What is Arthroplasty?
Arthroplasty is the operation for construction of a new movable joint. It is not applicable to every joint: in practice, its use is almost confined to the shoulder, the elbow, the hip, the knee, certain joints in the hand, and the metatarso-phalangeal joints in the foot.
Methods of Arthroplasty
Three methods are in general use:
- Excision arthroplasty
- Half-joint replacement arthroplasty
- Total replacement arthroplasty
Each has its merits, Disadvantages and special applications.
Ø Excision Arthroplasty : In this method one or both of the auricular ends of the bones are simply excised, so that a gap is created between them. The gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn in between the bones. By virtue of its flexibility the interposed tissue allows a reasonable range of movement, but the joint often lacks stability. The method is applicable to all the joints for which arthroplasty is practicable except the knee and ankle. It is used most commonly at the metatarso-phalangeal joint of the great toe, in the treatment of hallux valgus and hallux rigidus. At the hip it may be used as a salvage operation after failed replacement arthroplasty.
Ø Half-joint Replacement Arthroplasty:In half-joint replacement arthroplasty one only of the articulating surfaces is removed and replaced by a prosthesis of similar shape. The prosthesis is usually made from metal (as in replacement of the femoral head), occasionally from silicone rubber (as in replacement of A carpal bone); and when appropriate it may be fixed into the recipient bone with acrylic filling compound or cement'. The opposing, normal articulating surface is left undisturbed. The technique has its main application at the hip, where prosthetic replacement of the head and neck of the femur is commonly practised for femoral neck fracture in the elderlyIt has rather a limited use elsewhere, an example being the replacement of the lunate bone by a silicone-rubber ('Silastic') prosthesis in Kienbock's disease.
Ø Total replacement arthroplasty: In this technique both of the opposed articulating surfaces are excised and replaced by prosthetic components. In the larger joints one of the components is normally of metal and the other of high-density polyethylene, and it is usual for both components to be held in place by acrylic 'cement'. In small joints such as the metacarpo-phalangeal joints a flexible one-piece prosthesis made from silicone rubber may be used.
- Synovial Membrane - a tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
- Ligament - a type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
- Tendon - a type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
- Bursa - a fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints.
- Meniscus - a curved part of cartilage in the knees and other joints that acts as a shock absorber.
Joints are formed where bones meet. Most joints are mobile, allowing the bones to move. Joints consist of the following:
- Cartilage - a type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
Reasons for the Procedure
Arthroplasty may be used when medical treatments no longer provide adequate relief from joint pain and/or disability. Some medical treatments for osteoarthritis that may be used prior to arthroplasty include, but are not limited to, the following:
- Anti-inflammatory medications
- Pain medications
- Limiting painful activities
- Assistive devices for walking (such as a cane)
- Physical therapy
- Cortisone injections into a knee joint
- Weight loss (for obese persons)
- Glucosamine and chondroitin sulfate
- Exercise and conditioning
People who have arthroplasty generally have substantial improvement in their joint pain, ability to perform activities, and quality of life, so these are important reasons for the procedure as well.
Most joint surgery involves the hip and knee, with surgery on the ankle, elbow, shoulder, and fingers being performed less often.
There may be other reasons for your physician to recommend arthroplasty. Please see hip replacement and knee replacement surgical procedures for more specific information.
Risks of the Procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to the following:
- Bleeding
- Infection
- Blood clots in the legs or lungs
- Loosening of prosthetic parts
- Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by the surgery.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Before the Procedure
- Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
- Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- If you are pregnant or suspect that you are pregnant, you should notify your physician.
- You will be asked to fast for eight hours before the procedure, generally after midnight.
- You may receive a sedative prior to the procedure to help you relax.
- You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
- The area around the surgical site may be shaved.
- Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
- Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
Arthroplasty requires a stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.
Arthroplasty may be performed while you are asleep under general anesthesia, or while you are awake under localized anesthesia. Your anesthesiologist will discuss this with you in advance.
Generally, arthroplasty follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- You will be positioned on the operating table in a manner that provides the best access to the joint being operated on.
- A urinary catheter may be inserted.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The physician will make an incision in the area of the joint.
- The physician will repair or remove the damaged parts of the joint.
- The incision will be closed with stitches or surgical staples.
- A sterile bandage/dressing will be applied.
After the Procedure
In the hospital:
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Arthroplasty usually requires an in-hospital stay of several days.
It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.
You will be discharged home or to a rehabilitation center. In either case, your physician will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.
At home:
Once you are home, it will be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Notify your physician to report any of the following:
- fever
- redness, swelling, bleeding, or other drainage from the incision site
- increased pain around the incision site
- numbness and/or tingling of the affected extremity
- You may resume your normal diet unless your physician advises you differently.
You should not drive until your physician tells you to. Other activity restrictions may apply.
Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:
- Proper handrails along all stairs
- Safety handrails in the shower or bath
- Shower bench or chair
- Raised toilet seat
- Stable chair with firm seat cushion and firm back with two arms, which will allow your knees to be positioned lower than your hips
- Long-handled sponge and shower hose
- Dressing stick
- Sock aid
- Long-handled shoe horn
- Reaching stick to grab objects
- Firm pillows to raise the hips above the knees when sitting
- Removing loose carpets and electrical cords that may cause you to trip
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm