Primary Total Hip Replacement
Here, the parts of the hip that are damaged are replaced by artificial implants. Usually, total hip replacement is suggested when arthritis has completely damaged the hip joints. When the patient is unable to lead a normal life because of hip pain, this procedure will aid in restoring near normalcy. The arthritis could be due to various causes.
- Osteoarthritis: Here, the cartilage inside the joints is damaged. Hence there is more friction and consequently more wear and tear.
- Rheumatoid Arthritis: This is an autoimmune condition in which the body’s immune system attacks its tissues.
Other than arthritis, osteonecrosis might also lead to a need for total hip replacement. Preparing for surgery involves giving a detailed medical history to your doctor, performing various blood tests and getting an x-ray. The surgical procedure is performed under general or spinal anaesthesia. Post-surgery, you might have to stay at the hospital 3 to 4 days. Smoking should be avoided as it inhibits healing. Physiotherapy will be started at the hospital, and this has to continue even after the patient goes home. Physiotherapy is an important part of the recovery process as it aids in strengthening the area. In 6-12 weeks, most of the daily activities can be resumed. However, high-impact sports should be avoided. Your doctor will guide you on the exercises that can be carried out without stressing the joint.
Revision Total Hip Replacement
A revision hip replacement might be needed by patients who have undergone total hip replacement in the past. The reason could be wear and tear of the prostheses, after which it becomes painful. Another reason could be an infection which damages the areas surrounding the hip joint. Both these conditions will cause a lot of hip pain and will inhibit normal functioning and movement. To restore mobility and improve quality of life, revision hip replacement is done.
Surgical preparation involves blood tests, x-ray, bone scans, etc. The doctor will need a detailed list of the medications the patient is taking; especially if the patient is on aspirin or blood thinners, the doctor has to be kept informed. During surgery, the old prostheses in the hip are replaced with new ones. Sometimes, if the hip is infected, more than one revision surgery will be required. In the first, the prosthesis will be removed. After the infection has been treated and healed, a second surgery will be performed to place a new prosthesis. 5 -7 days of hospitalization will be required. Recovery involves regular physiotherapy. Recovery is longer than after primary hip replacement and may take 6 weeks to 3 months.
Primary Total Knee Replacement
When the knee is damaged due to arthritic changes and even simple daily activities cause pain, a total knee replacement is suggested to relieve pain and perform normal activities once again. Pain while walking, climbing stairs, sitting down and getting up, etc. might all be successfully relieved with this procedure. The surgeon will perform a few tests to make sure the knee replacement will benefit the patient. These include tests to check the knee’s range of movement and strength. The choice of prostheses is varied, and the surgeon will choose one after taking into consideration the patient’s age, the activity the knee will be subjected to, knee structure, etc.
The surgery will take around 1 1⁄2 – 2 hours and will be performed under general or spinal anaesthesia. Hospitalization of around 4-5 days will be required. For the post-surgery pain, medications will be given. On the same day following surgery, physiotherapy will commence. The patient will also be apprised on how to take care of the surgical site and what diet to consume. If high fever sets in or if the patient experiences rigor or inflammation in the knee area, the doctor should be consulted immediately. Recovery will take around 3-6 weeks. Activities that do not stress the knees can be performed. High-impact sports are best avoided.
Revision Total Knee Replacement
Total knee replacements are very successful surgeries. But like everything else, the prosthesis used in total knee replacement can wear out. After that, it will need to be replaced. Factors like body weight and high-impact activities will also have an effect on the life of the prosthesis. Thus, a prosthesis that was once firmly fixed might move, leading to knee pain. Also, minute particles may get eroded from the plastic spacers used in the previous surgery, and these particles will face action from the body’s immune system. During the process, the bones too might get attacked by the immune system leading to a condition called osteolysis. This again will require revision knee replacement. Infection is a possibility in any surgery. An infection may set in immediately or even many years after the primary total knee replacement. The patient will experience pain, rigidity and inflamma-tion in the knee. This is another condition which will make revision surgery a necessity.
A revision surgery is more complex than the initial primary total knee replacement. Talk to the doctor about the possible complications of surgery. A number of tests will be conducted to determine the feasibility of surgery. Done under spinal anaesthesia, the procedure will take 2-3 hours. The surgeon will remove the old implant and replace it with a new one. Bone grafting might be done as well. After surgery, hospitalization of 5 days will be needed. After discharge, the patient will need help at home too for the ini-tial few days.
Partial Knee Replacement
When arthritis has damaged only a part of the knee, surgery can be done to replace the damaged part alone. This is called partial knee replacement. Done under either spinal anaesthesia, a prosthesis replaces the damaged part only. Recovery is relatively quicker. The range of motion in the knee after surgery is also more. Complete recovery will take around 2-3 weeks
Total Shoulder Replacement
Arthritis may cause severe shoulder pain in some patients. Movement of shoulder without experiencing pain may not be possible, thus debilitating the patient. To get pain relief, total shoulder replacement is performed. Another reason to consider total shoulder replacement is a bad fracture.
In total shoulder replacement, shoulder joints are replaced with prostheses. Before surgery, diagnostic tests like x-ray or MRI will be done. Blood tests too will be conducted. The surgery may be performed under general anaesthesia, with the patient in a seated position. The joints affected by arthritis will be replaced with prosthesis. After surgery, the arm movement will be restricted with a sling. Gradual movements will be started. Recovery will take around 6- 8 weeks. Lifting heavy objects should be avoided.
Reverse Shoulder Replacement
The shoulder joint is indeed one of the more complex joints in the human body. The upper arm bone and the shoulder blade meet to form the ball and socket joint of the shoulder. In a reverse shoulder replacement, as the name implies, the position of the ball and socket are interchanged. To elaborate, a metal ball takes the place of the socket and a plastic socket replaces the ball. This makes the joint more stable, and there is no need for the surrounding tendons to provide stability. Thus, in cases where the tendons are also damaged, reverse shoulder replacement is a good option. Patients who suffer from arthritis along with a torn rotator cuff are ideal candidates.
The surgical procedure will take around 3 hours. The patient will have to stay in the hospital for 4-5 days. This surgery is not recommended for patients who smoke as it will inhibit recovery. It is also not recommended for patients with systemic infection and those suffering from severe osteoporosis.
Total Elbow Replacement
The elbow joint is a hinge joint where three bones meet. The bones are the humerus, the radius, and the ulna. There is a cartilage present at the point where the bones meet each other to aid in smooth movement. There is also a synovial membrane which secretes a fluid to help in friction-free movement. The elbow joint is stabilised by the surrounding muscles and ligaments. When the elbow is damaged and the pain prevents normal activities, total elbow replacement is done wherein the elbow joints are replaced with prosthesis.
The reasons for elbow damage could be many: rheumatoid arthritis, osteoarthritis, a bad road traffic accident, etc. Depending on the extent of damage, total or partial elbow replacement may be required. The surgery will be performed under general anaesthesia and will last around 3 hours. Before surgery, a number of investigations will be done and detailed medical history will be recorded. Any medications the patient is on should be communicated to the doctor. After surgery, hospitalization of 2-4 days will be needed, during which antibiotics will be given to prevent possible infection. Physiotherapy will also be taught. Total elbow replacement will help the patient resume normal activities. However, activities that involve a lot of pressure on the elbows are best avoided.