All for Life
Joint Replacement Surgery
Article by Dr Karunagaran
(Consultant Orthopedics, Spine Surgeon, Specialist in Joint Replacement & Sports Medicine)
What are the common conditions affecting joints?
- Osteo-arthrosis is an aging process causing wear and tear of the joint. Often seen in the elderly people , 60 years and above. The most commonly affected joint is the knee, particularly in women. Currently, there is an increasing trend in the younger population and in men.
- Inflammatory arthritis like Rheumatoid arthritis, Ankylosing spondylitis, Gouty arthritis, Psoriatic arthritis etc. are a group of systemic disorders affecting multiple joints. Any age group and any joint can be affected. This disease often runs in family.
- Avascular necrosis is a condition in which blood supply to a part of a bone is compromised and the bone dies causing collapse of the bone and destruction of the joint. The most common and major joint affected is the hip and the shoulder joint.
- Tumour in and around a joint
What are the investigations required to diagnose these conditions?
In most cases, a brief history, systematic clinical examination and X-ray will be sufficient for diagnosis. In a few patients, blood investigation, MRI or CT will be required for appropriate diagnosis and management of surgery.
What are the treatment options available for these conditions?
Early stage of the disease can be managed conservatively with non-operative management. Patients with advanced and/or severe arthritis may benefit from
- Non-operative management includes activity modification, analgesic/anti-inflammatory medication, joint supplement, physiotherapy, exercise and injections within the joint.
- Operative management consist of arthroscopic debridement of the joint, joint replacement and reconstruction.
However the treatment modality is individualised depending upon the age, requirement of the patient, joint involved, stage of the disease and symptoms.
What is joint replacement and reconstruction and who may benefit from those surgeries?
Joint replacement is predominantly a resurfacing procedure where damaged cartilage and bone is trimmed with specialized instruments and implants are put in its place to create a new joint.
Joint reconstruction is a procedure where a part of the bone is removed and a prosthesis in the shape of a bone is implanted. Joint replacement or reconstruction would benefit people who have:
- Severe joint pain that limits everyday activities such as walking, climbing up and down the stairs, and getting in and out of a car.
- Moderate or severe joint pain while resting during the day or night.
- Joint deformity, i,e, the Joint gets fixed in a particular position and from where further movement is not possible therefore limiting one’s ability to sit, stand or walk.
- Joint stiffness, i.e. inability to bend and straighten the joint completely or doing it with some difficulty & pain.
- Failure to obtain pain relief following nonoperative medical management which has been tried for a reasonable time period.
What should one expect after a joint replacement surgery?
More than 90% of individuals who undergo total joint replacement surgery experience a dramatic reduction of joint pain and a significant improvement in the ability to perform common activities of daily living.
Following knee or hip replacement surgery, one will be advised to avoid some types of activity for the rest of their life, including regular running and high impact sports .
Following shoulder replacement surgery, patients will not be allowed to lift heavy weight in the operated limb for rest of their life.
With normal use and activity, every joint replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and tear and cause the joint replacement to loosen and become painful.
With appropriate activity modification, joint replacement can last for more than 15 years in 95% of individuals.
Avoiding frequent climbing of stairs, squatting, sitting cross-legged or sitting on low lying surfaces can prolong the longevity of the replaced joint at the hip or the knee.
What are the possible complications after surgery?
The complication rate following joint replacement is low. Chronic illnesses may increase the potential for complication, but it can be well controlled with the help of experts.
Blood clots. Blood clots in the leg veins is the most common complication following knee and hip replacement surgery. We routinely follow keeping the patient’s operated leg elevated, lower leg exercises to increase circulation, stocking support, mechanical compression device and/or medication to thin blood and to prevent blood clotting in the leg.
Infection. With a good peri-operative antibiotic cover, adhering to strict sterile precautions during the surgery and following clean operating room practices, the infection rate is almost nil.
Limited motion. Although an average of near normal functional movement is generally anticipated after surgery with the help of good physiotherapy, scarring of the tissues around the joint can occasionally occur, and motion may get limited. This is particularly true in patients with limited motion before surgery.
Nerve/ vascular injury. Theoretically, injury to the nerves or blood vessels around the joint can occur during surgery but adhering to safe surgical technique and meticulous dissection can eliminate this risk.
Implant problems. With the latest implant designs and materials and good surgical techniques the wearing of the bearing surfaces or loosening of the components, has been optimised. Other complications such as joint dislocation, limb length inequality, heterotropic ossification (growth of bone in muscle) are quite rare.
What post-surgical advice is given to patients?
The success of your surgery will also depend on how well you follow the orthopaedic surgeon’s instructions at home during the first few weeks of your surgery.
Wound care. The stitches or staples will be removed two weeks after your surgery. The incision area should be kept dry until suture removal. The wound may be bandaged to prevent irritation from clothing or support stockings.
Diet. Some loss of appetite is common for a few weeks after surgery. A balanced diet is important to promote proper tissue healing and restoring muscle strength.
Activity. Exercise is a critical component of home care and will require supervised physiotherapy during the first few weeks of your surgery. One should be able to resume most normal daily activities within 4 to 6 weeks following surgery. Some mild pain at night is not uncommon few weeks after surgery. This may continue till the complete healing of the soft tissue occurs. Walking aid support would be required for 6 to 8 weeks in case of hip or knee replacement and an arm sling support for 4 to 6 weeks following shoulder replacement surgery is necessary. Car driving is recommended 6 to 8 weeks after surgery.