What is arthritis?
Arthritis is wearing away of the cartilage of joint. In the normal knee joint, the cartilage protects the bone ends from rubbing against each other. As the cartilage gets worn away, the bone ends rub against each other and causes pain. There are two types of arthritis commonly, osteoarthritis and rheumatoid arthritis.
Which are the joints that are involved in arthritis?
Arthritis can affect any joint, but commonly involves the knee and hip joints.
What is the treatment for arthritis?
Initial treatment of arthritis of the knee includes pain killers, local application of pain killer gels. Some food supplements that protect the joints like glucosamine maybe added. Physiotherapy in the form of knee muscle (quadriceps) strengthening exercises will relieve some pain. Pain killer medications should not be taken on for a very long time, since they can damage the kidneys and other organs.
Most of the patients who have arthritis that is not cured by pain killer medications will require joint replacement surgery.
Are there any special medicines for the treatment of rheumatoid arthritis?
There are special medicines that are used to treat rheumatoid arthritis and include, methotrexate, leflunomide etc. These medicines will slow the progression of rheumatoid arthritis but will not reverse the changes that have already occurred in the joints.
Is there a role for arthroscopy (keyhole surgery) in the treatment of arthritis?
Arthroscopy may benefit some patients with localised involvement of the cartilage. But many patients undergoing arthroscopy for arthritis end up having a joint replacement surgery.
What is joint replacement surgery?
Joint Replacement Surgery is an operation in which the damaged or worn parts of the joint are replaced with new artificial joints.
Where is joint replacement surgery performed?
Joint replacement surgery should be performed in a well equipped operation theatre in any major hospital. Most modern operation theatres have laminar airflow systems. Laminar airflow systems provide clean airflow inside the operation theatre and that is essential for the prevention of infection.
How is knee replacement surgery performed?
Knee replacement surgery is essentially a ‘resurfacing’ surgery of the knee, in which only the damaged joint surfaces are removed and new material is placed in its place. The lower thigh bone (femur) is replaced with ‘metal’ and the upper part of the leg bone (tibia) is replaced by ‘polyethylene’ (plastic), which rests on metal. These ‘metal on polyethylene’ surfaces are very smooth.
Do you use metal on plastic combination for hip replacement surgery?
In hip replacement surgery various combinations can be used. We decide the combination based on the age of the patient and underlying disease of the hip. The various combinations that can be used include Metal on Poly combination, metal on metal combination, ceramic on ceramic combination and ceramic on plastic combination.
How long will a replaced joint last?
With the latest implants, most joint replacements done with a good surgical technique lasts for an average period of 15 to 20 years. This also varies according to the usage of the joint. In people who are less active, these artificial joints will last for a longer period.
What anaesthesia is used while performing knee replacement surgery?
Both hip and knee replacement surgeries can be safely performed under epidural anaesthesia (by injecting anaesthetic medicine in the spine via a catheter). Some patients who have disease of the spine may have difficulty in obtaining epidural anaesthesia and they can be operated under general anaesthesia (by inhaling anaesthetic medicine). The advantage of epidural anaesthesia is that these medicines given into the spine will give pain relief for another 2 days
How will my hospital stay be after the operation?
You will feel a dramatic relief of pain after the operation, though you may have some pain in the first few days. The epidural anaesthetic medicine will take care of your pain in the first 2 days; thereafter we will give you pain killer medications for another 1 week.
You will be made to stand and walk on the 2nd postoperative day (next day of operation is called the 1st postoperative day). Initially you will be made to walk with the help of a walker (a protective device that helps you to walk). You will need to undergo Physiotherapy in the form of knee bending exercises, knee muscle strengthening exercises and for some patients we give continuous passive motion (CPM). This CPM machine will help you bend your knees. Your stitches will be removed by the 12th postoperative day.
The time for full recovery maybe anywhere between 2 and 3 months.
Are there any complications of joint replacement surgery?
More than 95% of knee and hip replacement surgeries have successful outcomes. A possible complication is infection, which can occur during your hospital stay or after you have left the hospital. With ultramodern operation theatres with laminar airflow facilities the chances of infection are minimal. Blood clots can appear in your calf which needs preventive treatment in the form of injections. Other complications that can occur years after the replacement include wearing out of the plastic and loosening of the artificial joint.
Dislocation is a specific complication of total hip replacement.
What is the upper age limit for joint replacement surgery?
There is no upper age limit for joint replacement surgery. It is generally agreed that you can undergo a joint replacement surgery if your medical condition and fitness allows you to.
X-ray showing hip resurfacing performed on one hip and total hip replacement on the other hip
What is the difference between total hip replacement and hip resurface replacement?
Hip joint is a ball and socket joint. In total hip replacement the entire ball and socket are replaced by artificial joint. In hip resurfacing, only the surface of the ball is replaced leaving most of the ball intact. The replacement of the socket is the same in both procedures
Why is resurfacing called Birmingham Hip Resurfacing?
Hip Resurfacing was made popular by Dr. Derek McMinn, from the city of Birmingham in UK. Hence the name Birmingham Hip Resurfacingngng
In whom do you advise a hip resurfacing operation?
In young patients, with early arthritis and those who have an adequate bone stock, hip resurfacing can be performed safely. The advantage of a hip resurfacing is that only very little bone from the femoral head(ball) is removed.
In resurfacing the bearing is metal on metal which has very low wear rate. The resurfacing is done with an artificial joint which has the same size as the patient’s original hip. Therfore there is no risk of dislocation in resurfaced joint. The hip regains nearly full mobility. There is no actvity restriction for the patient after hip resurfacing unlike after total hip replacement.
X-ray showing a Total Hip Replacement with dysplasia cup for a patient with malunited acetabular (socket)fracture
Do you undertake total hip replacement for fractures?
A) Total hip replacement maybe required for acetabular(socket) fractures if they develop arthritis. After a socket fracture if the joint surfaces are not properly repaired by immediate surgery, these hips may develop arthritis. THR in acetabular fracutres is a technically demanding procedure. We have significant experience in managing these cases. There are only a few centres in India where they undertake this kind of surgery.