Knee
Knee Replacement
What Is A Knee Replacement?
Total knee replacement began in the 1970’s. Since then it has become a very common procedure. The aim of the operation is to replace the bottom end of the femur and the top end of the tibia with a man made device (prosthesis). The back surface of the patella is also commonly replaced. These devices are combinations of metal and plastic and occasionally ceramic materials. They are fixed to the bone either using bone cement or by using prosthesis with a rough surface, which relies on your bone growing on to the implant for long term stability. It may be reinforced with screws on the tibial side. In between the two components is a special plastic liner made out of polyethylene.
Arthroscopic Surgery
What is partial shoulder replacement?
Partial shoulder replacement, also called shoulder hemiarthroplasty is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact.
Why is partial shoulder replacement recommended? This surgical procedure is indicated in severe, persistent conditions of shoulder osteoarthritis in which the only the humeral head or ball of the joint is damaged. Osteoarthritis is a degenerative condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bone to rub against each other resulting in pain and stiffness. In such conditions, replacement of the damaged portion of the humerus will reduce the friction as bone ends can no longer come in contact and thus relieve pain.
Surgery remains as a sole treatment option when all possible conservative means of treatment such as rest, anti-inflammatory medications, physical therapy have been ineffective in resolving your symptoms. What are the risks associated with partial shoulder replacement? While the procedure may relieve your pain and other symptoms, there may also be associated risks and complications as with any major surgery.
Potential risks and complications that may occur following shoulder hemiarthroplasty include infection, instability, fractures of the humerus or scapula, shoulder stiffness, damage to the blood vessels and nerves.
Why is partial shoulder replacement recommended? This surgical procedure is indicated in severe, persistent conditions of shoulder osteoarthritis in which the only the humeral head or ball of the joint is damaged. Osteoarthritis is a degenerative condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bone to rub against each other resulting in pain and stiffness. In such conditions, replacement of the damaged portion of the humerus will reduce the friction as bone ends can no longer come in contact and thus relieve pain.
Surgery remains as a sole treatment option when all possible conservative means of treatment such as rest, anti-inflammatory medications, physical therapy have been ineffective in resolving your symptoms. What are the risks associated with partial shoulder replacement? While the procedure may relieve your pain and other symptoms, there may also be associated risks and complications as with any major surgery.
Potential risks and complications that may occur following shoulder hemiarthroplasty include infection, instability, fractures of the humerus or scapula, shoulder stiffness, damage to the blood vessels and nerves.
Conventional Shoulder Replacement
What is shoulder arthritis?
The term arthritis literally means inflammation of a joint but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. In an arthritic shoulder
- The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis. - The capsule of the arthritic shoulder is swollen. - The joint space is narrowed and irregular in outline; this can be seen in an X-ray image. - Bone spurs or excessive bone can also build up around the edges of the joint. Diagnosis of shoulder arthritis Doctors diagnose arthritis with a medical history, physical exam and X-rays of the shoulder. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.
Treatment of shoulder arthritis Your doctor may recommend anti-inflammatory medicine and occupational therapy or physiotherapy. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. A common surgery for treatment of shoulder arthritis may be total shoulder arthroplasty (replacement of the damaged joint).
What is shoulder joint replacement? Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial joint parts. There are two types of total shoulder replacements: a conventional shoulder replacement and a reverse shoulder replacement.
What is conventional shoulder joint replacement? Conventional total shoulder arthroplasty is a shoulder replacement surgery for patients who suffer from osteoarthritis but have an intact rotator cuff. A conventional prosthesis mimics the normal anatomy of the shoulder. The surgery involves replacing the round part of the joint with a metal ball and resurfacing the socket with a plastic cup. The aim of the surgery is to restore function to the shoulder joint by removing the damaged cartilage and bone.
- The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis. - The capsule of the arthritic shoulder is swollen. - The joint space is narrowed and irregular in outline; this can be seen in an X-ray image. - Bone spurs or excessive bone can also build up around the edges of the joint. Diagnosis of shoulder arthritis Doctors diagnose arthritis with a medical history, physical exam and X-rays of the shoulder. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.
Treatment of shoulder arthritis Your doctor may recommend anti-inflammatory medicine and occupational therapy or physiotherapy. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. A common surgery for treatment of shoulder arthritis may be total shoulder arthroplasty (replacement of the damaged joint).
What is shoulder joint replacement? Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial joint parts. There are two types of total shoulder replacements: a conventional shoulder replacement and a reverse shoulder replacement.
What is conventional shoulder joint replacement? Conventional total shoulder arthroplasty is a shoulder replacement surgery for patients who suffer from osteoarthritis but have an intact rotator cuff. A conventional prosthesis mimics the normal anatomy of the shoulder. The surgery involves replacing the round part of the joint with a metal ball and resurfacing the socket with a plastic cup. The aim of the surgery is to restore function to the shoulder joint by removing the damaged cartilage and bone.
Reverse Shoulder Replacement
What is reverse shoulder replacement?
Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear.
The shoulder joint is a ball and socket joint formed by the union of the head of the upper arm bone (humerus) and the shoulder socket (glenoid).
A rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.
When the rotator cuff is torn, it can cause wear and tear to the shoulder joint and lead to shoulder arthritis. Conventional surgical methods such as total shoulder joint replacement have been shown to be significantly ineffective in the treatment of Rotator cuff arthropathy.
Conventional shoulder replacement surgery involves replacing the ball of the arm bone (humerus) with a metal ball and the socket (glenoid cavity) of the shoulder blade (scapula) with a plastic socket. If this surgery is used to treat rotator cuff arthropathy, it may result in the loosening of the implants due to the torn rotator cuff. Therefore, a specifically designed surgery was developed called reverse total shoulder replacement to be employed in such cases.
In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. In other words, the humeral ball is placed in the glenoid cavity of the shoulder blade (scapula) and the plastic socket is placed on top of the arm bone. This design makes efficient use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.
Symptoms
Patients with rotator cuff arthropathy may feel pain (usually at night) and weakness within the involved shoulder. Patients may have had a prior rotator cuff repair or a history of multiple repairs. The most common symptom is the inability to raise the arm above the shoulder to perform overhead activities.
Why is reverse shoulder replacement recommended?
Reverse total shoulder replacement may be recommended for the following situations:
- Completely torn rotator cuff that is difficult to repair
- Presence of cuff tear arthropathy
- Previous unsuccessful shoulder replacement
- Severe shoulder pain and difficulty in performing overhead activities
- Continued pain despite other treatments such as rest, medications, cortisone injections, and physical therapy
Procedure for reverse shoulder replacement
Reverse total shoulder replacement surgery is performed with the patient under general anaesthesia.
- Your surgeon makes an incision over the affected shoulder to expose the shoulder joint
- The humerus is separated from the glenoid socket of the scapula (shoulder blade)
- The arthritic parts of the humeral head and the socket are removed and prepared for insertion of the artificial components
- The artificial components include the metal ball that is screwed into the shoulder socket and the plastic cup that is cemented into the upper arm bone
- The artificial components are then fixed in place
- The joint capsule is stitched together, the tissues approximated and the wound is closed with sutures
Post-operative care following reverse shoulder replacement
Patients can get out of the bed on the same day of the surgery but usually, stay in the hospital for 1-2 days. General post-operative instructions include:
- Take all prescribed medications as instructedUndergo gentle range of motion exercises to increase your shoulder mobility
- Physical therapy will be recommended to strengthen the shoulder and improve flexibility
- Avoid overhead activities for at least 6 weeksDon't push yourself up out of a chair or bed using your shoulder muscles
- Avoid lifting heavy objectsRisks and complications associated with reverse shoulder replacement
Possible risks and complications associated with reverse total shoulder replacement surgery include:
- Infection
- Dislocation or instability of the implanted joint
- Fracture of the humerus or scapula
- Damage to nerves or blood vessels
- Blood clots (deep vein thrombosis)
- Wound irritation
- Arm length discrepancies
- Wearing out of the components