A new dimension to joint replacement

Recent surgical techniques, specific design of artificial joints and computer-assisted surgery have given a new dimension to the science of joint replacement.

Dr. SanjeevArthritis is a debilitating condition where the surfaces of joints, covered by smooth cartilage, wear out. The commonly affected joints in this condition are hip, knee, shoulder and elbows. There are two main types of arthritis. One is an age-related degeneration known as Osteoarthritis where commonly knee joints are involved. This usually occurs by age 60. The second type is Rheumatoid Arthritis which is an autoimmune disease and starts as early as childhood. Commonly involved joints here are hip and knees.

At different stages of this natural wear out process, different kinds of treatment are recommended. These vary from simple physiotherapy, prescription of medications to surgery. Types of surgical treatments depend upon the stage of arthritis. Joint replacement surgery is advised to patients having painful, advanced arthritis even after trying all other kinds of treatment.

Joint replacement technique

Joint replacement is a surgical technique where arthritic joint surfaces [worn out cartilage] are replaced by an artificial material made of high grade metal, plastic or ceramic. These provide complete and permanent relief from pain. Patients usually have some apprehension regarding the consequence of this surgery. Therefore, they must first try and understand the whole procedure in detail before undergoing surgery. An experienced surgeon and a reputed hospital are also crucial factors to be considered.

Pain management

Patients about to undergo this surgery are anxious about the post-operative pain and recovery. This is usually taken care of by an efficient anaesthetist team. They can control pain by various programmes. One is the epidural analgesia, where a small epidural tube [which delivers continuous pain-killers] is put in the spine for 2-5 days. Other modalities include intake of pain killers, either orally or by injections - local, intravenous or intramuscular.

Physiotherapy and movement

The success of joint replacement surgery solely depends on competent post-operative care, in the form of physiotherapy rehabilitation programmes. This is usually started 24 hours after surgery. For five post-operative days, patients are taught to walk with a walker and then with a stick. Patients are also made to undergo a range of exercises for movement and strength.

Before discharging the patients from the hospital, they are trained to do day-to-day activities on their own. The extensive physiotherapy programme is then continued for another six weeks. Later, patients have to continue this by themselves throughout their life. Conventional knee replacement provides 90-100 degrees bending after surgery. However, a new technology known as RPF [Rotating Platform Flex] allows patients to sit cross-legged, kneel and even perform other routine activities where complete bending of the knees is essential.

Computer navigation surgery

A well done joint replacement usually lasts for 10-15 years. Longevity of joint replacement depends on - proper sizing and alignment of components of the artificial joint, alignment of the leg, and balancing of the ligaments of the joint. These can be accurately done to a high level of precision using computer navigation system - which is not possible with conventional methods. Such a joint replacement can last up to 20 years or more.

Another advantage of this technique is that both knees [bilateral knee replacement] can be replaced at the same time very safely. Here the incision or skin cut is very small and with the help of proper pain management recovery is very quick. More than 90 per cent people who have joint replacement surgery will never need revision surgery. Revision surgery is becoming common because younger people go through these surgeries and wearing away of the joint surface becomes a problem after 15-20 years.

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Sanjeev Jain
Sanjeev Jain is a Joint Replacement Surgeon, M.S. Orth, M. Ch. Orth [UK], FASIF [Germany] Fellowship in Joint Replacement, Adult Reconstruction, and Sports Medicine [USA]. He is a full-time consultant orthopaedic surgeon at Dr L H Hiranandani Hospital, Mumbai.

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