What is Arthroplasty?
Arthroplasty is a procedure that makes possible the creation of a new movable joint. This procedure is not appropriate to every joint. In practice, its use is roughly restricted to the shoulder, the elbow, the hip, the knee, certain joints in the hand, and the metatarso-phalangeal joints in the foot.
Candidates for Arthroplasty
Arthroplasty may not be the answer to rheumatoid arthritis or prevent disease activity. Nevertheless, this surgery may offer pain relief and improve function if a joint is badly diseased. Arthroplasty is considered when:
- Medication, joint injections, physical therapy, and exercise can no longer control specific symptoms.
- Pain from rheumatoid arthritis proves to be untolerable.
- You cannot perform your normal daily activities.
- There is narrowing of the joint space or wearing away of the cartilage and bone is causing serious pain or decreased range of motion.
Before executing arthroplasty, standard preoperative blood and urine tests are completed to rule out conditions such as anemia and infection. Clotting tests may be done if a patient has a history of bleeding. With regard to the administration of anesthesia, the patient and the anesthesiologist will have to meet up to talk about any special conditions that may influence it. Should there be apparent infection anywhere in the body, or should the patient show certain heart or lung disease, surgery will not be performed. Patients who smoke will also be asked to cease smoking. In addition, overweight patients may be recommended to lose weight. Specific pain medications may have to be discontinued in the weeks prior to surgery.
The Arthroplasty Procedure
Arthroplasty may be performed under either general or regional anesthesia by an orthopedic surgeon. Arthroplastic surgery has two types: joint resection and interpositional reconstruction. Joint resection entails the removal of a portion of the bone from a stiffened joint, increasing the space between the bone and the socket to enhance the range of motion. Ultimately, scar tissue seals the gap, narrowing joint space again. In effect, pain is lessened and motion is restored, although the joint is less stable. On the other hand, interpositional reconstruction involves reshaping the joint and attaching a prosthetic disk between the two bones forming the joint. The prosthesis can be made of plastic, metal, ceramic material, or created from such body tissue as skin, muscle or fascia. When interpositional reconstruction is unsuccessful, total joint replacement may be essential. Joint replacement is also called total joint arthroplasty.
A patient may have to stay in a hospital from 2 to 14 days to recover after arthroplasty. Rehabilitation, on the other hand, may take several weeks to several months, depending on the joint.
Aside from the risks of surgery and use of anesthetic, the following are some risks that may arise from arthroplastic surgery:
- Infection developing in the artificial joint (entails elimination of the artificial joint and treatment of the infection).
- Development of blood clots (thrombophlebitis).
- Loosening of the joint.
What are the indications for Arthroplasty?
Indications for arthroplasty consist of osteoarthritis, rheumatoid arthritis, avascular necrosis or osteonecrosis, congenital dislocation of the hip joint, acetabular dysplasia (shallow hip socket), frozen shoulder, loose shoulder, traumatized and malaligned joint, and joint stiffness.
Is Arthroplasty really effective?
Arthroplasty works in such a way that it alleviates pain and restores enough function in a joint to allow a person to accomplish normal daily activities.
What is involved in Arthroplasty?
The major objective of arthroplasty is to reconstruct or replace a diseased joint. In the case of rheumatoid arthritis, arthroplasty is completed to bring back function to a joint or correct a deformity. It is possible that bones in a joint are reshaped, or even all or part of the joint are replaced with metal or plastic parts.
Are there risks in this procedure?
Joint resection and interpositional reconstruction do not yield successful results all the time, particularly in patients with rheumatoid arthritis, a chronic inflammatory disease that may persist to narrow the joint space and hasten the development of scar tissue. In this case, repeat surgery or total joint replacement may be needed. Given any major surgery, a number of risks may always arise such as the risk of an allergic reaction to anesthesia, post-operative infection, or the formation of blood clots that may cause pain and swelling near the surgery site and travel through the veins to other parts of the body. It is also imperative to know that a joint that has gone through surgery is less stable compared with a healthy joint. With this in mind, dislocation or loosening of the resected joint may take place, particularly with improper physical activity.