Joint Disorders - Types, Causes, and Surgical Management

Introduction:

The joint is where two bones meet, and due to disorders like osteoarthritis, injury, or overuse of the joint, the joint capsule or tissue may break down, causing pain, swelling, or stiffness. In severe cases, osteotomy or joint replacement surgeries are done.

What Is a Joint?

A joint is a junction where two bones meet, which helps in a wide range of movements and can bear weight. Joints are complex structures, including muscles, tendons, cartilage, ligaments, synovium, and bone. Cartilages cover the ends of bones, tendons connect the muscles to bone, and ligaments connect the joint bones.

What Are the Different Types of Joints?

According to the type of cells of joints, there are three types, which are:

• Fibrous joints consist of collagen tissue that connects bones; they have no joint cavity and are immovable, which include:

  1. Joints in the skull.

  2. The periodontal ligament connects the joint between the tooth and the socket.

  3. Middle tibiofibular joint and middle radio-ulnar joint.

• Cartilaginous joints consist of cartilaginous tissue and are slightly movable, which include:

  1. Joints of epiphysis and diaphysis of long bones.

  2. Pubic symphysis.

• Synovial joints are freely movable joints that have a synovial fluid, which includes:

  1. Ball and socket joints, such as hip and shoulder joints, in which movements in all directions are possible.

  2. Saddle joints are in which side-to-side and back-and-forth movements are possible, such as thumb joints.

  3. Hinge joints, in which movement in one axis is possible, include knee, ankle, and elbow joints.

  4. Condyloid joints are those in which there is movement without rotation, such as temporomandibular joints and finger joints.

  5. Pivot joint is one in which one bone rotates within the ring of another bone, such as the joint in the upper part of the neck.

  6. A gliding joint in which movement is between two flat surfaces, such as the wrist joint.

What Diseases Can Affect the Joints?

Joint disorders that occur due to diseases are:

• Arthritis causes swelling and pain in one or more joints, which causes stiffness in the joint. The most common types are:

  1. Osteoarthritis is where the joint tissue wears off when the bones rub together. It can occur in the knees, hands, hips, or spine.

  2. Autoimmune inflammatory arthritis is when the immune system attacks healthy joints, which includes rheumatoid arthritis.

  3. Infectious arthritis is caused by fungus, bacteria, or viruses and usually affects the knee.

  4. Gout, called metabolic arthritis, is where uric acid crystals accumulate in joints causing pain.

  5. Juvenile idiopathic arthritis occurs in children.

  6. Psoriatic arthritis is caused by psoriasis, an autoimmune disease that causes skin inflammation.

• Lupus is an autoimmune disease that causes inflammation of tissues, including joints.

• Sjögren's Syndrome is an autoimmune disease causing dry mouth and eyes and causes joint pain.

Joint disorders that occur due to injury are:

• Sprains and strains: Injury to the ligament (connects joint bones) is called a sprain, and injury to muscles (connected to the bone) is called a strain.

• Dislocated joints occur when the bones detach from the joint socket, which is an emergency.

Joint disorders that occur due to overuse are:

• Bursitis is inflammation of the bursae, a fluid-filled sac in the joint’s cavity that occurs due to high repetitive pressure on the joint or by an infection.

• Tendinitis is the tendon inflammation that connects the muscle to the bone.

What Are the Surgical Management Of Joint Disorders?

Different types of surgical interventions include:

• Arthroscopy: This is a keyhole surgical procedure where a narrow tube with a fiber optic video camera is used to see inside the joint, and other small incisions are made for cutting tools or grasping instruments. The procedures which are performed are;

  1. Repair of torn tendons, cartilage, or ligaments.

  2. Synovectomy (removal of synovium, the membrane that lines the joint).

  3. Carpal tunnel release.

  4. Removal of loose cartilage or bone in case of injury.

It has the advantages of minimal trauma, small incisions, faster healing, less pain, and a low infection rate. However, complications such as nerve or tissue damage, instrument breakage, blood clots of veins, bleeding, excessive swelling, and infection can occur.

• Osteotomy: This is a surgical procedure of cutting bone by reshaping and realigning the bone to relieve pressure on any part of the bone. It is performed to,

  1. Correct the angles and alignments of deformed bones.

  2. To shorten or lengthen the bone.

  3. To shift the weight from the damaged area on the joint to a healthy area on the joint.

  4. To relieve pain from osteoarthritis.

  5. To delay the joint replacement surgery.

  6. To improve the function of the knee or to slow the deterioration.

It retains the anatomical structure, proprioception preservation, and fast recovery. Complications may include injury to vascular and nerve tissue and thromboembolism.

• Total Joint Replacement (TJR), Or Total Joint Arthroplasty: This is a surgical procedure where the entire joint is replaced by a metal, ceramic, or plastic prosthesis. It is indicated in the case of:

  1. Severe pain and functional disability.

  2. Ineffective conservative therapies such as medications or physiotherapies.

  3. Extreme joint damage.

Complications such as inflammation of the prosthesis, blood clots in the vein, injury to nerve or blood vessels, calcification near the prosthesis, loosening of the prosthesis, or allergies can occur.

• Joint Resurfacing: This is a procedure in which the defective part of the cartilage is replaced using metal to create a smooth, continuous surface.

• Joint Revision Surgery: This procedure involves the removal of an old and damaged implant joint and replacing it with a new one; it is done in cases of

  1. Loosening of the implant from the bone.

  2. Osteolysis, where particles of plastic spacers near the joint are attacked by the immune system and also attack the healthy bone tissue.

  3. Infection, instability, or fracture of the implant.

  4. Stiffness of the implant due to excessive scar tissue.

It has the advantages of complete relief from pain and increased function, and complications such as poor healing, decreased range of motion, infection, or bleeding can occur.

• Arthrodesis: This is a surgical procedure where diseased joints are fused. It is indicated in the case of:

  1. Articular tuberculosis.

  2. Instability caused by poliomyelitis.

  3. Sepsis.

  4. Recurrent dislocation.

  5. Unreconstructable rotary cuff tear.

  6. Failed joint replacement.

Complications such as soft tissue, bone infection, or wound dehiscence (separation of approximated edges) can occur.

Conclusion

Joint disorders are usually chronic, and patients should maintain proper physical health to help strengthen the joint muscles and prevent or slow down joint deterioration.