Arthroplasty and its types/ total joint replacement

Arthroplasty is a surgical procedure that involves the reconstruction or replacement of a damaged or deteriorated joint with artificial materials. This procedure is commonly performed to relieve pain, improve joint function, and restore mobility in patients with conditions such as arthritis, joint injuries, or other musculoskeletal disorders.

There are different types of arthroplasty procedures, depending on the specific joint being treated and the extent of damage. The most common arthroplasty procedures include total joint replacement, partial joint replacement, and joint resurfacing.

In a total joint replacement, the entire joint is replaced with prosthetic components made of metal, plastic, or ceramic materials. This is often done for joints such as the hip, knee, or shoulder. During the procedure, the damaged components of the joint are removed and replaced with artificial implants that mimic the natural movement of the joint.

Partial joint replacement involves replacing only the damaged parts of the joint with prosthetic components, while preserving the healthy parts. This procedure is often performed on joints such as the knee or shoulder.

Joint resurfacing is a type of arthroplasty that involves smoothing or reshaping the damaged surfaces of a joint, without completely replacing the joint. This procedure is commonly done for joints such as the hip or shoulder.

Arthroplasty is typically performed by an orthopedic surgeon in a hospital setting. Before undergoing arthroplasty, patients will undergo a thorough evaluation to assess their overall health, the extent of joint damage, and the most appropriate treatment plan. Recovery from arthroplasty involves post-operative rehabilitation, physical therapy, and a gradual return to normal activities.

Overall, arthroplasty is a highly effective treatment option for patients with severe joint pain and dysfunction, with the goal of improving quality of life and restoring function to the affected joint.

1. arthroplasty DR.ANEEKA EHSAN (PT)

2. CONTENTS 2 Introduction to arthroplasty Indications Types Materials used & implant design Forces acting on arthroplasty joints Surgical procedure Rehabilitation Risks & Complications Biomechanical analysis

3. ARTHROPLASTY A surgical procedure involving the reconstruction or replacement of a joint. The aim of arthroplasty is to restore function to a damaged or diseased joint, alleviate pain, and improve or maintain joint mobility. This procedure is commonly performed in joints such as the hip, knee, shoulder, elbow, and ankle.

4. INDICATIONS OF ARTHROPLASTY Osteoarthritis: Commonly affected joints include the hip, knee, and shoulder. Rheumatoid Arthritis: Advanced rheumatoid arthritis that does not respond to conservative treatments. Traumatic Injuries: Severe joint fractures or injuries resulting from accidents, falls, or sports-related incidents. Common examples include hip fractures and complex fractures around the shoulder or elbow. Avascular Necrosis: Occurs when the blood supply to a bone is disrupted, leading to bone cell death. The hip is a common site for avascular necrosis. 4

5. 5 Congenital Joint Disorders: S uch as developmental dysplasia of the hip (DDH). Inflammatory Joint Diseases Failed Previous Joint Surgery (Revision Arthroplasty): Patients who have undergone previous joint surgery, such as joint replacement, may experience complications,wear and tear on the implant over time, a failed or worn-out joint prosthesis,implant loosening, instability, or infection. Bone Tumors: Benign or malignant tumors affecting the bone around a joint can compromise joint integrity. Severe joint deformities Joint infection

6. CONTRAINDICATIONS Active Infection: at the surgical site or elsewhere in the body. Medical Instability: poorly managed diabetes, uncontrolled hypertension, or cardiovascular instability. Severe Obesity Poor Bone Quality: such as severe osteoporosis Allergies to Implant Materials Active Substance Abuse: including drug or alcohol abuse. Previous Joint Infections Neurological Disorders: that affect muscle control or sensation. Bleeding Disorders: clotting disorders or the use of anticoagulant medications. 6

7. 7 TYPES OF ARTHROPLASTY Total joint replacement (TJR) Total Hip Arthroplasty (THA) Total Knee Arthroplasty (TKA) Total Shoulder Arthroplasty (TSA) Total Elbow Arthroplasty (TEA) Total Ankle Arthroplasty (TAA) Hemiarthroplasty Unicompartmental Knee Arthroplasty (UKA) Reverse Total Shoulder Arthroplasty ( rTSA ) Revision Arthroplasty

8. Total JOINT REPLACEMENT ( tjr ) C omprehensive surgical procedure in which the entire joint is replaced with artificial components. C ommonly used to address severe joint conditions e.g advanced arthritis, that significantly affect joint function, cause pain, and limits mobility. Involves the replacement of both sides of a joint with prosthetic components. Commonly performed in major weight-bearing joints such as the hip and knee, as well as in other joints like the shoulder and elbow. 8

9. TOTAL HIP ARTHROPLASTY (THA) involves the replacement of both the acetabulum (hip socket) and the femoral head with artificial components. Indications: Severe osteoarthritis, rheumatoid arthritis, avascular necrosis, and fractures of the hip. Components: The prosthetic components typically include a metal or ceramic femoral component and a metal or plastic acetabular cup. 9

10. TOTAL knee ARTHROPLASTY (TKA) replaces the damaged knee joint surfaces with artificial components. Indications: Advanced osteoarthritis, rheumatoid arthritis, and severe knee joint deformities. Components: metal femoral and tibial components, often with a plastic (polyethylene) spacer to facilitate smooth movement. 10

11. TOTAL SHOULDER ARTHROPLASTY (TSA) involves replacing the damaged humeral head and glenoid with artificial components. Indications: Osteoarthritis, rheumatoid arthritis, and severe shoulder fractures. Components: a metal humeral head, a metal stem, and a plastic glenoid component. 11

