislocation. The Swedish experience showed that systematic surveillance and early intervention reduced dislocation rates from 10% to less than 0.5%."
          },
          {
            "q": "What happens if displacement is detected?",
            "a": "MP 30–40%: soft tissue surgery (adductor release, psoas lengthening) is considered. MP 40–60%: bony reconstruction (femoral varus derotation osteotomy with or without pelvic osteotomy). MP over 60%: reconstructive surgery or, in some cases, salvage procedures. The earlier intervention occurs, the simpler and more effective it is."
          }
        ]
      }
    ]
  },
  "shoulder-clavicle-nonunion": {
    "name": "Clavicle Non-Union Surgery",
    "region": "Shoulder",
    "tag": "Trauma",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Clavicle non-union surgery is an operation to treat a broken collarbone that has failed to heal. It involves freshening the bone ends, applying bone graft, and stabilising with a plate and screws to promote union.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the clavicle along Langer's lines. The non-union site is exposed and the fibrous tissue between the bone ends is excised. The bone ends are debrided to bleeding cancellous bone. Autologous bone graft (from the iliac crest or locally) is packed around the site. A pre-contoured locking plate is applied. Occasionally the non-union involves significant bone loss requiring a structural graft or shortening. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Clavicle non-union causes pain, shoulder weakness, and difficulty with overhead activities. Risk factors include initial displacement, smoking, NSAID use, and inadequate immobilisation. Non-union is defined as no healing at six months with no radiographic progression."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Continued observation (some non-unions are painless and functional), bone stimulator (limited evidence), and acceptance with activity modification."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays and CT to assess the non-union gap and bone quality. Blood tests to exclude metabolic causes (vitamin D, calcium, thyroid). Smoking cessation is mandatory."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Union rates with plate fixation and bone grafting exceed 90–95%. Pain relief and restoration of shoulder strength and endurance."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Plate prominence",
            "detail": "The clavicle is subcutaneous — the plate is often palpable and may need removal.",
            "freq": "Common"
          },
          {
            "risk": "Graft donor site pain",
            "detail": "Iliac crest discomfort.",
            "freq": "Common"
          },
          {
            "risk": "Numbness",
            "detail": "Supraclavicular nerves may be damaged, causing numbness below the scar.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent non-union",
            "detail": "Despite grafting and fixation. Approximately 5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Plate failure",
            "detail": "If union is delayed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pneumothorax",
            "detail": "The lung apex lies directly deep to the clavicle. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Subclavian vessel injury",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Brachial plexus injury",
            "detail": "Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Two surgical sites if iliac crest graft."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Sling for two to four weeks. Gentle shoulder exercises from one to two weeks. Progressive strengthening from six weeks. Return to sport at three to four months. Full recovery four to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Persistent pain at the fracture site despite fixation",
          "Shortness of breath or chest pain (possible pneumothorax)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks, three months, and six months."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why didn't my clavicle heal?",
            "a": "The most common causes are significant initial displacement, smoking, NSAID use during healing, and inadequate treatment of an initially displaced fracture. Metabolic factors (vitamin D deficiency) may contribute."
          }
        ]
      }
    ]
  },
  "bicruciate-retaining-knee": {
    "name": "Bicruciate-Retaining Knee Replacement",
    "region": "Knee",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Bicruciate-retaining (BCR) knee replacement is an advanced prosthesis design that preserves both the anterior and posterior cruciate ligaments during total knee replacement. It aims to restore more natural knee kinematics than conventional cruciate-sacrificing or posterior-stabilised designs.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical technique is similar to standard TKR but more demanding — both cruciate ligaments must be carefully preserved while the bone is cut and the implants are positioned. Specialised implant designs accommodate the retained ligaments. The tibial component has a unique geometry that works with the natural cruciates. Precise ligament balancing and component positioning are critical. The operation takes one and a half to two hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "BCR knee replacement may be offered to patients with intact cruciate ligaments who wish to maximise natural knee feeling and kinematics after TKR. It may provide better proprioception, more natural stair descent, and improved deep flexion compared to conventional designs."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All standard non-operative knee arthritis treatments. Conventional TKR (cruciate-sacrificing or posterior-stabilised), partial knee replacement, and osteotomy are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI to confirm both cruciate ligaments are intact and functional. Standard TKR pre-assessment. Surgeon must have specific training and experience with BCR designs."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Potentially more natural knee kinematics — better proprioception, more normal stair descent, and improved 'knee feeling.' Early clinical results are promising but long-term data is still maturing compared to conventional TKR designs with forty years of follow-up."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "All standard TKR risks",
            "detail": "Infection, blood clots, stiffness, ongoing pain.",
            "freq": "See standard risks"
          },
          {
            "risk": "Technically demanding",
            "detail": "Cruciate preservation requires precise surgical technique.",
            "freq": "Expected"
          },
          {
            "risk": "Limited long-term data",
            "detail": "Compared to conventional designs with decades of follow-up.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Cruciate ligament damage",
            "detail": "Despite intent to preserve, one or both cruciates may be damaged during surgery requiring conversion to a conventional design.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "If ligament balancing is imprecise.",
            "freq": "Uncommon"
          },
          {
            "risk": "Limited revision options",
            "detail": "Revision may be more complex than conventional TKR.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia — same as conventional TKR."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Similar to conventional TKR. Hospital one to three days. Physiotherapy from day one. Potentially faster return of natural knee function due to preserved proprioception. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as conventional TKR. X-rays at six weeks, one year, then every two to five years."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is this better than a standard knee replacement?",
            "a": "Early results are very promising — patients may experience more natural knee feeling and kinematics. However, conventional TKR designs have forty years of proven long-term data. BCR designs are newer and long-term survivorship data is still maturing. Both are excellent options."
