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Joint Replacement

A joint is where the ends of two or more bones meet. There are different types of joints within the body. The knee is considered a “hinge” joint, because of its ability to bend and straighten like a hinged door. The hip and shoulder are “ball-and-socket” joints, in which the rounded end of one bone fits into a cup-shaped area of another bone.

Several conditions can cause joint pain and disability and lead patients to consider joint replacement surgery. In many cases, joint pain is caused by damage to the cartilage that lines the ends of the bones (articular cartilage)—either from arthritis, a fracture, or another condition.

If nonsurgical treatments like physical therapy, bracing, medications, injections and changes to your everyday activities do not relieve your pain and disability, your doctor may recommend total joint replacement.

Total Knee Replacement

The goal of knee replacement surgery is to decrease pain and restore function. Although total knee replacement (also called “arthroplasty”) is an excellent option for patients with osteoarthritis of the knee, other options exist.

Your knee is divided into three major compartments: the medial compartment (the inside part of the knee), the lateral compartment (the outside part) and the patellofemoral compartment (the front of the knee between the kneecap and thighbone).  Patients with osteoarthritis that is limited to just one part of the knee may be candidates for unicompartmental knee replacement (also called a “partial” knee replacement).

Total knee replacement (also called knee arthroplasty) is a common orthopedic procedure that is used to replace the damaged or worn cartilage, as well as any related loss of ligament support or bone structure. The procedure is a resurfacing of the damaged knee. Replacing these surfaces with an implant or “prosthesis” will relieve pain and increase mobility, allowing you to return to your normal, everyday activities. Total knee replacement is performed to treat advanced arthritis. It is considered when deterioration of the gliding surfaces in the knee joint has advanced to the point where medical management is not effective and pain has become severe and debilitating.

In a unicompartmental knee replacement, only the damaged compartment is replaced with metal and plastic. The healthy cartilage and bone in the rest of the knee remain untouched.

Partial knee resurfacing minimizes the trauma to healthy bone and tissue as the surgeon removes only damaged bone and fits the prosthetic to that bone.

After a regional (spinal) or general anesthetic is administered, the surgeon makes a small incision to gain visibility into the injured knee compartment. He or she extracts damaged cartilage and bone tissue from the surfaces of the tibia and femur and inserts the prosthetic components, which are sized specifically to the patient’s joint. Cement is used to hold the prosthetic in place.

In a partial knee replacement, only the damaged portion of the knee is replaced with metal and plastic.  The healthy cartilage and bone in the rest of the knee remain untouched.

Partial knee resurfacing minimizes trauma to healthy bone and tissue as the surgeon is only placing an implant on the specific area of damage in the knee; leaving the rest of the cartilage in the knee alone.

After a regional (spinal) or general anesthetic is administered, the surgeon makes a small incision to gain visibility into the injured knee compartment.  He or she extracts damaged cartilage and bone tissue from the surfaces of the tibia and femur and inserts the prosthetic components, which are sized specifically to the patients joint.  Cement is used to hold the prosthesis in place.

Total Hip Replacement

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other. The acetabulum is ringed by strong fibrocartilage called the labrum which forms a gasket around the socket. The joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. The interior of the capsule is lined by a thin membrane called the synovium. It produces synovial fluid that lubricates the joint.

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 285,000 total hip replacements are performed each year in the United States.

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

  • 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 (acetabulum) 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 liner is inserted between the metal socket to allow for a smooth gliding surface for the ball to move within

Osteoarthritis: This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.

Rheumatoid arthritis: This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed “inflammatory arthritis.”

Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.

Avascular necrosis: This occurs when an injury to the hip, such as a dislocation or fracture, limits the blood supply to the femoral head. The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.

Childhood hip disease: Some infants and children have hip problems that though successfully treated may still cause arthritis later in life. This occurs because the hip doesnot grow normally, and the joint surfaces are affected.

Total Shoulder Replacement

Total Ankle Replacement

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