Joint replacements

Pain of joints and limited movements trouble many of us. In the case of severe joint damage the only solution can be usage of artificial replacement.

Only some parts of human body are replaced. Those are hip, knee, shoulder, elbow, ankle joints and tiny joints of fingers and toes. Among most often performed procedures belong hip joint replacement and knee joint replacement.

Joint replacements are divided:

1) According to the number of replaced parts

  • Total – all parts of joint are replaced
  • Partial – only the damaged part of a joint is replaced, the part that stays must be fully functional

2) According to the type of fixation to the bone

  • Cemented – the replacement is fixed with so-called bone cement, sometimes with added antibiotics
  • Non-cemented – the replacement is fixed to the bone by its gradual growing into specially formed surface of the replacement – mostly with hydroxyapatite coat.
  • Hybrid (mixed) – the replacement has one component out of cement and the other non-cement.

Used certain prosthesis has its professional indication and we can never say that non-cemented replacements are better than cemented or opposite.

3) According to the shape

There are different shapes of each part of joint replacements. Their usage is selected individually according to the shape of joint and anatomical proportions of each patient. It is therefore impossible to state, which shape is the best.

The choice of a suitable replacement depends always on the decision of the surgeon; he/she takes into account patient’s examination and experiences of the clinic.

Materials used during creation of joint replacements

Most often used material is titanium, shafts and sockets of joints are made out of it. Porous titanium surface by modern products is enriched with a layer of hydroxyapatite, which is bio compatible compared to titanium. Heads of joints can be metal or ceramic. Metal heads are produced from non-corrosive steel, titanium alloy or CoCrMo alloy. Contiguous areas are covered with carbon surface, which is resistant to abrasion. Ceramic heads contain microparticles of polycrystallic corundum. All used materials must meet ISO norms. Already mentioned above bone cements are without antibiotics or they contain mostly antibiotics gentamycin. There are also cements with combination of antibiotics gentamycin and klindamycin. Those are used by revision procedures caused by inflammatory complications. Cement of good quality is very viscous; RTG is contrasting and fast hardening.

When is it necessary to replace joint with artificial one?

It is in situation when a joint is damaged by inflammation, degenerative process – arthritis of 3rd or 4th degree or by injury. The patient usually complains about pain and reduced power of the joint. He/she cannot do common movements. The joint is usually swollen and even a transudate – a fluid in joint cavity – can be present.

Surgical procedure

A thorough pre-surgical examination is done before the procedure, which eliminates inflammation and evaluates patient’s general state. Most of the patients that need joint replacement are of higher age, with reduced mobility, with a lot of associated diseases and often even overweight. Therefore it is important to consider their ability to undergo the surgery. The procedure is performed under general or local anesthesia.

Huge blood loss is associated with the surgery. It can be replaced either by classic transfusion or by using own blood – autotransfusion.

It is relatively complicated surgery. The patient is usually after the procedure placed to department of ICU (intensive care unit), where his/her life functions are checked with the help of machines. After stabilization the patient recovers already at standard department. Time spent at the hospital is individual and it depends on the type of procedure, complications after the surgery and so on.

Already three days after the surgery an intense rehabilitation begins under professional control. Rehabilitation is very important part of the whole procedure. It should be initiated already before the surgery (exercise, weight reduction, walking with crutches). Continue with rehabilitation after the procedure and even out-patiently after release from the hospital. It is also possible to use even spa treatments.

Complications after the surgery

Complications might be associated with used anesthesia and also with the general state of health.

Among other risks belong already above mentioned bleeding that in most of the cases need blood transfusion. Naturally an autotransfusion is more suitable. Although the possibility of transfer of HIV infection and hepatitis B, C from blood conservation from the donors is minimalized. Also undesired reaction by taking or application of transfusion can occur. They are not often though.

Risk of thrombosis – a clot of coagulated blood threatens like in every surgery. Pulmonary thrombosis is most severe. Medications against blood coagulation are prescribed, although they worsen bleeding.

Infection belongs to significant complications because a foreign element – joint prosthesis- is inserted into the organism. Antibiotics are administered 1-2 days before the surgery as prevention. Another surgery is needed if the prosthesis is attacked with infection. In most cases it involves removal of the prosthesis, treatment of the spot with special filling with antibiotics and also taking antibiotics for even 6 weeks. It is possible to insert new joint replacement only when the infection is completely healed. If the infection is unmanageable usually an arthodesis – fixation of the joint is recommended. This results in bone fusion and the joint cannot be used anymore.

If you are the owner of total joint replacement you should thoroughly treat all viral and bacterial diseases after consultation with a doctor. Taking antibiotics as prevention is recommended even in invasive treatments (e.g. colonoscopy).

Injuring vessels and nerves close to joint is less frequent complication.

In some patients unceasing pain may occur, which can naturally be healed with analgesics.

How long does the joint replacement endure?

The durability of joint replacement is individual for each patient and it depends mainly on its usage. How often it is used and for what kind of activities. If the patient goes to check-ups, has overweight. What is his/her physical condition and so on. Knee and hip replacements are constructed for common activities, walking, swimming or hose riding. Less suitable are for example jogging or skiing. However some patients use them even for these activities without great problems. The joint replacement can be replaced after worn off – revision replacement. The positive result cannot be explicitly forecasted. It depends on the reason, why the prosthesis must be replaced.