KNEE REPLACEMENT

The largest joint in the body, the knee joint is formed where the lower part of the thighbone (femur) joins the upper part of the shinebone (tibia) and the kneecap (patella). Shock-absorbing cartilage covers the surfaces where these three bones touch. In a standard total knee replacement, the damaged area of the thighbone, shinebone and kneecap in knee joint are removed and replaced with prostheses held in place with bone cement.

In the knee, the cartilage is a smooth, slippery covering found at the mating surface of the femur (thigh), tibia (shine bone) and patella (knee cap). Cartilage can wear in nay or all of these areas. Osteoarthritis is a wearing of articular cartilage. There are many types of arthritis but osteoarthritis and rheumatoid arthritis are the most common. The patient may become bow legged or knock-kneed.

Your doctors will decide if you are a good candidate for this surgery. Their decision will be based on your medical history, exam and x-rays. Your doctors will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There is no harm in waiting to have surgery if conservative, non-operative methods can adequately control your discomfort. If the joint does not respond to conservative treatment such as medication, weight loss, activity restriction and use of walking aids such as a cane, joint replacement is considered appropriate. Delaying surgery until a person is older is reasonable as, like all man-made things, artificial joints do wear out.

You should speak to your rheumatologist or orthopedic surgeon about the possibility of joint replacement:

* You are unable to sleep at night because of the pain.
* You’ve tried a series of different medication that don’t help alleviate the pain, or the medication you have been on no longer works.
* You feel that the pain from arthritis is keeping you away from regular outings, such as visiting friends, going shopping, or taking a vacation.
* Your activity is restricted to the point where you have trouble getting out chair, going up stairs, getting off the toilet, or getting up from the floor.

Age is generally not a problem if you are in reasonably good health and have the desire to continue living a productive, active life.

You will stay in bed for 12-36 hours after surgery. You will generally be free to move around in the bed. You will be encouraged to move your toes, feet and legs to assist circulation and minimize the risk of clot formation. In the case of knee joint replacement, emphasis is placed on quadriceps (thigh muscle) strength and knee bending. We use a CPM (continuous passive motion) machine which bends and straightens the knee for you. Your physiotherapist will help you and will teach you how to get in and out of bed, and in and out of chair. You will experience moderate pain after surgery. The pain should gradually decrease and by third day after surgery, oral medication may be sufficient to control your pain. 

That depends on various factors, including the type of surgery, your health and your recovery. Six weeks following surgery, you will be feeling confident and most of the discomfort related to the surgery will have gone. Some people continue to experience discomfort for 6-12 weeks you will be able to return to most normal activities.

Q: what are the possible complications of joint replacement surgery?

While uncommon, complications include, but are not limited to infection, blood clots, implant breakage, malalignment and premature wear, any of which can require additional surgery. Infection and blood clots are two of the complications that concern surgeons the most.

Among the most important, known measures to lower the risk of infection after total joint replacement are:

* Antibiotics  before and after surgery.
* Short operating time.
* Use of strict sterile techniques and sophisticated sterilization techniques.
* Use if short term special nursing care after the surgery.

Most who opt for knee joint replacement are generally happy with the results. Ninety percent of those who have total knee replacement report fast pain relief, improved mobility and better quality of life, according to a panel of independent experts. Overall, total knee replacement surgery is a safe, very successful and relatively low-risk treatment for decreasing pain and increasing mobility in people who are not helped by non-surgical treatments. Follow-up studies showed that revision surgery was needed in 10 percent of knee replacement after 10 years and in 20 percent after 20 years.

HIP REPLACEMENT

Diseases of the hip
There are number of causes that can lead to diseases of the joint. The most common ones are:

* Osteoarthritis – Pathological wear of the joint cartilage.
* Secondary Osteoarthritis
* Congenital deformities
* Accidents – Resulting in injury to bones or joint parts

Symptoms

                                                                                         X-Ray of an Arthritic Hip>

* Pain on walking
* Progressive reduction in the distance you can walk without pain.
* Hardly any relief from pain even on resting or with pain killers.
* Clear reduction in general mobility of the hip joint.
* Difficulty in sitting on floor in cross legged positions, using Indian toilets & doing activities. of daily living like wearing shoes, stairs climbing etc.

Q:What is Total Hip Replacement ?

In principle, Total Hip Replacement or THR is the replacement of the diseased joint by an artificial implant. Many decades ago, the relatively simple structure of the hip joint a ball-and-socket joint had inspired physicians and medical technicians to create an artificial hip, and in the course of time follow-up examinations and improvements in operative methods and materials have led to great progress, and the optimization of total hip prosthesis. Thus, we can view THR as a routine operation.

<Healthy Hip  

 

Arthritic Hip >
Over time, normal wear and tear may cause cartilage to crack or wear away .When this happens, the bones making up the joint rub together.Stiffness and pain occur when the ball starts to grind in the socket.

  Femoral Neck>
Fracture a bad fall or blow to the hip can break (fracture) the thigh bone, typically around the femoral neck region. If the broken bone does not heal properly,the joint may slowly wear down.Blood flow through the femoral head may restricted or cut off,leading to necrosis of the joint.

Q:What's Involved in a Total Hip Replacement-THR?

The hip prosthesis is designed to simulate the human anatomy and is comprised of a hip socket and a hip shaft. The ball head which articulates in the socket is placed on the hip shaft. The ball head may be a ceramic or metal head running against a polyethyulene socket. The socket can also be entirely of ceramic. The materials used in the joints have been specially developed for medical purpose with good tissue tolerance and allow the function to be as painless and lasting as possible.

Q:Having your hip replaced?
<Cemented prosthesis-
in which the hip socket and the shaft are fixed with special bone cement.
<Uncemented prosthesis-
in which the hip socket and shaft are screwed or press-fit into the bone.Long term fixation is attained by the growth of newly formed bone on the prosthesis surface.
<Hybrid prosthesis-
in which the socket is cementfree and the prosthesis shaft is anchored in the bone with cement.

The hip is a simple ball-and-socket joint where the thigh bone joints with the pelvis. When these joint surfaces become roughened, causing severe pain and stiffness, the ball-and-socket have to be replaced.Total hip replacement is when a cup is inserted into the pelvis and fixed into place and a stem with a head attached is inserted into the shaft of the femur. The artificial ball-and-socket are then fitted together to function as a normal hip joint. For each prosthesis type, there is wide range of models, manufactured in different sizes. Selection of the prosthesis is dictated by the bone condition and the weight and physical activities of the patient. The surgeon will prepare for the operation on your hip with a graphic plan compiled on the basis of X-rays and will thus determine the model, size and position of the prosthesis parts.

Q:What are artificial hip joints made up of ?

<Ceramic on Ceramic hip implant <Metal on poly hip implant

Materials used for artificial joints are highly developed. They provide maximum tolerance and long-term  acceptance by the human body, which is called biocompatibility. For decades, Stryker has been a leader in material development and fundamental know-how in metallurgy, material, research and testing. In general, there are three different types of material employed for orthopedic purposes: Metals, Polymers, Ceramics.

Q:When is total hip replacement required?

1. Persistent pain in the joint requiring regular pain killers, affecting activities of daily living and compromising your quality of life.
2. When other treatments like medicines, physiotherapy etc have failed and no other alternative treatment is likely to help.
3. X-ray confirming advanced arthritic changes in the joint.