JOINT REPLACEMENT SURGERY – Modern day Panacea for painful joints & improved quality of life

Joint Replacement Surgery

When osteoarthritis is the case, joint replacement surgery is often recommended by a doctor. Osteoarthritis can be a mild problem, one you might be able to live with and control with medication. But for some people, the joint pain and stiffness of osteoarthritis can become so severe that the pain never goes away and they can no longer lead an active life. Make no mistake, this surgery isn’t for the faint-hearted: It requires a lot of hard work during the recovery period. Over time, however, people who receive new joints not only report being pain free, but also feel more independent and enjoy a better quality of life.

Osteoarthritis is often referred to as “wear-and-tear” arthritis, and it results in the wearing away of the normal smooth cartilage until bare bone is exposed. Other types of arthritis include rheumatoid arthritis, gouty arthritis, and lupus arthritis. Hip joint replacement is also performed for other reasons e.g. avascular necrosis of hip (AVN) and fracture of the hip. AVN of hip is common in young age group in India who require Total hip replacement (THR). 

THR surgery for osteoarthritis removes the damaged, painful hip joint and replaces it with an artificial joint (implant). You might consider hip replacement if your osteoarthritis pain is constant, keeps you from your normal activities, and is no longer helped by drugs.  The damaged hip joint which is a ball and socket joint is replaced with metal components along with plastic or ceramic sockets. The joint could be cemented or uncemented. This depends upon the age of the patient and skills of the surgeon. Hip replacement implants have been modified in order to provide the best possible functioning with long-lasting results. This effort to perfect hip replacement implants is constantly taking place. Some newer implants have promise, others may not turn out to be better. We try to avoid hip replacements in patients below the age of fifty years. If younger patients need hip joint replacement surgery then they should be performed by surgeons who have a long experience in uncemented joint replacement surgery. 

Hip replacement is generally reserved for patients who have tried all of the other treatments and are still left with significant pain during normal activities. Patients who have occasional pain, are able to participate in athletic activities, or have not tried non-operative treatments are probably not ready for a hip replacement. The joint replacement is performed using precise instruments to create surfaces that can accommodate the implant perfectly. An artificial hip replacement implant is then placed in to function as a new hip joint. Rehabilitation after hip replacement begins immediately. Patients will work with a physical therapist as soon as the surgical procedure has been performed. The emphasis in the early stages of rehab is to maintain motion of the hip replacement and to ensure that the patient can walk safely. 

 

Knee Joint

The most common knee surgery is total knee replacement, a procedure in which the damaged knee joint is removed and replaced with prosthesis of metal, and plastic components. Knee replacement is an option when irreparable joint damage interferes with function and causes constant pain that is not alleviated by more conservative therapies. Treatment should begin with the most basic options and progress to the more involved, which may include surgery. Not all treatments are appropriate for every patient.

Knee replacement is generally reserved for patients who have tried all of the other treatments and are still left with significant pain during normal activities. Patients who have occasional pain, are able to participate in athletic activities, or have not tried non-operative treatments are probably not ready for a knee replacement. 

Non-operative treatment options include: Weight Loss, Activity modifications, anti-inflammatory medications, Joint supplements, Cortisone injections, Synvisc injection etc. 

When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create surfaces that can accommodate the implant perfectly. A metal and plastic knee replacement implant is then placed in to function as a new knee joint. Depending on the condition of the cartilage underneath the kneecap, the kneecap surface may also be replaced.

The emphasis in the early stages of rehab is to maintain motion of the knee replacement and to ensure that the patient can walk safely. The body reacts to surgery by making scar tissue, and patients may never recover normal motion if they do not focus on bending and straightening their knee replacement.

How do you know if the hip or knee replacement surgery is right for me?

To decide if knee replacement surgery is right for you, discuss the pros and cons with your orthopedic surgeon. You’ll need to think about:

•  your age
•  your weight
•  your overall health
•  your ability to do the physical therapy and exercises necessary after  the surgery
•  how much help you will have at home during your recovery 

What should you expect after Hip or knee replacement surgery?

After Hip or knee replacement surgery, you should expect to stay in the hospital for three to seven days. As soon as possible after the surgery — usually the same day — hospital staffers will help you start to bend your Hip or  knee, walk with a walker or crutches, and do exercises to strengthen the Hip or knee. When you get home, you will need to work with a physical therapist a few times a week for several weeks to help you regain full function in your leg. You will also need to continue knee exercises at home for at least two months.  

