All about Arthroplasty

All about Arthroplasty

What is Arthroplasty?

Arthroplasty is a procedure performed to restore the function of a joint. The joint can be restored by resurfacing the bones, or an artificial joint (prosthesis) may also be used. 

While hip and knee arthroplasties are most common, arthroplasty can also repair or replace other joints in the body, including the shoulders, ankles, elbows and fingers. Total joint replacement involves surgical replacement of a diseased joint with an artificial joint called a prosthesis. For instance, a knee joint affected by arthritis may be replaced in its entirety—this is called total knee arthroplasty. 

While arthroplasty is performed to restore joint functions affected by rheumatoid arthritis, osteonecrosis and joint injuries, osteoarthritis (degenerative joint disease) is the most common reason for performing this procedure. Osteoarthritis is a loss of the cartilage or cushion in a joint. 

Why do you need arthroplasty?

Arthroplasty is used when medicines and medical treatments do not relieve joint pain and disability effectively. A few medical therapies for joint conditions (or osteoarthritis) that could be used before arthroplasty include:

• Physical therapy 
• Limiting painful activities 
• Anti-inflammatory medicines
• Pain medicines
• Cortisone injections into a knee joint
• Viscosupplementation injections: this adds lubrication into the joint to make their movement less painful
• Assistive aids for walking (like a cane)
• Exercise and conditioning
• Weight loss (for obese people)

People who have undergone arthroplasty generally have significant progress and improvement to perform their daily activities and quality of life.

There can be other reasons for your treating doctor to suggest arthroplasty. Please check hip replacement surgery and knee replacement surgery for more specific information.

What are some risks of arthroplasty?

As any surgical procedure has complications, arthroscopy also has a few potential complications. Some possible complications may include:

1. Infection 
2. Bleeding
3. Blood clots in the lungs or legs 
4. Loosening of the prosthetic parts

There may be other complications depending on your specific health condition. Make sure you discuss any concerns with your doctor before the procedure.

How do I prepare for arthroplasty?

Your healthcare provider or treating doctor will review and instruct you about the procedure and you can ask any questions about the procedure. Preparation for your procedure may include the following steps: 

• First, your healthcare provide will ask you to sign a consent form that gives your permission to perform the procedure. Read the form carefully and completely. Tell your doctor or healthcare provider if something is not clear.
• Your healthcare provider will perform a complete physical examination, in addition to a complete medical history, to ensure you are healthy before arthroplasty. You may undergo some diagnostic tests or certain blood tests. Talk to your doctor/healthcare provider if you are allergic or sensitive to any tape, latex, medicines and anesthetic agents (general and local).
• Inform your treating doctor or healthcare provider of all drugs (prescribed and over-the-counter) including any herbal supplements you are taking.
• It is important for you to inform your doctor if you have any history of bleeding disorders. It is also important to inform if you taking any blood-thinning (anti-coagulant) drugs, aspirin or other medications that affect blood clotting. Your healthcare provider may suggest you to stop these drugs before the procedure.
• You should notify your healthcare provider if you are pregnant or suspect that you are pregnant.
• You have to fast for 8 hours before arthroplasty .
• You may be administred a sedative to help you relax before the procedure.
• You may meet with a physiotherapist before your surgery to discuss your rehabilitation plan
• Depending on your health condition, your doctor may request for other specific preparation

What will happen during arthroplasty?

Usually, an arthroplasty procedure requires a stay in the hospital. may vary depending on the practices of your healthcare provider and your medical condition.

Arthroplasty can be performed while you are awake under spinal  anaesthesia or asleep under general anaesthesia. Your anesthesiologist may discuss this with you before the procedure.

Usually, the arthroplasty follows the following process:

1. You will be provided with a hospital gown to wear
2. An IV (intravenous) line will be put in your hand or arm
3. A urinary catheter may also be inserted
4. Hair at the surgical site may be shaved off if required 
5. You will be positioned on the operation table in a position that provides the best access to your joint that is being operated
6. The anesthesiologist will continuously monitor heart rate, breathing, blood pressure, and blood oxygen levels during the procedure.
7. An antiseptic solution is used to cleanse the skin over the surgical site 
8. The surgeon will make a cut/incision in the area of your joint
9. The surgeon will repair/remove the damaged parts of your joint
10. The cut/incision will be closed with the stitches or the surgical staples
11. A sterile dressing or bandage will be applied

Recovery

Recovery and rehabilitation will be different for each individual. Generally, your treating doctor would want you to use your ‘new’ joint shortly after the procedure. While it may be challenging at times, physiotherapy and adhering to your treating doctor’s instructions will speed your recovery.

Recovery in Hospital

Immediately after your procedure, you will be taken to a recovery room for observation. As soon as your breathing, pulse and blood pressure are stable, and you become alert, you will be shifted to a hospital room. 

Exercise is the most vital part of your road to recovery plan. Soon after your surgery and during your stay in the hospital, your physical therapist will plan an exercise rehabilitation program for you to help restore movement and strengthen the joint. 

You may experience pain in the replaced joint because your body is adjusting to the new joint, the surrounding muscles become weak from inactivity, and the tissues will eventually  heal. Your pain is controlled with medication, so you can participate in your exercise program – both in the hospital and after discharge too.

Recovery at Home

Once you are back at home, you need to keep the surgical site clean and dry. Your doctor will give specific instructions for bathing. Your stitches or surgical staples will be removed during your follow-up visit to the doctor office.

It is important to take pain relievers as recommended by your doctor only.  

Call your doctor or healthcare provider to report any of the following:

1. Bleeding or other drainage, redness, or swelling from the incision site
2. Fever or chills
3. Tingling and/or numbness at the affected extremity
4. Increased pain around the incision area
5. You can start your regular diet unless your doctor advises otherwise
6. Do not drive until your doctor tells you to. 
7. Other activity restrictions may also apply

If you have any queries about activity limitations after total joint replacement, consult your treating doctor.

Long-Term Outcomes of Arthroplasty

A majority of patients can perform everyday activities more easily post arthroplasty or joint replacement procedures. In addition, arthroplasty (or a joint replacement) can last for many years for many people offering them an improved quality of life which includes less pain and improved movement and strength that would not have been possible otherwise.