          },
          {
            "q": "Can everyone have this?",
            "a": "No — both cruciate ligaments must be intact and functional. Patients with ACL-deficient knees, severe deformity, or inflammatory arthritis are generally not suitable."
          }
        ]
      }
    ]
  },
  "hip-dual-mobility": {
    "name": "Dual Mobility Hip Replacement",
    "region": "Hip",
    "tag": "Arthroplasty",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Dual mobility hip replacement uses a specialised acetabular component with two articulation surfaces — providing enhanced stability against dislocation. The femoral head moves within a large polyethylene liner, which itself moves within the metal shell.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "The surgical procedure is identical to standard total hip replacement. The difference is the acetabular component: a metal shell is impacted into the acetabulum, and a large polyethylene liner with a polished inner surface is placed inside. The standard femoral head (28 or 32 mm) articulates within the liner (first articulation), and the liner can also move within the shell (second articulation). This dual articulation dramatically increases the arc of motion before impingement and dislocation. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Dual mobility is used for patients at high risk of dislocation — revision hip replacement, neuromuscular conditions (cerebral palsy, Parkinson's disease, dementia), fracture patients with poor compliance, previous hip dislocation, spinopelvic pathology affecting hip mechanics, and tumour reconstruction around the hip."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "All standard non-operative hip treatments. Standard THR with conventional bearings is the alternative — with appropriate precautions, dislocation rates are low in most patients."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Standard THR pre-assessment. Identification of dislocation risk factors. Discussion of bearing options."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Dramatically reduced dislocation rate — from approximately 3–5% (standard bearing) to less than 1% with dual mobility. This is particularly valuable in high-risk populations where dislocation rates with standard bearings can exceed 10%."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "All standard THR risks",
            "detail": "Infection, blood clots, leg length discrepancy.",
            "freq": "See standard risks"
          },
          {
            "risk": "Intraprosthetic dislocation",
            "detail": "Very rare failure mode where the small head dislocates from within the liner (rather than the liner from the shell). Risk less than 1%.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Accelerated polyethylene wear",
            "detail": "The dual articulation may increase total wear, though modern highly cross-linked polyethylene has dramatically reduced this concern.",
            "freq": "Long-term"
          },
          {
            "risk": "Liner impingement on stem",
            "detail": "The large liner may impinge on the femoral stem neck, causing wear and metallosis.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Prosthetic joint infection approximately 1%.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Same as standard THR."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Same as standard THR — but with fewer or no hip precautions in many protocols, because the dual mobility design is inherently very stable. This may allow faster functional recovery. Hospital one to three days. Driving at four to six weeks. Full recovery three to six months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Calf pain or leg swelling",
          "Toes turning blue or numb"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Same as standard THR."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Why not use dual mobility for everyone?",
            "a": "Dual mobility adds cost and there are theoretical concerns about long-term polyethylene wear and intraprosthetic dislocation. For standard-risk patients, conventional bearings with modern techniques have very low dislocation rates. Dual mobility is most valuable for high-risk patients."
          },
          {
            "q": "Can I have fewer hip precautions?",
            "a": "Yes — many surgeons allow unrestricted movement with dual mobility hips because the design is inherently very resistant to dislocation. This can make early recovery easier."