What possible problems should you expect after Hip or knee replacement surgery?

Most hip or knee replacement operations go smoothly, but problems can come up. Blood clots may form around your thigh or knee. To prevent this, you will be given blood-thinning drugs. Infection is another threat. You will be given antibiotics to help fight infection. In addition, you’ll be shown how to take care of the incision to help avoid infection. Dislocating your new hip or knee (knocking it out of position) is a big concern for the first few weeks. During this time you need to use your crutches, walker, or cane and be careful to avoid tripping or falling.

When do you decide for yourself that you need to see an Orthopaedic surgeon for a Joint replacement?

• Does your affected joint hurt one or more days per week?
• Does the pain interfere with your sleep?
• Is it painful for you when you perform everyday activities?
• Are pain medications no longer working?
• Is joint pain limiting your participation in activities you love?

 

Shoulder and elbow Joint

Elbow and shoulder replacements are less common than hip and knee replacements because there is normally less wear and tear on those joints, and patients often tolerate elbow and shoulder arthritis better than hip and knee conditions. For those who don’t, surgery can offer relief.

The primary reason for doing a total elbow or shoulder replacement is pain – such as that experienced by patients with serious degenerative or rheumatoid arthritis. Another subset of candidates for the procedures includes patients with un-reconstructable joint fractures.

Total shoulder and total elbow replacement are more common in older patients, because the prostheses tend to have a finite life expectancy – usually around 15 years – and because the condition of younger patients suffering from joint problems can often be improved without surgery. 

Older patients with severe elbow fractures can, at times, do well without surgery, but that’s not the case with displaced shoulder fractures. In significantly displaced shoulder fractures in older patients, acute replacement often provides a better, more functional outcome. If the fragments of bone attached to the rotator cuff are significantly displaced and nothing is done, the muscle will ultimately atrophy and make delayed surgery significantly less successful.

Patients who undergo elbow and shoulder replacement can expect to return to normal, pain-free daily activity, but not to resume sports like tennis, golf or bowling, which can wear out the shoulder.

 

Ankle Joint

Ankle joint replacement is a newer operation than the well-established replacement operations for hip and knee joints. Whereas the hip is a ball in socket joint and the knee is fundamentally a hinge joint, the ability of the ankle and forefoot to flex, extend, invert and evert makes it a complex joint. These actions are necessary to be able to walk over uneven ground. The results of ankle replacement today are good and the outcome of ankle replacement from a functional standpoint is better than that of arthrodesis. What does this mean? In an ankle arthrodesis, the joint is fused or glued together, limiting the up and down movement. An ankle replacement, however, allows a more normal “function”. By function, we are talking about the day to day activities that a person is able to do. Movement of the ankle also prevents the stress that accumulates in joints next to the ankle following a fusion of the ankle. The main advantage of total ankle replacement is the return of some freedom of movement in the ankle. This movement is important for simple activities such as bending, walking, exercise and climbing. Full movement of the ankle joint is never regained even with total ankle replacement. 

The ideal patient, is someone who is over the age of 50, is not too heavy, and is not extremely active. Some activity is always ideal, and it does not mean however that patients with an ankle replacement have to be sedentary. Quite on the contrary, patients can walk, hike, climb, ride a bicycle, and in some circumstances even ski after ankle replacement. The activities then which are not ideal are those which involve repetitive pounding of the ankle for example running and a job which includes heavy labor. Patients who have poor circulation in the leg, those who have diabetes, or nerve conditions of the leg are not good candidates for an ankle joint replacement. The bone quality of the ankle must be fairly healthy, and we do not normally implant a joint if the ankle bone is dead (a condition called avascular necrosis or AVN of the talus bone). When we perform an ankle replacement, one of the goals is of course to improve the movement of the joint (called the range of motion). Interestingly, the more movement of the ankle that there is before the joint replacement surgery, the more will exist later. If a patient has no motion or very poor motion of the ankle before surgery, we can improve this, but not nearly as much.

Wish all my patients a good quality of life following the joint replacement surgery. 

Prof (Dr) Ujjwal K Debnath