Hip and Knee Replacement Surgeries are now performed commonly., so let us understand more about it.
ABOUT HIP AND KNEE JOINTS
Hip joints and knee joints are the two most important weight-bearing joints of the body. They are the strong pillars responsible for maintaining proper posture of the body. The hip and knee joints are highly mobile and provide a good range of movement to the person. These joints play a major role in different body movements, such as walking, running, jogging, dancing, etc.
Therefore, if these joints are affected, it can adversely impact the person’s daily life significantly.
Arthritis or inflammation in the joints leads to damage of the bone ends and cartilage.
As a result, the person faces a lot of difficulties while walking or moving the joints. Medical treatment consists of anti-inflammatory drugs as pills/injections and many other modalities, options, and health measures. However, in many cases, there may be no or inadequate relief, and quality of life may not be optimum. At the same time taking medicines long-term can also have its own limitations, and cannot be given indefinitely.
Surgery is an effective, readily available, and lasting option. The joints can work perfectly fine just like before after a Hip or a Knee Replacement Surgery.
JOINT REPLACEMENT SURGERY
Total Joint Replacement Surgery is a surgical process in which some parts of a damaged or an arthritic joint are replaced with metal, ceramic, or plastic devices. Essentially joint replacement involves resurfacing the joint with an artificial metallic coating. These devices are called implants or prostheses. These implants are designed in a way to reproduce the joint motion with full range of motion (ROM).
There are various types of implants that can be considered. But certain points are to be kept in mind before finalizing an implant such as-
- Joint anatomy of the individual patient
- Patient’s weight, height, and age
- Patient’s health status and physical activity level
Total Knee Replacement (TKR)
Implants are made up of ceramic, plastic, or metal alloys. During a TKR, up to 3 bone surfaces are replaced –
- lower end of the femur (thigh bone)
- back surface of the patella (knee cap)
- top surface of tibia (shin bone)
Total Hip Replacement (THR)
The femoral head or the ball is replaced with a metallic ball and its socket (acetabulum) is resurfaced with a metallic or plastic part depending on the type of total hip replacement being performed.
The damaged femoral head is removed and replaced with a metal ‘stem’ that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press-fit” into the bone. A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
The damaged cartilage surface of the socket is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Various implant designs are made keeping in mind the individual joint movements. For example, various designs for TKR include posterior stabilized designs, cruciate-retaining design, fixed bearing implants, mobile-bearing implants etc.
All the designs are crucial and have both advantages as well as disadvantages. Finally, the type of implant is best chosen by the surgeon after having considered every individual factor.
In THR, implants differ in the way they are fixed as in being bone-cemented or uncemented (press fit). In cemented total hip replacement both the socket and stem are fixed in parent bone with bone cement, while uncemented components don’t need the use of bone cement and are implanted as press-fit in the host bone.
POST-OPERATIVE CARE IN HOSPITAL
Pain management after joint replacement surgery is of utmost priority and is followed by a combination of pain control medicines which are administered through different routes- oral, intravenous and use of indwelling epidural catheters through which a local anesthetic agent is given for a period of 2-3 days. Perineurial nerve blocks with use of indwelling catheters has further revolutionized pain control. This combination of various pain control agents using different pathways is called multimodal analgesia (pain relief), a technique that gives effective pain control after joint replacement surgery
The stitches or staples are removed approximately 2 weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
It is essential to mobilize the operated joint early to get the best benefits of the surgery and to avoid the problem of clot formation in the leg or pelvic veins. One should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for some weeks.
Your activity regime should include:
- A graduated walking program to slowly increase your mobility, initially in your home and later outside.
- Resuming other normal household activities, such as sitting, standing, and climbing stairs.
- Specific exercises several times a day to restore movement and strengthen your joint. You probably will be able to perform the exercises without help, but you may need the supervision of a physiotherapist for few days
COVID Precautions at Hospitals
Hospitals are going to great extents to effectively mitigate the risk of COVID infection while in the hospital for joint replacement surgery. The precautions taken are-
- COVID patients are kept on separate floors
- All patients, visitors and employees are to compulsorily wear masks
- Screening of patients and employees upon arrival
- Completely isolating COVID patients from other patients
- Practicing social distancing in waiting rooms
- Increasing housekeeping and vigilance in the disinfection protocols
- Testing every patient for COVID prior to surgery
POST-SURGERY HOME CARE
Once at home after undergoing a joint replacement surgery, it is very important to follow certain instructions post-operatively –
- Proper dressing of the wound
- Taking bath only after the dressing has dried
- Taking proper medications prescribed by the surgeon
- Physiotherapy (full range of motion can be started the next day of the operation if the conditions permit)
- Weight-bearing and gait-training after 7-10 days with/without assistance (depending upon the conditions of the patient)
- Follow-up consultations as advised
There are some warning or alert signs that the person is required to be vigilant about, and must contact the surgeon immediately-
- Infection signs – swelling, redness, discharge, increased pain, fever
- Blood clots formed deep in the veins can cause swelling or pain in that particular part.
- Embolism is the detachment of the blood clots and their deposition to another site leading to symptoms. If they lodge in the lungs (pulmonary embolism), there can be cough, breathlessness and chest pain.
- Dislocation of joint
- Excessive and persistent pain
- Joint stiffness
SHOULD ONE OPT FOR JOINT REPLACEMENT SURGERY?
Joint Replacement Surgery is suggested after all the conventional methods of treating damaged joints have failed. If you have such symptoms and are tired of taking repeated medications, you may want to consider surgery for longer-lasting pain relief and an improved lifestyle. Consult a good Orthopedic Surgeon who can guide you further.
Dr. Biren Nadkarni (MBBS, MS Orth., MCh Orth., Dip. SIROT; Zimmer Arthroplasty Fellowship- Germany, AO Trauma Fellowship – Austria) is a Consultant Orthopedic & Joint Replacement Surgeon at Sitaram Bhartia Institute and Holy Family Hospital, New Delhi. He also practices at Joint & Bone Solutions, Hauz Khas, New Delhi.