          }
        ]
      }
    ]
  },
  "ankle-arthrodesis-arthroscopic": {
    "name": "Arthroscopic Ankle Fusion",
    "region": "Foot & Ankle",
    "tag": "Fusion",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Arthroscopic ankle fusion is a minimally invasive technique to fuse the ankle joint using arthroscopic (keyhole) surgery rather than a traditional open incision. It achieves the same outcome — a fused, pain-free ankle — with less soft tissue disruption and potentially faster fusion.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Two to three small arthroscopic portals are made around the ankle. The remaining articular cartilage is removed from the tibial plafond and talar dome using arthroscopic shavers and curettes. The joint surfaces are prepared to bleeding bone. The ankle is compressed and fixed in the optimal position (neutral dorsiflexion, 5 degrees external rotation, slight valgus) with two or three large cannulated screws inserted percutaneously under fluoroscopic guidance. The operation takes one to one and a half hours."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Arthroscopic fusion is preferred for straightforward ankle arthritis without significant deformity (less than 15 degrees of varus/valgus). It preserves the soft tissue envelope, has lower wound complication rates than open fusion, and may achieve faster union."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Ankle brace, rocker-bottom shoes, injection, physiotherapy, activity modification. Ankle replacement (motion-preserving) and open ankle fusion are surgical alternatives."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Weight-bearing X-rays and CT. Assessment of deformity — significant malalignment may require open fusion to correct alignment. Assessment of subtalar joint (if also arthritic, a hindfoot nail may be more appropriate)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Union rates of approximately 90–95% — comparable to or better than open fusion. Lower wound complication rates. Potentially faster time to union (average ten to twelve weeks vs twelve to sixteen weeks for open). Less post-operative pain."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Loss of ankle motion",
            "detail": "Expected — the ankle is permanently fused.",
            "freq": "Expected"
          },
          {
            "risk": "Altered gait",
            "detail": "Shorter stride, reduced push-off.",
            "freq": "Expected"
          },
          {
            "risk": "Subtalar arthritis",
            "detail": "Increased stress on the adjacent joint.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Non-union",
            "detail": "5–10%. Higher in smokers.",
            "freq": "Uncommon"
          },
          {
            "risk": "Malposition",
            "detail": "The ankle may fuse in a suboptimal position.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Superficial peroneal nerve near the portals.",
            "freq": "Uncommon"
          },
          {
            "risk": "Screw prominence",
            "detail": "Screws may require removal.",
            "freq": "Common"
          },
          {
            "risk": "Conversion to open",
            "detail": "If the joint cannot be adequately prepared arthroscopically.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General or spinal anaesthesia with ankle block."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Non-weight-bearing cast for six to eight weeks. Boot with progressive weight-bearing from eight to twelve weeks. Rocker-bottom shoes long-term. Full recovery six to twelve months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Wound problems",
          "Fever",
          "Cast too tight",
          "Toes blue or numb",
          "Ankle pain not settling"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-rays at six weeks and three months. CT if non-union suspected."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is arthroscopic fusion as reliable as open?",
            "a": "Yes — published union rates are at least equivalent, with lower wound complication rates. The main limitation is deformity correction — significant malalignment is better addressed with an open approach."
          }
        ]
      }
    ]
  },
  "minimally-invasive-decompression": {
    "name": "Minimally Invasive Lumbar Decompression (Tubular / MIS)",
    "region": "Spine",
    "tag": "Decompression",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Minimally invasive lumbar decompression uses a tubular retractor system to decompress spinal stenosis through a small incision with minimal muscle disruption. It achieves the same neural decompression as open laminectomy while preserving more posterior spinal stability.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A midline or slightly paramedian incision of approximately 2 cm is made. A series of dilators are passed through the muscle (rather than stripping muscle from bone). A tubular retractor holds the muscle apart, creating a working corridor. Under the operating microscope, the lamina is thinned, ligamentum flavum removed, and the nerve roots decompressed. For bilateral stenosis, both sides can be decompressed through a single midline incision by tilting the tube (over-the-top technique). The operation takes 45–90 minutes per level."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "MIS decompression is offered for lumbar spinal stenosis when a less invasive approach is desired — particularly for single or two-level stenosis without instability. It preserves more of the posterior musculature and bony structures than open laminectomy."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy, epidural injection, pain medication, and activity modification — the same as for standard decompression."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "MRI confirming stenosis. Assessment for instability (dynamic X-rays) — if unstable, fusion should be added. Day-case or overnight procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Equivalent decompression to open laminectomy with potentially less post-operative pain, shorter hospital stay (often day-case), faster recovery, less muscle damage, and preservation of more posterior stability — potentially reducing the need for later fusion."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Same risks as open decompression",
            "detail": "Dural tear, nerve injury, infection.",
            "freq": "See standard risks"
          },
          {
            "risk": "Conversion to open",
            "detail": "If decompression is inadequate through the tube. Approximately 2–5%.",
            "freq": "Uncommon"
          },
