What is a Joint Replacement?
JOINT REPLACEMENT: SPARE - PART SURGERY!Only those with arthritis know how painful it is and how debilitating
the pain can be. Until a few years ago, persons with severe arthritis
suffered agonizing pain, had to limit their activities, were disabled
and often became bedridden and housebound. Joint replacement surgery
offers relief from the pain and an improved quality of life.
Remarkable advances have been made in joint replacement technology
over the last few years. the materials are long-lasting and durable.
The surgical technique has become better. As a result, joint replacement
operations are now among the most successful of all operations -
provided they are performed in well-equipped centers by surgeons
specially trained and experienced in performing these highly technical
operations.
In this operation, the damaged bone ends and cartilage are replaced
with artificial surfaces. These usually consist of two parts that
are shaped like the normal bone ends and designed to restore function
and movement like the normal joint while getting rid of pain.
Why is Joint Replacement necessary?
Once cartilage is badly damaged there is no known treatment to
make it grow again and function normally. The bare bone ends without
cartilage rub against each other producing pain and later become
roughened leading to difficulty in movement. At this stage joint
replacement surgery remains the only option.
How do I know when I am ready for Joint Replacement?
When all other methods of treatment have been tried and have failed
to relieve pain and disability, and when arthritis has affected
one’s quality of life, then joint replacement must be considered.
You must decide when the time is right for this surgery along with
your doctor. You are probably the best judge of when you need an
operation - when the pain becomes so chronic, so constant and so
crippling that nothing seems to help. You will know when you are
ready. Ideally your age should be over 60-65 years although patients
with RA and some other conditions may need surgery at a younger
age.
What are the benefits of Joint Replacement?
Once healing is complete, you will reap the benefits of surgery
such as:
++ Freedom from pain
++ Easier movement and mobility
++ Increased leg strength
++ Improved quality of life through greater independence
++ Ability to return to most pastimes (walking, swimming, golf, etc).
++ Which joints can be replaced?
The hip and knee joints are most commonly replaced. Worldwide over
500,000 replacement operations are performed each year. Shoulder,
elbow and small joints of the hand can also be replaced but this
is done less often.
What are the new joints made of?
The artificial joint consists of a special metal part on one side
and dense plastic (polyethylene) on the other side usually fixed
to bone with special bone cement. The materials are well tolerated
by the body and rarely cause any reaction or allergy. Imported joints
cost more but have been successfully used for 10-20 years. Hundreds
of different models of joints are available. Some perform better
and have superior results to others.
What are the preparations for surgery?
Before surgery, you need to:
++ Undergo a complete medical check-up and some tests (blood tests,
x-rays,
ECG, etc)
++ Stop or start some drugs before surgery
++ Learn specific exercises to speed your recovery
++ Lose excess weight
++ Stop smoking
What type of anaesthesia is needed?
Surgery may be carried out under
general anaesthesia when the patient is made fully unconscious
or
spinal or epidural anaesthesia when only the legs are made numb.
The decision depends partly on the medical condition and preference
of the patient, and the judgment of the doctor giving the anaesthesia.
Will the operation be painful?
With modern techniques of anaesthesia and better medication available,
pain can be very well controlled during the operation (which lasts
1-2 hours) and afterwards. After the first few days, the need for
pain medication reduces considerably and usually there is very little
or no pain by the time the patient is ready to go home.
What to expect after surgery?
You will be in bed for the first day after surgery, with a drip
providing intravenous fluids and tubes to allow injections to be
given. There will be one or two tubes (drains) coming out from the
dressing around the operated part. You will be advised to keep your
leg on a pillow and start exercises for the leg right away. Over
the next few days, most tubes will be removed and more exercises
started. Standing and walking will commence in a day or two, initially
with a walker, and later with a stick or crutches. Periodically
the dressing will be changed to check the progress of wound healing.
Stitches (or staples) will be removed usually at the end of two
weeks.
How long do I need to stay in hospital?