12. TOTAL ELBOW ARTHROPLASTY 12 TOTAL ANKLE ARTHROPLASTY

13. HEMIARTHROPLASTY Hemiarthroplasty involves replacing one half of a joint, commonly the femoral head in the hip joint or the humeral head in the shoulder joint. Indications: Femoral neck fractures in the hip, fractures involving the humeral head in the shoulder. Components: The prosthetic component replaces only the damaged portion of the joint, preserving the native joint surfaces whenever possible. 13

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15. REVISION ARTHROPLASTY Revision arthroplasty involves replacing a previously implanted joint prosthesis with a new one. Indications: Wear and tear of the original prosthesis, implant loosening, infection, or other complications. Components: may be specialized and include longer stems or additional fixation mechanisms. 15

16. Materials used The choice of materials depends on factors such as the specific joint, patient characteristics, and advancements in medical technology. Metal Alloys Ceramics Polyethylene (Plastic): Ultra-High-Molecular-Weight Polyethylene (UHMWPE) Biocompatible Coatings: Hydroxyapatite (HA): coated onto metal implants to enhance bone integration. Porous Coatings: Some implants have porous coatings to promote bone ingrowth and improve the long-term stability of the implant. 16

17. Materials used Biodegradable Materials: Polylactic Acid (PLA) and Polyglycolic Acid (PGA), the material gradually degrades as the bone heals, eliminating the need for a second surgery to remove the implant. Smart Materials: Shape Memory Alloys (e.g., Nitinol), have the ability to return to a predetermined shape after deformation. The selection of materials depends on factors such as the specific joint, patient age, activity level, and the surgeon's preference. 17

18. How implant design affects joint biomechanics? Material Selection: affects factors such as wear resistance, strength, and compatibility with surrounding tissues. Geometry and Shape: the size and shape of the articulating surfaces, can influence joint range of motion, stability, and load distribution. Bearing Surfaces: such as metal-on-metal, metal-on-polyethylene, ceramic-on-ceramic, or ceramic-on-polyethylene, can impact the wear rate, lubrication, and stability of the joint. Fixation Methods: (e.g., cemented or uncemented fixation) affects load transfer and stress distribution. Stability and Range of Motion. Load Transfer and Stress Distribution: Even load distribution is important for preventing excessive stress on specific areas, reducing the risk of complications such as implant loosening or bone resorption. 18

19. FORCES ACTING ON ARTHROPLASTY JOINTS Compression forces. Tension forces. Shear Forces. Bearing forces: where two components of the implant come into contact. Contact forces: The forces at the interface between the implant components are crucial. Torque Forces, rotational forces Cyclical Loading, repetitive loading Impulse Forces, Sudden and high-impact forces, such as those experienced during jumping or falling. Muscle Forces 19 Crypto: investing & trading

20. PREOPERATIVE PREPARATION Patient Evaluation: P atient's medical history, physical condition, and joint function. Preoperative imaging, such as X-rays or MRI. Anesthesia: general anesthesia or regional anesthesia, depending on the joint and patient factors. 20

21. SURGICAL PROCEDURE Incision Joint Exposure: Soft tissues (muscles, tendons, ligaments) are carefully moved aside to expose the joint. The damaged or arthritic components of the joint are removed. Preparation of Bone: This may involve reshaping the bone to accommodate the prosthetic implants. Implantation of Prosthesis Fixation Methods: cement (bone cement) is used to secure the prosthetic components to the bone. In others, components may rely on press-fit or porous coatings to encourage bone ingrowth. 21

22. SURGICAL PROCEDURE Closure of Incision: using sutures or staples. Attention is given to proper wound closure to minimize scarring and reduce the risk of infection. REHABILITATION 22 Pain Management: Administered medications to manage pain and discomfort. Physical therapy: ROM exercises, Progressive Exercises,Functional Activities,Proprioception Training,Maintenance Exercises. Ambulation Training: Gradual progression from bed to walking with assistive devices.

23. RISKS AND COMPLICATIONS Infection: Complications: leading to pain, swelling, and, in severe cases, implant failure. Prevention: Strict sterile techniques during surgery, prophylactic antibiotics, and proper wound care. Blood Clots (Thrombosis): Reduced mobility after surgery increases the risk of blood clot formation. Complications: Blood clots can travel to the lungs (pulmonary embolism) and cause serious complications. Prevention: Early ambulation, compression stockings, and blood-thinning medications. Implant Loosening: Over time, wear and tear or other factors can lead to the loosening of the artificial joint components. 23

24. Dislocation: artificial joint dislocation. Nerve or Vascular Injury: Injury to nerves or blood vessels during surgery -> sensory or motor deficits. V ascular injury can cause bleeding or compromise blood supply. Allergic Reactions: Some patients may have allergic reactions to materials used in the prosthetic components. Delayed Wound Healing: C ertain health conditions -> Prolonged wound healing -> increased risk of infection. Joint Stiffness: Early and consistent rehabilitation is crucial to maintaining joint flexibility. Heterotopic Ossification: Formation of abnormal bone within soft tissues around the joint. Prophylactic measures and specific medications may be prescribed to reduce the risk. 24

25. BIOMECHANICAL ANALYSIS Computer-aided design (CAD): To create 3D models of implants and test their biomechanical properties. Motion analysis: gait analysis and other motion capture techniques are used to assess joint function and guide implant selection. Finite element analysis (FEA): computer stimulation method that predicts how implants will respond to various loading conditions. 25

26. FUTURE DIRECTIONS Personalized arthroplasty : Implants tailored to individual patient needs and biomechanics. Biomimetric designs: Implants that mimic the natural structure and function of human joints. Robotic surgery: minimally invasive procedures with enhanced precision and accuracy 26

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