FAQ – Joint Replacement

It is a surgical process that brings about the complete removal and replacement of the diseased or damaged joint with a prosthetic part. Commonly known as prosthesis, these implants are manufactured so that they serve to move about in a pain-free manner.

The average lifespan of the synthetic joints is, about twenty years or so (depends on the activity of the patient)

The main reason for knee replacement is joint pain. The expected benefits include limb alignment, functional improvement and pain reduction. The reduction in knee function is accompanied by pain in the knees and thus requires Replacement Surgery to improve functionality.

The latest implants delivering good results post operation are used by us. We have experts in knee replacement who provide accurate solutions to any problems concerning knee surgery. Today’s system of knee care is designed to provide excellent solutions for patients as well as surgeons.

The materials we use for implants are:
• Titanium and alloys of Cobalt-Chrome
• Extra-high Molecular Mass Polythene Plastics

A medical evaluation is recommended by us primarily in order to ensure the patients’ health and fitness before surgery. The following tests are necessary:
• Samples of blood
• EKG
• ECG
• Samples of urine

The activities that the patient needs to perform after hospital discharge include:
• Continuing the use of towel roll and CPM or also other exercises which are suggested by surgeon.
• Continuing knee exercises that are taught by the therapist.
• Having a discussion with surgeon about the timeline to return to other daily activities

Some benefits that follow a successful Replacement Surgery include:
• Absence or reduction in joint pain
• Increased mobility as far as daily activities are concerned
• Angular deformity of leg is corrected
• Leg strength increases
• Life quality improves

Following complications may arise after a Knee Replacement:
• Excess swelling and bleeding
• Blood clot formation
• Pulmonary embolism
• Phlebitis
• Damage of Neurovascular tissues
• Problems with skin healing
• Peri-articular and intra-articular disorders
• Stiffness in joints
• Early loss of implants
• And allergy to the metallic parts of the artificial parts

While performing Knee revision surgery, problems related to the following areas are taken into consideration,

• Femur or the bone of the thigh
• Tibia or the bone in the shin
• Patella (kneecap)

The implants that fail are extracted using a variety of surgical instruments and special tools which are effective in bringing about lost stability of ligament.

In Revision knee Surgery, due to the possibility of complications being high, the surgeons ought to have a good plan of action ready before the operation begins. It is more extensive than the primary surgery which is done previously owing to its varying nature between a minor liner exchange to that of changing one or more of the implanted parts.

The care to be taken post operation for Revised Knee Surgery is similar to that needed after actual replacement surgery. Patients must follow all instructions related to:

• Health care at home
• Therapy related to occupational and physical conditions
• Other rehabilitation forms

Describe the various Complications and Risks present in Revision Surgery of the knee

The risk in Revision Knee Surgery is similar to that in the other major surgeries. After observing if the advantages of the surgery are more than the disadvantages, it is the surgeon’s responsibility to take the primary decision after consulting the patient.

The following medical (general) and local (specific) complications can arise during the surgery:

Medical–

Allergic reactions caused by medicines

• Loss of blood with transfusion requirement. ( must involve little risk of transmission of disease)
• Heart attacks, kidney failure, stroke and other related complications.
• Nerve blockage related complications

Local–

• Knee stiffness that requires knee bending under anesthesia in the operation theatre.
• Deep or superficial infections
• Clots of blood which are capable of travelling to the lungs ( Pulmonary Embolism)
• Nerve or blood vessel damage, leading to loss in sensation in any part of the leg
• Wearing down of the plastic liner that the implant is made off.
• Dislocation including the knee joint ends or loss of contact of the plastic inserts.
• The Patella being dislocated
• Ligament injuries around the knee which might need corrective surgery.
• The possibility of fractures or broken bones during or post- surgery due to a fall.

This is a surgical procedure that is recognized for fulfilling the demands of Arthritis of the hip with respect to treatment. The process involved in Total Replacement of hip is removal of the hip socket as well as the ball that are damaged parts of the joint of the hip. These are replaced surgically using artificial implants by the name prostheses which assist the hip and make it strong, flexible and stable. In this case the doctor may or may not use cement to fix the joint replacement to the bones.