Most patients can go home within one week and return for removal
of sutures two weeks after the operation.
How soon will I recover? After a hip or knee replacement you will
be made to stand and begin walking in a day or two after the operation.
Initially, you will be given a walker, crutches or stick. By 4-6
weeks, most patients can walk unaided, climb stairs and can do most
daily activities independently. This depends to some extent on the
condition of the other leg, muscle strength and one's motivation
to perform exercises, which play a vital role in the recovery process.
Will I need physiotherapy afterwards?
The exercises are quite simple and not as painful as some people
believe. Only in some severe cases is extensive physiotherapy needed.
Most patients are taught the exercises while in hospital and can
do them easily at home on their own. Rarely is physiotherapy needed
after a month.
How successful is Joint Replacement?
As the new surfaces are artificial, there is no pain on movement.
Results are very good in 9 out of 10 people and last for 10-15 years.
Indeed, joint replacement is the most successful operation for severe
arthritis provided the following three requirements are satisfied:
++ It is performed properly by surgeons specifically trained and experienced
to
perform replacement surgery
++ It is carried out in a well-equipped centre with appropriate facilities
++ It is done in a person who is well motivated, understands the limitations,
and
follows instructions.
++ In what way will my new joint be different?
Initially the knee may feel a little different. However, soon you
will become used to it and will even forget that you have had an
artificial joint implanted.
What are the possible risks and complications?
If you are in average health, the risk of dying from the operation
is so slight that it is no greater than the normal risk associated
with everyday activities. Every care is taken to prevent complications,
but sometimes they are unavoidable.
Infection of the new joint is the most severe complication that
may occur. The risk of infection is minimum - less than 1% - if
the operation is performed in specially-designed operation theatres
with laminar airflow, by using special gowns and other advanced
techniques. If infection does not respond to antibiotics, a further
operation may be needed to remove the new joint. By advanced techniques
another joint may be inserted after an interval. Care must also
be taken that infection elsewhere in your body is treated so that
it does not spread to the joint.
Loosening of the joint may occur but, if it occurs at all, it is
usually after many years of good use of the part and may be seen
in 5-10% patients after 10-15 years or more. Sometimes it is due
to poor technique, and sometimes due to overuse by the patient who
has not followed instructions. If it causes pain, revision of the
replacement may be required.
Blood clots may occur in the veins of the legs due to many factors.
Your doctor will take precautions to reduce the risks and will explain
these measures to you.
Dislocation of one of the components may occur. This is commoner
after hip than knee replacement and occurs in 1-2% cases. Following
instructions carefully in the first few weeks can greatly reduce
the chance of this happening.
Wear occurs to some extent in all joint replacements. Wear depends
on the design and quality of the materials, the load on them (your
weight and activity level) and length of time since they were implanted.
Only if excessive wear occurs and causes loosening does it need
revision.
How can I increase my chances for success?
Choose a surgeon who is a specialist in joint replacement surgery
and does them regularly and frequently, not once in a while.
Make sure that the operation theatre is appropriate for joint replacement
surgery.
Ensure that the surgeon is going to use good quality parts.
Meet with and talk to several other patients who have been operated
upon by the surgeon performing your operation.
Follow the instructions given by your surgeon.
What are the do’s and don’ts after Joint Replacement?
Walk as much as you want, play golf, swim and even dance.
Avoid strenuous sports, such as singles tennis or running.
Do not squat or sit on the floor.
Keep your weight under control.
Watch for and prevent infection of any kind particularly urinary
and dental infections.
Regularly follow-up and visit your surgeon as advised by him to
ensure the long-term success of your operation.
Always check with your surgeon when in doubt.
Will my new joint last forever?
It may last up to 20 years providing you are careful with it -
and techniques are getting better and better all the time. Most
older persons can expect their total joint replacement to last the
rest of their lifetime, giving them years of pain-free living that
would otherwise not have been possible. Younger patients may need
a second replacement - called revision surgery. The first joint
is removed and a new one can be inserted. Materials and techniques
are constantly improving and the future is bright for those who
choose to have a joint replacement.