          {
            "risk": "Learning curve",
            "detail": "The tubular technique requires specific training.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Dural tear",
            "detail": "Risk approximately 3–5%, similar to open.",
            "freq": "Uncommon"
          },
          {
            "risk": "Incomplete decompression",
            "detail": "The limited field of view may result in inadequate decompression, particularly for central stenosis.",
            "freq": "Uncommon"
          },
          {
            "risk": "Nerve injury",
            "detail": "Risk approximately 1%.",
            "freq": "Rare"
          },
          {
            "risk": "Infection",
            "detail": "Wound or deep infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Instability",
            "detail": "If significant bone is removed despite the minimally invasive approach.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia. Prone position. Day-case in many centres."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Most patients go home the same day or next morning. Walking immediately. Minimal wound care. Return to desk work at one to two weeks. Driving at one to two weeks. Full activity at four to six weeks. Recovery is generally faster than open laminectomy."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Worsening leg pain or weakness",
          "New bladder or bowel symptoms",
          "Wound problems",
          "Fever",
          "Severe headache when upright"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Review at six weeks. Further follow-up as needed."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Is MIS decompression as effective as open?",
            "a": "Yes — the decompression achieved is equivalent. The advantage is in the approach — less muscle damage, less pain, and faster recovery. Long-term outcomes are equivalent."
          },
          {
            "q": "Can this be done as a day case?",
            "a": "Yes — many MIS decompressions are performed as day cases, with patients going home a few hours after surgery. This is one of the significant advantages over open laminectomy."
          }
        ]
      }
    ]
  },
  "pelvic-binder": {
    "name": "Pelvic Binder Application",
    "region": "Trauma",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A pelvic binder is an emergency circumferential compression device applied around the pelvis to stabilise an unstable pelvic fracture and tamponade haemorrhage. It is a first-aid and resuscitation measure that can be life-saving in major pelvic trauma.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "A commercially available pelvic binder (such as SAM Pelvic Sling or T-POD) or a folded bed sheet is positioned at the level of the greater trochanters (the bony prominences on the outer thighs — NOT at the waist or iliac crests). The binder is tightened using the manufacturer's mechanism or sheet clamps to provide circumferential compression, reducing the pelvic volume. Application takes 30–60 seconds. The binder is left in place until definitive surgical fixation or until cleared by the trauma team."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Pelvic binders are applied in the pre-hospital or emergency department setting for suspected unstable pelvic fractures — particularly anteroposterior compression (open-book) injuries. Pelvic fractures can cause massive retroperitoneal haemorrhage (bleeding behind the abdomen) — the binder reduces pelvic volume, which increases tamponade pressure and reduces bleeding."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "There are no alternatives for emergency pelvic stabilisation in the field or ED. External fixation and definitive surgical fixation are performed subsequently in theatre."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "This is an emergency first-aid measure. Applied based on mechanism of injury (high-energy trauma) and clinical suspicion (pelvic instability on examination or haemodynamic instability)."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Immediate pelvic stabilisation and haemorrhage reduction. The binder can reduce a disrupted pelvic ring to near-anatomical alignment, dramatically reducing the pelvic volume available for haemorrhage. It is a bridge to definitive treatment."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Skin pressure",
            "detail": "Prolonged application causes pressure sores, particularly over the greater trochanters and sacrum.",
            "freq": "Common"
          },
          {
            "risk": "Over-tightening",
            "detail": "Excessive compression can worsen lateral compression injuries or cause soft tissue damage.",
            "freq": "Uncommon"
          },
          {
            "risk": "Incorrect position",
            "detail": "If placed too high (at the waist/iliac crests), the binder is ineffective — it must be at trochanteric level.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Worsening lateral compression injury",
            "detail": "In lateral compression fractures, the binder may further displace internally rotated hemipelvis. Clinical judgement is needed.",
            "freq": "Uncommon"
          },
          {
            "risk": "Skin necrosis",
            "detail": "From prolonged tight application.",
            "freq": "Uncommon"
          },
          {
            "risk": "Urological injury",
            "detail": "If applied over a displaced urethral injury.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed. Applied in the emergency setting."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "The binder is a temporary measure. It is removed when definitive fixation is performed, the pelvis is confirmed stable, or the trauma team clears removal. Skin under the binder is inspected regularly (every two to four hours) for pressure damage."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent haemodynamic instability despite binder (may need angioembolisation or surgical packing)",
          "Skin changes under the binder",
          "Increasing abdominal distension",
          "Blood at the urethral meatus"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "The binder is a resuscitation tool — follow-up is determined by the underlying pelvic injury and its definitive management."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "Where exactly does the binder go?",
            "a": "At the level of the greater trochanters — the bony bumps on the outer thighs that you can feel when you stand. This is lower than most people expect. Placement at the waist or iliac crests is the most common error and renders the binder ineffective."
