Joint Replacement Surgeries
Joint replacement surgery has given a new lease of life to many who have suffered from pain due to damaged joints. Commonly replaced joints are the hip, knee, shoulder, ankle, elbow, wrist and the finger joints. Thousands of hip and knee joints are replaced every day all over the world. Joint replacement has enabled arthritic patients to lead a more active life. Jack Nicklaus, the famous golfer, who had his hip replaced and is actively competing, is a classical example.
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What is joint replacement?
The ends of two bones which form a joint are covered by smooth tissue known as cartilage. This tissue is damaged by various diseases or injury, which in turn produces pain. Eventually the cartilage is totally worn out and the bone ends rub against each other causing severe pain and disability. In joint replacement surgery the damaged surface of the joint is removed and replaced with an artificial joint called ‘prosthesis’
What are the common causes of joint damage?
Osteoarthritis is the commonest cause of damage requiring joint replacement. Other causes are rheumatoid arthritis, fracture involving the joint causing arthritis, poor blood supply (avascular necrosis) and various childhood problems causing delayed arthritis.
Hip replacement
There are two types of hip replacement; the traditional total hip replacement and the surface replacement. In the traditional hip replacement, the diseased ball along with the top part of the thigh bone and the surface of the socket are removed and replaced with artificial components. These can be fixed either with a type of glue known as bone cement or without any such material and bone is allowed to incorporate in the specially made components. In surface replacement which is meant for younger patients, very minimal bone is removed from the thigh bone.
Resurfacing of hip
Articular surface replacement of the hip is a recent addition to the various types of hip replacements. It was popularized in Birmingham and is suitable for younger patients involved in more active life. Unlike the traditional hip replacement where the replaced ball is much smaller than the original head of femur, in surface replacement the original head is preserved and only the surface is replaced with a metal component. Surface replacement has allowed the patients to get back to a normal life in the most active and productive phase of their life.
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Newer materials in hip replacement
There has been a lot of research going on to find out an ideal material with which the artificial joint can be made, which will last forever. Researchers started using a material called ceramic in the mid, late 90’s and this has become a boon to younger patients needing total hip replacement. Ceramic is very hard and scratch resistant. The wear property of this material compared to the traditionally used metal on poly ethylene is about 1400 times superior. Therefore a well performed hip replacement with this material should last any one’s life time. In the traditional metal on plastic, the plastic wears slowly over time, and as the plastic wears out small particles of plastic debris develop. This triggers response by the body which can lead to loosening of the joint implant over time. This causes pain and leads on to revision surgery. In ceramic hips the amounts of wear is negligible. Another new material which has recently been introduced is oxinium, which also has superior wear properties compared to traditional metal alloys.
Knee replacement
This is the commonest joint replaced in India. Here the diseased ends of the thigh and leg bones and sometimes the surface of the knee cap are replaced. The components are made of cobalt chrome alloys and poly ethylene. Recently implants made of titanium and oxinium have also been introduced. If only one half of the knee joint is badly worn out, that half alone can be replaced. This is called unicondylar knee replacement.
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Shoulder replacement
Shoulder replacement is becoming more and more popular as a remedy for arthritis and fractures of the shoulder. Shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. In a total or hemi shoulder replacement, the worn head of the upper arm bone or humerus is replaced with a metal ball mounted onto a stem. The socket or glenoid bone of the scapula may also be resurfaced with a polyethylene (plastic) component.
Reverse shoulder replacement
This is a different type of shoulder replacement, where the ball and socket components are reversed, that is the socket is on top of the arm bone and the ball where normally the socket will be in the shoulder blade. This type of joint is used in cuff tear arthropathy.
Elbow replacement
Elbow can also be affected by osteo or rheumatoid arthritis. Elbow joint replacement can effectively treat the problems caused by arthritis of the elbow. The procedure is also becoming more widely used in aging adults to replace joints damaged by fractures. In elbow replacement surgery, the painful surfaces of the damaged elbow are replaced with artificial elbow parts. One part fits into humerus (arm bone) and other part fits into ulna (strongest bone in the forearm).The two parts are then connected and held together by a pin. The resulting hinge allows the elbow to bend.
Revision hip and knee replacement
When an already replaced joint fails either due to wear and tear after many years, infection, injury or some other problem, the joint needs to be replaced. This is known as revision joint replacement. This is much more difficult and complex compared to a primary joint replacement. These procedures require careful planning and preparation, specialized tools and implants (Prosthesis).These specialized implants are expensive and the procedures are done only by surgeons who have considerable experience in joint replacement surgery.
I have been regularly performing primary and revision joint replacement procedures for the past 15 years.
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Paediatric Orthopaedics
One of my special interest is Paediatric orthopaedics. The following are some of the common orthopaedic problems which I deal with.
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Club foot
Also known as CTEV, this is the commonest congenital deformity requiring treatment. The current method of treatment is known as Ponseti’s technique of serial plastering. Neglected cases are treated with open surgery or correction using external frames.
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Developmental dysplasia of hip
Previously known as congenital dislocation of hip, this condition has to be diagnosed early to be treated with a brace. If diagnosed late, surgery is invariably required. Many of these patients need to undergo complex pelvic osteotomies to reconstruct the socket. I specialize in reconstructive hip surgeries for patients who have had delayed diagnosis or failed surgeries for DDH.
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Cerebral palsy
This condition is caused due to an irreversible damage to the brain, which occurs before, during or after birth. This results in tightness of muscles in the limbs and occasionally in the trunk as well. These children are commonly referred to as ‘spastic’ children. The orthopaedic treatment involves physiotherapy, using certain medications like Botox injections to reduce the tightness and surgeries like correction of contractures, tendon transfer to balance muscles and bony surgeries to correct deformities and stabilize joints. These include pelvic osteotomies to stabilize hip and foot stabilization procedures.
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Obstetric Brachial Plexus Palsy
Obstetric Brachial Plexus Palsy is one among the severe types of birth injuries. The Incidence of OBPP in new born babies is 1.5/1000 birth. The child with shoulder dystocia has 100 times greater risk and large babies have 14 times greater risk, whereas twin or multiple pregnancy and caesarian section have protective effect. I have been treating children with this condition and routinely perform reconstructive procedures like contracture release, corrective osteotomies and modified quads procedure.
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Limb lengthening and deformity correction
Shortening or deformity of the limb due to congenital conditions, infections, trauma or any other cause can be corrected using special frames known as fixators which are available in a variety of designs.
Muscular dystrophy
Muscular dystrophy is a hereditary condition where there will be progressive weakness of upper and lower limbs due to a defect in the muscle. The problem may start at a very young age or during adolescence depending on the type of problem. The common types are Duchenne and Becker muscular dystrophies. These children require surgeries to correct limb or spine deformities or to stabilize the hip joints.