Dr. Arun Partani

Debilitating inflammation in the joints and its surrounding tissue usually characterize arthritis. This ailment can greatly weaken the body. At the point when joints are seriously influenced by joint pain, there are a number of treatment methods that may be available for the patient. Pain relievers, physiotherapy and other forms of treatment can help in offering relief. Yet, when these methods fail, one can go in for replacement surgery of the affected joint. This may not just lessen or eliminate the pain experienced but it can also it can reestablish better strength in the joint. Hip, knee, and shoulder joint substitutions are a portion of the more normal surgeries suggested when managing joint pain.

Joint Replacement Surgery for Various Joints: Arthritis can affect a variety of joints in various ways. In the shoulder, this can be found in the humerus (the upper arm bone) and a bit of the scapula (the shoulder bone). In the knee, it includes the finishes of the femur and tibia (the thigh bone and shin bone, separately) and the patella (the knee top). In the hip, the influenced zones are the femur and the attachment in the pelvic bones in which it rests (the hip bone socket). In simple words, an aggregate joint trade or replacement for joint pain includes replacing the harmed joint surfaces with simulated segments artificially.

Ideal Candidate: In the event that your joint pain is progressed yet you are generally healthy, joint substitution might be a choice. Notwithstanding, you should take the advice of an accomplished orthopedic pro who can give you moderate treatment choices and other negligibly intrusive ways to deal with the condition before resorting surgery.

As a rule, you may not be a decent candidate of the replacement if:

• You have inadequately controlled diabetes
• You are a chain smoker
• You are extremely chubby
• You have encountered contaminations in the influenced ligament joint before

Who all are candidates for replacement:

• Have joint pain that is extreme
• Are encountering a debilitating effect in their personal life due to the painful symptoms
• Have discovered moderate medicines, for example, mitigating drugs and non-intrusive treatment to be ineffectual
• Are willing to effectively and regularly participate in a recovery program after surgery

The accomplishment of a joint substitution surgery relies on upon the stability of the remaining parts of the joint. In the event that the joint has endured a few diseases, or in the event that it has experienced a few surgeries, it may not be sufficiently solid to withstand a joint replacement procedure. What's more, if you there are immune system disorders or long ailments like diabetes at play, then there may be little chance of aligning with the new joint. In case you have a concern or query you can always consult an expert & get answers to your questions!

What are the symptoms of osteoarthritis in relation to the different affected areas?

An osteoarthritis is a form of arthritis which means unexpected inflammation of the joints/muscles, which is usually very painful. This form of arthritis is not curable, and the only thing that you can do is to take measures to reduce the painful effects of the condition. The symptoms of the medical condition often occur gradually and are chronic and long lasting in nature. Some of the body parts that get affected easily are:

• Hips- pain is felt in the groin area or buttocks at the hip joint.
• Fingers- bony growths at the edge of joints can cause fingers to become swollen, tender and red. There may be a pain at the base of the thumb.
• Knees- a 'grating' or 'scraping' sensation occurs when moving the knee.
• Feet- pain and tenderness are felt in the large joint at the base of the big toe. There may be swelling in ankles or toes.

Some of the most common symptoms which are more common to all body parts are as follows:

• Chronic pain - The arthritis related pain is very intense and chronic in nature, and it has an ever increasing trend if proper care is not taken. This pain can appear in any body joint of a person and it can cause visible inflammation or swelling in and around the muscles of that particular joint.
• Body stiffness - Another characteristic feature of this medical disorder is that there is stiffness in the normal movement of the joints and muscles. This symptom also results in a lack of flexibility of the concerned person.
• Inflammation and tenderness - Osteoarthritis is such a condition which is observable by the naked eye, as it shows signs like inflammation and tenderness. Inflammation can be noticed if a joint has a considerable amount of swelling.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement and revision knee replacement.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

The Rehabilitation After Total Knee Replacement: 

1. Full weight bearing walking, knee bending, exercise next day after surgery 
2. Commode use, sitting on chair 2nd day 
3. 3rd day: Stair climbing, start cross leg sitting 
4. 2 weeks: Suture removal and walking to outdoors

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Human bones are continuously being removed and formed, which is necessary for its proper maintenance. However, in certain cases, especially with aging, some bones and joints will be worn down to an extent where the body will not be able to reform them. This is especially true in the case of hips, which may become worn due to age or other problems within the body. 

