Know about Joint Replacement Surgery, its Problems and type of replacements.

A joint is formed when two or more bones come together, e.g., the knee, the hip, and the shoulder.  The joints are supported by muscles, ligaments (bands of tissue joining the bones), and tendons (bands of tissue connecting the muscles to the bones).   Joint replacement surgery means removing a damaged joint and putting in a new one in its place.  It is one of the greatest medical advances of our times.  Total joint replacement (hip, knee, shoulder, elbow, and ankle) is done by the orthopedic surgeon for severely painful joints. 

PROBLEMS FROM A DAMAGED JOINT:

A damaged joint:

  1. Gives rise to pain. 
  2. Destroys the joint shape. 
  3. Limits the movement. 

These 3 problems cause misery to the patient.  Therefore, to provide relief from pain, maintain the joint shape, and help in normal movement, a surgery is performed where parts of the damaged joint are removed and replaced with either a metal, or a plastic or a ceramic device.  This device (artificial joint) is medically called as "prosthesis."

CANDIDATES FOR REPLACEMENT:

They are those who:

  1. Suffer severe joint pain.
  2. Have joint stiffness.
  3. Limp while walking.
  4. Have muscle weakness around the joints.
  5. Have limitation of movement.
  6. Have swelling of the joint. 

Depending on which joint is affected and the amount of damage to it, ordinary activities such as putting on a tee shirt, driving a car, washing the face, walking, putting on socks and shoes, getting  into and out of cars, and climbing stairs become more and more difficult. 

JOINT REPLACEMENT SURGERY:

Joint replacement surgery is designed to replace the damaged cartilage and bone.    The patient must have the muscles and ligaments for support and function.  The prosthesis (artificial joint) is usually made of titanium, cobalt chrome, stainless steel, ceramic material, and polyethylene (plastic).  The artificial joint parts are fixed to the area from where the original joint was removed by a process called as “fixation.”  Replacing a damaged joint with a new one improves the quality of life of the patient (patient feels comfortable).  The pain reduces.  The shape is restored.  The movement is possible.   Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts. The joint now behaves like a normal, healthy joint.

TYPES OF FIXATION:

The 2 types of fixation are:

  1. Cemented:  Here, the device is fixed to the bone with acrylic cement.  A cemented joint is used more often in older people who do not move around as much, and in people with “weak” bones.  
  2. Uncemented:  Here, the press-fit is used, which allows the bone to grow into the device.  An uncemented joint is
  • often recommended for younger, more active people and those with good bone quality.

 Once the joint replacement is done, its motion and function are restored through physiotherapy (exercises).  The three most common joint replacement surgeries done are for the hip, the knee, and the shoulder.   New joints, generally, last for at least 10 to 15 years.  Therefore, younger patients may need to have the same damaged joint replaced more than once.

TYPES OF JOINT REPLACEMENTS

Total hip replacement (THR).

Total knee replacement (TKR).

Partial knee replacement.

Partial hip replacement.

Shoulder joint replacement.

Elbow replacement.

Other small joint replacement surgeries. 

FACTORS FOR THE INCREASED NUMBER OF JOINT REPLACEMENT SURGERIES:

  1. An increasing number of trained joint replacement surgeons.
  2. Aging population (> 60 years suffer arthritis).
  3. Sedentary lifestyle.
  4. Improved healthcare infrastructure.
  5. Improved implant designs have also helped surgeons choose the implant that best suits the needs of each patient. 
  6. Better quality of life.
  7. Less dependency.

REVISION REPLACEMENT SURGERIES AND ITS BENEFITS

The primary joint replacement devices last for 10 to 15 years.   Approximately 10% of devices (implants) fail in the long run, and this failure calls for doing a second procedure called revision replacement surgery.  In revision procedures, the old implants are removed and replaced with new components.

Primary implants may fail for any of several reasons like:  loosening of the nuts, bolts, plates, screws (hardware) that are placed during the surgery; infection of the implant; displacement or discontinuity of the implant; injury to the implant; and patient-related factors.

As a result, the joint may become painful or swollen.  The function of the joint decreases.  This results in a limp, stiffness, or instability.  The revision surgery is a difficult one that requires proper planning before the surgery, making use of special tools and implants for insertion, and gaining mastery of the surgical techniques in order to achieve good results.

Tags: Joint replacement , Surgery , total knee replacement , Knee Surgery , painful joints

 

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