Orthopaedics & Joint Replacements

Prosthetic Implant is an artificial substitute or replacement of a part of the body such as a tooth, eye, a facial bone, the palate, a hip, a knee or another joint, the leg, an arm, etc. It is designed for functional or cosmetic reasons or both. Typical prostheses for joints are the hip, knee, elbow, ankle and finger joints.

Prosthetic implants can be parts of the joint such as a unilateral knee. A prosthesis may be removable, as in the case of most prosthetic legs or a prosthetic breast form used after mastectomy. A person who uses a removable prosthesis, for example, an artificial hand, may want to have more than one available for different types of tasks. Other types of prosthetic devices are permanently implanted, like an artificial hip, testicle or tooth.

Prosthetic Implant for Hips

Prosthetic Implant for hips encompasses of the following procedures:

The total hip replacement is performed in a highly sterile operating room with a special laminar airflow system, which helps reduce the chances of infection. The surgery is performed, post administration of an epidural anaesthesia. The incision will measure anywhere from 4 to 10 inches, depending upon your anatomy.

The arthritic ball and socket are then exposed and the bone is prepared to receive the artificial hip joint, and then the prosthesis is inserted. During the closure, two drains may be inserted around the operated area to assist for blood evacuation. Combinations of staples and/or sutures are used to close up. The entire operation will take from 1 to 2 hours.

Risks of having a prosthetic hip-

There may be instances of loss of blood, formation of a clot in your leg, and some chances of infection.

The overall incidences of these risks are extremely small, which are discussed in detail with your hip replacement surgeon, prior to proceeding with the surgery.

Some Others are-

1. Ball dislocation (come out of the socket)
2. Wear and tear of parts used
3. Infection of prosthesis

Longevity

A total hip replacement depends upon a variety of factors, including:

1. Patient weight
2. Patient activity
3. The mechanical properties of the prosthesis used

Pre-Operative Orientation

Some patients will be asked to donate a pint of their own blood in the weeks preceding their hip replacement surgery. This addresses the need for blood transfusion during the surgery. Almost all of the patients will receive this donated blood as a transfusion post-surgery. A thorough medical examination is conducted as a precaution to ensure that a patient is healthy enough to undergo this surgical procedure. Additional tests to examine patient’s heart and lungs are carried out.

Post-Operative Course

After spending time in the recovery room to heal; most patients go back to their rooms, once the sensation returns to the legs. A pain pump is connected to the epidural catheter which will allow the patient to control pain medicine. Most people are quite comfortable with the pain pump in place. The first day after surgery will have an active schedule focussed on patient’s agility.

Physiotherapists advice upon the need to perform few exercises, while in bed and take dedicated care in helping the patient to stand up and take few baby steps with the help of the walker. A short-term placement in a rehabilitation facility may be suggested, depending upon the patient’s age and other factors. Otherwise, the he will be discharged home with rigorous physio-therapy in place.

With the constant support and guidance from our highly specialized and talented doctors, patient’s progress is under constant observation.

Knee Arthritis

Your knee joint is simply the hinge between two bones, the thigh bone (femur) and the shin bone (tibia) whose ends are covered with a thick cushion of soft, white cartilage. Due to wear and tear age or other factors this cartilage begins to wear away and thus the underlying bones rub together causing extreme pain and inflammation.

The major types of arthritis that affect knees are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

This is the most common form of arthritis in the knee, which is a degenerative, "wear-and-tear" type of arthritis that occurs most often in people above 50 years of age, but may occur in younger people, too.

The cartilage in the knee joint gradually wears away, becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, thus causing painful bone spurs. Osteoarthritis develops slowly and the pain it causes worsens over time.

In total knee replacement surgery, the surface of the joint is replaced with that of a metal or a plastic surface which can function similar to a normal joint. Most of the supporting ligaments, tendons and muscles around the knee joint are retained. Thus the new joint’s surface mimics that of the natural knee replaced.

Rheumatoid Arthritis

Characterized as a chronic and autoimmune disease, it attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body. It attacks its own tissues, damaging the normal tissues (such as cartilage and ligaments). The synovial membrane that covers the knee joint begins to swell resulting in knee pain and stiffness.

