Hip replacement is a surgery procedure in which the hip joint is replaced by a prosthetic implant Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement (total hip arthoplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis Other indications include rheumatoid arthritis avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures benign and malignant bone tumours arthritis associated with Paget’s disease,ankylosing spodylitis and juvenile rheumatoid arthritis The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed. Risks and complications in hip replacement are similar to those associated with all joints replacement. They can include dislocation, loosening, impingement, infection, osteolysis, metal sensitivity, nerve palsy, pain and death. Two basic types of hip replacement are cemented and uncemented. In cemented hip replacement, cement is used to fix the metallic implant to the bone while in Uncemented replacement the implants are fixed by bone in growths. Consequently there is a difference between the two types of implant.
Generally speaking Uncemented hip is done in young patients and in patients with good bone stock while cemented replacement is done in older patients.
Total Knee Arthroplasty or TKA is a surgical procedure where the diseased and damaged surface of knee joint is replaced with metallic and polyethelyn surface. Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States
Joint is open through front by cutting the skin and muscle. Size of the incision is approximately 15 cm in length. After incising the skin and muscle end of the tibia and femur bone; constructing knee joint, are exposed by partially dislocating it. Damaged surface of the two bones are cut precisely with the help of different jigs and blocks. Which reproduce a measured resection shape of the two bone end and as well as space in between to accommodate a predefined implant size. The bone cuts are done in such a manner that it corrects the deformity that was produced due to the disease and also stabilize the ligaments to get a stable aligned joint limb.
Implant surface is inert so pain insensitive as well as the procedure corrects the deformity and instability so reduce stress on the muscles and bones around the joint thus relieves from pain and improves mobility.
3-4 days after TKA one should be able to do basic activity of daily living; getting out of bed, walking around and use commode independently with help of walking aid (walker). By the end of 4-6 weeks can start all outdoor activity except impact sports and by 6-12 months starts forgetting about the surgery. After TKA one can regain their normal activity with more than 90% satisfaction in 3 to 6 months time. Patient’s satisfaction depends on preoperative counselling to reduce mismatch of expectation and reality, identification and treatment of concomitant other medical issues which can produce pain in the leg and around knee joint.
The knee joint is divided into three compartments; medial (the inside part of the knee between thigh and leg bone), lateral (the outside part of the knee between thigh and leg bone), and patella-femoral (the joint between the kneecap and the thighbone).uni-compartmental Arthroplasty (UKA) or partial knee replacement involves replacing only one compartment of the knee joint. Osteoarthritis of knee commonly starts from medial side of joint. Nearly 30% of the severe arthritic knees do not have any involvement of the lateral joint and minimal involvement of patella-femoral joint and normal ligaments of the knee. This group of patients who have indication for TKA are also a very good candidate for UKA and produce similar outcome as TKA. Advantages of UKA compared to TKA include smaller incision, easier post-op rehabilitation, better post-operative range of motion, shorter hospital stay, less blood loss, lower risk of infection, and lesser chance of blood clots. Persons with post infective arthritis, inflammatory arthritis rheumatoid, Lupus, Psoriatic), or marked deformity beyond joint are not candidates for this procedure.
Revision TKA is required for a failed previously done TKA. The most common cause for doing revision TKA is implant loosening, infection, periprosthetic fracture or the mal alignment. Compared to primary revision TKA surgeries are more complex and require special expertise and implants. Life span of a revision surgery is lesser compared to a primary Arthroplasty.