Arthroplasty Surgery in India

Overview

Arthroplasty is the operative procedure for construction of a new movable joint. It is a surgical procedure to restore the integrity and function of a joint. A joint can be restored by resurfacing the bones. An artificial joint also known as prosthesis may also be used. Various types of arthritis may affect the joints. Osteoarthritis a degenerative joint disease results in a loss of the cartilage or cushion in a joint and is the most common reason for arthroplasty. It is not applicable to all joints it is used in the diseases affecting shoulder, elbow, hip, knee, certain joints in the hand, and the metatarso-phalangeal joints in the foot. Osteotomy to restore or modify joint congruity is also an arthroplasty.

Why Arthroplasty Surgery?

The goal of Arthroplasty is to restore the function of a stiffened synovial joint and relieve pain. As a surgical procedure, it is usually performed when medical treatment has not improved function in the affected joint. Arthroplasty is performed on people suffering from severe pain and disabling joint stiffness. Osteoarthritis (OA), a degenerative joint disease, is the most common condition causing joint destruction with pain and impaired movement. Other causes include rheumatoid arthritis (RA), hemophilia, synovitis, and rare bone diseases, which are all known to destroy cartilage. Joint resection, rather than joint replacement, is more likely to be performed on people with rheumatoid arthritis, especially when the elbow joint is involved.

Symptoms for Arthroplasty Surgery:

Significant disabling pain, deformity, and reduced quality of life are the primary indications for Arthroplasty Surgery. Patients at this stage of discomfort and disability will most likely have already been diagnosed with a form of arthritis. Pain and stiffness on weight-bearing joints are the major symptoms that patients report, though some people experience night pain as well. Other symptoms may include stiffness, swelling, and locking of the joint; and even the joint giving way, particularly when the knees or hips are affected.

Diagnosis for Arthroplasty Surgery:

To determine the extent of disabling, the referring physician and/or the surgeon will likely ask about walking distance, sporting ability, the need for walking aids, and the ability to perform self-care tasks such as dressing and bathing. Besides evaluation of the joint itself and level of mobility, the clinical examination will include evaluation of the patient's general health, the condition of the ligaments and muscles around the affected joint, and also assessment of the patient's mental outlook and social circumstances to help develop the most effective postoperative rehabilitation plan.

Diagnostic testing will typically include:

• X rays of the affected joint (and other joints as well)to determine loss of joint space and to differentiate between OA and RA
• Imaging studies, such as computed tomography (Cat scans), magnetic resonance (MRI), and bone densitometry to assess bone loss or bone infection
• Cardiac tests, such as electrocardiogram, to evaluate the heart and circulatory system
• Blood tests t
• o rule out infection and possibly to confirm arthritis

Preparing for Arthroplasty Surgery:

Arthroplasty is major Surgery. Pre-operative preparation begins immediately following surgical consultation and lasts approximately one month. Patient is to perform range of motion exercises and hip, knee and ankle strengthening as directed daily. Before the surgery is performed, pre-operative tests are done: usually a complete blood count, electrolytes, APTT and PT to measure blood clotting, chest X-rays, ECG, and blood cross-matching for possible transfusion. About a month before the surgery, the patient may be prescribed supplemental iron to boost the hemoglobin in their blood system. Accurate X-rays of the affected knee are needed to measure the size of components which will be needed.

Medications such as warfarin and aspirin will be stopped some days before surgery to reduce the amount of bleeding. Patients may be admitted on the day of surgery if the pre-op work-up is done in the pre-anesthetic clinic or may come into hospital one or more days before surgery. Some hospitals offer a pre-operative seminar for this surgery. Many surgeons ask arthroplasty candidates to begin strengthening exercises during the weeks before surgery. Strengthening muscles around the joint can make the recovery process quicker and smoother. In addition a physician may recommend quitting certain prescription medications and even herbal supplements. If a patient smokes, a doctor will most likely recommend quitting a month prior to surgery. Every case is different, and different surgeons may have different procedures. If you are considering or planning arthroplasty, consult your orthopedic surgeon for the best advice on your case.

