Arthroplasty substitutes (from the Greek arthron , joints, branches, articulations, plassein , to form, shape, forge, pretend, of), or joint replacement surgery , is an orthopedic surgical procedure in which the surface of the arthritic or dysfunctional joint is replaced by an orthopedic prosthesis. Joint replacement is treated as a treatment when severe joint pain or dysfunction is not mitigated by less invasive therapy. It is a form of arthroplasty, and is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.
Joint replacement surgery becomes more common with knees and hips replaced most often. Approximately 773,000 Americans experienced hip or knee replacement in 2009.
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Stephen S. Hudack, a surgeon living in New York City, started animal testing with artificial joints in 1939. In 1948, he was at New York's Orthopedic Hospital (part of Columbia Presbyterian Medical Center) and with funding from the Office Naval Research, is replacing hip joints in humans.
Two previously popular forms of arthroplasty are: (1) interopted artoplasty , with the interposition of some other tissues such as skin, muscle or tendon to maintain a separate inflammatory surface and (2) excision arthroplasty] where the surface and joints are removed from scar tissue to fill the gap. Other forms of arthroplasty include resection (al) arthroplasty , re-coating arthroplasty , arthroplasty , cup arthroplasty , and silicone substitute arthroplasty . Osteotomy to restore or modify joint congruity is also a form of arthroplasty.
In the last few decades, the most successful and common form of arthroplasty is surgical replacement of joint or joint surfaces with prosthesis. For example, hip joints affected by osteoarthritis may be completely replaced (total hip arthroplasty) with prosthetic hips. This procedure involves replacing both the acetabulum (hip socket) and the head and neck of the femur. The purpose of performing this surgery is to relieve pain, to restore motion and to improve walking ability, leading to increased muscle strength.
Maps Joint replacement
Joints
Shoulders
For shoulder replacement, there are several main approaches to accessing the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires supraspinatus to be cut. The second is the transdeltoid approach, which provides a direct approach to the glenoid. However, during this approach deltoid is at risk for potential damage. Both techniques are used, depending on the surgeon's preference.
Hip
Hip replacement can be done as a total replacement or a hemi substitute (half). Total hip replacement consists of replacing the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Pelvic replacement is currently the most common orthopedic surgery, although short-term and long-term patient satisfaction varies greatly.
Knee
Knee replacement involves exposure of the front of the knee, with the separation of part of the quadriceps muscle (vastus medialis) of the patella. Patella is transferred to one side of the joint, allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of this bone are then cut accurately into shape using a cutting guide oriented to the long axis of the bone. The cartilage and anterior cruciatum ligament are removed; the posterior cruciate ligament may also be removed but the tibial and fibular collateral ligaments are maintained. The metal component is then affected to the bone or fixed using a polymethylmethacrylate cement (PMMA). Alternate techniques exist that implant implants without cement. This cement-less technique may involve osseointegration, including porous metal prostheses.
This surgery usually involves great postoperative pain, and includes strong physical rehabilitation. The recovery period can be 6 weeks or longer and may involve the use of mobility aids (for example, walking frames, sticks, crutches) to allow patients to return to preoperative mobility.
Ankle
Ankle replacement is a treatment option for patients requiring arthroplasty, replacing the use of conventional arthrodesis, bone fusion. Movement range recovery is a key feature that supports ankle replacement with respect to arthrodesis. However, clinical evidence of excellence from the preceding has only been shown for certain isolated implant designs.
Finger
Finger joint replacement is a relatively quick procedure of about 30 minutes, but it takes several months of subsequent therapy.
Procedural timeline
Before major surgery is done, complete preparation of pre-anesthesia is required. In elderly patients, this usually includes ECG, urine test, haematology and blood tests. Blood bouts are also routine, as a high percentage of patients receive blood transfusions. Pre-operative planning requires an accurate Xray of affected joints, selection of implant designs and size matching to xray images (a process known as templating).
Hospital treatment for several days followed by several weeks of protected function, healing and rehabilitation. This may be followed by several months of slow increase in strength and endurance.
Initial mobilization of the patient is considered to be the key to reducing the possibility of complications such as venous thromboembolism and pneumonia. The modern practice is to mobilize patients as soon as possible and walk with walking help when tolerated. Depending on the involved joints and patient status prior to surgery, hospitalization times vary from 1 day to 2 weeks, with an average of 4-7 days in most areas.
Physiotherapy is widely used to help patients recover function after joint replacement surgery. A gradual training program is required initially, because the patient's muscle takes time to recover after surgery; exercises for various joint motions and ambulation should not be heavy. Then when the muscles have healed, the goal of the exercise is extended to include strengthening and restoration of function.
