Joint Reconstruction After Trauma

Introduction:

Most joints in the human body, including the neck, shoulders, elbows, hands, hips, knees, ankles, etc., are synovial joints, allowing smooth movements between the adjacent bones. Surgical repair or replacement is necessary when these joints undergo traumatic injuries or wear out due to age.

Orthopedic surgery deals with acute trauma or injuries, chronic arthritis, overuse of joints, and congenital or acquired disorders. Surgery is done only if conservative treatments are tried and do not work. People surviving accidents are often left with chronic pain and issues with mobility; they find simple daily activities difficult to perform. There are different treatment options available for chronic pain and other joint issues. Joint reconstruction is a surgical procedure to alleviate long-term pain and restore the functional ability of the joints. An orthopedic surgeon assesses various factors like the patient’s age, location, severity of the condition, muscle strength, condition, etc., before deciding to opt for joint reconstruction surgery.

What Is Joint Reconstruction?

Joint reconstruction is a surgical procedure ranging from minor joint repair to replacing the entire joint with prosthetic parts. Joint reconstruction provides pain relief and permanent solutions to various joint disorders. Joint reconstruction provides pain relief and permanent solutions to various joint disorders. Joints commonly treated with joint reconstruction surgery include hips, knees, shoulders, ankles, elbows, and fingers.

What Are the Types of Joint Reconstruction Surgery?

There are several types of joint reconstructive surgery. Some of them are described below.

Arthroscopy:

• Arthroscopy is a minimally invasive procedure in which a small tube called an arthroscope is inserted into the body. This tube has a system of lenses, a light, and a small camera to look into the joint. The camera is connected to a system that allows the doctor to visualize the site on a monitor.

• Other cutting, probing, and grasping tools are used with the arthroscope through another incision.

• Arthroscopy is done either in local or in general anesthesia.

• Inflammation, injuries, and pieces of loose bones or cartilage can be discovered and treated using an arthroscopic procedure.

Joint Replacement Surgery (arthroplasty):

• Joint replacement is a type of joint reconstructive surgery. In joint replacement surgery, the damaged joint is usually replaced with an artificial metal, ceramic, or plastic prosthesis.

• In some cases, only the part of the damaged joint is replaced by a partial joint replacement procedure.

• Arthroplasty is done more commonly in the hips, shoulders, and knees.

• Arthroplasty is indicated in the following conditions

  • Joint pain that does not get better with conservative treatment procedures

  • Limited mobility of the joint, which interferes with daily activities.

  • Persistent inflammation that does not improve with medications and other treatments.

• Several conditions like arthritis, mainly osteoarthritis, fractures, rheumatoid arthritis, joint abnormalities, and joint trauma, are treated with joint replacement surgery.

Osteotomy:

• Osteotomy is a surgical procedure that involves reshaping and realigning the bones by cutting them.

• Osteotomy is a major surgical procedure done under general anesthesia.

• It is commonly done in the hips, knees, chin, spine, jaws, and big toe.

• Osteotomy in young people is mainly done to postpone the total joint replacement.

Arthrodesis:

• Arthrodesis is also known as joint fusion.

• Arthrodesis is a surgical procedure in which the orthopedic surgeon manually straightens out the joint, removes the cartilage, and stabilizes the bones with wire, pins, screws, or plates. This procedure allows the bones to fuse, which helps in preventing painful movements.

• Arthrodesis is resorted to only if the pain is uncontrolled by other treatments, physiotherapy, splints, and medications.

• This procedure is commonly performed in the hands, ankles, feet, and spine.

• Traumatic injuries, fractures, and osteoarthritis with unrelenting pain are the conditions treated using arthrodesis. However, since joint replacement procedures have become more successful, arthrodesis procedures are done less commonly in recent days.

Resurfacing Surgery:

• Resurfacing surgery is more commonly performed in the hip.

• It is indicated in young patients and in patients with medical conditions that make hip replacement not advisable.

• In resurfacing surgery, only the damaged cartilage and the bone are trimmed. A smooth metal cap is placed over the trimmed bone, allowing for smooth bone movements.

• Studies have shown that hip resurfacing poses a higher risk of complications.

Synovectomy:

• Synovium is the membrane that lines a joint. Synovectomy is a procedure in which this membrane is surgically removed or debrided.

• In conditions like inflammatory arthritis, the synovium is inflamed, which can predispose the surrounding bones and cartilage to damage. Synovectomy is done to prevent further damage to the joints.

Small Joint Surgery:

• Small joint surgery is done in the joints of the hand and feet.

• This is done if these joints are severely damaged, limiting everyday activities. Small joint surgery is done to restore mobility in the small joints and to improve the management of simple daily tasks.

What Are the Factors That Influence the Success of Joint Reconstruction Treatment?

Some factors that influence the positive outcome of a joint reconstruction surgery are listed below.

• Patient characteristics like age and sex.

• Design of the implant and the surgical procedure.

• Conditions of the patient include obesity, diabetes mellitus, cardiovascular diseases, and immune system disorders.

• Degree of osteoarthritis before the surgery.

• Functional status of the joint before surgery.

• Patient compliance in following the medical advice before and after the procedure.

• Patients' expectations and personality traits also influence surgical outcomes.

• Complications during and after the procedure.

What Are the Possible Complications of Joint Reconstruction?

• Inflammation and Pus Formation (Suppuration) Near the Prosthesis - This occurs when the pathogens that enter from outside or the already existing pathogens accumulate on the surface of the prosthesis or implant. This accumulation of bacteria results in infection and pus at the site. Patients with diabetes mellitus and immune disorders are more prone to infection. Risk of infection is controlled by administering antibiotics during surgery.

• Blood Clots - Thrombosis and embolism are common in knee and hip joint surgery. Antithrombotic drugs are used to reduce the risk of blood clots.

• Injury - Injury to blood vessels and post-operative bleeding.

• Nerve Damage - Inadvertent nerve damage may occur during the surgical procedure.

• Fractures - Fractures may occur due to unnecessary pressure in rare cases.

• Ill-fitting Prosthesis - Loosening of the prosthesis.

• Calcification - Calcification in the tissues near the prosthesis may occur in the first few months after the surgery. This will interfere with mobility and may result in pain.

• Allergies - Specific materials in the prosthesis may cause allergic reactions in the patient.

• Persistent Symptoms - In relatively rare cases, persistent complaints may be present after surgery.

Conclusion:

Joint reconstruction is an important part of orthopedics. It helps patients regain function and have a better life after an injury. Joint reconstruction is an important treatment for people with serious injuries. It usually works well and gives hope and relief to those who need it. This procedure helps patients move better and feel less pain by fixing damage and making the body stable. Advancements in surgery and therapy are making joint reconstruction better. This means people with joint injuries can recover even better and have good long-term results.