Types of Arthroplasty Surgery:

The following are the types of Arthroplasty Surgery:

• Interpositional Arthroplasty: The main goal of interposition surgery is to ease the pain of osteoarthritis where the surfaces of the elbow joint are rubbing together. It involves placing of some other tissue like skin, muscle or tendon to keep inflammatory surfaces apart. The term interposition means that new tissue is placed between the damaged surfaces of the elbow joint. In this surgery, tissue is taken from another source to fill in the space in the elbow joint. The soft tissue forms a false joint. This surgery has best results in younger people with healthy tissue around the elbow joint. Interposition arthroplasty is different than a fusion surgery. Fusion simply binds the joint together, and the elbow loses much movement. Interposition arthroplasty can help take away pain while allowing the elbow joint to retain some movement.
• Excisional Arthroplasty : In this procedure the joint surface and bone creating the problem is removed from the joint so that the scar tissue can grow and fill the joint space. In this method one or both of the articular ends of the bones are simply excised, so that a gap is created between them. The gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn in between the bones. By virtue of its flexibility the interposed tissue allows a reasonable range of movement, but the joint often lacks stability. The method is applicable to all the joints for which arthroplasty is practicable except the knee and ankle. It is used most commonly at the metatarso-phalangeal joint of the great toe, in the treatment of hallux valgus and hallux rigidus.
• Resection Arthroplasty : A resection arthroplasty is a procedure where the bone around the hip joint is removed and the joint space is allowed to fill with scar tissue. This procedure is usually done in patients with severe infection that cannot be controlled, or in patients whose physical condition is such that they have little chance of normal walking. Patients who undergo a Girdlestone resection arthroplasty will likely need some assistive device for walking. The rehabilitation following surgery for a simple resection arthroplasty is usually fairly rapid. Patients should expect the soreness to last for three to six weeks. Postoperatively, patients usually have the affected arm in a sling for two weeks. Thereafter, a progressive passive range of shoulder motion exercise is started, usually with range-of-motion exercises that gradually evolve into active stretching and strengthening.
• Resurfacing Arthroplasty : This is a type of surgery that replaces the arthritic surface of the joint, however, removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement. Surgeons perform this operation using several different incisions, or approaches, to the hip joint. The anterior approach from the front of the hip and the posterior approach from the back of the hip. After surgery, your hip will be covered with a padded dressing. Special boots or stockings are placed on your feet to help prevent blood clots from forming.
• Cup Arthroplasty : Is a surgical replacement procedure performed by a metal or plastic mold to relieve pain and increase motion in arthritis or to correct a deformity. The damaged or diseased bone is removed, and the acetabulum and the head of the femur are reshaped. A cup is inserted between the two and becomes the articulating surface of the femur. After surgery the patient's leg is placed on an abduction pillow to hold it in a position of abduction extension and internal rotation to keep the disk in place in the acetabulum. The patient receives extensive physical therapy for a complete recovery.
• Silicone Replacement Arthroplasty : It is a surgical procedure where the chemical silicone is used as a substitute for rubber that is stable and doesn't react or heat up. It can be formed into the shape of the trapezium and inserted into the thumb to replace it. The first silicone implant for the thumb was done in 1965. Since then, the implant and the surgery have both been changed and updated many times. The kind of patient selected for this surgery is also important. Patients with jobs that have low activity are good candidates. The new joint works well for patients who have advanced arthritis in the base of the thumb. This treatment happens to be is a very good treatment choice for thumb arthritis, while it has very less risks or complications involved.
• Mould Arthroplasty : Mould arthroplasty is a conservative operation in which only one side of the joint is replaced, preserving bone stock for future, more extensive procedures if necessary. These operations may buy time before a total hip replacement (THR) is indicated but the effect of these implants on the long-term performance of a subsequent cemented THR has not been clear.

How is the Arthroplasty Surgery performed?

You will be given an anesthetic and the surgeon will replace the damaged parts of the joint. For example, in an arthritic knee the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee movement and function. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal ball attached to a metal stem fitted into the femur and a plastic socket is implanted into the pelvis, replacing the damaged socket. Although hip and knee replacements are the most common joint replaced, this surgery can be performed on other joints, including the ankle, foot, shoulder, elbow, and fingers. The materials used in a total joint replacement are designed to enable the joint to move just like a normal joint. The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Several metals are used, including stainless steel, alloys of cobalt and chrome, and titanium. The plastic material is durable and wears resistant (polyethylene). Plastic bone cement may be used to anchor the prosthesis into the bone. Joint replacements also can be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly.