Materials
Some of the commonly used ceramic materials in joint replacement are alumina (Al 2 O 3 ), zirconia (ZrO 2 ), silica (SiO 2 ), hydroxyapatite (Ca 10 (PO 4 ) 6 (OH) 2 ) , titanium nitride (TiN), silicon nitride (Si 3 N 4 ). The combination of titanium and titanium carbide is a very hard ceramic material often used in arthroplasties components because of its impressive level of strength and toughness, as well as its compatibility with medical imaging.
Titanium carbide has been proven to allow for use in combination with sintered polycrystalline diamond surface (PCD), a promising superhard ceramic to provide better, stronger, and longer lasting material for artificial joints. PCD is formed from polycrystalline diamond compact (PDC) through a process involving high pressure and temperature. When compared to other ceramic materials such as cubic boron nitride, silicon nitride, and aluminum oxide, PCD exhibits many better characteristics, including high hardness and relatively low coefficient of friction. For artificial joint applications, it is likely to be combined with certain metals and metal alloys such as cobalt, chromium, titanium, vanadium, stainless steel, aluminum, nickel, hafnium, silicon, cobalt-chromium, tungsten, zirconium, This means that people with allergies or nickel sensitivity to other metals are at risk of complications due to chemicals inside the device.
In knee replacement there are two ceramic parts and they can be made of the same or different ceramics. If they are made of the same ceramics, they have different weight ratios. These ceramic parts are configured so that they must break from the implant, the particles are benign and not sharp. They are also made so that if the breaks break from one of the two ceramic components, they will be visible via x-rays during inspection or implant examination. With implants such as hip implants, implanted balls can be made of ceramics, and among ceramic layers and where attached to the rest of the implant, there is usually a membrane to help hold the ceramic. Membranes can help prevent cracks, but if cracks should occur at two points that separate parts, the membrane can hold the shard in place so as not to leave the implant and cause further injury. Because these cracks and separations can occur, the membrane material is a bio-compatible polymer that has high fracture toughness and high shear toughness.
Risks and complications
Medical risk
Stress surgery can lead to various medical problems incidents and severity.
- Heart Attack
- Stroke
- Venous thromboembolism
- Pneumonia
- Increased confusion
- Urinary Tract Infection (ISK)
Intraoperative risk
- Mal-positioning component
- Shortening;
- Instability/dislocation;
- Loss of range of motion;
- Close bone fractures;
- Nerve damage;
- Damage to blood vessels.
Immediate risk
- Infection, either Superficial or Deep
- Dislocation
Medium-term risk
- Dislocation
- Continuous pain;
- Loss of range of motion;
- Weakness;
- Infection is slow.
Long-term risk
- Loosen components: bonds between bones and components or cement can break down or fatigue. As a result, the component moves inside the bone, causing pain. Fragments of disposable debris can cause an inflammatory reaction with bone resorption that can cause loosening. This phenomenon is known as osteolysis.
- Polyethylene Synovitis - Wear from load-bearing surfaces: polyethylene is thought to be used in weight-bearing joints such as hips at a rate of 0.3 mm per year. This may be the problem itself because the bearing surfaces are often less than 10 mm and may change shape as they become thinner. Wear and tear can also cause problems, because inflammation can be caused by an increase in the number of polyethylene wear particles in the synovial fluid.
There is a lot of controversy. Most of the research efforts of the orthopedic community are directed to studying and increasing joint replacement. The main controversy is
- the best or most suitable bearing surfaces - metal/polyethylene, metals, ceramics;
- fixation of cemented components vs vs uncemented;
- Minimally invasive surgery.
Replacement prosthesis
Prosthesis may need to be replaced due to complications such as infection or prosthetic fracture. The replacement can be done in one single surgical session. Alternatively, preliminary surgery may be performed to remove previous prosthetic material, and new prostheses are then included in separate operations at a later time. In such cases, especially when complicated by infection, a spacer can be used, which is a solid mass to provide some basic joint stability and mobility until a more permanent prosthesis is entered. May contain antibiotics to help treat any infections.
See also
- Rheumasurgery
- Artroplasty
- Orthopedic surgery
- The shared replacement registry
Related care
- Automatic condominium implants
- Microfractor operation
References
External links
- Patient Information from the American Academy of Orthopedic Surgeons
- Patient Information from the FDA
- P. Benum; A. Aamodt; and K. Haugan Femoral Component Armed Ruler In Hip Arthroplasty
- Finkelstein, JA; Anderson, GI; Richards, RR; Waddell, JP (1991). "Synovitis of polyethylene following total hip bone arthroplasty. Histomorphometry analysis". The Journal of arthroplasty . 6 Suppl: S91-6. doi: 10.1016/s0883-5403 (08) 80062-9. PMID 1774577.
Source of the article : Wikipedia
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