          },
          {
            "q": "How tight should it be?",
            "a": "Tight enough to close the pelvic ring — typically a fist should just fit between the binder and the thigh. Over-tightening is counterproductive. Commercial devices have tension-limiting mechanisms."
          },
          {
            "q": "Can this be applied in the field?",
            "a": "Yes — pelvic binders are designed for pre-hospital application by paramedics and first responders. They are part of standard major trauma management (ATLS, ETC)."
          }
        ]
      }
    ]
  },
  "acl-return-to-sport": {
    "name": "ACL Reconstruction — Return to Sport Testing",
    "region": "Sports Medicine",
    "tag": "Procedure",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Return to sport (RTS) testing after ACL reconstruction is a structured assessment to determine whether an athlete is physically and psychologically ready to return to pivoting sport. It reduces the risk of re-injury by ensuring adequate strength, power, proprioception, and confidence before clearance.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "RTS testing typically includes: isokinetic dynamometry — quadriceps and hamstring strength measured on a machine, comparing the operated leg to the non-operated leg (limb symmetry index, LSI). Target: greater than 90% LSI. Hop testing — single hop for distance, triple hop, crossover hop, and timed 6-metre hop. Target: greater than 90% LSI. Functional testing — Y-balance test, single-leg squat quality, agility tests, and sport-specific drills. Psychological readiness — ACL-Return to Sport after Injury (ACL-RSI) questionnaire. Target: score greater than 56/100. The assessment takes approximately one hour and is performed by a physiotherapist experienced in ACL rehabilitation."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Athletes who pass RTS testing criteria before returning to sport have a significantly lower re-rupture rate than those who return based on time alone. Simply waiting nine to twelve months does not guarantee readiness — objective criteria must be met."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Time-based return (e.g., 'return at nine months') — this is inferior to criteria-based return and is associated with higher re-injury rates."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Not a surgical procedure. Performed at nine to twelve months post-ACL reconstruction. Requires access to isokinetic dynamometry and a structured testing protocol."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Athletes who meet all RTS criteria have approximately 60% lower re-rupture rates. The testing identifies specific deficits that can be targeted with additional rehabilitation before clearance."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Delayed return",
            "detail": "Athletes who do not meet criteria must continue rehabilitation before retesting. This may be frustrating but reduces re-injury risk.",
            "freq": "Common"
          },
          {
            "risk": "False reassurance",
            "detail": "Passing RTS testing does not eliminate re-injury risk — it reduces it. Re-rupture rates are approximately 6% even with testing.",
            "freq": "Expected"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Provocative testing",
            "detail": "The hop tests place load on the reconstructed ACL. There is a theoretical (very low) risk of graft injury during testing. Not reported in the literature.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "No anaesthesia needed."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "If criteria are met: graduated return to sport over four to six weeks (training → non-contact → contact → competition). If criteria are not met: targeted rehabilitation addressing specific deficits, with retesting at four to six week intervals."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Knee pain or swelling during testing",
          "Knee giving way",
          "Psychological unreadiness or fear of re-injury"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Retesting every four to six weeks until all criteria are met. Ongoing neuromuscular training (FIFA 11+, injury prevention programme) after return to sport — indefinitely."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "When should RTS testing be done?",
            "a": "At nine to twelve months post-ACL reconstruction — never before nine months. Each month of delay between nine and twenty-four months reduces re-rupture risk by approximately 50%. There is no rush to return."
          },
          {
            "q": "What if I fail the tests?",
            "a": "Failure identifies specific deficits — usually quadriceps weakness, hop asymmetry, or psychological unreadiness. These are targeted with additional rehabilitation. Most athletes who initially fail pass within four to eight weeks of focused training."
          },
          {
            "q": "Does passing guarantee I won't re-tear?",
            "a": "No — but it dramatically reduces the risk. Athletes who pass have approximately 60% lower re-rupture rates than those who return without testing. Ongoing neuromuscular training and warm-up programmes (FIFA 11+) provide additional protection."
          }
        ]
      }
    ]
  },
  "paediatric-osteomyelitis": {
    "name": "Paediatric Acute Osteomyelitis Management",
    "region": "Paediatric Orthopaedics",
    "tag": "Emergency",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Paediatric acute osteomyelitis is an emergency infection of the bone in a child requiring urgent antibiotics and, in many cases, surgical drainage. The metaphysis of long bones (distal femur, proximal tibia, proximal humerus) is the most common site.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Medical management: urgent IV antibiotics are started after blood cultures are taken — typically flucloxacillin or clindamycin to cover Staphylococcus aureus (the most common organism). Surgical management: if there is a subperiosteal abscess on MRI/ultrasound, or if the child is not improving after 48 hours of IV antibiotics, surgical drainage is performed. An incision is made over the affected bone, the periosteum is opened, and pus is drained. The bone surface is washed, and samples are taken for culture. A drain may be left. The operation takes 30–60 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Surgery is needed when an abscess has formed (seen on MRI or ultrasound), when the child is not responding to IV antibiotics within 48 hours, or when there is a concern about adjacent joint infection (as the metaphysis is intracapsular in the hip, shoulder, elbow, and ankle)."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "IV antibiotics alone are appropriate when there is no abscess, the child is responding clinically (temperature settling, inflammatory markers falling), and there is no concern about adjacent joint involvement."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Blood cultures (before antibiotics if possible). Blood tests: CRP, ESR, WCC. MRI to confirm the diagnosis and assess for abscess, subperiosteal collection, and adjacent joint involvement. Ultrasound as a rapid alternative for subperiosteal collections."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Drainage of the abscess, identification of the organism, and rapid clinical improvement. Most children with appropriately treated acute osteomyelitis recover fully without long-term sequelae."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Prolonged antibiotics",
            "detail": "IV antibiotics for at least three to five days, then oral for a total of three to six weeks guided by CRP.",
            "freq": "Expected"
          },
          {
            "risk": "Recurrence",
            "detail": "If antibiotics are stopped too early or if the organism is resistant.",
            "freq": "Uncommon"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Chronic osteomyelitis",
            "detail": "If acute infection is not adequately treated, it may become chronic — much harder to eradicate.",
            "freq": "Uncommon"
          },
          {
            "risk": "Growth plate damage",
            "detail": "The infection may damage the adjacent physis, causing growth disturbance or angular deformity.",
            "freq": "Uncommon"
          },
          {
            "risk": "Pathological fracture",
            "detail": "Through weakened infected bone.",
            "freq": "Uncommon"
          },
          {
            "risk": "Septicaemia",
            "detail": "Systemic spread of infection.",
            "freq": "Uncommon"
          },
          {
            "risk": "Adjacent joint infection",
            "detail": "The metaphysis is intracapsular at the hip, shoulder, elbow, and ankle — infection can spread into the joint.",
            "freq": "Uncommon"
          },
          {
            "risk": "Venous thrombosis",
            "detail": "Panton-Valentine Leukocidin (PVL) Staph aureus causes DVT in children.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "General anaesthesia for surgical drainage. Emergency case — fasting status managed pragmatically."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "IV antibiotics for three to five days minimum, transitioned to oral when CRP is falling and the child is clinically improving. Oral antibiotics for a total of three to six weeks guided by CRP. Most children recover rapidly — returning to school within one to two weeks and full activity within four to six weeks. Long-term monitoring for growth disturbance if the physis was involved."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Persistent fever despite antibiotics",
          "Child becoming more unwell",
          "Increasing limb pain or swelling",
          "Refusal to use the affected limb",
          "New joint swelling (possible spread to adjacent joint)"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Twice-weekly blood tests (CRP) to guide antibiotic duration. Clinical review at two weeks, six weeks, and three months. X-ray at six weeks (may show periosteal new bone — a sign of previous infection, not ongoing disease). Long-term review if growth plate involvement."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do children get osteomyelitis?",
            "a": "Most commonly from haematogenous spread — bacteria in the bloodstream (often from a minor skin wound or sore throat) seed the metaphysis of a long bone, where blood flow is slow and turbulent. The distal femur and proximal tibia are the most common sites."
          },
          {
            "q": "Will my child need long-term antibiotics?",
            "a": "Typically three to six weeks total (a few days IV then oral). The duration is guided by CRP — antibiotics continue until CRP normalises. Shorter courses (three weeks) are increasingly supported by evidence for uncomplicated cases."
