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Arthritis means inflammation of joint. Arthritis is the wearing of
any joint articular cartilage which is the covering of end of
bones which form joint. This leads to severe pain, swelling,
deformity, restricted movements, reduced normal activity levels
and difficulty in walking, getting up from a chair, climbing
stairs. Osteoarthritis usually starts around 55 years of age.
Apart from examination from your doctor X-ray and blood tests
helps in determining the type of arthritis and management is done
according to type and stage of arthritis.
 Arthritis is the condition where cartilage at the joint surface of
bone wears away. It is this cartilage which normally makes the
bone ends slippery and helps the joint to move smoothly without
friction and also functions as a shock absorber. Since this
cartilage can not be regenerated joints remains painful and at
different stages of arthritis causes different problems like pain,
swelling, inability to walk, deformity and so on. Arthritis in
people of India is similar to other part of the world, except that
incidence of degenerative arthritis (osteo arthritis) is more as
compare to rheumatoid inflammatory arthritis. What is more of
concern in our situation is that arthritis specially of hip joint
in younger patients which is more common. These are due to
avascular necrosis of femoral head, ankylosing spondylitis,
rheumatoid arthritis and post traumatic arthritis. These
situations are more disabling then cancer and cardiac diseases.
Understanding Arthritis Section End
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Arthritic or damaged bones surfaces are removed and resurfaced
with an artificial joint know as prosthesis. Knee and hip
replacements are most common, but joint replacement can be
performed on other joint such as the shoulder, elbow, etc.
Artificial Hip
Artificial Knee
What is Joint Replacement Section End
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If the pain becomes so severe that a person avoids using the
joint, the muscles around the joint weaken making movements even
more difficult and painful. Total joint replacement to be
considered if other options like medication, physiotherapy etc
will not relieve pain and disability. The goal is to relieve the
pain in the joint caused by the damage done to the cartilage.
Total joint replacement which is also called as Arthroplasty is
one of the most successful and innovative surgery of 20th Century.
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Under the effect of spinal or epidural or general anesthesia the
damaged ends of the bones and cartilage are replaced with an
artificial joint made of metal and plastic surfaces that are
shaped to restore joint movement and function.
The materials used in a total joint replacement are designed to
enable the joint to move just like your normal joint and hence
resemble the normal joint closely. The prosthesis is generally
composed of two parts: a metal piece that fits closely into a
matching sturdy plastic piece. Alloys of cobalt, chrome and
titanium are main metal used. The plastic used is
ultra-high-molecular-weight-polyethylene. Using these advanced
bio-materials and well executed surgical technique provides
consistently excellent results of long term durability.
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This surgery is the most successful innovation of 19th Century.
This remains gold standard procedure. In this operation socket and
ball (head) of the femur bone is removed and depending up on the
bone quality new socket and stem-head made of different materials
is put in. This articular surface material could be combination of
plastic (ultra high molecular weight polyethylene) on Metal
(cobalt chrome molibdinum), plastic on ceramic ball and ceramic on
ceramic ball. Again depending up on the age and quality of bone
these joints have been put in with bone cement or without bone
cement. Results of this conventional hip replacement surgery are
excellent only difference from hip resurfacing is that original
ball is not conserved, patients are not allowed to squat and
recovery period is longer.
Cemented Hip Implant
Implant X-ray Before Hip Replacement
X-ray After Hip Repl.
Hip Replacement Surgery Section End
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When whole knee joint (all compartments) is affected then only
solution to relieve pain and get back to normal routine is total
knee replacement surgery. In this procedure thigh bone side of
joint (femur) is replaced with metal prosthesis, leg side (tibia)
is replaced with metal and plastic and knee cap (patella) is
replaced with plastic prosthesis. Results and durability of this
surgery is excellent.
There is a breakthrough technology with RPF – Rotating Platform
Knee where patient can get complete knee bending and can squat,
kneel and sit cross legged after surgery. This has been done
regularly in hiranandani hospital.
Total Knee Implant X-ray Before
Total Knee Replacement X-ray
After Total Knee Replacement
Total Knee Replacement Section End
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When one
compartment of knee joint is arthritic then replacing this part
with metal and plastic joint through a small incision (skin cut)
provides excellent quick recovery. Benefit of this operation is
that patient can bend the knee fully and can squat.
Hospitalization for this surgery is just three days.
Unicondylar Knee Replacement Section End
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A very special technique patient control analgesia (PCA) is used
where a catheter is kept in epidural space and through PCA pump
pain relieving medicines are delivered in controlled fashion. If
patient need more dose a bolus can be injected by patient by
themselves through hand press button given to them in
post-operative period for 2 to 5 days. There is no post-operative
pain, hence this is painless joint replacement surgery.
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In case of knee, hip, shoulder and elbow replacements patients
have to be in the hospital for about 5-7 days. After
unicompartmental knee replacement patient goes back home in 2 days
time.
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In general physiotherapy program is not strenuous and not painful.
Few simple actions of exercises are taught to the patients by
physiotherapist. They have been also taught proper gait training
with the use of walker and crutches or canes and have been
explained when to take off use of these walking aids.
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Expectation
after Joint Replacement Surgery
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Relief of pain.
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Increased movements and mobility – walking ability.
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Correction of pre-operative deformity.
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Stability of joint.
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Improved and better quality of life.
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Advantages of
joint replacement surgery
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Complete relieve from pain.
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Correction of deformities.
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Increase range of movements of the joint.
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Improvement in walking ability.
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Better quality of life.
All these joint replacement techniques have excellent results.
Although durability in hip varies. Hip resurfacing has better edge
over conventional hip replacement because of above mentioned
reasons. What is most important for excellent results and
longevity – experienced well trained surgeon, the most modern
fully equipped state of the art joint replacement theatre and the
overall involvement of whole team. This is all we have in Dr. L.
H. Hiranandani Hospital.
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What are
the complications?
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Infection: This is avoided by performing surgery in special
joint replacement operation theatre having laminar air flow, use
of body exhaust gown and appropriate antibiotics.
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Loosening and Dislocation: This is avoided by proper
instruction to patients and proper surgical technique.
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Risk of clot formation: This clot formation in leg blood
vessels can be avoided by proper precautions in high risk
patients.
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