Joint Arthroplasty - Indications, Contraindications, Types, and Procedure

Introduction:

A joint is a part of the body where two or more bones meet to allow movement. The joint contains various ligaments, tendons, and muscular attachments and makes the skeleton flexible. There are 360 joints in an adult human body. Most of the joints have fluid within for lubrication and frictionless movement.

Damage to the joint from trauma or inflammation can lead to joint dislocation or degeneration. These joint disorders may cause pain and limit their movements. Arthroplasty is a Greek word; arthro means joint, and plasty means molding or forming. However, the term arthroplasty is the other name for joint replacement in medical practice.

What Is Joint Arthroplasty?

• Arthroplasty is a surgical treatment for joint injury or disorders. In arthroplasty, the articular surface of the musculoskeletal system is replaced, reconstructed, remodeled, or realigned. An artificial joint (prosthesis made of plastic or metal) can also be used. Arthroplasty is a major surgery that removes pain significantly and preserves the biomechanics and functionality of the joint.

• In some situations, hemiarthroplasty is preferred over total replacement, where only a portion of the damaged part is operated. The procedure can be carried out immediately after a fall or injury since it has less preparation time. The advantage of hemiarthroplasty is less surgical time, less blood loss, and less chance of dislocations after treatment.

• The most common type of arthroplasty is knee replacement and hip replacement.

What Are the Principles of Joint Arthroplasty?

The following are the principles applied to replacement surgery with a prosthesis.

• Proper patient and procedure selection are essential for any surgery.

• The operative site must be exposed satisfactorily for better visualization and good access.

• Soft tissue balance is critical to the success of the procedure.

• The selected prosthesis must be durable and reliable.

• After replacement, it must not provoke any unwanted reactions in the tissue.

• The prosthesis must be firmly attached to the skeleton and allow low friction movement in the joints.

What Are the Indications of Joint Arthroplasty?

1. Osteoarthritis: A degenerative joint disorder where the flexibility of the joint tissue is lost over time due to normal wear and tear reaction. The most common form of osteoarthritis affects joints in the hand, knee, hip, and spine.

2. Rheumatoid Arthritis: An autoimmune disorder where the body's immune system attacks the joint tissues' healthy cells, causing inflammation (painful swelling). It is a chronic disorder affecting many joints in the body.

3. Fracture: A broken joint has severe manifestations since it is usually a displaced fracture (broken bone moves out of alignment). Therefore, treating a joint fracture immediately is essential to restore the harmonization of the joint.

4. Birth Defects: Some of the birth defects of the joints, especially hallux valgus, need replacement surgery.

5. Avascular Necrosis: A localized death of bone due to lack of blood supply may result from injury or drug side effects.

6. Tumors: Any cancerous or noncancerous tumor may cause severe damage to the joints.

What Are the Contraindications of Joint Arthroplasty?

• Absolute Contraindication:

1. Active joint infection.

2. Systemic infection or sepsis.

3. Chronic osteomyelitis (bone infection).

4. Muscle dysfunction.

5. Vascular disease (a condition affecting the system of blood vessels).

• Relative Contraindication:

1. Localized infection.

2. Insufficient bone.

3. Severe soft tissue damage.

4. Debilitating diseases (diabetes, heart or lung disease).

What Are the Types of Joint Arthroplasty?

The most successful and common form of arthroplasty is replacement surgery. Hence, joint arthroplasty and joint replacement are used interchangeably. However, theoretically, arthroplasty can be of various types.

Replacement Arthroplasty: A procedure where the dysfunctional joint surface is replaced with an external prosthesis for functional continuity is called replacement arthroplasty. It can be;

• Hemi Arthroplasty: It is also known as a hemi replacement, where only one of the joint surfaces is removed and replaced by a prosthesis.

• Total Arthroplasty: It is also known as a total replacement where both of the opposing joint surfaces are removed and replaced with prosthetic components.

Excisional Arthroplasty: In excisional arthroplasty, one or both joint surfaces are removed and left empty. The gap created between the joints is filled with fibrous or scar tissue. It is the most common type of surgery preferred in chronic infection conditions.

Interpositional Arthroplasty: Grafting (moving tissues from one site to another in the body) the joint surface with other tissues like skin, muscles, or tendons to keep away inflammation.

Resurfacing Arthroplasty: Trimming or slicing away the damaged joint surface is called resurfacing arthroplasty. It is an excellent alternative treatment for replacement surgery, especially in younger and active adults, because of its bone-preserving nature.

How Is Joint Arthroplasty Performed?

Knee, hip, shoulder, ankle, and fingers are the most common joints for arthroplasty.

• A complete history of the patient is evaluated.

• Pre-surgical medical examination and routine laboratory investigations are done. Since the replacement surgery should be performed under general anesthesia, the necessary safety precautions are followed.

• The standard protocols before any surgery are preparing the patient by starting an intravenous line, inserting a urinary catheter, and monitoring vitals (heart rate, blood pressure, blood oxygen level, breathing).

• The surgical site is cleaned with an antiseptic solution.

• An incision is made in the area of the joint.

• The damaged area is removed and replaced with prosthetic material mimicking the natural shape of the joint.

• The prosthesis is either fixed with the bone cement or press-fit type (cementless). Then the incision is closed and placed together with a stitch or staple. A sterile bandage or dressing is applied.

A few days of hospitalization followed by several weeks of rest to promote healing and rehabilitation is advised.

What Are the Complications of Joint Arthroplasty?

• Pain, swelling, infection, bleeding or blood clots, and damage to any nearby nerve or blood vessel are some common complications anticipated post-surgery.

• Stiffness, soft tissue imbalance, weakness, instability, and fracture of adjacent bone are risks specific to the joints.

• Rejection of the material, malposition, loosening, and dislocation of the prosthesis are the problems pertaining to the artificial joint.

Conclusion:

Arthroplasty is an elective surgery to reduce pain and restore the functions of the joint. It is the most successful surgery with a high satisfaction rate. In addition, replacement surgeries can significantly improve the quality of life. Recent advancements in arthroplasty like minimally invasive techniques, a porous-coated prosthesis (for better adhesion to the bone), and 3D-printed patient-specific prostheses are appreciable and motivate many people to opt for this procedure with much confidence.