SURGERY FOR ARTHRITIS
Most people with arthritis never need Surgery, but when all else fails, it can dramatically improve independence and quality of life by reducing pain and improving mobility. The surgeon may remove damaged or chronically inflamed tissue or replace the joint entirely. Artificial replacements are available for all of the most commonly affected joints.
Arthroscopy: Visualisation of the interior of the joint. A small incision is made on the skin near the joint, and a thin strawlike device is inserted to view the joint. Surgical instruments can be inserted through other incisions near the joint.
Arthroplasty: When long-term deterioration has occurred, a surgical procedure called arthroplasty may be the best option. Total joint arthroplasty involves Replacementig certain parts of the joint with a plastic or metal device. All critical joints now have such replacements, but artificial hips and knees have been the most successful.
Joint Replacement: a regular practice for hips, knees, shoulders, elbows, ankles and wrists, an artificial joint replaces the entire joint.
What is A Hip Replacement?
Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called prostheses. Hip replacement surgery aims to improve mobility by relieving pain and improving hip joint function.
Who should have Hip Replacement Surgery?
The most common reason people have hip replacement surgery is the wearing down of the hip joint resulting from osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury and bone tumours also may lead to the breakdown of the hip joint and the need for hip replacement surgery. Before suggesting hip replacement surgery, the doctor will likely try walking aids such as a cane or non-surgical therapies such as medication and physical therapy.
What does Hip Replacement Surgery involve?
The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the back. The acetabulum is a socket or cup-like structure in the pelvis or hip bone. This ball and socket arrangement allows a wide range of motion, including sitting, standing, walking and other daily activities.
The surgeon removes the diseased bone tissue and cartilage from the hip joint during hip replacement. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours.
Sometimes the surgeon will use a special glue or cement to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a cemented procedure. In an uncemented approach, the artificial components are made of porous material that allows the patient’s bone to grow into the pores and hold the new features in place. Doctors sometimes use a hybrid replacement which consists of a cemented femur part and an uncemented acetabular part.
What can be expected immediately after Surgery?
Patients are allowed only limited movement immediately after hip replacement surgery. When the patient is in bed, the hip is usually braced with pillows or a device that holds the hip in the correct position. The patient may receive fluids through an intravenous tube to replace fluids lost during Surgery. There also may be a tube near the incision to drain fluid, and a tube (catheter) may be used to drain urine until the patient can use the bathroom. The doctor will prescribe medicine for pain or discomfort.
What are the possible complications of Hip Replacement Surgery?
Hip dislocation is the most common problem that may happen soon after hip replacement surgery. Because the artificial ball and socket are smaller than usual, the ball can become dislodged from the socket if the hip is placed in certain positions.
The most dangerous position usually is pulling the knees up to the chest.
The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (Replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation.
Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the regular edges of bone).
What types of exercise are most suitable for someone with a Total Hip Replacement?
Proper exercise can reduce joint pain and stiffness and increase flexibility and muscle strength. People with artificial hips should discuss developing an appropriate exercise programme with their doctor or physical therapist. Most exercise programmes begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when the patient can move on to more demanding workouts. Many doctors recommend avoiding high-impact activities like basketball, jogging, and tennis. These activities can damage the new hip or cause the loosening of its parts. Some recommended exercises are cross-country skiing, swimming, walking, and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.