The common procedures performed under Arthroplasty Surgery:

• Shoulder Arthroscopy and Reconstruction
• Total Joint Reconstruction
• Foot and Ankle Reconstruction
• Hand Surgery
• Knee Arthroscopy and Reconstruction
• Elbow Joint Replacement
• Half-joint Replacement Surgery
• Joint Fusion
• Hand Joint Replacement Surgery

Post Operative Care Arthroplasty Surgery:

Immediately after surgery, while still in the hospital, patients will be given pain medications for the recovery period and antibiotics to prevent infection. When patients are discharged after joint surgery, they must be careful not to overstress or destabilize the joint, requiring rest at home for a period of weeks. Physical therapy will begin immediately to improve strength and range of motion; it is the most important aid to recovery and may continue for several months. Activity may be resumed gradually, using devices if necessary, such as walkers or crutches, as recommended by the physical therapist. Lifestyle changes may include the use of special seating or sleeping surfaces, and employing home care assistance for help with shopping, cooking, and household tasks.

Recovery after Arthroplasty Surgery:

Early mobilization of the patient is thought to be the key to reducing the chances of complications such as venous thromboembolism and Pneumonia. Modern practice is to mobilize patients as soon as possible and ambulate with walking aids when tolerated. Depending on the joint involved and the pre-op status of the patient the time of hospitalization varies from 1 day to 2 weeks with the average being 4-7 days in most regions. Physiotherapy is used extensively to help patients recover function after Arthroplasty Surgery. A graded exercise programme is needed. Initially the patients' muscles have not healed after the surgery; exercises for range of motion of the joints and ambulation should not be strenuous. Later when the muscle is healed the aim of exercise expands to include strengthening and recovery of function. A few days hospitalization followed by several weeks of protected function, healing and recovery. This may then be followed by several months of slow improvement in strength and endurance.

Benefits of Arthroplasty Surgery:

The following are the benefits of Arthroplasty Surgery:

• Improved movement and use of a joint: Arthroplasty Surgery can replace or stabilize the joint, allowing you to stand and walk more and move your body easily.
• Pain relief : Surgery can relieve pain that doesn't respond to other treatment options.
• Improved alignment of deformed joints : Re-aligning the joints can improve the functioning of those joints, plus make cosmetic improvements. Thus improve the look and alignment of the joints.

Risks of Arthroplasty Surgery:

The Risks for Arthroplasty Surgery includes infections, blood clots, being overweight can add extra stress during surgery. However, the complications of infection and blood clots can be alleviated by precise medications.

Advance Arthroplasty Surgery:

Laser Assisted Arthroplasty Surgery : This procedure uses laser lights/beams to help surgeons align cutting instruments in Arthroplasty Surgery. The technology allows implanting your joint replacement with increased accuracy and precision. Laser Assisted Arthroplasty Surgery at AOA is the only device of its kind. It is a completely new method of surgical guidance and navigation. The various benefits for having the laser assisted arthroplasty surgery includes, the use of small incision by the surgeon during the procedure, which leaves you with minimal muscle and tissue damage, less recovery time and hospital stay. Due to these advantages of the laser assisted arthroplasty surgery, the procedure seems to be becoming popular with patients suffering from joint patients.

Arthroplasty Surgery in India:

India has emerged to be the most preferred destination for global patients opting for Arthroplasty Surgery. Since the Surgery has successfully rendered with best services of quality par with international benchmark and that too at low cost affordable to everyone.

The team of physicians and orthopedic surgeons performing Arthroplasty Surgery in India includes board-certified orthopaedic surgeons with fellowship training at prestigious medical centres of the developed nations. They are a well-known and respected physician's resource for consultation, diagnosis, and ongoing treatment of patients with joint pain and arthritis issues.

The Orthopaedic hospitals in India have an excellent infrastructure and are equipped with the latest amenities that help the surgeons to perform high quality Arthroplasty Surgery. Many of the foreign patients have successfully returned to their home-towns with much freer and fitter joints through these procedures. They are available at various hospitals in the following Indian cities:

The Cost of Arthroplasty Surgery in India:

Significant cost difference is the key in bringing patients all across the world for Arthroplasty Surgery in India. India is not only cheaper but offers quality service in terms of treatment and service. Cost is often the deciding factors for international patients coming for any Arthroplasty Surgery in India.

Some of the common countries from which patients travel to India for surgery are

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