Arthroplasty

Arthroplasty is surgery performed to relieve pain and restore range of motion by realigning or reconstructing a dysfunctional joint.

Why Arthroplasty is performed?

The goal of arthroplasty is to restore the function of a stiffened synovial joint and relieve pain. As a surgical procedure, it is usually performed when medical treatment has not improved function in the affected joint. There are two types of arthroplastic surgery: joint resection and interpositional reconstruction. Joint resection involves removing a portion of the bone from a stiffened joint, increasing the space between the bone and the socket to improve the range of motion. Scar tissue eventually fills the gap, narrowing joint space again. Pain is relieved and motion is restored, but the joint is less stable.

Interpositional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint. The prosthesis can be made of plastic, metal, ceramic material, or formed from such body tissue as skin, muscle, or fascia. When interpositional reconstruction fails, total joint replacement may be necessary. Joint replacement is also called total joint arthroplasty.

In recent years, joint replacement has become the operation of choice for most chronic knee and hip problems, particularly because of advances in the type and quality of prostheses (articifical joints). Elbow, shoulder, ankle, and finger joints are more likely to be treated with joint resection or interpositional reconstruction.

Arthroplasty is performed on people suffering from severe pain and disabling joint stiffness. Osteoarthritis (OA), a degenerative joint disease, is the most common condition causing joint destruction with pain and impaired movement. Other causes include rheumatoid arthritis (RA), hemophilia, synovitis, and rare bone diseases, which are all known to destroy cartilage. Joint resection, rather than joint replacement, is more likely to be performed on people with rheumatoid arthritis, especially when the elbow joint is involved. Joint replacement is usually reserved for older patients, because of the limited longevity of benefits. The younger the patient, the greater the reliance on medical treatment.

How Arthroplasty is performed?

Arthroplasty is performed under general or regional anesthesia in a hospital, by an orthopedic surgeon. Although many hospitals and medical centers perform common types of joint surgery, orthopedic hospitals that specialize in joint surgery tend to have higher success rates than less specialized centers.

In joint resection, the surgeon makes an incision at the joint, then carefully removes the minimum amount of bone necessary to allow free motion. The more bone that remains, the more stable the joint. Ligament attachments are preserved as much as possible. In interpositional reconstruction, both bones of the joint are reshaped, and a disk of material is placed between the bones to prevent their rubbing together. Length of hospital stay depends on the joint affected; in the absence of complications, a typical stay is only a few days.

What are the risks of an Arthroplasty Surgery?

Risks of arthroplasty include:

• Infection developing in the artificial joint (requires removal of the artificial joint and treatment of the infection).

• Development of blood clots (thrombophlebitis).

• Loosening of the joint.

After Arthroplasty 

Immediately after surgery, while still in the hospital, patients will be given pain medications for the recovery period and antibiotics to prevent infection. When patients are discharged after joint surgery, they must be careful not to overstress or destabilize the joint, requiring rest at home for a period of weeks. Physiotherapy will begin immediately to improve strength and range of motion; it is the most important aid to recovery and may continue for several months. Activity may be resumed gradually, with the help of devices, such as walkers or crutches, as recommended by the physiotherapist. Lifestyle changes may include the use of special seating or sleeping surfaces, and employing home care assistance for help with shopping, cooking, and household tasks.