Doctors recommend Joint Replacement technique in cases of hip pain being severe or if there is functional loss and no help can be obtained via oral medication to relieve the pain. Before the operation, the doctor uses X-rays while examining the cartilages and bones of the hip area to see possible damage and ensures that the pain does not result due to any different reasons.

They attach to the existing bones with cement which performs the function of glue and helps in adhering the artificial joint to the bones.

They are fixed making use of porous coating that is designed to let the bone stick to the artificial join. Over tie, the new bone grows to fill up the openings in the porous coating, hence, bringing about joint and bone attachment.

Generally, joint replacement operations are carried out using general anesthesia. However, on examining the complete health of the patient and owing to their personal preferences, the use of regional anesthesia may also be considered.

For approximately a day after the surgery, the patients who go through Hip Replacement are given intravenous drugs in order to control clotting of blood and soothe pain. In the initial stages they are directed to take medicines as per the doctor’s prescription which include pain killers that will decrease as time goes. However, it may be necessary to use anticoagulant drugs for a few weeks post-surgery.

• The rehabilitation process starts the next day post-surgery
• A team accompanied by a physiotherapist supervises exercises
• They allow the patient to sit by the bedside or chair the next day post-surgery.
• On the second day after surgery, they start gait training sessions.
• In the initial stages, they allow the patient to walk with the help of a walker enabling him to bear partial weight. Gradually, replaced by crutch/cane and after 6 weeks they allow the patient to bear full weight.

People undergoing hip replacement have a lesser feeling of pain than before surgery stage. They are successful in resuming their daily activities. As days go by, they would be capable of handling daily activities regularly as the movement of joints improves. Most of the surgeries carried out in presence of experienced guidance can last for up to 20 years and longer even without the loosening of the joint.

The average lifespan of implant depends upon factors like:

• Patient’s lifestyle (depending upon the stress on the joint)
• The patient’s weight
• The degree of mending of the bones and joints

Owing to the surgeon’s skills and health issues of the patient, risk during surgery is categorized into following two categories: Risks during surgery or post-operative risks –

• Blood clots
• Surgical wound infections. Can be treated using antibiotics or if present deep in the joint, surgery may be required to remove the artificial joint.
• The injury in nerves leading in difficulty to move muscles or cause numbness.
• In diabetic and rheumatoid arthritis patients, there may be problems with regard to healing of wounds
• Bone deposits present within soft tissues surrounding the hip joint which may decrease the hip’s motion range.
• Hip dislocation after surgery
• Leg length differences which are small but cause pain and function related issues.
• Risks through general anesthesia for people with recent heart attacks, lung , kidney and liver disorders.

Risks in the long run

• Artificial joint parts loosen
• Infection surrounding the implant
• Bone fracture
• Breakage of implant

There are three main mottos –

• To relieve pain in the affected region
• To restore mobility
• To avoid damaging the joint by removing loose prostheses.

Generally, revision surgery is considered for relieving pain when all other measures like taking medicines fail. Other factors which decide a revision surgery are as follows:

• Loosened prosthesis
• Wearing of surface of the joint
• Bone tissue loss
• If infection is present
• If the prosthesis is dislocated

During such an operation, both femoral as well as acetabular (socket) implants are addressed. A suitable method is selected to remove the implants that already exist in case of deficiencies with respect to loosening, shielding or fracture of bone due to normal stress. However, the implants that are still functioning properly are tried to retain by the surgeon.

In order to address the issue, a special removal technique may be performed by us to surgically split the femur bone so as to remove cement as well as implants. The newly chosen revision implant must be fixed firmly to the bones by bone growing into the pores in the upper layer of the implant or by cementing technique.