          },
          {
            "q": "What is PVL?",
            "a": "Panton-Valentine Leukocidin is a toxin produced by some strains of Staphylococcus aureus. PVL-producing strains cause more aggressive infections with higher rates of abscess formation, deep vein thrombosis, and multifocal disease. Surgical drainage is almost always needed for PVL infections."
          }
        ]
      }
    ]
  },
  "thumb-ulnar-collateral": {
    "name": "Thumb UCL Repair (Skier's / Gamekeeper's Thumb)",
    "region": "Hand & Wrist",
    "tag": "Ligament",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "Thumb UCL repair is an operation to fix a torn ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint. This ligament is essential for pinch grip and is commonly torn during falls (skier's thumb) or chronic overuse (gamekeeper's thumb).",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "An incision is made over the ulnar side of the thumb MCP joint. The torn UCL is identified. In acute injuries: if the ligament has avulsed from bone with or without a fracture fragment, it is reattached using a suture anchor or small screw. A Stener lesion — where the torn ligament end has flipped over the adductor aponeurosis, preventing healing — is a specific indication for surgery because the interposed tissue blocks healing. In chronic injuries: the ligament is reconstructed using a tendon graft (palmaris longus or plantaris). The operation takes 45–75 minutes."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Acute UCL repair is recommended for complete tears (especially with a Stener lesion), bony avulsions with displacement, and gross instability on stress testing. Partial tears may heal with splinting, but complete tears — particularly Stener lesions — do not heal without surgery."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Thumb spica splint for six weeks for partial tears and stable complete tears without Stener lesion. Hand therapy for rehabilitation."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "X-rays to assess for bony avulsion. MRI or ultrasound to identify Stener lesion. Stress testing under local anaesthetic to assess stability. Surgery within two to three weeks of injury gives the best results."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Restoration of thumb stability and pinch grip strength. Acute repairs have excellent outcomes — over 90% return to full function. Chronic reconstructions have good but slightly less predictable outcomes."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Thumb stiffness",
            "detail": "Some loss of MCP joint motion.",
            "freq": "Common"
          },
          {
            "risk": "Scar tenderness",
            "detail": "Over the ulnar thumb.",
            "freq": "Common"
          },
          {
            "risk": "Weakness",
            "detail": "Mild residual weakness compared to the uninjured side.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Persistent instability",
            "detail": "The repair or reconstruction may fail.",
            "freq": "Uncommon"
          },
          {
            "risk": "Digital nerve injury",
            "detail": "The radial digital nerve of the index finger crosses the surgical field.",
            "freq": "Uncommon"
          },
          {
            "risk": "Infection",
            "detail": "Wound infection.",
            "freq": "Rare"
          },
          {
            "risk": "Arthritis",
            "detail": "Post-traumatic MCP joint arthritis.",
            "freq": "Long-term"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local, regional, or general anaesthesia."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Thumb spica cast or splint for four to six weeks. Hand therapy for range of motion and pinch strengthening from six weeks. Return to sport at three months (with protective splint). Full recovery three to four months."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing pain, redness, or swelling at the wound",
          "Wound discharge or bleeding",
          "Fever or feeling unwell",
          "New numbness or weakness",
          "Thumb giving way during pinch",
          "Increasing instability"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "X-ray at two weeks (if bony repair). Review at six weeks. Stress testing at three months to confirm stability."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "What is a Stener lesion?",
            "a": "When the UCL tears completely, the torn end sometimes flips over the adductor aponeurosis (a tough sheet of tissue). This interposes tissue between the ligament and its attachment, preventing healing — like trying to reattach a rope with a blanket in the way. Stener lesions never heal without surgery."
          },
          {
            "q": "Why is the UCL important?",
            "a": "The UCL stabilises the thumb during pinch grip. Without it, the thumb buckles when you try to grip between thumb and index finger — turning a key, opening a jar, or writing become difficult."
          }
        ]
      }
    ]
  },
  "sacroiliac-joint-injection": {
    "name": "Sacroiliac Joint Injection (Diagnostic and Therapeutic)",
    "region": "Pelvis & Acetabulum",
    "tag": "Injection",
    "reviewer": "Professor Mohamed A. Imam",
    "reviewed": "March 2026",
    "nextReview": "March 2028",
    "version": "1.0",
    "overview": "A sacroiliac (SI) joint injection is a procedure to inject local anaesthetic and corticosteroid into the SI joint under image guidance. It serves both as a diagnostic test (to confirm the SI joint as the source of buttock/low back pain) and as a therapeutic treatment.",
    "sections": [
      {
        "title": "What This Procedure Involves",
        "icon": "⚙️",
        "content": "Under fluoroscopic (X-ray) or CT guidance, a spinal needle is directed into the lower portion of the SI joint. Contrast dye is injected to confirm intra-articular position (arthrogram). A mixture of local anaesthetic and corticosteroid is then injected. The procedure takes 15–20 minutes. Ultrasound-guided approaches are also used."