Hip replacement surgery: 
When this happens, a hip replacement surgery can be performed to replace the original joints with a prosthesis or artificial hip, which is usually made out of metal or a specially formed composite material or even a combination of the two. Along with other parts, it replaces the natural hip with an artificial hip to restore mobility and other related functions.

Benefits of hip replacement surgery:

1. Lessening hip pain: This is one of the major factors as well as symptoms of requiring hip replacement surgery. Due to the grinding down of the bones, even the slightest movement causes pain and after the surgery and the recovery period, the pain is lessened.
2. Correction of bone deformity: When the bones grind down and are abnormally reformed, deformities may occur reducing mobility. Artificial hips will ensure that deformities are corrected and resulting problems are thus eliminated.
3. Return to normal activities: This is possibly one of the primary advantages of this surgery, although it entails a long recovery period. However, most patients can get back to their normal activities and are able to resume a pain free life.
4. Ability to have painless sleep: Many people who suffer from hip displacements or bone deformities are not able to sleep properly due to pain. After the surgery and the recovery period, they can return to normal functions and habits, thus are able to sleep properly.
5. Leg strength increase: Many patients tend to have an increase in their leg strength as one side of the hip tends to become very weak due to bone problems before surgery. After surgery and recovery, the same side tends to have an increased strength due to the implant.
6. In most cases a lifelong solution to hip problems: As the hip replacement prosthesis is made out of metal and if the operation is successful, it usually tends to last till the end of a person's life and this area usually doesn't tend to have problems again. If you wish to discuss about any specific problem, you can consult an Orthopedist.

Knee replacement is a procedure where the weight carrying surface of knee joint is replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types

Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure

In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage, and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical-grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anesthesia, an incision of 8-12inches is made in the front part of the knee. The joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin, as well as knee cap, is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure

After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well for 20 to 22 years of surgery. Hence, knee problem is no problem at all!

The Rehabilitation After Total Knee Replacement: 

1. Full weight-bearing walking, knee bending, exercise next day after surgery 
2. Commode use, sitting on chair 2nd day 
3. 3rd day: Stair climbing, start cross leg sitting 
4. 2 weeks: Suture removal and walking to outdoors

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. The post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, the patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, the patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping. If you wish to discuss about any specific problem, you can consult a Orthopedist.

Literally translated into two words – arthro (joint) and scopy (to look), arthroscopy refers to a process used to look into a joint. The doctor uses an instrument known as arthroscope which is used to examine a joint in greater detail. What was initially used mainly in diagnosis has gradually grown to include use of instruments through the arthrocope, thereby allowing for some surgical treatments to be done as well.

Indications/uses:

1. Diagnosis of joint problems like cartilage tears
2. Repairing joint problems
3. Remove foreign bodies in a joint
4. Track response to treatments
5. Identify disease progression
6. Used during an open surgery to:
   • Remove fragments or spurs of tissues
   • Shave off sharp edges
   • Collect fluid or tissue samples
   • Remove swollen tissues
   • Take biopsy
   • Extract swollen joint fragments
   • Remove deposits of calcium or other minerals

Procedure:

1. Usually done as an outpatient procedure
2. The procedure in terms of what to expect will be explained to the patient
3. A sedative is given and the area to be studied is usually shaven and topical antiseptic is applied
4. Vital signs are monitored
5. Regional or local anethesia is generally used, where only the joint to be studied is injecte with a local anesthetic.
6. In cases where the patient is undergoing an open surgery, general anesthesia would be given.
7. The patient’s position would depend on the joint being studied, usually, is made to lie on the back.
8. A tourniquet is used to restrict blood flow to the particular joint
9. A small incision is made in the joint space and the instrument is introduced into the joint space. There is a constant slow flow of saline or another irrigant (to which chlorhexidine might be added) to improve visibility and to remove debris and control infection
10. Other joint tools are used as required during the procedure either to cut off small fragments of tissue or to remove debris or foreign body.
11. Once all procedures are done, the joint is thoroughly flushed to clear off any debris.
12. It is closed with stitches after final inspection
13. During recovery, crutches or splints may be used depending on the patient’s overall condition
14. Duration of the procedure depends on what actually was done. An inspection could last about 20 minutes while a procedure could take a couple of hours.

After the procedure:

1. Complications are very rare, maybe painful operated joint for a couple of days
2. Rest the joint well for a couple of days
3. Ice, pain killers, and compression bandage may be required
4. Return to normal activity and exercises to be followed as dictated by the orthopedist.