Some factors affecting time span of operation and several stages that occur in revision of hip are the conditions of bone tissue in femur. Following are the stages in which the faults in bones are categorised into:

• Minimum bone defect
• Minimum damage to the bone shaft with most damage to the metaphysis
• All damage to metaphysis
• Extensive loss of bone in the shaft of femur and also at metaphysis

The following are indications to perform revision surgery:

• Increasing pain
• Difficulty is placing complete weight on the hip.
• The mobility of hip joint is lost

Aftercare requirements for revision of hip are similar to those of primary replacement operation. The only difference is that patients with weak bones are advised to use canes and walkers for a prolonged time after revision surgery.

It helps in locating the pain and points out the affected part of the prosthesis. Generally, diagnostic imaging shows:

• Loss of bone
• Prosthesis being loosened
• Joint tissues becoming loose

Also, X-rays help to diagnose fractures in hip and dislocated prostheses

Following are the hip conditions that are considered as indications for performing hip revision:

• Hip infection
• Serious vascular disease
• Poor state of the skin covers the hip
• Quadricep muscles get paralyzed.

The risks are similar to those occurring in major surgeries. Some specific risks involved are:

• Possibility of cracking in the femur bone neck as a result of drilling a guide hole from the neck to hold pin in the metal cap.
• Bone death can occur due to the unfavorable reaction of femur which leads to dislocation or reshaping to fit into metal cap.

This surgery takes an operating time of around 45 minutes. In this case, the surgeon extracts only that region of the damaged bone from the femur head and the acetabulum through a 15-20cm incision running over the outer hip joint edge. Maximum part of the operation is performed in presence epidural spinal intravenous injection that is safer and also quicker during injury.

It is an alternative of hip replacement and is preferred for young people suffering from hip arthritis. It involves replacement of only the damaged surface of the bone using metal parts. The way the implant is designed permits a greater range with regards to movement and lowers dislocation risk.

Following are the reasons as to why this is beneficial:

• Here the patients do not expect substantial lengthening of leg as in the case of hip replacement.
• The process of rehabilitation is easier and quicker.
• The hip joints have normal feeling
• Variety of sizes of implants are available
• This bone conserving technique is a process in which the femoral head can be reshaped as well as resurfaced with the help of metal cap.
• This metal on top of metal (MoM) type of joint helps eliminate wearing of prosthetic joint.

This surgery is preferred for those who require hip replacement early in life. By performing this operation, the patient experiences relief from various hip diseases.

Following points are taken into account for this particular surgery:

The Candidates’ Activity level– activity level is considered as the prosthetics in MoM resurfacing is hard to wear off by higher activity levels.

The Candidates’ age– Generally individuals with 65 years of age obtain benefits from this technique. It is not advised for older people to take it up due to risks related to femoral fractures.

Candidates’ Health Status– It is unadvisable for individuals with deformed hips and those who have osteoporosis. It is also not advisable for patients who have undergone surgery of the hip joint which has led to deformity.

Depending upon the condition of the patients, the physical exercises will begin either on the day of the surgery or one day later. The physical therapy aims on imparting:

• How to move comfortably in bed
• How to get into or out of bed
• How to use walker or crutch when walking up and down the stairs.
• Beginning easy exercises to make leg movement
• Protecting hips during the above activities
Most patients can sit or stand a day following the operation and can also walk using crutches or taking assistance. It takes not more than 3 months for the individual to walk freely without any support and this movement improves over a few years.

It has an advantage of preserving the femoral bone. It also serves as an easy way to revise the THA that if required in place of femur is maintained in the initial process and avaialable for supporting the THA stem. Other following benefits are:

• Maintains composition of femur and aides to transfer stress and weight.
• Thigh pain that is felt by people undergoing THA is absent
• Smaller device is used and thus it enables quick recovery.
• There is reduction due to the bone removed allowing preservation of femur.
• Complications decrease as disruption of joints is removed, thus quickening recovery.
• Hip is more stable due to use of smaller ball. Also, rate of dislocation is less since the ball remains in the hip and is not extracted. • Revision is easy since this keeps the thigh bone undamaged. If there is failure, the patients can convert to undergo total replacement of the hip.