Joint Replacement Surgery

A joint is formed by/ combination of ends of two bones. It is enclosed by soft tissues like capsule,synovium, muscles, fascia and overlying skin. There are many types of joint diseases which lead to derangement of the joint. The common result of these joint diseases is the distruction of the joint leading to various signs and symptoms. Most commonly involved joints are the major joints like knee, hip, shoulder, elbow and the small joints of the fingers.

Degnerative joint disease or Primary Osteoarthritis is the most common manifestation of the major joints like knee, hip , shoulder and elbow. This is classified into four grades depending upon the severity of the joint involvement. Out of the above stated joints it is the Osteoarthritis of the knee joint which constitutes the 80% of the joint involvement. Osteoarthritis of the hip joint constitutes for 15% of the joint involvement and remaining 5% of the joint involvement is of shoulder, elbow and ankle joint.

There are basically two types of Osteoarthritis. First, the primary osteoarthritis is the degenerative disease of the involved joint which is mostly old age related. In this there is no specified cause of the joint involvement. Other group is the secondary osteoarthritis where there is a specified cause of the joint involvement like trauma, infection, tuberculosis, rheumatoid arthritis, metabolic disorder, psoriatic arthritis etc. Small joints like joints of fingers, wrist, elbow and some times ankle joints are mostly involved in the auto immune disorder, rheumatoid arthritis. It presents itself as morning stiffness of these small joints, difficulty in carrying out daily activities due to severe inflammation of these joints. If not adequately and timely treated this disease can lead to total distruction of these joints and can make the patients totally crippled. Unlike in primary Osteoarthritis patients suffering from rheumatoid need longterm disease modifying anti rheumatoid drugs . Those patients who present late require replacement surgeries of their joints along with adequate medication.

Grade-1 and 2 Osteoarthritic patients can be managed non surgically with the proper medication, physiotherapy, lifestyle modification and anti inflammatory drugs. However if patients present late when they are the Grade-3 and Grade-4 osteoarthritic changes total joint replacement of their involved joint is the only and the best remedy for them. If not treated timely due to altered alignment and biomechanics the joint stresses from the malaligned joint is transmitted to other normal joints thus causing their distruction as well in due course of time. So it becomes absolutely important to replace the malaligned joint timely as this will help sparing other joints from involvement.

Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity steadily increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. However, up until the 1890s, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, there was significant controversy about whether orthopedics should include surgical procedures at all.

Total knee replacement

Total knee replacement is the most common joint replacement surgery being performed world wide. With the advent of newer implants and latest refined surgical techniques this surgery has become one of the most gratifying surgery bringing a total U-turn in ones otherwise sedentary life due to their crippled joints. After this surgery patients who were totally bed bound are able to walk more than 5kms a day, can easily negotiate stairs, can sit cross legged and can do all their daily routine activities without pain and limping.

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