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Joint Replacement Surgery

What is Knee Replacement? (Knee Arthroplasty pronounced as ARTH-ro-plas-tee)

In simple terms, Knee replacement is a surgical procedure most often performed to relieve the pain and disability and restricted mobility arising out of degenerative arthritis. Major causes of debilitating pain include meniscus tears, osteoarthritis, rheumatoid arthritis, post trauma, ligament tears, and cartilage defects.

Knee Replacement at Nidhi

Nidhi Hospital has been carrying out Knee Replacement Surgeries. Patients at Nidhi do not go through the traumatic post-op pain thanks to the use of high end technology, the highly rated skills of its surgical team and of course analgesics.

Also, at Nidhi Hospital, TKR (Total Knee Replacement, is minimally invasive and which can be rightfully termed as the quickest surgery possible.. It is medically proved that the lesser time the patient spends in OT, lesser is the tissue trauma and quicker is the healing. Majority of patients in Nidhi are on their feet the very next day with encouragement to walk under the supervision of well trained and dedicated team of Physios. On the 4th day patients are given staircase climbing training to ensure maximum flexion of muscles and also as a confidence building measure.

At Nidhi Hospitals the patients are treated under highly sterile conditions in Class 100 OTs that match the strictest infection control standards. The use of Surgical Space Suit worn by our surgeons during the surgery to rule out the minutest possibility of an infection.

Salient Features of Department of Knee Replacement

  • Painless Knee Replacement (Total & Partial)
  • Quick Knee Surgery
  • Good Flexion of the knee
  • Use of superior quality implants (prosthesis)
  • Quick Post – Surgical Mobilization
  • Knee Revision Surgery
  • Dedicated team of Physiotherapists

Knee Revision Surgery

Knee revision surgery, which is also known as revision total knee arthroplasty, is a procedure in which the previously implanted artificial knee joint, or prosthesis is removed. It is replaced with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an auto graft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from another donor.

Reasons for Knee Revision Surgery

A knee joint may malfunction or fail due to one or many reasons, some of them may be:

  • Infection
  • Aseptic Loosening
  • Wear of plastic
  • Mal-alignment
  • Unstable Joint

Different types of Knee Replacement surgeries

Yes, primarily there are two kinds of Knee replacement surgeries TKR (Total Knee Replacement) and UKR (Unicondylar / Partial Knee Replacement). Knee Replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee joint. This is termed as Implant or Prosthesis.

Partial Knee Replacement (PKR)

Partial knee replacement, also called ‘unicompartmental knee arthroplasty or unicondylar knee arthroplasty' is a surgery that may be considered for treatment of osteoarthritis of the knee joint where the complete knee joint does not require replacement. Traditionally, patients have undergone total knee replacement for severe arthritis of the knee joint. In a total knee replacement, all cartilage is removed from the knee joint, and a single metal and plastic implant (prosthesis) is substituted.

Conditions for Partial Knee Replacement

The partial knee surgery may be possible if the arthritis in the knee is confined to a limited area. If the arthritis is widespread, then the partial knee replacement is not the solution. . In addition, the partial knee surgery is recommended in patients who are:

Total Knee Replacement (TKR)

In a Total Knee Replacement procedure, the surgeon removes damaged cartilage and bone from the surface of knee joint and replaces them with metal and plastic. In Total Knee Replacement, the surgeon replaces three parts of the knee joint.

The three parts of the prosthesis are fixed onto the ends of the femur, tibia, and undersurface of the patella using special bone cement. Usually, metal is used on the end of the femur, and plastic is used on the tibia and patella for the new knee surface.

Situations when TKR t is helpful

Pain that limits activities such as walking, climbing stairs and getting in and out of chairs, or even moderate or severe knee pain at rest.

Restricted knee function or mobility, such as chronic knee stiffness and swelling that prevents one from bending and straightening the knee.

Failure of other methods to improve symptoms, for example, resting, weight loss, physical therapy, a cane or other walking aid, medications, braces and surgery, but they've failed.

Knee deformity, such as a joint that bows in or out.

What to expect post TKR surgery?

At Nidhi Hospitals, under the expertise and guidance of Ortho Specialists, the results of a Total Knee Replacement are excellent. The operation relieves pain in patients, and they need no help walking after full recovery.

Reasons for Failure of Total Knee Replacement (TKR)

Like any other mechanical prosthesis (implant), knee implant also has a failure / malfunction possibility. There are several reasons which attribute to failure of a prosthesis (implant). Some of the major ones are:

  • Infection
  • Aseptic Loosening of the joint
  • Plastic Wear
  • Mal-alignment or Instability of the joint
  • Quality of the Implant

At Nidhi Hospitals we ensure that the patients are treated under highly sterile conditions. Our Class 100 OTs match the strictest infection control standards, we have pioneered the use of Surgical Space Suit which is worn by our surgeons during the surgery to rule out the minutest possibility of an infection. Positive Air pressure in the OTs makes sure that the air outside the complex making the OT completely sterile.

What is Knee Revision Surgery?

Knee revision surgery, which is also known as revision total knee arthroplasty, is a procedure in which the previously implanted artificial knee joint, or prosthesis is removed. It is replaced with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an auto graft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from a donor other than the patient.

 

Improved Mobilization – Total Hip Replacement (THR)

Total Hip Replacement (THR or Total Hip Arthroplasty)

Hip Replacement is a treatment modality when other pain management therapies fail to provide relief from the arthritis of the Hip. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Such joint replacement surgeries are generally conducted to relieve pain due to arthritis or severe physical joint damage as part of the hip fracture. After the Hip Replacement surgery one gets back all motions that one may need to carry out daily tasks. Also referred to as Total Hip arthroplasty or Total hip replacement

Why THR

Osteoarthritis of the hip joint is the most common reason for people opting in favour of Hip Replacement surgery. Hip Replacement is an option worth considering if there is severe pain, loss of motion or deformity of hip joint. Hip replacement is also used in people with hip injuries, rheumatoid arthritis and other medical conditions, such as a bone tumor or bone loss due to insufficient blood supply (avascular necrosis).

Symptoms requiring hip replacement:

  • Pain that keeps one awake at night
  • Little or no relief from pain medications
  • Difficulty walking up or down stairs
  • Trouble standing from a seated position
  • Having to stop activities such as walking, because of pain

Earlier Hip replacement was an option primarily for adults aged 60 and above. But rapid improvements in medical technology has made strong and longer lasting artificial joints easily available that are suitable for even active and younger people. However, active people face the possibility of another surgery to replace worn out artificial hip joints after 15 or 20 years.

Preparing for THR

Before the surgery an orthopedic surgeon will counsel the patient in person and carry out examination and evaluation. The surgeon will thoroughly check the patient’s medical history so as to ensure that the patient is healthy enough to undergo surgery. The surgeon will physically examine the hip, paying attention to the range of motion in your joint and the strength of the muscles around the hip. Blood tests, and X-ray or other radiological investigations are routine procedures that may be required..

This preoperative evaluation is a good opportunity to ask questions and doubts if any about the procedure..

The hip is a ball and socket joint, linking the "ball" at the head of the thigh bone (femur) with the cup-shaped "socket" in the pelvic bone ( as seen in the image below). A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint.

The total hip prosthesis (implant) consists of three parts:

A cup that replaces the hip socket. The cup is usually plastic, although some centers are trying other materials like ceramic and metal.

  • A metal or ceramic ball that will replace the fractured head of the thigh bone.
  • A metal stem that is attached to the shaft of the bone to add stability to the prosthesis.
  • If the surgery is a "hemi-arthroplasty," the only bone replaced with a prosthetic device is the head of the femur.

Expectations from the new joint

The Chances of a successful recovery in case of a THR are highly favourable as clinical studies show . Hip replacement surgery is successful more than 99% percent of the time. Expect the new hip joint to considerably reduce the pain and increase the range of motion in the joint. However, one must not expect to carry out activities which were not possible before the surgery such as extreme sports or advanced yogic postures.. Such and other high-impact activities — such as running or playing basketball — may never get the doctor's approval. However with time one can swim, play golf, walk or ride a bike comfortably.

Hip resurfacing: An alternative to conventional hip replacement?

Unlike traditional hip replacement, hip resurfacing doesn't replace the "ball" of the hip with a metal or ceramic ball. Instead, the damaged hip ball is reshaped and capped with a metal prosthesis. The damaged hip socket is fitted with a metal prosthesis — similar to what is used in a conventional hip replacement.

With newer materials, the artificial joint implants used for total hip replacement last about 15 years. This isn't an issue for older people who receive a hip replacement late in life. But hip resurfacing might be a better choice for younger people because the procedure leaves more bone intact, which can make it easier to perform a total hip replacement if needed later.

Resurfacing generally results in a bigger hip ball than what is typically used in a conventional hip replacement, which may reduce the risk of dislocation. But newer implants used for conventional hip replacement now offer the option of a larger hip ball, similar in size to what results from hip resurfacing procedures.

Hip resurfacing is technically more difficult and generally requires a larger incision than what is used for a conventional hip replacement. And the risk of complications is slightly higher with hip resurfacing — even when counting against factors such as age, sex and activity levels.

Hip resurfacing isn't recommended for people who have:

  • Osteoporosis
  • Impaired kidney function
  • Known metal hypersensitivities
  • Diabetes
  • Large areas of dead bone (avascular necrosis)

 
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