Shoulder Replacement
The shoulder is a ball-and-socket joint. Shoulder Replacement is
required most commonly for rheumatoid arthritis, severe fractures
and fracture-dislocations, and osteoarthritis. In some conditions
only the ball is replaced, in others both ball and socket are replaced.
Elbow Replacement
This operation is done for rheumatoid arthritis and elbows that
have been severely damaged by prior injury (such as fractures or
disclocations).
Hip Replacement
Commonly this operation is done for certain type of hip fractures,
avascular necrosis, ankylosing spondylitis and rheumatoid arthritis.
Unicompartmental Knee Replacement
This lesser known operation can only be done in selected patients
who have osteoarthritis affecting only one half (called compartment)
of the knee joint. It is in many ways a superior option to the older
operation of tibial osteotomy.
Total Knee Replacement
Most commonly performed for Osteoarthritis affecting all three
parts (compartments) of the knee, it is also done for rheumatoid
arthritis, gout, and occasionally for arthritis following severe
trauma to the knee.
Revision Joint Replacement
The best results of Joint Replacement are when it is done correctly
the first time. However, due to loosening after many years or infection
setting into the joint, repeat surgery (called Revision) may be
required. With advanced techniques, the results are almost as good
as if done for the first time.
How do I proceed further if I think I need Joint Replacement?
If you have severe pain from arthritis and want a better quality
of life, make up your mind whether you might need joint replacement
after asking yourself six questions:
++ Am I suffering from intolerable pain?
++ Is it getting worse over the last few weeks or months?
++ Is the pain constantly troubling me, even when I am sitting or sleeping?
Am I unable to carry out my daily activities and do things that
I like (such as
going out to meet people, taking long walks, etc.)?
++ Is no treatment that I have tried really helping me?
++ Is this how I want to live the rest of my life?
If the answer to questions 1-5 is "Yes" and the answer
to the last question
is "No", then you must consult a
specialist doctor who can help you.
How do I choose a specialist in this field?
Find a good specialist you like and one you can talk to comfortably.
He should be experienced in arthritis surgery and should be a specialist
in Joint Replacement surgery and doing lots of them regularly. Results
are better if surgeons do more than 100 replacements a year. Select
your specialist carefully even if you have to travel a long distance
to see him. Take your time and remember, there is never any rush
to get admitted and have surgery urgently. Make sure your doctor
has enough time for you, talks in simple language that you understand,
explains and listens to you. To get the most out of your doctor,
communicate well with him.
Prepare: Write your questions down and have a clear idea why you
are visiting him. If possible prepare a summary of your history,
symptoms, treatments tried, side-effects, etc. Take with you all
your x-rays and previous medical reports.
Ask: questions about your diagnosis, tests, treatment options,
future outlook and follow-up visits.
Repeat: anything important the doctor has told you to double-check
that there is no misunderstanding.
Take action: Make sure you understand what to do next. If in doubt,
do not hesitate to ask for a second opinion. Most good doctors will
not feel offended and will even suggest some other names.
Five questions to ask your doctor
Can I undergo an operation with my medical condition and specific
circumstances?
Will Joint Replacement improve my condition?
What are the specific risks in my case?
What will happen if I do not choose to have an operation?
Can I meet and speak with several people who have had the operation?
Once you have come so far you the last thing left is…
Making up your mind: They conquer who believe they can
We have tried to give you plenty of facts. Read them. Digest them.
The possession of facts is knowledge; the use of them is wisdom;
the choice of them, education. The choice is yours. Choose wisely.
The power within you and the support that lies behind you are infinitely
greater than the problem that lies ahead of you.
Remember, where you are today is the result of choices you made
yesterday. But where you will be tomorrow will be the result of
decisions you will make today.
For Detailed Dossier on
Joint Replacement Surgery, please write to us at
mktg@mediescapes.com
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