What is Joint Replacement?
Joint replacement surgeries are commonly done for degenerative joint disease, especially severe osteoarthritis. It is often referred to as arthroplasty. In essence, it is a surgical correction performed, either by reconstruction or replacement of a degenerated or malformed joint.
The replacement procedure is done by prosthetic joint placements in the site of the damaged joint. These are usually made of stainless steel or cobalt chrome and often made from a mould. They possess a bearing surface around which movement of the joint occurs and is usually metal or plastic (or polyethylene). Metal on metal and ceramic bearings are also available alternatives. Newer materials are also available.
The joints commonly replaced are the knee and hip joints; however shoulder, ankle and finger joint replacements are also performed.
Who requires a joint replacement?
A damaged joint may be considered for a joint replacement surgery and the causes maybe as follows:
- Severe degenerating osteoarthritis: This is quite unavoidable especially in the weight bearing joints like the hip and the knee. With advancing age, there can be wear and tear associated with the joints. These can cause age related degenerative changes to a joint. Though, it usually affects the larger joints, smaller joint involvements may also be seen in some individuals
- Traumatic joint injury causing post traumatic arthritis: This occurs in cases where an episode of trauma would have created a significant damage to the joint. This trivial trauma would cause loss of tissue or injury to the articular surfaces, that can create a lot of stress and strain to the joints, reducing joint function
- Rheumatoid arthritis causing joint damage: This can cause an autoimmune mediated damage to the joints, and usually of the smaller joints and is often symmetrical. The activity of the disease process decides on the severity of symptoms.
What are the signs and symptoms of severe joint damage?
The signs and symptoms of a joint damage may include signs of inflammation:
- Severe debilitating pain: This is due to arthritis which has restricted the individual from active movements
- Swelling of the joints: It can be due to joint effusions during the inflammatory process
- Warm and tender joints: The release of cytokines which are mediators of inflammation will make the joint warmer, oedematous and tender. Moreover, the skin overlying the joints may appear red as well.
- Limitation of joint movements: A drastic limitation of the overall range of movement, essentially leaving a joint dysfunctional
- Joint malformations: It marks severity of the disease. These can present with a structural deformity, and necessitates a surgical correction.
Types of Disease:
There are different types of joint replacement surgeries available:
- Knee replacement: The knee joint is the most commonly affected joint requiring a replacement. The surgeries available are:
- Total knee replacement
- Partial knee replacement
- Knee cap replacement
- Hip replacement: Often we see cases where hip replacement becomes a necessity due to osteoarthritis or trauma. The surgery may be done by a lateral or posterior approach
- Shoulder replacement: More commonly associated with traumatic damage to the shoulder joint.
- Ankle replacement and Finger joint replacement surgeries
- Revision surgeries for joints: This is if you already had a replacement which was not done by experienced surgeons.
- Minimally invasive total joint replacements: These are performed in younger individuals, and smaller incisions are made.
How is an arthroplasty performed?
- We will require an initial X-ray to see for the activity of the disease and how much it has affected the joint, so as to decide on sustainability versus operability
- To continue, we might send you for some blood checks, imaging and pre-anaesthetic clearance. You might have to adjust some medications or see more specialists depending on whether you have any comorbidities
- Once you are fit for surgery, we will have to follow the pre anaesthetic plans on your medications and get you admitted in our hospitals. The surgeon who performs the procedure, will see you again and get an informed consent and the availability of the prosthesis for the surgery will be ensured.
- The next morning, you will be asked to be shifted on your scheduled timing to the operation theatre in empty stomach. Meanwhile, you will be given intravenous fluids to prevent dehydration and to maintain your glucose levels.
- Once in the theatre, you will be seen by the anaesthetist and the operating surgeon. Once anaesthesia is performed, the surgeon will start to carry out the procedure.
- The principles of surgery include:
- Biomechanical considerations and proper orientation of the joints and its components to reduce any risk of dislocations in future, and to attain functional improvement
- Use of biomaterials or prosthesis
- Fixation of the prosthesis: This may be performed by bone cement (polymethylmethacrylate) as space filler between the bone and the prosthesis and not as glue.Uncemented implants and screws are also used.
- Design of the surgery: This is very important to be considered. For e.g. total replacement (both joint surfaces) or hemi-arthroplasty (only one joint surface)
- Other considerations:
- hinging with different degrees of constraints in the lever action
- re-surfacing in case of cupped joints like hip and knee to ensure a smooth contact for articulation
- Sometimes mobile or fixed bearing joints may not require a ligamentous support
- Once the surgery is performed, we will recover you from anaesthesia and shift you to the step down ICU (Intensive Care Unit) near the operation theatre, which is to make sure that you are absolutely perfect to be managed on a room or ward based care.
- The anaesthetist and surgeon together decides on the shift out and finally, we will see you in the ward or room
- We will make sure that all parameters are safe for you to start mobilising and physiotherapists may help you with active movements.
- The nursing personnel will ensure your medications and the surgeon decides to discharge you based on your response to treatment.
- The faster you mobilise the joint, we will be happy to send you home to review in a few days of time.
- We will provide you any course of medications that need to be taken over the time span and plan on an active physiotherapy to help a speedy recovery.
Am I a Good Candidate for joint replacement surgery?
Do you suffer from disabling pain which keeps you away from your normal activity levels?
Do you feel the pain in your joints which are extremely intolerable?
Does your joint pain force you to use analgesics in the form of tablets and ointments on a regular basis for a long time frame?
Do you have episodes wherein the regular medications do not help much with managing your symptoms?
Yes!! You said it. You will know if you are the right candidate for the surgery.
It is often performed quite later in life when the other comorbidities may make a surgery challenging, and we take into consideration, the future requirement of a joint to be considered for replacement, during our consultation
Advanced age can sometimes be challenging because recovery might not be same as it would be in case of younger patients, because active mobilisation of the joint sooner after surgery is advised in order to prevent any complications and to improve the quality of the range of movements
What Are The Benefits Of Joint Replacement Surgery?
The surgery may help you in the following ways:
- It helps in improving your overall quality of life
- It increases the range of motion significantly, by correcting any deformities which commonly co-exist with joint disease.
- Although, there are problems related to an artificial joint, recent technological advancements have employed the latest biomaterials available, and a structural and functional replacement of the joint with the joint prosthesis has become possible to a greater extent.
- It improves the productive years of an individual’s career, and we have had some cases in their fifties, presenting to us for a joint replacement surgery, following which he was extremely grateful for the help as it has helped him cope with his work stress in a lot better way.
Why Choose MedcureIndia?
We at MedcureIndia provide the best quality assured joint replacement surgery with our amazing team of experts in orthopaedics. We also have a panel of rheumatologists who can handle the medical issues related to joint.
Moreover, we urge you to perform adequate research before you can finalise with any care providers because ensuring the best biomaterial usage is important as with the wrong choice, it can permanently cause loss of a functioning joint and might necessitate revision surgeries.
We here at MedcureIndia can help you feel confident about the surgery and the biomaterials, because we have a well organised flow pathway which can guide you to meet your requirements at reasonable and affordable rates without any compromise on the quality because our motto reflects ‘quality care’.