Introduction:
A joint is a part of the body where two or more bones meet to allow movement. The joint contains various ligaments, tendons, and muscular attachments, making the skeleton flexible. There are 360 joints in an adult human body. Most of the joints have fluid within them for lubrication and frictionless movement.
Damage to the joint from trauma or inflammation can lead to joint dislocation or degeneration. These joint disorders may cause pain and limit their movements. Arthroplasty is a Greek word; arthro means joint, and plasty means molding or forming. However, the term arthroplasty is the other name for joint replacement in medical practice.
What Is Joint Arthroplasty?
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Arthroplasty is a surgical treatment for joint injury or disorders. In arthroplasty, the articular surface of the musculoskeletal system is replaced, reconstructed, remodeled, or realigned. An artificial joint (prosthesis made of plastic or metal) can also be used. Arthroplasty is a major surgery that removes pain significantly and preserves the biomechanics and functionality of the joint.
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In some situations, hemiarthroplasty is preferred over total replacement, where only a portion of the damaged part is operated. The procedure can be carried out immediately after a fall or injury since it has less preparation time. The advantages of hemiarthroplasty are less surgical time, less blood loss, and less chance of dislocations after treatment.
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The most common type of arthroplasty is knee replacement and hip replacement.
What Are the Principles of Joint Arthroplasty?
The following are the principles applied to replacement surgery with a prosthesis.
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Proper patient and procedure selection are essential for any surgery.
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The operative site must be exposed satisfactorily for better visualization and good access.
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Soft tissue balance is critical to the success of the procedure.
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The selected prosthesis must be durable and reliable.
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After replacement, it must not provoke any unwanted reactions in the tissue.
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The prosthesis must be firmly attached to the skeleton, allowing low-friction movement in the joints.
What Are the Indications of Joint Arthroplasty?
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Osteoarthritis: A degenerative joint disorder where the flexibility of the joint tissue is lost over time due to normal wear and tear reactions. The most common form of osteoarthritis affects joints in the hand, knee, hip, and spine.
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Rheumatoid Arthritis: An autoimmune disorder where the body's immune system attacks the joint tissues' healthy cells, causing inflammation (painful swelling). It is a chronic disorder affecting many joints in the body.
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Fracture: A broken joint has severe manifestations since it is usually a displaced fracture (broken bone moves out of alignment). Therefore, treating a joint fracture immediately is essential to restore the harmonization of the joint.
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Birth Defects: Some of the birth defects of the joints, especially hallux valgus, need replacement surgery.
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Avascular Necrosis: A localized death of bone due to lack of blood supply may result from injury or drug side effects.
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Tumors: Any cancerous or noncancerous tumor may cause severe damage to the joints.
What Are the Contraindications of Joint Arthroplasty?
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Active joint infection.
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Systemic infection or sepsis.
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Chronic osteomyelitis (bone infection).
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Muscle dysfunction.
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Vascular disease (a condition affecting the system of blood vessels).
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Relative contraindication:
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Localized infection.
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Insufficient bone.
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Severe soft tissue damage.
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Debilitating diseases (diabetes, heart or lung disease).
What Are the Types of Joint Arthroplasty?
The most successful and common form of arthroplasty is replacement surgery. Hence, joint arthroplasty and joint replacement are used interchangeably. However, theoretically, arthroplasty can be of various types.
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Replacement Arthroplasty: A procedure where the dysfunctional joint surface is replaced with an external prosthesis for functional continuity is called replacement arthroplasty. It can be;
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Hemiarthroplasty: It is also known as a hemi replacement, where only one of the joint surfaces is removed and replaced by a prosthesis.
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Total Arthroplasty: It is also known as a total replacement where both of the opposing joint surfaces are removed and replaced with prosthetic components.
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Excisional Arthroplasty: In excisional arthroplasty, one or both joint surfaces are removed and left empty. The gap created between the joints is filled with fibrous or scar tissue. It is the most common type of surgery preferred in chronic infection conditions.
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Interposition Arthroplasty: Grafting (moving tissues from one site to another in the body) the joint surface with other tissues like skin, muscles, or tendons to keep away inflammation.
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Resurfacing Arthroplasty: Trimming or slicing away the damaged joint surface is called resurfacing arthroplasty. It is an excellent alternative treatment for replacement surgery, especially in younger and active adults, because of its bone-preserving nature.
How to Get Ready for Surgery?
Individuals may require:
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A medical examination is needed to confirm the suitability of surgery.
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Blood testing.
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Electrocardiogram (EKG) to assess the condition of the heart.
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A dental examination to lower the possibility of infection following surgery.
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Imaging studies, such as radiography. Additionally, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be required.
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Inform the surgeon and the doctor about the over-the-counter (OTC) and prescription supplement use.
What Takes Place When an Arthroplasty Is Performed?
Individuals will be given anesthesia on the day of the procedure to ensure that they are pain-free. The anesthesiologist will either administer regional anesthesia to numb the area surrounding the replacement joint or general anesthesia to put them to sleep during the procedure.
The surgeon will do the following when performing a joint replacement:
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Take out any broken bone and cartilage.
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Place the prosthetic joint in place.
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Use more prosthetic components to replicate one's tissue.
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If necessary, reshape the bones surrounding the joint to accommodate the new prosthetic.
Typically, an arthroplasty requires a few hours to complete. It depends on whether it is a total or partial joint replacement and which joints are replaced.
What Occurs Following Arthroplasty?
The patient will be sent to a recovery room following surgery. For several hours after the procedure, the surgical team will monitor patients to make sure the anesthesia wears off without any problems. The pain threshold and vital signs will also be observed.
Following joint replacement surgery, some patients return home the same day. Sometimes, they may have to spend a night or several days in the hospital.
What Are the Benefits and Drawbacks of Replacing a Joint?
The advantages of a joint replacement greatly exceed the hazards for the majority of people. Since an arthroplasty is a significant surgery, there is always a potential that complications may arise. Nonetheless, a lot of patients, particularly those who have been in pain for a long period, report a significant, noticeable improvement in their everyday activities following a joint replacement.
Recuperation following an arthroplasty may be more challenging in certain medical situations. Discuss the medical background with the surgeon. Inform them of any:
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Diabetes.
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Other autoimmune illnesses (such as lupus).
The potential dangers of a joint replacement should be discussed with the surgeon or healthcare professional. They will assist in determining whether an arthroplasty is the best course of action.
What Are the Complications of Joint Arthroplasty?
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Pain, swelling, infection, bleeding or blood clots, and damage to any nearby nerve or blood vessel are some common complications anticipated post-surgery.
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Stiffness, soft tissue imbalance, weakness, instability, and fracture of adjacent bone are risks specific to the joints.
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Rejection of the material, malposition, loosening, and dislocation of the prosthesis are the problems pertaining to the artificial joint.
Conclusion:
Arthroplasty is an elective surgery to reduce pain and restore the functions of the joint. It is the most successful surgery with a high satisfaction rate. In addition, replacement surgeries can significantly improve the quality of life. Recent advancements in arthroplasty, like minimally invasive techniques, a porous-coated prosthesis (for better adhesion to the bone), and 3D-printed patient-specific prostheses, are appreciable and motivate many people to opt for this procedure with much confidence.