Post traumatic Arthritis:

This form of arthritis develops after an injury to the knee. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury. Meniscal tears and ligament injuries can cause instability and additional wear on the knee joint, which over time can result in arthritis.

Why should one go for total knee replacement?

Painful arthritic knees can lead to instability, causing falls and other injuries. It affects basic functionalities like climbing stairs, getting up from chairs and extended walking .While most arthritic knees are the result of degenerative arthritis or osteoarthritis, other conditions such as rheumatoid arthritis, trauma, prior surgeries, instability and tumours can also be relieved by total knee replacement. In total knee replacement surgery, the surface of the joint is replaced with that of a metal or a plastic surface which can function similar to a normal joint. Most of the supporting ligaments, tendons and muscles around the knee joint are retained. Thus the new joint’s surface mimics that of the natural knee replaced. The most common reason to have a total knee replacement is to relieve arthritic pain.

Total knee replacement is recommended for patients with arthritis having severe pain, significantly affecting quality of life. The pain may not be excruciating at any particular time, but it is often chronic and disabling.Everyone’s pain is different, and the degree of pain sufficient to justify surgery should be decided by the patient and the doctor together.

Minimally Invasive Total Knee Arthroplasty (MIS) uses a smaller incision (3 to 4 inches) as against the traditional knee replacement surgery, which requires a large incision (8 to 12 inches), causing significant disruption of the muscles and tendons.

With the help of small incisions, the diseased surfaces of the knee joint is checked and replaced, one at a time, with required artificial joint components. This new technique is also called quadriceps-sparing knee replacement.

MIS Knee Joint Replacement is considered a giant step forward because it requires shorter hospital stay, ensures faster recovery, less pain and much less scarring.

Potential benefits-

• Quick healing causing agile movement of the knee since, the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement, and the kneecap is not averted (flipped out of the way) with the other form of surgery.
• Smaller incision or opening during the procedure.
• Decreased post-operative pain and faster rehabilitation as the incision stays out of the important quadriceps muscle/tendon group.
• Reliable implants used as those in the traditional knee replacement surgery.

Flexion is the action of bending a joint, such as your knee or elbow. The opposite motion is extension, which is the straightening of a joint. Generally, traditional knee replacements accommodate flexion up to 110 degrees, not allowing patients to squat and kneel. Recent innovations in knee design (High Flexion Rotating Platform Knees) have resulted in knee replacement surgery facilitating complete flexion up to 155 degrees. Desire for high flexion may be dictated by patient’s favourite activities or cultural background. Many daily activities require the ability to flex the knee beyond 120 degrees.

Complete knee bending is a pre- requisite for the patients of Asia, Japan and more so in Indian continent, which warrants the patients from these areas to opt for high flexion knee replacement surgery.

The knee of a woman is not simply a smaller version of a man’s knee. There are differences involved in the bones, ligaments and tendons in the joints. There is proof that the shape of a woman’s knees typically falls into different ranges than a man’s knee, therefore making these differences significant.

Anterior knee pain in some female patients was a matter of concern before the prevalence of women specific knees. With the advent of specific knees designed for female bones, there was a remarkable improvement in the comfort factor, thus increasing their flexibility.

I-ASSIST is basically a computer assisted stereotaxic surgical instrument system, used to help the surgeon position the implant system components intra operatively. This improves accuracy, reduces complications and allows surgeon to focus in correcting deformities in the patient. It consists of an i-pad like computer which aids in accurate bone cuts and places the implants in desired position.

This computer aided surgery has multiple advantages like improving accuracy, reducing complications and allowing surgeons to focus in correcting deformities.

In this approach a CT scan and an X-ray of the patient scheduled to undergo the surgery are first taken. These are then sent to the knee implant company abroad, which creates an artificial model of the bones from this data. Based on this data, cutting blocks are cut for the required bones to get the alignment right and these blocks are shipped in a sterile container. During the surgery, a single customized block is used to cut the patient’s bone which, otherwise entailed usage of 6 blocks to perform the same procedure. This surgery, which lasts for a short period, is less painful, enabling faster recovery.

SERVICES AND FACILITIES

The joint replacement services at STAR Hospitals include: