Arthroplasty
Arthroplasty is the operation for construction of a new movable
joint. It is not applicable to every joint: in practice, its use is almost confined to the
shoulder, the elbow, the hip, the knee, certain joints in the hand, and the
metatarso-phalangeal joints in the foot
What is Arthroplasty used for?
The goal of arthroplasty is to restore the function of a stiffened joint and relieve
pain. Two types of arthroplastic surgery exist. Joint resection involves removing a
portion of the bone from a stiffened joint, creating a gap between the bone and the
socket, to improve the range of motion. Scar tissue eventually fills the gap. 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 and
metal or from body tissue such as fascia and skin. 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 knee and
hip problems. 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 that result from osteoarthritis or rheumatoid arthritis. Joint resection, rather
than joint replacement, is more likely to be performed on people with rheumatoid
arthritis, especially when the elbow joint is involved. Total joint replacement is usually
reserved for people over the age of 60.
If both the bone and socket of a joint are damaged, joint replacement is usually the
preferred treatment.
Information about Arthroplasty
Arthroplasty is performed under general or regional anesthesia in a hospital, by an
orthopedic surgeon. Certain medical centers specialize in joint surgery and tend to have
higher success rates than less specialized centers.
In joint resection, the surgeon makes an incision at the joint, then carefully removes
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 which joint is treated, but is normally only a few days.
Preparation for Arthroplasty
Prior to arthroplasty, all the standard preoperative blood and urine tests are
performed. The patient meets with the anesthesiologist to discuss any special conditions
that affect the administration of anesthesia.
Aftercare
Patients who have undergone arthroplasty must be careful not to over stress or
destabilize the joint. Physical therapy is begun immediately. Antibiotics are given to
prevent infection.
Risks of Arthroplasty
Joint resection and interpositional reconstruction do not always produce successful
results, especially in patients with rheumatoid arthritis. Repeat surgery or total joint
replacement may be necessary. As with any major surgery, there is always a risk of an
allergic reaction to anesthesia or that blood clots will break loose and obstruct the
arteries.
Normal results for Arthroplasty
Most patients recover with improved range of motion in the joint and relief from pain. |