      },
      {
        "title": "Why It May Be Recommended",
        "icon": "💡",
        "content": "Diagnostic: the gold standard for confirming SI joint dysfunction as the pain source. If the injection provides at least 50–75% relief, the SI joint is confirmed as the pain generator. Therapeutic: corticosteroid provides anti-inflammatory relief for SI joint arthritis, sacroiliitis (inflammatory or post-partum), and SI joint dysfunction."
      },
      {
        "title": "Non-Operative Alternatives",
        "icon": "⚖️",
        "content": "Physiotherapy (SI joint mobilisation, core and pelvic stability exercises), SI joint belt, oral medication, radiofrequency denervation of lateral branch nerves (for longer-lasting relief), and prolotherapy."
      },
      {
        "title": "Preparing for Surgery",
        "icon": "📋",
        "content": "Clinical suspicion of SI joint pain — typically one-sided buttock pain that may radiate to the groin or posterior thigh, reproduced by specific provocation tests (FABER, thigh thrust, compression, distraction). Outpatient procedure."
      },
      {
        "title": "Expected Benefits",
        "icon": "✅",
        "content": "Diagnostic: confirms or excludes the SI joint as the pain source — invaluable for treatment planning. Therapeutic: corticosteroid provides relief lasting weeks to months in approximately 50–70% of patients."
      },
      {
        "title": "Common Risks",
        "icon": "⚠️",
        "isRisk": true,
        "items": [
          {
            "risk": "Injection site discomfort",
            "detail": "Buttock soreness for a day or two.",
            "freq": "Expected"
          },
          {
            "risk": "Steroid flare",
            "detail": "Temporary pain increase for 24–48 hours.",
            "freq": "Uncommon"
          },
          {
            "risk": "Short duration of relief",
            "detail": "Steroid effect may be temporary.",
            "freq": "Common"
          }
        ]
      },
      {
        "title": "Less Common but Serious Risks",
        "icon": "🔴",
        "isRisk": true,
        "items": [
          {
            "risk": "Infection",
            "detail": "Septic arthritis of the SI joint. Very rare.",
            "freq": "Rare"
          },
          {
            "risk": "Sciatic irritation",
            "detail": "If the needle is positioned too anteriorly.",
            "freq": "Rare"
          },
          {
            "risk": "Vascular injection",
            "detail": "Inadvertent injection into pelvic vessels.",
            "freq": "Rare"
          },
          {
            "risk": "Allergic reaction",
            "detail": "To contrast dye or corticosteroid.",
            "freq": "Rare"
          }
        ]
      },
      {
        "title": "Anaesthetic Considerations",
        "icon": "💉",
        "content": "Local anaesthetic at the skin. No sedation needed."
      },
      {
        "title": "Recovery and Rehabilitation",
        "icon": "🏃",
        "content": "Normal activities immediately. Avoid heavy lifting for 24 hours. Record the pain response carefully — the diagnostic value is maximised by documenting the degree and duration of pain relief."
      },
      {
        "title": "Warning Signs After Surgery",
        "icon": "🚨",
        "isWarning": true,
        "items": [
          "Increasing buttock pain, warmth, or swelling after 48 hours",
          "Fever",
          "New leg weakness"
        ]
      },
      {
        "title": "Follow-Up",
        "icon": "📅",
        "content": "Record the pain response at the time of injection and over the following 48 hours. Report to the clinical team. If positive, further treatment (SI fusion, radiofrequency denervation) is planned based on the response."
      },
      {
        "title": "Frequently Asked Questions",
        "icon": "❓",
        "isFaq": true,
        "items": [
          {
            "q": "How do you know my pain is from the SI joint?",
            "a": "SI joint pain is notoriously difficult to diagnose clinically. The injection is the gold standard — if numbing the joint relieves the pain, the joint is confirmed as the source. This is why diagnostic injection is so valuable."
          },
          {
            "q": "How many injections can I have?",
            "a": "Most clinicians limit to two to three per year. If injections provide reliable but temporary relief, SI joint fusion or radiofrequency denervation may offer more durable benefit."
          }
        ]
      }
    ]
  }
}