Definition and Overview
Joints allow mobility of the body, being the area where the bones meet. In the knee, for example, the joint acts as a hinge between the upper and lower leg bones. Due to arthritis or injury, the cartilage that should cushion the joint no longer functions normally leading to swelling and constant pain.
Arthroplasty is a surgical procedure meant to repair or replace a diseased or injured joint. It is a relatively common procedure performed to bring back the functional use of the affected joint as well as to relieve pain.
There are several types of arthroplasty, namely: joint resection, joint reconstruction, and total joint arthroplasty. The first involves widening the space between joints by surgically removing a small portion of the bone. Joint reconstruction, on the other hand, inserts a disc in between two bones and reshapes the joint to restore mobility. Meanwhile, total joint arthroplasty involves replacing the whole joint with prosthesis and is usually performed as the last option.
Who Should Undergo and Expected Results
Arthroplasty is usually recommended for those suffering from osteoarthritis, the most common type of arthritis that affects constantly moving parts of the body like the knees, hips, spine, and hips. A study conducted in the United States reveals that osteoarthritis often affects men and women under the age of 45. Arthroplasty is usually recommended for patients who suffer from debilitating pain, greatly reduced mobility, swelling of the affected joints, and overall reduction of the quality of life and have tried pain medications, cortisone injections, or underwent physical therapy but failed to achieve pain relief.
Other conditions that require arthroplasty include injuries, bacterial infections, and rheumatoid arthritis that mostly affects older people.
The outcome of arthroplasty is generally favourable, with patients reporting distinct improvements in their joints and resumption of normal daily activities with little to no pain. The procedure requires several days of hospital stay, as well as continued physical therapy to restore muscle strength and normal joint movements. Patients are also expected to continue taking medication for a period of time. Younger people who underwent joint reconstruction can even resume low-impact sport activities after the procedure. Despite making few modifications of their lifestyle before surgery, most patients report overall satisfaction afterwards.
How Does the Procedure Work?
Prior to the procedure, patients undergo several laboratory tests and meet with their physician for consultations to prepare them both physically and mentally.
Depending on the extent of damage and complexity of the condition, arthroplasty may be performed either under general or regional anaesthesia.
After disinfecting the affected site, the surgeon makes incisions where the affected joint is located to remove the damaged bone or to insert prosthetic material. The procedure can be performed in two ways: One is through a minimally invasive procedure in which special instruments and an arthroscope with a small camera are inserted through small incisions and threaded around muscles and tendons to reach the affected part. However, joint reconstruction and total joint arthroplasty would require the surgeon to make a large incision to access the joint and repair or replace the damaged parts. The bones are also resurfaced to accommodate the inserted prosthetic material. Surgical thread or staples are then used to close the incision, followed by the application of sterile bandage or dressing.
After surgery, patients are immediately referred to a physical therapy program to make sure they can regain movement of the affected joint.
Possible Complications and Risks
Like any other surgical procedure, arthroplasty has several possible complications and associated risks. During surgery, the patient could experience an allergic reaction to anaesthesia, bleeding, or injury to surrounding nerves and blood vessels. There is also a concern on the incorrect positioning of the implanted prosthesis.
Post-operative complications could also occur, with the formation of blood clots in the legs or lungs being one of the major concerns. Bacterial infection is also another possible complication, while the dislocation of the affected joint can also happen when the patient tries to resume normal movements. In some cases, a difference of leg length is observed that might require surgical correction.
Though relatively rare, there is also the risk of a heart attack or stroke in patients who underwent arthroplasty, especially if there are pre-existing conditions related to these medical conditions.
After hospitalisation, any instances of swelling, numbness of affected body part, shortness of breath, or dizziness should not be ignored and must be reported immediately.
Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1):71-86. PMID: 17367693. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17367693.
Mihalk WM. Arthroplasty of the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 7.